Complex Illness, Brain Symptoms & Paths to Healing - With Neil Nathan, MD

The Intersection Between Complex Illness, Brain Symptoms and the “Vagal-Limbic-Mast Cell Trifecta” in Multisystem Conditions Like Fibromyalgia, Chronic Fatigue (ME), CIRS, MCAS, POTS, Multiple Chemical Sensitivity, EHS, Mold, Lyme, Coinfections & Long COVID
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​ In this episode, I have the pleasure of speaking with Dr. Neil Nathan about the intersection between brain symptoms and complex illness. Dr. Nathan has practiced medicine for over 50 years. He is one of the leading experts in complex chronic illness and mold toxicity — author of the bestselling Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivity, and Chronic Environmental Illness and The Sensitive Patient's Healing Guide.

I am grateful to call Dr. Nathan a mentor and colleague. His pioneering work has been responsible for my healing from chronic illness, as well as that of many patients I've treated. Together, we co-lead a small peer group (within the larger mentoring group he provides with Marie Matheson, ND), supporting practitioners who treat those with complex chronic illness.

In this episode we discuss:
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03:43 – Dr. Nathan’s path to understanding complex illness
11:20 – Why complex illness is rising and underrecognized
19:30 – Why new medical ideas take decades to reach patients
23:15 – Mold, Lyme, and long-COVID: the “big three” root causes
25:58 – The limbic-vagal-mast cell “trifecta”
30:31 – Are some people born more vulnerable?
44:39 – The risk in “just do limbic retraining” advice
47:35 - Biochemical contributors
49:26 – Structural root: jaw and cervical instability
53:58 – Differentiating Between Mold, Lyme & Long-COVID
58:49 – A message of hope, and where to learn more

You can find Dr. Nathan’s books, consultations and mentoring program through his website at neilnathanmd.com.

If you’d like to help get this information out into the world, please consider liking, sharing, or commenting.

Until next time,
Courtney

Courtney Snyder MD
Dr. Courtney Snyder MD is a holistic and functional child and adult psychiatrist and host of the Holistic Psychiatry Podcast and can be found at courtneysnydermd.com

Medical Disclaimer
This podcast is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having.

                                                                    For full transcript...

Transcript
Dr. Nathan’s Path to Understanding Complex Illness
03:43
Courtney: I’m so glad we’re doing this, and I feel like it’s long overdue. As you know, in the mental health space in psychiatry, there’s a lot of recognition of a dysregulated nervous system, threat response in the body, but oftentimes that’s attributed to external forces or trauma, and not necessarily internal threats that we see, obviously, in complex chronic illness, which we’ll be talking about. There’s also not the recognition of the relationship between physical symptoms and brain-related symptoms. So I know you’re going to help us connect a lot of these dots. As we sort of just lay the groundwork for what complex chronic illness is — when in your path did you start to recognize the distinction, when was the beginning of your work and appreciation of complex health issues?
Neil: Okay, there are two answers to that question. First, when I went to medical school, my hope was to become a healer. And I was very disappointed that when I got there, I realized they weren’t going to teach me to be a healer. And back then I used to question my professors at medical school — why do you do it this way, and how is that? And I kept feeling in all of our interactions that we were missing something. And my professors would go, “Okay, Mr. Wise Guy, smart guy, what are we missing?” And I’d go, “I don’t know, I just know we’re missing something.” Later I would come to recognize that we were missing the emotional and spiritual component to whatever was affecting people in their illnesses. And I have language for it now — I didn’t then. The person in medical school who influenced me the most was Elisabeth Kübler-Ross, who I view as my main mentor in medical school. She, unlike anyone else, had a one-and-a-half-hour seminar once a week. Back then there weren’t video cameras — you were in a small confined room with a two-way mirror, and you’re sitting there watching someone do this. And she would simply interview one of her patients. She was a psychiatrist, but she was the only one in medical school who demonstrated how to really listen to people, how to really communicate with them, and not have this standard review of systems — here’s my questions, here’s your answers, and that’s what I do, and this is what I write up. She was really listening. She was trying to really take in, okay, what happened to you, and what’s going on with you? So I would want to give her credit as a role model to change how I learn to listen. Okay, that was step one.
I’m going to fast forward to the early 1980s. And I am, at that point, the medical director of a regional pain clinic. And we are starting to see a whole bunch of patients who had this complicated process of fatigue, unrefreshed sleep, irritable bowel syndrome, and pain migrating all over their body. And back then we called it fibrositis. Now we call this fibromyalgia. And so whenever medicine encounters a thing that they don’t know what they’re looking at, it’s psychological until proven otherwise. And people would get therapy, and they would take antidepressants and anti-anxiety agents. Didn’t help much. And so it became clear to me that we didn’t understand what this was at all. It was not psychological. Something was going on in their bodies — now I recognize it as an inflammatory process. Back then there was no concept of that at all. And then, slowly, in the early nineties, we began to find pieces of the puzzle to understand what was triggering fibromyalgia. I was working back then with Jacob Teitelbaum, who did a lot of work with chronic fatigue and fibromyalgia, and we both independently came up with an understanding that a deficiency of magnesium, DHEA, adrenal issues, thyroid issues, sex hormone deficiencies, GI dysbiosis, and food allergy — if we looked at those and treated those, the majority of people with fibromyalgia got cured. It was different for different patients. It was not like there was one thing that caused it. And as time evolved, we began to realize that there was lots of other biochemical imbalances in the body that would contribute to this kind of a process that represented chronic fatigue and fibromyalgia.
We discovered that Lyme disease and coinfections was a huge piece of that. And later still we discovered that mold toxicity was a huge piece of that. And so my understanding of the complexity — and it’s not really confined to chronic fatigue and fibromyalgia at this point, we’re really talking about almost all chronic illness — with a huge psychological component to that. So we’ve begun to understand this as essentially some version of inflammation. And if we start to really dig into what are the potential causes of that inflammation, we can make a huge impact for them. So this is a multi-year evolving understanding of how a person’s genetics, biochemistry, physiology impacts their whole being in every way. And that inflammation extends to the nervous system, contributing greatly, if not causing directly, a large number of what are now called psychiatric diagnoses.
Courtney: Right. So even among those patients that you were seeing — you were seeing, I’m assuming, depression, anxiety, brain fog?
Neil: Yeah, the vast majority of our patients with mold toxicity have brain fog and anxiety, depression, OCD behaviors, mood swings, depersonalization, derealization. I mean, all of that is super common in our patients.

Complex Illness Is Rising — and Underrecognized
11:20
Courtney: Do you feel like this is more recognized now — or do you feel like the number of people being hit with these complex health issues is increasing — or both?
Neil: Both. I would love to say that the medical profession is increasingly recognizing all of this as important, but that recognition is coming very, very slowly. The majority of folks out there, if they were to list the symptoms that they had, their doctors would basically look at them like, “I have no idea what’s causing it, so this must be in your head.” And that is the message they’re getting from their physicians at this point. So many patients are being gaslighted, so many patients are being told it’s in your head. And the repercussions of that are the family is hearing that same message, and the families become less supportive of those people, because they’re saying, “This is not real, so why would I support you? This is still in your head, go get your head fixed.” And they’re wrong, and it’s really a travesty. But so yes, very slowly, this awareness is growing. There are now more medical meetings that I’m aware of where psychiatrists can learn more about this than there were ten, fifteen years ago, for sure. But not enough — it’s still not enough.
The other part of that is some of the main triggers for this inflammatory process are increasing. So we’re seeing more and more mold toxicity, we’re seeing more and more Lyme and coinfections, partly because the environment that we are all exposed to has gotten extremely increasingly toxic. So it’s now known, for example, that there are 350,000 new chemicals in our environment than existed 70 years ago. The vast majority of those have never been tested for safety in human beings. So human beings have a tremendous amount of chemical exposure that they never had before. Human beings have a tremendous amount of EMF, electromagnetic exposures that they never had before in the history of the human race. So these exposures are cumulative. Our major organs, like our liver and our kidney, that have to deal with toxicity, are overloaded. And so, yes, we are seeing an epidemic of a whole bunch of these conditions. In children, we are aware that autism has skyrocketed — it went from one in several thousand kids to one in thirty kids in many states now have autism. And forgive me, but the pediatric profession is not taking this seriously. It’s like, “Yeah, that’s sad, it’s unfortunate.” It’s like — really, you don’t want to look at this? This means one in every three kids born are getting autism — does that not concern you? But, forgive me, the medical profession is very slow to embrace new information, and that is really to the detriment.
We’re seeing an epidemic of Alzheimer’s, Parkinson’s, ALS, all of which involve neuroinflammation. We’ve seen already an epidemic of chronic fatigue and fibromyalgia. And all of these things are interrelated, because — yes, I’m supposed to be an expert on mold toxicity, and I probably am — but mold toxicity doesn’t exist in a vacuum. You have mold toxicity as one of multiple environmental toxins we’re being exposed to. It is simply one of the most common, the easiest one to diagnose, because we have tests for it. We don’t have tests for the hundreds of thousands of chemicals out there. We’re just beginning to be able to have some tests that will tell us what’s in someone’s body that might be making them sick.
Courtney: Right, right. And I would imagine that this typical medical model of looking for one cause to autism, one cause to dementia — it’s a completely different way of thinking. When you get away from that and you look at complexity of the human body, that way of thinking holds back the research, it holds back any progress.
Neil: What I think is helpful for people to look at is: we are all uniquely, biochemically, genetically different. And so the same inflammation in one person could trigger cardiovascular disease, and another person could trigger Alzheimer’s, and another person could trigger chronic fatigue. So we need to take a step back and go, okay — and this is not a brand new idea. For the last ten years, there are many papers in the medical journals that are saying chronic illness is almost certainly an inflammatory process. Now, it hasn’t really integrated into what people are being taught in medical school or in their residency program. But this is not a brand new idea, and there’s tons of medical research documenting that.
What behooves us as physicians is to look at every human being and go, “Okay, this is your named chronic condition — what are the triggers for you?” We have to kind of be like a medical detective and dig in and go, okay, what’s triggering your inflammation, so I can treat the cause — not put a band-aid on it, which is, forgive me, in the psychiatric field, taking antidepressants and benzodiazepines. That’s a band-aid. It’s a helpful band-aid, it could be a very important band-aid, help someone to function. But you really need to be looking at, okay, I have this great band-aid, but wouldn’t it be nice to actually cure this? And I think that would be, for me, to your audience, Courtney, my take-home message — which is always look for the root cause, because it is possible that we will find that root cause, and you won’t have whatever name you’ve been given, depression, anxiety, OCD, for the rest of your earthly life. Maybe.
And I’ve treated thousands of people successfully here. So this is not — I’ve had one or two successes here — we’re talking thousands of people that have responded to this way of practicing medicine, with fabulous results. People who’ve been literally bedridden, incapacitated by their illness, are now out there working again and being with their family and living full lives. So that’s the take-home message.
Courtney: Right. Which makes it so satisfying to treat. And I mean, I can speak to that, having experienced it personally. But at the same time, you do get pushback from other areas of medicine that don’t give it necessarily credibility, even though people, on the other side, are thriving and healing, and it’s really amazing.

New Medical Ideas & Research Take Decades to Reach Patients
19:30
Neil: You know, the history of all science, including medicine, is: new technology, new drugs are fast-tracked to get into our lives. Ideas, not so much. Typically it takes a generation — twenty, twenty-five years — for a new idea to come into acceptance. And the first reaction of any science, medicine included, is to get into denial, which is, “There isn’t enough data to support this concept, and I can’t be perceived as practicing bad medicine by embracing a concept that isn’t proven yet.” But that means that all of their patients are going to have to wait twenty years — until suffering — until that person goes, “Now there’s enough evidence, now I can learn how to do this, and now I’ll begin to help you.” I’m not wired that way. I’m wired that if I have a suffering person, and I have something that I can offer them that might help, I’m going to try it. I’m going to do it in the safest way I know how, but I can’t leave someone dangling for twenty years and say, “I’m sorry, I have to wait until my profession figures out what to do.” That’s not me.
I worked at the medical school at the University of Minnesota Duluth for eleven years. And I was not only on the faculty, but I was on the committee that determined what new information was put into the curriculum. For example, AIDS was just coming into vogue at that particular point, and it was obvious that we needed to have courses on AIDS for the medical students, because this was big. What a lot of people wouldn’t understand is that each department in a medical school fiercely guards its time allotment. Everyone gets a certain number of hours, and they’re not open to adding new things or giving up any of their time slots for anything new. And so what I would watch is, as new information came into the medical school, each department fiercely refused to add any new lectures in their department, or give up any of the time that they had to anybody else to add that information. So we’re talking about university politics now — this is not even medicine, this is people guarding their turf. And I don’t even think that would occur to any consumers, that that would happen like that — well, certainly, why would that happen in a medical school? Well, it’s because human beings are responsible for each department, and they guard their own turf. So it’s a kind of an insidious process about how new information isn’t embraced by the profession, to go into the medical school curriculum.

Mold, Lyme, and Long-COVID: The “Big Three"
23:15
Courtney: I want to come back to what you were saying about inflammation being at the core of chronic illness and complex chronic illness. And when it comes to complex chronic illness, whether it’s SIRS or mast cell activation from mold or Lyme, we talk about multiple systems being affected — the central nervous system, gastrointestinal tract, endocrine, skin, just you name it. If the inflammation then is from a source of oxidative stress or a major insult — would you say that mold toxicity is the most common, or would you put Lyme or now even COVID on a par with that, as far as the deepest roots causing the inflammation? Not that the chemicals, metals, and everything else we’re being exposed to aren’t at play.
Neil: In my experience, those three are the biggies — mold toxicity, Lyme with its co-infections, and long-haul COVID. Those are the three most common. Of those, in my experience, mold is the most common, and the one that has to be treated first if you have some or all of them. So, for example, in people who have long-haul COVID or Lyme, often their body will not respond to that treatment optimally until you first get the mold out. So there’s a little hierarchy of what we do, in what order. And then within that hierarchy, there’s also an order in which we do things for people to respond optimally. So, for example, mold toxicity will trigger — and Lyme and Bartonella will do the same thing — limbic dysfunction, vagal nerve dysfunction, and mast cell activation in most of our patients. Not all, but in most. And the longer they have it, the more likely those things are going to get triggered. Once somebody does not feel safe — and the systems that we have in our body to monitor that safety and to keep us safe are the limbic system, the vagal system, and mast cell activation — we have to get the body safer, or it will not be able to take what you need to take to treat mold or Lyme or long-haul COVID. People will literally shut down — their limbic system will essentially go, “Mm, I see what you’re trying to do there, and I can’t let you do it, because I’m not sure that’s safe.” And it will literally not allow people to do it.

The Limbic-Vagal-Mast Cell “Trifecta”
25:58
Courtney: So with one of those, or a combination of those, on board, these threat mechanisms would be kicked up — mast cell activation, limbic system dysfunction, autonomic nervous system dysfunction. If they look similar, or a timeline isn’t easily helping parse out what might be primary, how able do you feel to make the distinction — versus if mold is present, starting there?
Neil: If we look at our patient’s symptoms, they will point us clearly to whether there’s a limbic or vagal or mast cell piece, to be specific. The limbic system’s job involves primarily monitoring and regulating and keeping emotion and sensitivity in check. So any symptoms that involve those two things are limbic almost by definition. So on the sensitivity side, if someone describes an increased sensitivity to light, sound, touch, smell, chemicals, EMFs, food — they’re already telling me my limbic system is dysfunctional. In some ways it doesn’t matter what the cause is; if someone has this increased sensitivity, regardless of the cause, I know we have to treat their limbic system first.
On the vagal side, the symptoms would primarily run into symptoms that involve the autonomic nervous system, which would involve things like temperature dysregulation, palpitations, insomnia, POTS, blood pressure dysregulation, or symptoms that involve the gastrointestinal tract, because the vagus nerve controls almost the entire intestinal tract. So any GI symptoms — gas, bloating, distension, reflux, diarrhea, constipation, abdominal pain — again, that would lead me to go, the vagus is involved here. So by listening to my patient’s symptoms, I can immediately know what’s dysregulated here, and what my first treatment arm will be — to get the limbic and vagal systems back up and running again at a safer level, because otherwise our patients aren’t going anywhere. They can do binders and antifungals and antibiotics for Lyme, and they will get worse. Their body will basically go, “I know I might need that, but why are you doing that? I can’t even get to a place of safety to respond. I’m on self-preservation mode here.”
And in the mast cell category — again, all of the same symptoms that could be mold or Lyme or long-haul COVID could also be mast cell. Again, it’s a multi-systemic process. A tip-off, which I find very helpful, is if someone describes a symptom that comes on immediately after eating, sometimes while eating. Nothing causes that kind of reaction that fast except mast cell activation. Allergy — and most people, if they do have some symptom that comes after eating, they’re going to be thinking, “It must be what I ate, what did I just eat?” But it’s not food allergy, it’s mast cell activation. In that context, many of our patients have already observed that they can eat a particular food one day and have a very strong reaction, and the next day, same food, nothing. And they’ll go, “That doesn’t make sense — if this was allergy, I ought to react the same way every time.” And so that is classical mast cell activation, which fluctuates. So — for the first part of your question — that’s what I’m looking for. When I take a history, when I talk with patients, I’m going to really dig into: are they already manifesting symptoms that clearly tell me what we need to do first, to get them safer, so that now they can respond properly to the treatment that will really get at their root cause.

Are Some People More Vulnerable?
30:31
Courtney: I know you take deep timelines when you meet with someone, so you’re really accounting for a lot. But one of the things that I think about a lot is: who is most vulnerable? Do some of us come into the world already with a vulnerability similar to Elaine Aron’s highly sensitive person model? And then maybe there’s trauma, early attachment disruption — and already vulnerabilities — but then the toxic load that we’re all experiencing. But then something like mold or Lyme then hits. And then, all the years and all the patients you’ve seen — I’m curious how many you feel already had sort of a vulnerability. Not that they ever had to really become sick necessarily, but already had a vulnerability.
Neil: Honestly, I would say most. Our limbic system evolves from the time we were in our mother’s uterus, so that almost no one has had a perfect childhood. And so whatever someone has had to deal with in childhood — it could be recurrent ear infections or throat infections, or it could be a surgical procedure, or it could be parents, both of whom worked and they didn’t get enough time, or they could be abusive parents, sexually, physically, verbally abusive — whatever someone has been exposed to, that forces their limbic system to have to deal with it. Because that’s the job of the limbic system, is to keep you safe. So your limbic system is basically going, “Okay, I’m just a little thing here, what do I need to do to cope with this?” And so their limbic system slowly, inexorably, becomes more and more hypervigilant to protect them. Let’s say someone had an alcoholic parent, and they would come home, and you were never sure what their status would be — and so you’d kind of hold yourself back from that, which is, “I’ve got to see what this person is showing me, is it safe for me to come up and give them a hug, or do I want to hang out in my room for a bit until whatever this is settles down?” That’s the beginning of this limbic hypervigilance process. And then it just goes on through life. So that if you’ve had difficult relationships, or surgeries, or severe infections, or anything in the physical or emotional or spiritual plane, a betrayal of some type — the limbic system becomes slowly more and more and more hypervigilant, when the straw hits the camel’s back. And that straw could be COVID, or Lyme, or mold toxicity, or another infection of some type — that’s the straw that breaks the camel’s back. At that point the limbic system goes into shutdown, which — we know the vagal system goes into shutdown, literally, that’s something the vagal system is trained to do. It’s “okay, we are so unsafe that I’m shutting down my systems here.” And so that predisposes to illness. But I want to tie that back to inflammation, which — a lot of people don’t understand that the vagus nerve, for example, controls inflammation in the body also. There are branches of the vagus that go to the spleen, to the gut-associated lymphoid tissue, and to the thymus, all of which are major immune organs. And if the vagus is dysfunctional, inflammation can rage out of control. So again, this comes back to understanding this complexity of inflammation, and how we need to both understand it and know where it is we want to look to get at that inflammation. So there is a profound interconnected limbic-vagal-mast cell piece. Each totally connects to the other. There’s an interaction between the thousand biochemical mediators that mast cells make and the nervous system itself. So I call this interconnection the trifecta, which is: you can’t just treat the limbic system in a vacuum, because if you’re not also looking at the vagal and mast cell system, your treatment may be a little bit helpful, or it might not even work at all, until you combine all three — so that you really understand this is a package deal here, in terms of how we work with it.
There was one more piece I wanted to add, Courtney, to understanding the inflammation piece: whether or not someone gets mold toxicity or Lyme or COVID depends on how robust their immune system is. So you could have a family living in a moldy environment — one person is really sick, several are a little bit sick, and one is not sick at all. And the one who’s not sick at all can easily go, “I’m not sure what’s wrong with you all, but I’m fine in this environment, it can’t be my environment because I’m fine.” And what they’re not understanding is: yes, they are fine, as long as their immune system stays robust. For the others, they were at risk for all of these conditions because their immune system took a hit. And for many people who were living in a moldy environment, during COVID, for example, when we isolated and people were spending twenty-four hours in their home rather than the eight hours out, they were many now being exposed to more mold at home than they were before. I don’t think people began to think about that or look at that. So in that environment, whether or not they were affected depends on the hit they took. Now, the things that will hit an immune system to weaken it, and allow whatever’s there to manifest, are: COVID was a biggie, any severe infection, a surgical procedure, childbirth, menopause, or any emotional upheaval will weaken that immune system, and then the immune system loses containment, and now we are off to the races. So what I try to convince people who are living in a moldy environment who are well is that they’re living with a ticking time bomb. Should they take an immune hit, they will be just as sick as their family member who they’re kind of lording it over, which is, “I’m not sick, what’s wrong with you?” You’ll be right there yourself if you take that hit — to try to help them understand, yeah, you’re okay for now, but once your immune system weakens. So I’m trying to tie together the immune system, its ability to regulate inflammation, and this whole process here.
Courtney: Right, right. Which I guess is why we call it complex, complex illness.
Neil: It is the way human beings are. We’re not making up a new word of complex illness — illness was always complex. We’re just beginning to understand how complex it always has been.

The Limits of Treating Symptoms Alone
44:39
Courtney: Right, so there’s communities out there addressing mast cell activation. There’s communities out there addressing POTS and dysautonomia. Communities out there addressing OCD and more obvious limbic-type issues. And then there’s the whole mental health field. And the dots aren’t getting connected. I mean, I’ve yet to see someone with OCD — I think it’s like eighty to ninety-five percent have mold toxicity as part of the picture.
Neil: You know, an example — and I won’t name names — is there’s an eminent pediatric physician who is very well known for his work in autism, who thought he was ADD his whole life until he recognized that he had mold toxicity and started taking antifungals, and all of a sudden his brain went online and he doesn’t have it anymore. So that’s just a very clear example of what you’re talking about. And what we are talking about is: it’s absolutely essential that all people who work in the medical field, all healthcare providers, embrace this complexity, because if you’re only working on a piece of it, you will help some people to a certain extent, but you will not help people optimally. I mean, that is the absolute bottom line.
The understanding that mast cell activation was huge came in 2016, when Larry Afrin wrote his book, Never Bet Against Occam. It was a huge game changer. When I read his book, it was like, “My goodness, I’ve been missing this in my patients.” And the whole world embraced this information, so that every medical center in the country now has a mast cell activation clinic. However, they’re looking at it as a single thing with a label to it, and they’re treating it just that way. They have not recognized that if they don’t add limbic and vagal work to it, their treatment is not going to be adequate. And so, yes, they’re helping people, but absolutely not optimally. And to make it worse, very few of those clinics have recognized that what’s causing mast cell activation, which absolutely needs to be treated, is mold toxicity and Lyme. So people go to these clinics and get a certain amount of help, but they’re not being treated comprehensively, which is a pet peeve of mine — which is, come on, if you’re going to have a clinic, understand the whole interactions of whatever name it is you’re working with. If you’re going to be an ENT specialist, understand everything that impacts that area. If you’re going to be a cardiologist, understand everything that impacts it. And we just don’t see that. We see people kind of in their little box — “No, no, I’ve learned this, this is what I do, this is how I work” — and it’s just unfortunate that they’re not looking at the bigger picture.
Courtney: Right, I think add to that PANS and PANDAS, because in psychiatry, people feel like they’re deep diving because they’re getting to PANS and PANDAS. It’s like, okay, you’ve got to go deeper than that, because even those conferences, they talk about the need for treating relapse, and it’s just going to keep reoccurring.
Neil: I mean, they’re using IVIG to help. That’s nice, but they’re not getting to cause. And we know when PANS and PANDAS first emerged on the scene, it was all about strep, and that was the focus for a long time. But as time emerged, it was very clear that this was a neurological inflammation triggered — here we go, broken record — Lyme, mold, other infectious agents had to be looked for. And if we treated those, you could cure PANS. It wasn’t something that needed IVIG for the rest of your earthly life.
Courtney: Even among those, would you say very often mold is underlying the mycoplasma, the candida?
Neil: I think mold is one of the most missed components to illness that I can think of. If I have a goal in life, it would be to raise the consciousness of our profession as to the importance of mold toxicity, how common it is. We’re talking millions and millions of people who are not diagnosed, because their doctors don’t know about it, and therefore are not making the diagnosis. I’d love to see the consciousness get to the point that someone would present with these complicated stories and a doctor would say, “Why don’t we think about mold toxicity?” That would be the most important thing I would have done in my career.
Courtney: Yeah, well, you’re certainly raising awareness.
Neil: I’m working — it is slow. As we said, I’m working on a twenty-year generational issue here.
Courtney: You’ve mentioned that the underlying source needs to be addressed, but the nervous system and immune systems need to be addressed. So one of the things that comes up with limbic system retraining is: I’ve had people hear the message that if they just address their limbic and autonomic nervous system, then they wouldn’t need to address what I see as an ongoing threat, such as a mold toxin. So I’m hoping you can speak to that, and the importance of these programs, despite that.
Neil: Sure. A couple of the better-known limbic retraining programs, the coaches get a little bit zealous about — “limbic retraining is so important, this is all you need to do alone, don’t even do anything else, just do limbic retraining.” And I suspect that there are a handful, very few, but a handful of people who’ve gotten well just doing limbic retraining. If, for example, if you had mold toxicity, if it was relatively new, if you had not colonized, and you moved out of your mold exposure soon, it is possible that the limbic retraining would help reboot it to the point that your immune system rebooted itself and you’d be fine. I believe there are a few people like that. The vast majority of people who have limbic dysfunction — you need to do limbic retraining and vagal retraining. You may also need to do mast cell retraining, and please look for the cause of that. Those are downstream effects, those are not named diagnoses that you treat alone and it fixes it. Please look for at least mold and Lyme, which are the two most common things that are triggering this at this point. And people are getting the wrong message if they think they need to do it in a vacuum. To make it worse, they’re being told, “No, no, just do limbic retraining, that’s all you need.” And the truth is, no, you need to combine limbic retraining and vagal rebooting and mast cell activation most of the time. And of course you’ve got to get back to cause.
Courtney: Right, I mean I try to liken it to — if they were in an abusive relationship or toxic relationship, they wouldn’t just limbic-system their way out of that, if there was an external threat.

Biochemical Contributors
47:35
Neil: No, you’ve got to fix what’s primary here. I want to add to this discussion — we’re focusing on inflammation from toxins and infections, but there are also other biochemical issues, some of them downstream, that need to be looked for and addressed in order for people to recover completely. So, for example, Lyme and mold will trigger kryptopyrrole issues, or imbalances in the ratio between zinc and copper, or they’ll trigger methylation issues super commonly. And I just wanted to expand this discussion — I know it’s complicated enough, but I don’t want to oversimplify it either — that there are other biochemical things that we want to be looking for, because they’re treatable, and they will help people to heal faster, if we’re also addressing methylation, the need for zinc, the need for magnesium or B6 — those are common components of this whole process here. And so I just want to kind of tie that all together for a moment.
Courtney: No, I’m glad you did, because those are topics that I talk about here, so it’s important to connect those. The other thing I see, because I integrate the Walsh approaches with treating people that have complex health issues, is zinc seems so amazing when it comes to mast cell activation — making sure that’s optimized. As well as connective tissue — and that was something else I wanted to ask you about — is structural issues that can be impacting the autonomic nervous system. I just see a lot of people — I inquire about it because I had it myself — but who have upper cervical instability as part of this whole picture.

Structural Contributors
49:26
Neil: Again, all of these things are interrelated, and the physical structure can prevent people from moving forward in several different ways. One is the structure of the jaw and the face — the body puts a priority on teeth occluding properly. And if the teeth don’t meet just quite right, and the jaw is a little bit out of structure, people often talk about TMJ — the body basically freaks out, it goes into sympathetic overdrive. And for some patients — it’s not common, but I’ve seen several dozen — where the jaw had to be realigned by a combination of dentists specially trained in this work, working with osteopathic physicians, to realign the jaw. Often in those patients, they couldn’t respond to the limbic and vagal treatment until their jaw got realigned.
Same thing is true with what you’re talking about, as cervical cranial instability, which is basically a weakening of the ligaments at the base of the skull, where it attaches to the first cervical vertebra. Now, these are all again intertwined — for example, it begs the question of what weakens those ligaments. And the answer is: if you have mast cell activation, some of the materials that the mast cell makes weakens the ligaments. So the ligaments get weak, and where the skull attaches to the first cervical vertebra, instead of being pulled apart, like ligaments do, it collapses. And that influences the blood flow to the brain, the nerve flow to the brain. And again, the body recognizes that as a priority, and often you can’t get that better — you can’t get limbic and vagal response until that gets fixed.
So there are a bunch of structural issues that also need to be looked at, when people become overly sensitive and are not responding properly. And there’s more in that area. So, for example, there’s a chapter by Tasha Turzo, who’s an expert on the jaw structure. There’s a chapter in there by Andy Maxwell on cervical cranial instability. So that book would give people a really good overview of how complicated things are, and they might, chapter by chapter, get a clue of, “I haven’t looked at this piece yet.” I mean, we haven’t talked about oxalate or salicylate imbalances, which can add to that. So I just think that is a resource for folks that could really help them understand how they’ve gotten where they are, and understand the path out.
Courtney: Right, right, because not everyone has all of these areas, but certainly could be held back or have a unique something that they could be getting relief from early on in the process. So I think it’s both, to the degree that people are able to learn, and your book Toxic, too — it’s like an encyclopedia, even if someone doesn’t read straight through it, they can go to the mast cell section, or they can go to the Bartonella section.
Neil: It was intended to be a readable way to understand this complexity, because it basically will talk about almost everything we’ve talked about today, and help people to get better understanding. I mean, we’ve talked about the bigger picture today. We didn’t talk about, okay, how do you diagnose Lyme, how do you diagnose mold toxicity, how do you diagnose long-haul COVID, and most important, because this is very complicated, how do you decide which of those is the biggest player that you want to address first?

Distinguishing Between Mold, Lyme & Long-COVID
53:58
Courtney: Right, I have shared resources on diagnosing mold toxicity. Would you comment on your last point — how do you recognize, are you using specific testing that you want to reference, the RealTime?
Neil: I do. But I would emphasize, we’re taught in medical school that if you really listen to patients, ninety-five percent of the time you will make the diagnosis by history alone. And I don’t want to get too focused on testing, because listening to the patient and having them describe in detail what they’re going through will really give you the little pieces you need to tease it apart to a certain degree. That’s only possible to a certain degree, because there’s a huge overlap between the symptoms of Lyme and Bartonella and mold and long-haul COVID and mast cell activation. Huge overlap. So there’s little teeny pieces that will tend to lean more in one way than another. And honestly, that’s what’s required from all of us, literally years of study, to really get a handle on — someone will say something, okay, that’s much more of a mold symptom than it is a Lyme symptom, something else. So I do encourage people, if they think they might have mold, to get a urine mycotoxin test. That has revolutionized our ability to make these diagnoses.
Courtney: Would you still set RealTime as the preferred? That’s what I’ve communicated to this audience.
Neil: I would. Any test can help make the diagnosis, but for follow-up testing, the only one that’s been really consistent is RealTime. And you want a follow-up test, so you want to know what your baseline starting is, and then you want to know, okay, am I getting these toxins out of my body? From my perspective, you know that you’re done treating it when that RealTime comes back reading not present in every category. We have better tests now for Lyme than we’ve had in the past. Years ago, our tests were inadequate to say the least. And the CDC recognized years ago that the tests were so inadequate that it was basically a diagnosis made by a physician by examining all of the history and information that you had. That was enough — you didn’t need a lab report to make the diagnosis of Lyme disease. A new test that I’m particularly fond of is Bruce Patterson’s fourteen-panel cytokine test. This is a test that measures cytokines, which are the molecules of inflammation — cytokines are made by your immune system to deal with, or fight, different inflammational causes. And so what Dr. Patterson has discovered is there’s a pattern of cytokines that we see with long-haul COVID, which is different than the pattern we see for Lyme. And I’m working with him now on the pattern for mold. So we can literally look at that test and look at, okay, what is inflaming this person primarily now, because I’m looking at that inflammational pattern, and I can literally read that. Some of my patients will have all of those on a particular test, or only one, but it really helps tease apart what is — I call it public enemy number one for my patient, what do I need to address as root cause right now. So our science is improving as we go here.

A Message of Hope — and Where to Learn More
58:49
Courtney: And that’s huge. Before we go — I think all of your books, but I’m thinking specifically about Toxic and The Sensitive Patient — all the information you generously share gives people a lot of hope who’ve been struggling out there. And I think your mentoring and teaching so many of us helps extend some of that reach. Is there anything you’d want to convey to people out there in the throes of chronic illness who are feeling hopeless and not getting the feedback from their doctors that this is something they can get beyond?
Neil: Sure. My take-home message is always: everything we talked about today is treatable. Is there hope in there? You bet there is. But if you are not getting the help you need from whoever you are seeing, find someone who understands these things. For example, I do have on my website a list of physicians that I’ve trained over the years that I’m comfortable that they really know what they’re doing — it’s a growing list. There’s someone like Courtney, who’s been trained for years to do this, she’s good at it. Find someone who knows what they’re talking about, so that you can get someone who does embrace this complexity, and will look at it in its entirety, and then get you moving in the right direction, doing the right things in the right order. To me, this can be done. I mean, I have personally helped to cure four or five thousand people with mold toxicity, and an equal number of people with Lyme disease. So we can help the vast majority of people that we’re seeing. So, regardless of how long you’ve been sick, if you haven’t been properly diagnosed and you haven’t gotten the right treatment, you can be helped.
Courtney: Right, right, that’s great. And for physicians out there who are interested in learning more about complex chronic illness — are there resources you would point to? I’ll be sharing your books, because I think those are great references — but also how people can find what you’re doing currently.
Neil: Sure, my books — particularly with this discussion, Toxic and The Sensitive Patient’s Healing Guide would be the two most appropriate. I would add that I have just finished writing a book on this whole subject of inflammation. It’s currently being edited, I hope it’ll be out by early next year. So if you stay tuned to my website, I’ll let people know when that’s going to be available. And I think, Courtney, what you’re referring to is: I do have a mentorship program for healthcare providers. We now have three hundred and fifty-plus people in the mentorship program, it keeps growing. You were in one of the first groups — we started with eight, and then people kept wanting to get in on it. So we welcome people to join. If you go to my website, which is simply neilnathanmd.com, there’s a whole thing which talks about the mentorship and how to sign up for it. So I certainly welcome people who want to learn more.
Courtney: And then you offer consultations and professional consultations also?
Neil: I do. My consultations — I am, at this point, since I’m semi-retired, not seeing people directly. But I do offer consultations with a patient and their primary treating physician — so we all get on a Zoom together, and we will go over the details of that person’s history and their lab work, and I will help outline a treatment program that looks to me like it will get people well. And actually, Courtney, I actually do a lot of that — I’m not really retired, my wife will tell you. I stay pretty busy. I love helping people. I love being able to take this complicated information and tease it apart, so that I can help people to understand what they need to do, in what order, in order to get better.
Courtney: And we’re all grateful — grateful that you’ve followed your path, because so many people have benefited personally and professionally. So thank you for bringing your wisdom and expertise, really appreciate it.
Neil: You’re very welcome, happy to do that.

You can find Dr. Nathan’s information, consultations, and mentoring program through his website at neilnathanmd.com.

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Until next time,
Courtney

Courtney Snyder MD is a holistic, functional, and environmental psychiatrist for children and adults. Find her at courtneysnydermd.com and on the Holistic Psychiatry Podcast on all major platforms.

Medical Disclaimer
This podcast is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having.