The patient: “Cheryl,” a 36-year-old massage therapist.
Why she came to see me: Cheryl arrived at my office with soft tissue and joint pain that had surfaced—and worsened—within the last 10 months. On the morning she came in to see me, she said her pain was a six out of 10, but that it often escalated to nine. Indeed, the pain had gotten so bad that it had restricted her from using her hands for anything but the most vital tasks, such as brushing her teeth, preparing food and driving. Frightened by the prospect of losing her facility with her hands entirely—given her line of work and love of weight-lifting, bike-riding and swimming—she wanted to get to the bottom of her pain and to treat it naturally.
How I evaluated her: Cheryl and I began our work together with an in-depth discussion about her present symptoms, medical history and lifestyle.
Cheryl relished her job as a massage therapist and, at first, believed that the joint and soft tissue pain she was experiencing was due to her work and nothing more than a mere case of tendinitis. When the small joints on her fingers began to hurt, however, she knew she was undergoing more than just over-strained tendons. What’s more, after several weeks of not working—due to the state-wide lockdown mandated during the pandemic—her pain still persisted. In addition, and quite alarmingly, she began experiencing pain and achiness in her hips and feet.
Upon further questioning, I discovered that Cheryl had a number of symptoms that were suggestive of irritable bowel syndrome, including episodic intestinal pain and a tendency towards constipation, gas and bloating when she ate certain foods. Furthermore, she had a lifelong history of upper respiratory allergies, and had frequently taken the antibiotic Ciprofloxacin in the last three years for recurring urinary tract infections.
When reviewing her lifestyle, I learned that she lived near the beautiful Koolau Mountains in Kaneohe, Hawaii, which is one of the wetter places on the island of Oahu. She had no history of travel out of the state for the last two years—important to note, as some patients can pick up a tick-borne disease such as Lyme disease when on the mainland (Hawaii does not have Lyme disease), which can generate joint and soft tissue pain.
To get a solid handle on Cheryl’s health, I conducted a full physical exam that included an abdominal exam. I also ordered a standard blood test to assess for autoimmune and inflammatory conditions such as systemic lupus, rheumatoid arthritis, and a sedimentation rate (an inflammatory marker). In addition, I ordered a blood test to evaluate for food allergies for delayed reactions to foods. This particular test looks at antibodies—IgA, IgG, and immune complexes, to be precise—that a person’s body can produce when they react to foods 24 to 72 hours after eating them. Most conventional food allergy tests done by blood look only at immediate reactions (antibody IgE). While IgE testing provides important information, it does not help determine what a person may be reacting to days after ingesting the food or substance. Furthermore, I ordered an organic acid test and a Mycotoxin test through a specialty lab called The Great Plains Laboratory, Inc. The organic acid test examines breakdown products from yeast and bacteria, as well as markers for vitamin and mineral levels and other compounds such as oxalates—naturally occurring compounds found in high amounts in leafy greens (such as spinach and Swiss chard), beets, chocolate, nuts and beans. The Mycotoxin test I ordered, meanwhile, provides data on mold toxins that are being excreted in the patient’s urine.
What my evaluation revealed: Cheryl’s standard lab test was unremarkable for an autoimmune condition or chronic inflammatory condition, even though she felt like she was inflamed.
Her delayed-antibody testing for food allergies showed that she was having reactions to gluten, dairy, paprika, guar gum and eggs. Upon hearing this, Cheryl said that she had been eating a great deal of Mexican food lately, especially burritos with beans, cheese and paprika-laced salsa.
Her physical exam did not yield any signs of joint changes or swelling, but the joints of her hands were tender when I touched them, and her forearms, upper back and shoulders were very tight. She also had a host of tender trigger points on her body that I believed could be indicative of fibromyalgia—a condition that can cause whole-body pain and other symptoms. Her abdominal exam revealed a notable amount of gas in her intestines, as well as some tenderness with light and deep palpation.
And yet, the most revealing results arrived from her organic acid test. This assessment determined that Cheryl was exceptionally high in oxalates. What’s more, she had a high level of a mold toxin on her Mycotoxin test—specifically ochratoxin, a toxin derived from Aspergillus and Penicillium species. My belief? Her exposure to this mold could have been from exposure to a water-damaged building or from contaminated foods. The most commonly ochratoxin-contaminated foods include coffee, grapes and contaminated grains or pork. This raised the question: Was Cheryl eating too many of these foods? Or were the oxalates coming from another source? At an Environmental Medicine conference I attended, I learned that oxalates are also a common mold toxin. This means that Cheryl’s high oxalates were a potential sign that her exposure to mold had been significant enough that it could have been a major contributor to her soft tissue and joint pain. Furthermore, according to Jill Carnahan, MD—one of the esteemed speakers at the conference I attended—there is a connection between excessive oxalates and symptoms of irritable bowel syndrome. Another piece of the puzzle solved.
How I addressed her problem: The information I discovered on Cheryl’s tests gave me the green light to pursue dietary changes and strategies to bind up oxalates to see if doing so would provide relief from her ongoing pain.
First, I asked her to avoid the foods she was having delayed immune reactions to—the gluten and paprika previously mentioned among them.
Second, I recommended she start a low-mold diet, and a lower-oxalate diet—not a no-oxalate diet, which can be extremely restrictive. She loved her coffee, so I recommended she drink purity coffee, a mold-free coffee, instead of her standard morning brew.
Third, I recommended she start taking minerals that can bind up oxalates, including magnesium citrate and calcium citrate (50mg magnesium + 100mg calcium; one pill with meals three times a day for the first week, and then two pills three times a day thereafter). I eased her into this routine, as binding up oxalates too fast can sometimes cause aggravation and, in Cheryl’s case, more joint pain. I also increased her vitamin B6 to 50mg a day, in that Vitamin B6 can help support the degradation of oxalates in the body. Cheryl also started a probiotic containing lactobacilli and bifidobacterium. My reason for this is that research has found that certain antibiotics such as Ciprofloxacin (which is in the fluoroquinolone family) can reduce important friendly bacteria in the intestines that naturally lower oxalates, while probiotics can help restore “good” intestinal flora. Also, I told Cheryl to stop taking the oral vitamin C she had adopted during the pandemic, as an excess of vitamin C may increase oxalates.
Next, Cheryl took inventory of her home and went on a warpath to remove mold sources. She did a mold test by Immunolytics, a company that provides petri dishes to place in the rooms of one’s house to evaluate for mold. She then remediated the rooms that showed any signs of mold (as is common, she had the most issues in the bathroom). She also removed her shower curtain and regularly aired out her bathroom. Additionally, she was able to get her whole family to shower outside since they have a gorgeous hot/cold outdoor shower (remember they live in Hawaii!), and when the indoor shower is used, she sprays it down with an all-natural cleaning and disinfecting spray. She also bought an air filter to help her deal with the mold spores that were in her house.
Lastly, after a few weeks on the low-oxalate diet—to which Cheryl responded extremely well—I started her on a two-month systemic mold-cleansing program consisting of taking antifungal herbs including oregano oil, IV nutrients including glutathione, and binders, like charcoal and bentonite clay, to eradicate the mold and mold toxins from her body.
The patient’s progress: Cheryl’s recovery was swift—and lasting. The treatment plan I prescribed, as well as her lifestyle changes, eradicated her joint and soft tissue pain—so much so that when the island reopened and began to come alive again, she was delighted to return to work. She was just as delighted to see her intestinal problems come to an end, all of which inspired her to hit her bike—and the gym and ocean—with newfound strength.
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