My “Don’t Miss” Interview with Dr. Neil Nathan, MD, Environmental Illness Thought Leader and Best-Selling Author

Learn How to Reboot Your Body to Heal from Mold Toxicity

How do you become the “difficult patient” or “outlier” doctor? You know, the doctor who people or other doctors turn to when symptoms or a diagnosis eludes them. In business, the person in this role is often dubbed the “fixer”—the guy or gal who is sent in to flesh out and get to the root of the underlying problems, to get all parties to come to an understanding, and to remedy or bring a formidable solution to all issues that everyone can agree with. In short, an unenviable role that not many people are up for, much less want to volunteer for. In the mold, Lyme disease and environmental illness community, these days, the go-to “fixer” seems to be Dr. Neil Nathan, and he is tackling this role with a gusto, transparency, and compassion that is consummate and heartening.

Dr. Nathan didn’t start out with the most complex patients and cases as the base of his practice, though. So, how did he get to this point?

From the beginning of his medical career after graduating from the University of Chicago’s Pritzker School of Medicine, Dr. Nathan wanted to help people get to the root of their medical issues. While working as a Family Physician, he quickly discovered that his medical training hadn’t given him all of the tools he needed to help some of his more “difficult” patients. These patients had complicated symptomology with multiple diagnoses that crossed medical specialties. And, while he had delivered babies, performed minor surgeries, and helped patients with pain management, it was becoming more and more apparent, that these patients needed a different and more holistic type of care. Thus, he sought to expand his “toolbelt.”

As Dr. Nathan’s approach changed and he began using herbal and naturopathic modalities in conjunction with
western medicine, his practice also evolved into something new, which he began calling “Complex Medical Problem Solving.” Eventually, his practice focus became, and still is, for the most part, patients suffering from persistent and debilitating illnesses for which there is no “accepted” medical diagnosis, like Fibromyalgia, Chronic Fatigue Syndrome, Chronic Lyme disease with its co-infections, Autism, and all varieties of Chronic Pain, amongst others.

Dr. Nathan also began teaching colleagues his approaches to successfully treating chronically ill patients, and has condensed that same information into simplified book form, so that those being treated or seeking answers for themselves can also understand his methodologies. His books include On Hope and Healing and Healing is Possible: New Hope for Chronic Fatigue, Fibromyalgia, Persistent Pain, and Other Chronic Illnesses. His latest book, that I will be exploring with this post, is Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities, and Chronic Environmental Illness.

In it, he really hones in on the causes of these debilitating illnesses and explores what he has found to be the most precise and effective forms of treatment, especially for his most sensitive patients. In my opinion, the book’s real value comes from Dr. Nathan’s clinical expertise with these illnesses concentrated and distilled to the point that he addresses each body system and what steps to take to “reboot” it, so that patients may recover their health and their lives. The book also sheds light on the importance of a synergistic doctor/patient relationship when chronic and environmental illness is being addressed and illustrates that, when in the care of a skilled and compassionate doctor, even the most complex and hopeless patients can recover.

Lucky for me, I was able to speak with Dr. Nathan about his latest book and some of the sections that interested me most—namely, those on mold, of course, and the treatments he uses with mold patients. In addition, we discussed his views on mold maintenance, recovery, and the future of mold toxicity treatment as more and more people become aware of the toxins in their indoor environments contributing to health symptoms or disease.

What follows are snippets from my conversation with Dr. Neil Nathan:

(Note: I say “snippets,” because I tried to take the most relevant and useful parts and to condense them for this post. Our conversation was lengthy and detailed, so I am unable to include everything here. I intend to write another post with some detailed information that I discussed with Dr. Nathan about testing, disorders, and symptomology specific to mold patients that he often sees in his practice, as well as the methods and tactics he takes to address them. I encourage all of you to purchase and read Toxic. It provides insight into treatment modalities and suggests causal relationships that I had never heard before and that were extremely enlightening and useful—especially if you are stuck in the “why am I still sick” rut.)

Me: Dr. Nathan, I am so happy to speak with you. I just finished reading your latest book, and I have to say that it was the first time I read something where I felt like someone was speaking my language. Thank you so much for writing the book, I recommend it to almost everyone I come into contact with.

Dr. Nathan: Well, thank you. I appreciate that. I really wanted to get the word out there, because there are so many people who are struggling with the things in the book, but don’t even know it. The instance of chronic illness only seems to be growing, not getting better.

Me: I realize that this is a broad-scope question and may be a difficult one to answer, but how many chronic Illnesses do you think are related to an underlying mold issue?

Dr. Nathan: Potentially many of them…potentially. The symptoms of mold toxicity are so far reaching and ubiquitous that essentially anything can be triggered by mold, if you put it into context. Some people have globally debilitating conditions and their symptom list is everything you can think of. For others, it is anxiety and depression. Some have mostly cognitive symptoms. For others, it is gastrointestinal. For some, it is most neurological. So, anytime you have a problem that other people can’t figure out or isn’t responding to a treatment that should work, you should at least consider if you have been exposed to mold, or if mold toxicity is at least a possibility.

Me: You deal with a lot of people that most people can’t help, so many of them know are at least open to considering mold when they get to you. I find though, that for some people, when mold is suggested, they balk, and don’t even want to consider it. Some people feel like mold is a questioning of cleanliness. It is taboo to talk about. Why do you think that is?

Dr. Nathan: I think one of the things you are bringing up is correct. It somehow implies that someone isn’t a good housekeeper. There is a tremendous amount of denial sometimes too, because, if there was mold, that could mean a lot of money to remediate it, or if you sell your house, you would have to divulge it to a prospective buyer. People don’t want to go there. Even patients who acknowledge that their home is making them sick, or that they have mold toxicity, still aren’t ready to go there. When that happens, every visit, I continue to gently bring it up: “Have you addressed the mold in your home or at your work yet? You need to do that to get well.”

For those patients who are already exhausted and can’t think straight, the thought of moving or of even cleaning things up is overwhelming. Even some of my brightest, most proactive patients will sometimes fight me on remediating. They will literally say, “I leave the house for a week vacation, and I feel much better. Then, when I come back, I’m sick again.” But they still don’t want to come to terms with that it’s their home. There is an accuse/denial cycle that can go on that is sometimes part of the problem.

Me: Is that when you suggest environmental testing, so that they can see that there is a problem?

Dr. Nathan: I suggest testing immediately. Whether a patient does it or not is another story. To me, the three major components of treating mold, other than diagnosing it properly, because, of course that comes first, are being certain that you are living in a mold-free environment, taking the binders that are most appropriate for the toxins that you’ve got, and then, if necessary, treating with antifungals to remove any internal sources of mold.

Me: How important do you feel that the antifungals are to the big picture? Do most of your patients need them to get better?

Dr. Nathan: Most do, but it’s a complicated answer. Not everybody needs them. If you catch it early enough, the mold has not yet colonized, so just taking binders will work. If I think that be true, I will just treat with binders for 2 to 3 months to see how they do. I’m not wedded to it. It’s not mandatory, but most of the people I see have been sick for a long period, and are debilitated and continually exposed and re-exposed and almost all have colonized. I would say maybe 5-10% of my patients don’t require antifungals.

Me: If someone is not willing to get out of the mold or to remediate when they come to you, how are you able to treat them? Are you able to treat them anyway?

Dr. Nathan: I believe you can get better with correct treatment, but you can’t get well if you remain in a moldy environment. Point blank—you can get better, but you can’t get well. It’s always worth treating it, though. Many people can’t leave a moldy environment immediately. Our job is to help people get as well as they can. I have to take people with where they are, not always with where I want them to be. I will treat them anyway, but every single visit, I look at them and ask, “Where are we with getting into a safe environment, or with remediating your home?” It isn’t always as simple as, “You’ve got to leave.” We keep plugging away with what we can do with treatment until that time comes.

Me: How do you feel about the statement, once mold is part of your story—aka you’ve experienced mold toxicity, your body will start to know immediately if you are somewhere with mold or being exposed and will react?

Dr. Nathan: One of the things about mold is that it sensitizes some people to where 2 minutes in a moldy environment, and they know they’ve got to get out of there. But there are definitely times when a spouse or someone may not believe it. I am not that sensitive, but I have no problem believing my patients. A huge percentage of the population perceives the world only through their own framework. So, if they don’t see or smell something, it isn’t there. That’s not fair, and it is incorrect, but unfortunately, that’s what a lot of people are working with—even with some of the doctors that they go see for help.

Me: What are your thoughts on cleaning regularly for mold and on mold avoidance for patients to continue to recover and to stay well?

Dr. Nathan: I definitely think all of that is very important. But it is a balance. It is not helpful to be paranoid about mold either. One of the great things that I think Annie Hopper has contributed to our understanding of mold is that limbic inflammation is really common from mold exposure. The limbic system and the vagus nerve, whose job it is to monitor our environments for danger and our safety, can conspire to make your life miserable, if you get into a paranoid way of thinking about things. It’s important to create as mold-free an environment as you can, but you also have to have hope and know that mold toxicity is treatable.

Me: How important to recovery is continuing to cycle on and off binders, continuous detox, and continuing to adhere to an anti-Candida diet? I have found all of those things very helpful.

Dr. Nathan: I think whatever you can do to minimize the growth of yeast or Candida helps. Consistency is the important thing and has been proven to be very important. Dr. Joe Brewer actually showed that in 100 patients, the ones that were the most consistent with treatment, taking their binders regularly, etc., had the best outcomes. The inconsistent patients, who only took binders and antifungals sporadically didn’t have as much success. The diet also is important in success.

Me: Can you talk about why, many times, people don’t test positive for mycotoxins when they are, in fact, very toxic and have mold toxicity?

Dr. Nathan: The most common reason is that one of the things that mold toxins do is interfere with the body’s ability to detoxify. So literally, people can’t get the mold toxins from their bodies into their urine to make a positive test. It is extremely common for someone who is toxic to have a negative test. Another reason is that many people don’t know to do a provoked urine. In order to get an accurate result, you have to do something to spur detox prior to testing. For example, doing something to provoke sweating, like a sauna, a hot tub, even a hot bath 30 minutes before you collect your urine is mandatory. I’ve had many instances when once I taught a patient how to collect their sample, a completely negative result turn into a floridly positive one immediately. The other thing I like to do, if the patient can, but I want to emphasize that some patients can’t do this, is to use glutathione to help mobilize toxins. As much as a patient can, I like to do both glutathione and something to make them sweat. Then, I’m getting a more accurate specimen.

Me: Doesn’t glutathione also help with treatment?

Dr. Nathan: For some patients. For some it helps, and for some, it will make them much worse. It depends on how compromised their ability to detoxify is. For at least half of the patients that I treat, taking glutathione will throw them under the bus.

Me: Because it makes toxins mobilize too fast?

Dr. Nathan: Yes. These people will know immediately. They’ll take one dose and be worse. For others, they will take it, have no negative effects and feel much better. Whether you use it or not should purely depend on how you respond to it.

Me: What other things could contribute to missing a diagnosis?

Dr. Nathan: This goes back to which toxins you have inside your body. For example, many patients have a Wallemia toxin, but nobody knows how to measure that yet. So, if someone has the symptoms, has tested their environment, but is not testing positive for mold toxicity, you still need to treat them. Sometimes 2-3 months down the road, you repeat the test, and it’s positive. That’s a patient where they’ve just now improved their ability to detoxify, and now they are getting the toxins into their urine. For some people, once they start treatment, they just get better and better, and I think they’ve got a toxin that we’re not yet measuring. It’s super important that patients not doubt themselves. Meaning that if they have the symptoms of mold toxicity, and are living in a moldy environment, even if a test is negative, they really ought to be treated.

Me: Do you believe that full recovery is possible? How often do you see patients make full recoveries?

Dr. Nathan: I think full recovery is entirely possible. I see it most of the time. I don’t claim to have the perfect treatment program. We are still working that out, but we are getting pretty decent at it. If you approach it correctly, the majority of people get well. We are still learning how to do this better. We are also learning that it’s not just mold that we have to be looking at. We need to be looking at other infections, like Lyme, co-infections, mycoplasma, viral infections, heavy metal toxicity, how the mold toxins disrupt the endocrine system—which needs to be treated and rebooted. We need to be looking at the thyroid and the adrenals, sex hormones, and we’ve got to get the gut to be healthy. It gets pretty complicated sometimes. So, when someone is not completely well, we need to be medical detectives and figure out what we haven’t addressed. What still needs to be repaired for this person, so that they can get well?

Me: How does mold affect us on a cellular level? Your book mentions how it affects mitochondria. Can you briefly explain this?

Dr. Nathan: The mitochondria are the body’s sensing organs for infection and toxins. Their job is to—in addition to making energy—monitor the environment of the cell for safety. If something is invading the cell, or if something is making the cell toxic, the mitochondria sense that immediately and shut themselves down in order to protect the cell. That’s why it is so important to address viruses and toxins first. If you try to treat the mitochondria with supplements before doing this, it doesn’t work. Until the mitochondria senses that the cellular environment is safe, they cannot take those supplements and run with them, because they are still protecting and shutting down.

Me: So, do you ever recommend things, like nutritional IVs for mold patients?

Dr. Nathan: It varies. There are a multitude of IVs that can be helpful. The one I find the most useful is intravenous Phosphatidylcholine. That most specifically helps with detoxification, especially for people who are compromised. It really helps to repair membranes. For your basic nutritional IV, they are invasive, expensive, and I’m not sure they are worth the money. The overall treatment is going to be fairly expensive, so we have to be careful about what we are spending money on.

Me: Once you are able to start getting a patient to mobilize and move some of those mold toxins out of their bodies, how do you help them to continue to progress without upping the ante to where they feel worse?

Dr. Nathan: An aggressive use of binders does sometimes work really well for some people, but for others, it draws them back and makes them worse. Part of why the book was written is that for sensitive people, you really need to understand that if some is good, more is not better. Even if you can only take tiny amounts of binder, you will get better if you stay the course. I think that’s the point that many people need to learn. As an example, I’ve had patients with large amounts of toxin get well by taking a 16^th of a teaspoon of Cholestyramine everyday with 1 quarter of a chlorella every other day. They are saying, “Come on, Neil! This is pathetic! How can I get well doing that?” But, they do! Sensitive people respond better to miniscule amounts than you would expect. The key is to find a dose you can take, and stay the course. You have to be patient.

Me: You don’t have to feel worse to know you are getting better.

Dr. Nathan: Right. Feeling worse sometimes actually means that you are not processing toxin properly. It may not be something you can avoid, but it certainly shouldn’t be something that you seek. So, if I had to say one thing that is critical for patients to understand, it is that if you are taking binders and you are even the teeniest bit worse, this isn’t something that you want to put up with. What it actually means is that you are getting more and more toxic. If you just put up with it, you will get worse. Each patient needs to find a dose that they can take comfortably.

Me: How important is it for patients to find a qualified practitioner to take them through the steps to heal? Can someone with mold toxicity do this on their own?

Dr. Nathan: This is really important. You really need to find someone who knows what they are doing. This is not a simple thing—not if you are sick with mold toxicity. You need to have someone monitoring you and tweaking it, so that you are optimizing treatment and not making it worse. Very few people can do that on their own, especially since so many mold patients are cognitively impaired already. It’s not always just mold toxicity either. The mold many times triggers mast cell activation, porphyria, it goes hand-in-hand with a wide variety of infections that need to be looked at—and orchestrating that and knowing how to treat it and in what order is beyond the capacity of most patients. In fact, it is beyond the capacity of most doctors at this point. I encourage people to use resources, like the ISEAI website to look for practitioners trained to look at all of these complexities.

(Note: ISEAI, the International Society for Environmentally Acquired Illness, is designed to educate health care providers and certify them in the understanding of the vital subject of chronic inflammatory illness, including mold toxicity, chronic Lyme disease–with coinfections, chronic viral infections and other chronic bacterial and parasitic infections, and toxicity from heavy metals and environmental toxins.)

Me: Are you working to help train other doctors at this point?

Dr. Nathan: ISEAI is a fairly new organization and I am on the Board. We are having our first conference in May. We have assembled some of the top people out there in integrative medicine to compile and share their knowledge and to be speakers for us. We are working on a certification process where we will train healthcare providers to do what we do. Personally, I’ve begun a mentorship program with other healthcare providers, where I’ll go online in a Go-To Meeting format with 8 doctors at a time. They are presenting cases, and I’m helping them to take them apart, dissect them, and to understand how to diagnose and treat the patients the best ways that I know how. I’m really trying to do everything I can to share what I know with other physicians, so that we can have many other physicians help these complicated patients as well.

Me: Are there any final things that you would like to share? Any current research that you are doing?

Dr. Nathan: One thing I am working on with Great Plains Laboratories is on determining what effect eating foods that are potentially moldy has on a patient’s lab numbers. In other words, some people say that a positive mycotoxin test is because the mycotoxins are coming from food. Most of us don’t think that’s true, but we’ve never studied it. That should get launched in early January, so that we can actually find out.

Me: Well, thank you for everything you are doing. You are bringing so much hope to a community of people who desperately need the help.

Did you learn something new from this interview, or find new hope for recovery? I hope so. Please feel free to comment below or to write me at catherine@moldfreeliving.com. For more information on Dr. Nathan, please visit his website www.neilnathanmd.com. His books are all available through Amazon.