The World Health Organization reported last year that at least 7 million deaths worldwide can be attributed to air pollution, indoors and out. In the Western world, everything from allergies to endocrine disruption (including thyroid, diabetes, weight loss resistance), neurological diseases, autoimmunity, heart disease and cancers are influenced by indoor air pollution. There are many sources of indoor air pollution, ranging from toxins tracked into the house, to mold, household cleaning products, carpets and more. Listen to this podcast with Dr. Winston Cardwell as he walks through a clinical approach to identifying (history, laboratory testing) and treating (diet, supplements, clean home tips) fall-out from indoor air pollution. This podcast covers materials for clinicians and offers good tips to anyone interested in maintaining a healthy, low-toxin home.
Pearls from Dr. Cardwell’s podcast: best home mold testing, laboratory testing for toxin exposures, best air filtration systems, home cleaning products, “green” building materials, “green” flooring sources and much more!
Dr. Kara Fitzgerald: Hi, everybody. It’s great to be with you here again. Again, I’m Dr. Kara Fitzgerald. Today, I’m with Winston Cardwell. He is a naturopathic physician as well as a licensed acupuncturist practicing in Atlanta, Georgie.
Winston and I go way back and I’m delighted to be talking with him today. He is a treasure trove of knowledge. He’s been in the trenches, working with patients directly for his entire career. We actually both graduated together from National College of Naturopathic Medicine.
Dr. Cardwell has received extensive training in integrative oncology, integrative cardiology, environmental medicine (and we’ll be picking his brain around environmental medicine today). He founded Atlanta Integrative Medicine in Roswell, Georgia where he practices Dr. Forrest Smith.
In his practice, he focuses generally on naturopathic oncology as well as difficult to treat chronic illnesses.
So again, today, we’re going to be picking his brain with regard to environmental medicine. And of course, toxins impact any disease process. So he’s focusing on this in his practice quite a bit. He’s one of my tribe members, one of the folks that I reach out to when I have a tough case or want to share some new research with other clinicians in the field. So it’s fun that I get to be with him today.
Our topic is, Winston, we’re talking about indoor air pollution today, how the effect of indoor air pollution and what kind of toxins we’re encountering in the air, as well as how we evaluate for it. And we’ll spend a good bit of time on remediation, really, where the rubber meets the road, how we help ourselves, our family, as well as our patients to turn this big issue around.
I just want to give a little bit of background and then we’ll jump in. I did some research looking at some data that was released around this time last year from the World Health Organization. And they actually cite that about seven million premature deaths annually are linked to air pollution both indoor and outdoor. And they say that this figure was startling to them, unexpected. But their analytical technology has improved, so they’re able to pick it up.
In your experience, Winston, what are you seeing with regard to indoor air pollution being an issue in your patient population?
Dr. Winston Cardwell: Well, thank you for having me. It’s great to be here. And regarding what we see a lot of problems with, particularly in the Southeast, but certainly not limited to this area, are often related to solvents and other biological agents like molds that are either known or unknown to the individual that can impact a number of different aspects of the individual’s health, whether it be neurologic, immunologic, psychiatric. There’s just a wide range of symptoms that can come from all these things.
Most people think of respiratory problems, which are also a big issue as well. And this varies from family to family and the house, the apartment that they are staying in depending on what is in the house. We see a wide variety of these types of symptoms and the system is affected. But at the same time, it doesn’t always affect everybody the same. And that’s one of the most difficult aspects of this. The question always arises, “Why does my son have these symptoms and myself, my husband, doesn’t? Why is it that no one else have the problem that we’re seeing here?”
We’re having answers very rapidly now with the human genome project being completed and having more…
Dr. Kara Fitzgerald: Let me back up. I’m so sorry to interrupt you because that’s an incredibly important topic and I want to get back to it.
“Why is my son sick, but I’m not sick and my daughter’s not sick” or, “My husband might be mildly sick.” So we want to get back to that, the impact of the genome.
But first, let’s back way up and talk about some common sources of indoor air pollution. You’ve named a couple but I wanted to just pick your brain. So what are you seeing?
Dr. Winston Cardwell: So we see the biggest ones, like I said earlier, are things along the lines of whether it be pesticides, herbicides, things we knowingly apply within the house from your exterminator or the individuals that live in the house to things like your fragrance, your Glade plug-ins, for example, or the little incense-looking sticks that stick out of the oil that’s scented. Everyone wants to have a fresh-smelling house. The problem is those are all solvents and those are known neurotoxins. They also have a significant impact on respiratory issues.
The other things that we’re seeing, as I said, are the mold problems. And that’s not just the visible mold growth, but it’s the mold spores. We all are familiar with the allergy aspect of that, but there’s much, much more to it than just plain allergy.
Most individuals, when they’re suffering from mold, they’re not suffering from the actual allergy, they’re suffering from the toxins that are produced by the mold that are volatile. They go into the air and we breathe them. They can pretty much penetrate just about anything. So having a basement that’s isolated or that backroom has got mold growth, but we keep the door shut, those kinds of things don’t make a difference really whatsoever in that aspect.
And then there’s also the particles of the mold that are airborne that cause some significant immune stimulation and dysregulation.
And so that’s one of the problems with the testing aspect. A lot of the mold plates that are used for culturing or the indoor suction devices that are filtering the air itself are looking for actual mold spores and mold things to grow, but that doesn’t include the particles that are involved in the air as well. And so that’s commonly missed.
There are a lot of other things that we don’t think about that are also ubiquitous in the American household and really, around the globe. The fluorescent light bulbs that are the compact fluorescent CFL, those little swirly light bulbs that are wonderful for saving and reducing energy, the downside to that is that they’re loaded with mercury.
We’ll see somebody that will break one. They’re easy to break (as all lightbulbs are) and what is commonly done is the individual will just vacuum up the glass and the particles on the floor. That all goes into the vacuum cleaner. And then every time the vacuum is run, it is re-distributing mercury into the air that then we breathe and absorb through the skin.
Candlewicks, for example, that have lead in them that are used to keep the candlewicks straight when the wax is poured around it. When those are burned, the lead goes into the air and we breathe that in and absorb it very easily and very well through that exposure.
There are problems with a lot of the cooking ware as well as the plate and dinnerware that we use that are loaded with heavy metals.
It’s astounding to see what we find in individuals’ homes. We’re doing an evaluation for heavy metals like that and things that are used every day. They’re not limited to other countries. A lot of times, we hear about China and Mexico having most of the problems, but that’s by no means the rule. It can come from any country including our own. And it’s not enough just to judge the plate by the country of origin.
Dr. Kara Fitzgerald: Right. I just want to throw out there (I think you alluded to this in your roundup list here), but carpets, the various cleaners that we’re using. Even in the news lately, there has been the whole Lumber Liquidators, whatever the name of that company, where they found massive amounts of formaldehyde in some of their flooring. Thank God they’ve identified it. That would be, obviously, another really important source.
So now, why don’t you just give me an overview of symptoms and disease associations that you might see with these myriad exposures?
Dr. Winston Cardwell: Sure! Obviously, there are definitely some associations with different chemicals and substances with particular or common symptom presentations. But as I’ve said, they come very widely and they can be from general constitutional symptoms, things that we hear all the time – fatigue, just not feeling like you’ve got the energy that you once had at one point in your life to flushing of the face or the chest or the ears out of nowhere. Sometimes, we’ll see fevers with that or just feeling hot in general. We see an increase in perspiration or sometimes even a decrease in perspiration.
But then you have more of the specific systems involved, anywhere from the neurologic symptoms like headaches, cluster headaches, migraine headaches. Just about every kind of headache you can think of can be triggered by a lot of these things.
You can also see the psychological aspect to be affected as well, from memory regarding recall or word-searching or just flat out short-term/long-term memory reduction. Across the board, we can see more profound neurologic problems. Parkinson’s disease has been associated with a number of these items, multiple sclerosis has, in some situation, as has ALS.
So those are one that we hear about and we are familiar with, but very rarely do we associate those with solvent exposures or other problems.
But then in the respiratory, you can have asthma, you can have chronic coughs, you can have people that are short of breath or they have something we call “air hunger” where their lung function is fine. When they go to a pulmonologist, everything checks out okay, but they still have this sensation that they can’t get their breath. And it’s literally air hunger. And that’s something that’s really common in a lot of our patients.
And then we can see things like hormonal changes influence the hormonal production. There are well-known and documented associations with a lot of these chemicals and their impact on estrogen, metabolism and testosterone.
That’s a big focus of a lot of our practices, hormone management. We can see it affect the thyroid as well. And that’s something that has skyrocketed in these incidents over the past couple of decades. Just about everybody over 40 has some sort of thyroid issue and then we’re starting to see it a lot more in kids now.
And so we check a lot of our pediatric patients for thyroid as part of the full workup and the screening that we do at our office. And then a lot of our colleagues around the globe are doing that now as well.
But then more commonly in our office, we will see immunologic problems, whether it be chronic sinusitis, chronic colds or flus that are just so easy to catch. Everybody else around them is sick and they look at somebody who is sick and they, all of a sudden, are sick. And it can last for weeks and months versus four or five days with an immunotypical individual. The issues with autoimmunity are increased whether that be things like an autoimmune thyroid problems to other autoimmune diseases that is also on the rise around the globe too.
And then certainly, heart issues. We see an increase in blood pressure, we can see increase in atherosclerosis and obviously, the end result, being an increase in a heart attack. But it can be more subtle in the form of angina. Just the tightening of the blood vessels and restricting the flow to the heart that gives just the symptom of chest pain.
And it’s the same thing. You go to the doctor and everything is okay and checks out, but the symptoms still remain.
And then lastly, things like cancer, whether it be blood cancers, leukemia, lymphomas, myeloma. We also see it with things like breast cancer, colon cancer. Gallbladder cancer is a good example because that is on the rise dramatically over the past couple of decades and that’s believed to be associated with the toxins our body is trying to get rid of going through the biliary tree and out through the gallbladder. And so that’s another concern.
Dr. Kara Fitzgerald: I think that you mentioned when we were talking about endocrine effects just this refractory weight that we’re seeing, weight loss resistance, obesity, anywhere on the metabolic continuum from metabolic syndrome to full on diabetes. I know that has a strong association with toxic exposures. So basically, Dr. Cardwell, any of the conditions we’re seeing commonly in our practice have, as one of the components of the cause of the condition, toxic exposures.
I also want to point out, Dr. Cardwell sent me this great overview that he wrote for our interview. And one of the things that he mentioned at the beginning I wanted to hit home is the fact that there’s a synergistic effect among all these toxins. So it doesn’t necessarily take a profound exposure of one toxin to get sick. It can be multiple low grade exposures over time. Is that correct?
Dr. Winston Cardwell: Exactly! And we see that with heavy metals, we see that with all of these chemicals. There really haven’t been any, or very few studies, if any, on the combined effect of these chemicals. When we have these chemicals that are newly-produced, sometimes they’re tested. More often than not, they’re not. But they’re never tested for their combined effect with other chemicals that are commonly found in the household.
So the most well-known is the combination of bleach with regular dish soap. If anybody has ever seen that done, it’s pretty, pretty scary because it foams up and steams up really quick and produces a very toxic gas that’s immediately can shut one’s breathing ability down.
But it’s a big problem across the board. And we just have absolutely no idea where to even start with this because there are just so many chemicals out in the world now that weren’t around in our grandparent and great grandparents’ lifetime.
Dr. Kara Fitzgerald: Well, you say that we don’t have anywhere to start, but the fact of the matter is you’re doing a lot already and I’m going to pick your brain around that in a minute. I know that you’re doing a tremendous service to your patients.
In fact, I think anybody in functional medicine is helping. And we’ll talk about, as we get into the interventions, you’ll see why. Our listeners will see why.
But I just want to back up a minute. You’ve outlined symptoms, signs, symptoms, disease states resultant from toxin exposures. But when the patient presents you in your office – I mean, everybody is presenting with fatigue, everybody has headaches. All of these things are really rather common. These are common presentations. But what flags you? When you’re thinking about the underlying causes of somebody’s condition, what flags you that environment is going to be a very large area of focus?
Dr. Winston Cardwell: It’s a great question and it’s one that is by no means a one-size-fits-all or a specific protocol. A lot of it is through the training that I received in school and through Walter Crinnion who is the grandfather of the environmental medicine and naturopathic world.
The way that we start with all of our new patients off is an environmental questionnaire. That is about a 60-question survey that patients complete. It’s anywhere from questions about their exposures specifically, as well as to symptoms, and then symptoms with exposures to chemicals.
So one of the questions that I always ask is, “How do you feel when you walk down the aisle in the grocery store where detergents are?” because as we all know, that’s a very fragrant aisle and specifically, other fragrant items are kept in that area to keep the smell from getting into the food.
And typically, when patients says, “I can’t stand that aisle” or, “Every time I go down that aisle, I feel funny,” that’s a starting place. That’s an indication that often either their body’s detoxification pathways in the liver and on a cellular level are maxed out and they are not able to keep up with it or there are some genetic differences in the individual, or both, of course.
But there are also a lot of things that we will pick up in the interview that they only have a headache in the certain situation or setting, or they’ll have a respiratory symptom in a particular room or they’ll be sick at the house, but they’re fine at work.
So there are a lot of little things like that that would not come out in a 10-minute intake. So all of our new patients, we spend two hours with and get a lot of information that would seem to be somewhat silly or not really related to why they came to the office in the first place. However, when we put all of that together, it creates quite a picture that the functional medicine world has since been doing for a while now by looking at a number of different systems. This is just an extension of that or an example of that way that we assess.
Dr. Kara Fitzgerald: Great! Thank you so much. So now, you’ve got somebody that you suspect from your history. I know that you do environmental medicine intake, so you know if their home is old, if it’s new, if they have carpeting, what year it was built and whether or not they might have some residual lead paint, et cetera. I know that you drill down to that level, having just worked with you for so many years.
But once you’ve done that, once you’ve determined that there is a body burden, how do you evaluate for that? And I want you to be specific.
Actually, you know what? I just want to say this little anecdote that I thought of when you were talking about the Glade plug-ins. When I was at the laboratory and we were first developing the organotoxin testing, the solvents and PCVs and VOCs, et cetera, when we were developing that testing, one of the guys in our shipping department – we all submitted our urine. And one of the guys in the shipping department had an incredible amount of solvent in his urine, just incredible amount. He later admitted that they had just started with the Glade plug-in at the house. And he was off the chart with the compound in his urine.
And similarly, one of my most allergic patients, challenging, with a physical therapist or is a physical therapist who was using triclosan-containing toothpaste as well as a hand sanitizer. So he was sanitizing his hands between every patient as a physical therapist. He had ginormous amounts of triclosan in his urine, well above the 95th. And this is a guy just doing his job, brushing his teeth, sanitizing his hands between patients.
But I want to talk to you about how you’re evaluating these folks. You’ve mentioned molds, you’ve mentioned organotoxins, you’ve mentioned heavy metals. What are some of the ways you’re doing that?
Dr. Winston Cardwell: That’s a great question. As you know, Metametrix has produced a number of different panels that are very helpful with identifying both from a functional perspective what the need is. And so a lot of times, with patients, they come to our office with a lot of nebulous symptoms like all the ones we’ve described. There often will be a core focus of the visit that we’ll spend more of our time assessing and looking into. But a lot of times, a lot of the ancillary symptoms, which are not necessary seeming related to the main complaint, will be pulled out and teased out through some of the labs that we’ve run.
So we certainly use a lot of the basic ones, anywhere from CBC and SCNT. They’re looking at cholesterol levels, looking at thyroid function, all of those things that everybody does that obviously need to be addressed if those are off. But more in the functional sense, we’ll use an organic acid panel that is full of a lot of very helpful information. It gives us a great starting place on where to support the body and that, from a metabolic perspective, is really a great starting place for a case that we really have no idea where to start even because there are so many different areas of focus.
So we will look at orotate and glucarate production. We look at methyl hippurate in the urine, always a urine test in the panel. We look at sulfate production, hydroxybutyrate, all of the areas that are involved with the body’s elimination/excretion of these chemicals.
If we have more of a specific area of concern that a lot of times we pulled out and teased out by the individual symptoms, we will look at the toxic core panel that also is available and was created by Metametrix (now available through Genova) that has a broad array of information in there, anywhere from phthalates, BPA, organo, chlorine phosphates, pesticides. There are so many areas that are available now for us to use and to benefit us.
And then take all of that information with the history and with their standard labs, and piece together a puzzle that often times can be incredibly revealing and fascinating. You see how it unfolds from a lab perspective. It’s a wonderful tool to also help the patient and their family understand why they’re feeling the way that they’re feeling and that there are actionable areas that we can do to improve them.
Dr. Kara Fitzgerald: So I just wanted to back up for any regular person listening who might not be familiar with the organic acid testing. What Dr. Cardwell is doing is looking at compounds that are produced by the liver in the liver’s attempt to detox from these various toxic exposures.
So for instance, 2-methyl hippurate that he mentioned, that is the end metabolite of petroleum exposure. So anywhere from the petroleum in your carpet to the petroleum in pollution in outdoor air, gasoline, et cetera, there’s a whole number of ways we’re exposed to the petroleum compound called pthalein, which is then metabolized to 2-methylhippurate. And so that’s what Dr. Cardwell is looking at in the urine.
Now, I know you do heavy metal testing via, probably, urine, blood and maybe other specimen as well. But I want to ask you about how you’re assessing the mold burden.
So you mentioned in your intro, Winston that you can’t just simply shut the basement door or you can’t just simply shut the bedroom door in the smelly room, that those particles are still in the ambient air. So you said that.
You also said that mold plates, which people buy at Home Depot, Lowe’s, et cetera, to measure the amount of molds in the home, won’t necessarily capture these particulates.
I actually use mold plates in my practice all the time. I have that as a very reasonably cheap starting point for a lot of my patients. Even if you have somebody come in and assess and take air samples, they might still miss these particulates.
So when you’re thinking mold as an issue, how are you measuring molds or microtoxins in the body?
Dr. Winston Cardwell: Great question. I agree. The mold plates are often a great, inexpensive way to get started with just the realization that there may be something going on. And one of my friends told me that one of the things that he did when he moved into a new house is he would just go buy some mold plates, put them out and let them sit for a day or so. And then put them in a warm area and then just take a look and see what is growing on there a couple of days later. So that’s not even with microscopic evaluation.
So they can be very simple and helpful when you’re looking at it. But the problem that we were talking about with regards to missing the particulate as well as the volatile organic compounds that are produced by the mold that are called microtoxins, those are much harder to take up.
And so one of the ways that we asses for that and, in my opinion, the best – and I have to give credit to Ritchi Shoemaker, who is the godfather of the mold research world and has been an incredible benefit to the progression of knowledge in very specific, scientific, rigorous way. He was the one who turned me on to the ‘environmental readiness mold index’, which is a term that was developed by the ETA as a way to quantify how sick a building was from mold.
And the difference in this test is it’s basically a DNA test, looking at the genetic material of different molds as opposed to seeing what grows in the petri dish. So it’s much more sensitive to picking up things that are even not growing or that were growing that are no longer in the house.
And there are a wide array of companies that do offer this. There are a few that seem to be, time and time again, more consistent and accurate with the results. But that’s the most common area that we start.
It’s a home kit. You call the companies and they will mail the collection to you. It’s basically either one of two things – a big swab that you wipe underneath the bed or on door jam places that are not commonly dusted or cleaned. Or if you have a carpet, you basically put something over the tip of the vacuum and vacuum over an area for a period of time. And that is the best way to get an idea of what you’ve got going on in the house and in regard to the particulates.
Dr. Kara Fitzgerald: Give me that name again, please.
Dr. Winston Cardwell: A lot of people refer to it as the ERMI test, So it’s E-R-M-I.
Dr. Kara Fitzgerald: And how are clinicians going to find that test?
Dr. Winston Cardwell: Good question. We use a company called Mycometrics. And that is the one that Dr. Shoemaker has vetted over the years and was found to be the most reliable and consistent with what he’s been finding. That’s been my experience as well.
We have tried a few other companies and we have patients that have come in with other companies’ results that they got on their own. And some of them were consistent with what we find. Some of them just don’t seem right. We’ll run the ERMI test through the Mycometrics and find quite a bit more than what was found on the initial panel.
So they’re a great, great support for the identification of what may be going on in the house.
Dr. Kara Fitzgerald: Can consumers order this themselves? So a clinician does not have to order this?
Dr. Winston Cardwell: That’s correct, yes.
Dr. Kara Fitzgerald: So once you suspect somebody has a physiologic mold burden, how are you assessing that? Are you looking at mold allergies? Are you looking at the presence of microtoxins in the urine, something else? What do you do in there?
Dr. Winston Cardwell: Yes, that’s a great question. Because of the genetic difference that I guess we’ll get to in a minute, because of that, it does show up in different ways in different individuals.
And so there are areas that depending on what the symptoms are or what we suspect may be going on that we will look a little bit more in one area or another, but we do obviously see mold allergies, just the basic IGE response that people are familiar with, the peanut allergy and the allergic reaction that comes from that. That is an area that we will often start with because it’s so easy to identify and readily available through your conventional labs.
And we’ll either do a mold allergy panel through a lab like Lab Corp or Quest and that’s an IGE-based panel. Or more commonly, I’ll run a quantitative IGE or total IGE and see if that’s elevated at all. And if it’s not elevated at all, there is generally no reason to go into more specifics of the IGE for mold themselves. But that is something that we do look at.
We look at eosinophils on a CBC. If those are elevated, that would give us an indication there might be some allergies, but there are some other things that will affect that too.
But then when we dive into that, there are the labs that are involved with inflammatory responses. So we’re looking at things like TGF beta 1 or NMP-9, things that are involved with inflammation, tissue repair, tissue destruction. We’ll look at other hormones that can be affected by the molds.
One of the common ones is antidiuretic hormone or ADH that will affect the individual’s ability to keep urine or fluid inside the body. So when we hear somebody that has a mold exposure or we suspect that, for example, they’re going to the bathroom all the time, we’ll take a look at that and see if that is depleted. If so, it’s one of the areas that can be commonly supported and supplemented with, in essence, bioidentical hormone replacement that can make a huge difference one’s individual ability to heal. If you’re not sleeping, you’re getting up to go to the bathroom all night, you’re not going to repair your body. And so that’s a big one that can be really helpful.
But we also look at things, like you mentioned earlier, the urine test for microtoxins. There is a company that will test for that. Unfortunately, at this time, it’s only limited to three microtoxins that are the most common, but there are many, many other ones that are also potentially produced by the different molds and things that we’re exposed to.
So there is a wide variety of lab assessments that can be done that are more, in essence, functional. How this is affecting the individual and what are we seeing in regard to their particular symptom presentation?
Dr. Kara Fitzgerald: Yes. So let me ask you (because we could spend the rest of our conversation talking about diagnostics with regard to mold toxicity), if the ERMI test is negative and they’ve run it through Mycometrics and they’ve run the test appropriately, they collected the specimen appropriately and it’s negative – well, let’s say it’s negative in the home and it’s negative in the workplace. So if they get a clean mold exposure bill through the ERMI test, then do you think that that’s adequate to rule out molds as an issue?
Dr. Winston Cardwell: That’s another wonderful question. And no, it’s not. The problem with the microtoxins and the mold exposure itself is that our body doesn’t excrete these things well at all. And so you can have an exposure five, ten years or even longer back that does not change because the arteriopathic recirculation that we have when our liver and gallbladder tries to excrete toxins, that then go through the intestines and unfortunately, those are very easily reabsorbed in the large intestines and the lower part small intestines, that then go back into circulation, back to the liver.
So they, in essence, just keep going around in a circle and we don’t get rid of them. And so that is something that we do look into as far as their previous exposures as well.
Dr. Kara Fitzgerald: So what kind of a presentation might flag you to a past history of mold exposure? What might get you moving in that direction because I know you’re using the Shoemaker Protocol for working people up. You should mention his book. And I want you to mention some of the DNA analysis just so that we can complete this. But what’s going to flag you to past mold exposure as a significant issue underlying their presenting complaints?
Dr. Winston Cardwell: Really, it’s most commonly people are familiar with. I grew up, I think as all of us did, with there’s a little mildew here, a little mildew there. You wipe it up and you clean it up and it’s no big deal. But most individuals will mention that they grew up in a moldy house or lived in an apartment that had water damage.
So those are probably the most common questions that we use to tease that information out. Have there ever been any leaks in the house? Has the roof leaked? Has the water here broken down and flooded the basement? Has the basement had any flooding? Have there been any marks in the walls?
And what we’d often see as a small presentation on the sheath rock from the ceiling or in the basement, a little bit maybe growing around the walls or something, that’s literally the tip of the proverbial iceberg. So it can be much more expansive.
Dr. Kara Fitzgerald: I have a patient whose urine microtoxin panel came back positive from Real Time Labs. And we’ve investigated the home. We’ve just done some work around figuring out where her current exposures could be. And so far, we’re coming up empty. We can keep looking. But she does have a history.
This is a25-year-old woman, about. I don’t have her chart in front of me. She does have a history of having been schooled in one of those outdoor accessory buildings, an extra building when the school is getting full. And that building did smell like mold. But we’re going back to sixth grade. That could be her exposure source and that could be contributing to her current complaints.
Dr. Winston Cardwell: Absolutely! A lot of times, it’s the things that we don’t think about like the car. I found a number of patients that have had serious mold infestations in their car. And every time that they get in there, they’re re-exposed to it. Old books, they were given from grandma that we don’t want to get rid of because they came from grandma, but they were pulled from a moldy basement – or not even. Any cellulose material, mold will grow on. So it’s easy to transport.
Dr. Kara Fitzgerald: So I want to move over to our action plan and what we do so people don’t leave this conversation needing to…
Dr. Winston Cardwell: Gloom and doom.
Dr. Kara Fitzgerald: Yeah, exactly, exactly. But before I do, do you want to mention any sources for further education and training? If somebody wants to chase this down and really learn how to evaluate and treat mold effectively, where would you direct them?
Dr. Winston Cardwell: Well, I think right now, probably the most comprehensive and effective approach is through the Shoemaker Protocol. He, unfortunately, retired a few years ago. But wonderfully generous of him, he has opted to teach other physicians how to identify and to eradicate and treat mold in the individual – and so a training program that he does from a distance and then you ultimately do one-on-one work with him.
His website is called SurvivingMold.com. And there’s a treasure trove of information there.
There are plenty other individuals that also have a number of tools in their toolbox to treat this from the naturopathic perspective as well as from the more of conventional angle that Dr. Shoemaker takes.
There are a lot of areas out there, but I would say that Dr. Shoemaker would be the easiest and the most significant go-to for that.
Dr. Kara Fitzgerald: Okay, great. And he also published Mold Warriors. And so that’s a book that people could access.
Dr. Winston Cardwell: Exactly!
Dr. Kara Fitzgerald: Thank you so much. If anybody is listening to this and has questions regarding the genetics that Dr. Cardwell mentioned, post a comment and I will tap him to respond.
But I really want to move in to allow the sun to start shining with regard to what we’re going to do.
So we all have a toxic burden. As clinicians, we need to figure out what that is. But we’re going to be advising our patients on how to take care of themselves. So let’s start really foundationally.
And this conversation today is about indoor air pollution, so let’s start foundationally around first, what we can do in the home, and then second, I want to talk about what the patient can do themselves, what they might be eating, what nutrients, et cetera.
So first, what are we doing? What are we advising for the individual to do in their home?
Dr. Winston Cardwell: The main principle of toxicology and environmental medicine is to first identify and remove the source. And so that is very easily said and certainly, more difficult now because of the ubiquitous nature of these chemicals in our building supplies and the carpet with the more energy-efficient homes that we have that are sealed much tighter to save us money.
Dr. Kara Fitzgerald: Give us the low-hanging fruit, Dr. Cardwell.
Dr. Winston Cardwell: The main area that we would want to work on is looking at from an internal, within-the-house approach, which is to reduce what is producing this stuff. So from the solvent aspect, looking at getting Glade plug-ins and getting any kind of fragrance out of the house. That doesn’t mean that you can’t have anything that smells good, but using food-grade essential oils as opposed to things that have the term “fragrance” on them. And that’s being your personal care products to the scents that are used for air fresheners to deodorizers.
The other thing is to pull out the carpet. The carpet is a tremendous reservoir of both its own chemicals. And when new carpets are placed, they off gas for years a significant amount of chemicals. But even worse is the glue underneath it. So if you do have to have carpet put in the house, be sure that you’re using wool, the natural carpet and ensure that glue is not used under the carpet
Dr. Kara Fitzgerald: So I just want to summarize. Get any fake smell out, be it personal care – I have to say, that I just accidentally purchased some cat litter that has this horrific deodorizer and we used it once. It’s out because it’s just a fake and disgusting smell.
So get fake chemicals out or fake fragrances out. I know that you’re huge on safe cleaners as well. What’s your go-to company for soap, for dishwashing detergent, for laundry detergent, et cetera, all of those kinds of things?
Dr. Winston Cardwell: I like Seventh Generation’s Free and Clear. The brand is Seventh Generation. I guess the option is Free and Clear. They provide just about everything you can think of from dish soap to dishwasher soap to laundry dryer sheets, all kinds of things. A lot of people have a hard time letting go of those, so that’s a great resource for that aspect.
Dr. Kara Fitzgerald: And now you’ve said – so your opinion is carpets are pretty much out unless you get a natural fiber carpet. Those are safe, you say?
Dr. Winston Cardwell: Well, yes and no. The problem with the carpet is that they hold dust and dust is – study after study has shown that dust is the vector, the vehicle for a lot of these chemicals to ride on. So whenever we vacuum, that dust gets into the air. We breathe that. And so the carpets, they house that. And no matter how good your vacuum cleaner is, you can’t get that stuff out.
And so while I’m mentioning that, I should say that if you do have a vacuum cleaner, be sure to have one that has a HEPA filter on there and to change the bag regularly, so that you’re not recirculating those things that you’re vacuuming up.
Dr. Kara Fitzgerald: Okay, thanks. Those are great, doable changes, I think, that we can make, particularly all the household goods and cleaners, et cetera.
Now, I know that you just mentioned the Lumber Liquidators or whatever they’re called and they’re formaldehyde-laden flooring. Are there any good flooring brands that jumps to mind or is this something that people are going to just have to research locally?
Dr. Winston Cardwell: Well, there’s certainly just the old fashion, solid wood. Unfortunately, that’s costly and it’s also not environmentally friendly in the sense of the deforestation aspect. But there are some that are more that are safer in general and a lot of that you have to drill down to the individual product. It’s not necessarily something that is company-wide.
So the Lumber Liquidators, they’ve gotten a black eye, unfortunately, from the incident as you mentioned. However, they do carry a number of other products that do have much lower and even some with no chemicals in them.
Dr. Kara Fitzgerald: Oh, they do? Okay.
Dr. Winston Cardwell: My go-to for that though is a wonderful company. I believe they’re in Colorado. But it is called the Green Building Supply. And they are a wealth of information on a lot of this and they also supply just about every kind of building, new building product you can imagine – from caulk to polyurethane-like coatings for wood floors to paints and all kinds of things that can be used. And they are a wonderful company and are also a great resource of information.
So when I have a question like that, I usually give them a call and see what is available.
Dr. Kara Fitzgerald: Thanks. That’s many pearls. I appreciate it. Now, you mentioned HEPA filters for the vacuum. I am prescribing HEPA filters for home use all of the time. And in fact, periodically, I pick your brain on it. And I know you recommend IQ filter, which is an air filter which is absolutely beautiful. So I want you to talk about that. But it’s pretty pricey. So I want you talk about some alternatives as well. So tell us about HEPA filters.
Dr. Winston Cardwell: Yes, so the HEPA aspect is really basically just particulate matter. And so we’ve been discussing that a lot of the problems are volatile compounds that are going to fit more into solvent category. They would just go right through a HEPA filter. And so it’s really important for an air filter to not only have the HEPA aspect for the particulate to filter out the dust that we mentioned earlier, carry so much, but also to have a carbon block component that absorbs a lot of these chemicals.
And the IQ Air is the best of the best. It’s Swiss-made and there is really no comparison to it. There are other ones that we use. The BlueAir and the Austin Air are other very good quality air filters. They don’t have quite the oomph that the IQ Air filters provide, but they are good as well to have on a room-by-room basis.
And then for people that don’t have the resources to purchase one of these filters that can run anywhere from $400 to $900, there is a filter that I commonly recommend, which is the Honeywell Circular Filter. Home Depot and Lowe’s carry them as most home supply companies do. You can add on a carbon filter on the outside of it. It’s very thin and it’s not anywhere near what you can get with these others, but it’s certainly better than nothing.
Dr. Kara Fitzgerald: That’s so great. Thanks, Winston. For our reasonably healthy patients, for our patients interested in prevention, the Honeywell might be appropriate, whereas if somebody truly is suffering from a significant burden of toxin and is really paying the consequences with what’s going on, then you would move them towards the Swiss Air or the Austin. Is that true? Is that safe to say?
Dr. Winston Cardwell: Yes. I think the downside about the filters like the Honeywell (and really, any of them) is that they are, in essence, limited to the space that they are in. So while they do have cubic feet ratings, ultimately, the best way for your everyday individual to work on this is to get a filter installed in the HVAC unit that has a MERV rating of 16 or higher. That’s basically the filters that are about six inches or more thick as opposed to the little one-inch or half-inch thick filters that we most commonly see.
Dr. Kara Fitzgerald: That’s extremely useful. I really appreciate that. So a rating of six or higher, and that’s a MERV.
Dr. Winston Cardwell: 16.
Dr. Kara Fitzgerald: 16 or higher, excuse me. Great!
Okay, so we’re talking about the home, and now, I want to move into what we’re going to do for the body. And unless there are any other aspects to clean living, changes in the home you want to mention?
Dr. Winston Cardwell: Oh, there are so many. And I agree, I think we should talk about what we can do to help the individual, but I would just get the toxic chemicals – the chemicals out of the house (all chemicals are toxic). Get them into a shed outside. Don’t put them in the garage. The garage door, or at least if it’s an attached garage, you’re going to be bringing all that stuff right in the house. So do whatever you can.
A hobbyist that are doing things in the basement or other parts of the house that are using glue guns or soldering or painting, all of that stuff goes throughout the house even if you don’t, in essence, smell it. It still does go everywhere. So those are the big ones.
But for the individual working on the body, it can be very basic, starting from things that we all have grown up hearing at one point or another to making sure that you’re getting adequate hydration, that you’re getting water throughout the day. Ideally, we’d typically recommend half your body weight in ounces of water a day. That may not be appropriate for everybody, but that’s a general rule and that’s something that can help flush a lot of this stuff through the kidneys, through the urinary system.
The other thing is to make sure that you’ve got fiber in your diet, whether that be added fiber such as oat bran fiber and rice bran fiber, other types, or things like the fiber that’s naturally found in food through ruffage. So eating lots and lots of your leafy, green vegetables, your salads, other soluble fiber, items like avocados, all of those will help with binding and trapping and pulling out these toxins that we’re all exposed to.
The other thing is making sure that you have the nutrients for the liver and the cells to do their job of detoxifying. They want to do it and they can get taxed from the exposures and so they can get depleted much easier these days. So that’s when we see more nutrient deficiencies. We probably did, as well as it’s not as rich in the food as it once was.
So making sure that you’re eating organic food. There was a study that just came out a few days ago, I believe, on going organic for a week or two and dramatically reducing the amount of toxins in the body – or I should say the pesticides. So that’ a very simple thing.
Also, supplementing with other specific items that are known to aid with detoxification through production of glutathione or other aspects of the body’s pathways – vitamin C and acetyl 15, alpha lipoic acid, glycine.
Probiotics have a profound impact on the detoxification ability, which is not something we typically think of; herbs that stimulate movement through the liver that are things like dandelion roots or turmeric or picrorhiza;
Bitter foods, we’ve really gotten away from bitter in this country and for understandable reasons. But that bitter flavor is what stimulates the bile production much more significantly than other flavors. Using things like endives and radicchio and artichoke, the globe artichoke. All of those are very easy ways to just change the diet and enhance detoxification [inaudible 00:55:08] the system.
Dr. Kara Fitzgerald: Would my favorite green, arugula, qualify as a bitter?
Dr. Winston Cardwell: Mine, too. And yes, it does. Technically, I would put it more in the pungent category, which also has its benefits. But yes, it does. A lot of the chemicals, the natural chemicals in there do help with movement of bile too.
Dr. Kara Fitzgerald: Woo-hoo! Okay. Alright, what else? So you mentioned a bunch of nutrients. People, obviously – and we will give your contact information at the end and then, of course, it will be printed on the website with this podcast. If somebody needs to bump it up a bit, they can be in contact with you or they can be in contact with me, et cetera. But these are nutrients that people can grab at the health food store – vitamin C and acetyl 15, et cetera – so they can incorporate some of these things into their lives.
But really fundamentally, you’re talking about eating health, eating organic, having adequate fiber, adequate hydration, just great foundational stuff.
What if somebody is not a strict vegetarian here like myself because we’re talking only about fruits and vegetables thus far and likes eating poultry meat, dairy, et cetera?
Dr. Winston Cardwell: Yeah, it’s a tough one because other animals are no different than us, they’re exposed to a lot of these things that we are as well through the outdoor air. Mercury is a well-known example that’s produced by coal-fired plants. It circles the globe many, many times before it settles down. So that’s why we hear about the problems from other countries affecting us. It gets into the food supply, so the animals are exposed to it as well.
Typically, when we’re trying to do a significant or aggressive detox diet or protocol for a set period of time, weeks or months, we will encourage the patients to be vegetarian, or really vegan, if possible, and if appropriate for their diet. There are obviously individuals that that’s not appropriate for. That’s one way to reduce it.
Also, of course, using organic products as much as possible. Organic eggs are pretty much everywhere now and just about anybody can get them. The animal products in the form of meat are also increasing in availability.
Of course, there’s a problem with the cost aspect of it that can prevent a lot of individuals from accessing that. And so just reducing the amount, it can make a big difference. So going from a piece of ham or turkey three times a day to once a day can make a significant difference.
But then again, having that fiber with those products that will help bind up things to get them out of the body will also help too.
Dr. Kara Fitzgerald: Well, you’ve been such a great interviewee today. And I just appreciate your time. You’ve shared so much for both the clinicians listening and wanting to improve what they’re doing in the environmental medicine arena, as well as the patient or the regular person who might be listening today with some basic things that they can do to support themselves in this unfortunate toxic world that we’re living in. It’s been my pleasure to be with you today.
Dr. Winston Cardwell: It’s been a lot of fun and I appreciate you having me. I look forward to do it again.
Dr. Kara Fitzgerald: Thank you. Yes, I would love to pick your brain at some point regarding Chinese medicine and how you might think about some of these things from that perspective.
Dr. Winston Cardwell: Absolutely!
Winston Cardwell, ND, LAc is a licensed naturopathic physician and acupuncturist. Dr. Cardwell graduated in 2005 from the National College of Natural Medicine, a federally accredited four year medical school, with degrees in both naturopathic and Classical Chinese Medicine. Additionally, he has advanced training in integrative oncology, integrative cardiology, and environmental medicine. He founded Atlanta Integrative Medicine in Roswell, GA where he shares a practice with Forrest Smith, MD, and specializes in naturopathic oncology and difficult to treat chronic illnesses. The comprehensive approach to wellness he uses includes an extensive historical intake, a detailed physical examination including tongue and pulse analysis, and conventional as well as functional laboratory testing, when indicated. He is a member of the following professional organizations: the AANP, OncANP, GANP, AHG, NAEM and is the current president of the Georgia Association of Naturopathic Physicians, a state organization dedicated to educating the public on the benefits of naturopathic medicine as well as bringing safety and standardization to the practice of naturopathic medicine in the state of Georgia.
Reach Dr. Cardwell at: www.atlantaintegrativemedicine.com