The Mold Treatment Playbook — Beyond the Course

Quick start — the whole protocol at a glance

If you read nothing else, read this. The one-screen version — what to order, the order of operations, and where to send it. Every line links to the full detail. Need doses fast? → ℞ Rx quick card (S/CS). The rule that governs all of it: low and slow — a flare is "too much, too soon," not failure.

The treatment arc — order of operations

What to order — the lab sheet

Where to send it — sourcing map (links open the lab's site — sign in with your practitioner account)

The core initial labs — the "why" and the ratio that matters

Full functional-optimal targets and every ratio are in Lab Interpretation (A4M); drop your values into the A4M Lab Interpreter to compute them automatically, or look up any single marker in the Marker Lookup.

Rx & compounded — quick card (S = sensitive · CS = constitutionally strong)

Nasal / sinus — order: Argentyn 23 → antifungal by tolerance (S→CS) → BE spray (antifungal sprays + BE are ℞c; per Nathan's ladder)

Note on EDTA: EDTA isn't a standalone nasal — it's the biofilm chelator that's compounded into the antifungal spray (e.g. itraconazole + EDTA) or comes as the "E" in BE/BEG spray. Order it combined, not separately.

Gut antifungal — oral

Mast cell / MCAS (ladder: naturals → H1/H2 → stabilizers → leukotriene → LDN)

Binders — by toxin (S / CS)

Systemic / recovery Rx

How to use this guide

This is my working clinical guide for evaluating and treating complex mold- and mycotoxin-driven illness — the patients who arrive already labeled, already treated, and still not well. It is organized the way I actually work a patient up: we start at testing, then move through the treatment sequence in the order the body will tolerate it.

Three mental models run quietly underneath the whole guide — you'll meet them where they matter, not as theory:

• Cell Danger Response — the cell that senses ongoing threat downshifts healing, detox, and repair. This is why safety work comes first.
• The biotoxin pathway — the inflammatory cascade that explains the multi-system symptom picture.
• The three-mechanism model — mold acts through allergy, infection, and toxicity; we're focused on toxicity, but all three can coexist.

Mold makes everything else worse. It potentiates Lyme and co-infections, reactivates viruses, drives mast cell activation, and sits under many PANS/PANDAS pictures. In any stalled complex patient, it belongs on the list.

Navigation: use the left menu for the clinical workflow (Testing → Recovery), the Quick Guides for point-of-care cards, and Tools for the calculators. Global search is top-right.

Testing & diagnosis

The workup runs in this order: decide who to test → test the building → test the patient (urine mycotoxins) → read the results by ratio, not just against optimal ranges → layer in adjunct labs only where they earn their place.

1 · When to suspect — who to test

Screen for mold in any multi-system, treatment-refractory patient, and reflexively when you hear the keynotes — the symptoms that should make you think mold before anything else:

Mold masquerades as CFS/fibromyalgia, "atypical" MS, early Parkinson's/Alzheimer's language, autoimmune disease, and new-onset psychiatric illness. The unifying history is an immune hit that unmasked it — COVID, flu, surgery, childbirth, menopause, or emotional upheaval — after which a person who had tolerated their environment suddenly couldn't.

Start the visit with a structured symptom screen (see the Symptom Burden Screener in Tools). A high, wide-ranging score also does something clinical: it gives the patient the confidence to follow through on testing and treatment.

2 · Test the building — early, before you chase the patient

Check the home and work environment at the start. Nothing downstream works while exposure continues, and you don't want to discover the moldy house a year in.

3 · Test the patient — urine mycotoxins

Urine mycotoxin testing is the most direct confirmation: toxin in the urine means toxin in the body. Know what each lab measures — and how to call a positive — right here, so you don't have to jump elsewhere at the point of care.

MyMycoLab (Campbell) — the blood antibody test, in detail

Unlike the urine tests (which measure excreted toxin), MyMycoLab is a serum antibody test — it measures the body's IgG and IgE antibodies to mycotoxins, i.e. the immune response, not the toxin itself (conceptually like antibody testing for an infection). It's a 14-mycotoxin panel (expanded from 12 — added Fumonisin B1 and zearalenone — alongside the aflatoxins, ochratoxin, trichothecenes, gliotoxin, and others).

• IgG positive → suggests current/ongoing exposure and/or fungal colonization — the immune system has "seen" the mycotoxin.
• IgE positive → suggests current exposure with mast-cell / allergic activation — the "is this active right now?" signal; source may be home, work, school, or an intermittent venue.

Collection & provocation protocol

• First-morning, concentrated urine. A dilute specimen (over-hydrated) reads falsely low — this is the creatinine caveat for uncontrolled assays.
• Provoke for a truer result: glutathione 500 mg BID × 7 days, collect on day 7. For glutathione-intolerant patients, use mixed bioflavonoids (e.g., quercetin 500 mg BID × 7 days) instead. A sauna / hot bath ~1 hour before collection improves yield.
• Repeat tests: stop all binders 3–4 days prior.

4 · Reading the results — the comparing & ratio method signature

Read every value two ways. First against the A4M optimal range — that tells you the direction and where the target sits. Then compute the fold-elevation and read it as a ratio — that tells you the magnitude the optimal range alone hides.

Reading ratios and indices on co-infection panels: the same logic applies to antibody indices — read the index against its ratio threshold, not just positive/negative. As a working red-flag line, an index climbing above ~0.700 earns attention even when the lab calls it equivocal. Low natural-killer-cell function can corroborate a clinically obvious but serologically "negative" co-infection.

Interpreting rising numbers on a repeat

Always read the number in clinical context and as a ratio to the prior result — the trend is the signal, not any single value. Repeat every 3–4 months; it does not change week to week.

5 · The baseline workup — labs I run on the complex patient

Beyond the mold panel, the complex patient needs a foundational workup — mold rarely travels alone, and the systems it disrupts (thyroid, adrenal, immune, kidney, coagulation) need eyes on them from the start.

6 · Adjunct labs — what I keep and what I set aside

7 · Actinomycetes & endotoxins

A water-damaged building is not just mold — it's an inflammatory soup that also includes Gram-positive Actinomycetes (which off-gas antibiotic-like metabolites) and Gram-negative endotoxins/LPS (bacterial "body parts"). Suspect them in the patient with persistent microbiome imbalance, skin/sinus involvement, or MCAS that won't settle despite good mold treatment.

Ordering: mold/mycotoxin and endotoxin body panels (RealTime, Mosaic, Vibrant, Cyrex, US BioTek) are available through practitioner platforms like Rupa Health / Fullscript; EnviroBiomics and MicroGenDx are usually ordered direct. Treatment for actinos & endotoxins is in Colonization & Antifungals.

Full mycotoxin-by-mycotoxin detail (source mold, target organs, symptom signature, and matched binder) is in the Mycotoxin Library and the Mycotoxin → Binder lookup.

Mycotoxin library

Each mycotoxin has its own source mold, target organs, symptom signature, excretion route, and matched binder/detox strategy. Knowing which toxin you're chasing is what makes binder selection precise rather than a shotgun.

Also referenced in the source material: Enniatin B1, Fumonisin, Patulin (source table only).

Lab interpretation reference — A4M optimal values & functional ratios

Conventional ranges tell you when a value is pathological. Functional (A4M) optimal targets tell you when it's optimal — the narrower band where physiology actually works well. Read every marker against the optimal target, then read the ratios, which often reveal the story before any single value goes out of range. Everything here is computed for you in the A4M Lab Interpreter (with iron-quadrant and thyroid-pattern reads and standing-order gap flags) — this page is the readable reference behind it.

Frameworks: A4M functional-medicine optimal targets and functional ratios, with immune-sequencing and CIRS biomarkers noted where used. Targets are for adults; correlate clinically. Units are US conventional unless noted.

Optimal values by system

Functional ratios

Ratios capture relationships a single value hides. Compute these on every panel (the interpreter does it automatically):

Corrective playbook — a flag is off, now what?

A flag tells you where to look; this tells you what to do. Each entry is the step-by-step I work when that pattern shows up. Treat the driver, then re-test the marker in 8–12 weeks to confirm you moved it.

Prepare the terrain — limbic, vagal & mast cell

The trifecta of sensitivity

Limbic + vagal + MCAS are treated as a package — quieting only one leaves the patient hypervigilant. Map symptoms at intake:

Limbic retraining — program selection

Vagal work

Exam pearls: have the patient repeat "Aah" and watch the uvula (should bounce; barely moving = vagal issue); ask them to gag — many sensitive patients can't. The vagus is ~80% sensory.

Menu: cues of safety (your voice, room, manner) → Safe & Sound Protocol → Rosenberg exercises → osteopathic cranial → FSM → Brain Tap → EFT/EMDR.

• Rosenberg Basic Exercise: lie back, hands behind head, move eyes fully to one side 20–30 sec until a yawn/sigh; stop if nothing happens.

Daily vagal toning — home practices

Cheap, self-administered, and cumulative — have the patient pick 2–3 and do them daily:

• Extended exhale — make the out-breath longer than the in-breath (e.g., in 4 / out 6–8) for a few minutes; the exhale is the parasympathetic lever.
• Hum / gargle / "Voooo" / chant "Om" — vibrates the vagus through the larynx.
• Cold to the face — a cold splash or cool pack over the eyes/cheeks triggers the dive reflex and shifts to parasympathetic.
• Lie on the right side, gentle joint rotations, and a weighted blanket (~10% of body weight) for calming pressure.
• Ear tVNS — a transcutaneous vagus ear-clip at the concha ("Point Zero"), used gently and briefly.
• Support tone with omega-3s and choline (alpha-GPC / CDP-choline).

MCAS — full stabilization protocol dosing

MCAS is a clinical diagnosis (blood/urine mediator tests are notoriously unreliable — most need a cold centrifuge; biopsy needs CD117 staining). The tell is a reaction within 10–15 minutes of eating that fluctuates day to day. If the MCAS component is real, you often see noticeable improvement within 2 weeks. And it is curable — because we find and treat the trigger (mold, Lyme, Bartonella, COVID, EMF).

Empiric starting regimen

Start H1/H2 once daily; many need them 2–3× daily for full effect. If one H1 is only partially helping, swap to another before escalating:

• H1 options: loratadine (Claritin) 10 mg, fexofenadine (Allegra) 180 mg, cetirizine (Zyrtec) 10 mg, levocetirizine (Xyzal) 5 mg — each once daily, may go to BID; for breakthrough, hydroxyzine (Atarax) 10–25 mg hs/PRN or diphenhydramine (Benadryl) 25–50 mg PRN.
• H2 options: famotidine (Pepcid) 20–40 mg BID, cimetidine (Tagamet) 200–400 mg BID, nizatidine (Axid) 150 mg BID.

Trial a low-histamine diet for 2 weeks — about half improve (continue); half don't (don't stay strict).

Natural adjuncts (all 30 min before meals unless noted)

• NeuroProtek LP (quercetin+luteolin, low-dose 40 mg — good for kids / the quercetin-intolerant): start 500 mg once daily → 1–2 caps
• DAO enzymes before each meal · AllQlear (tryptase inhibitor) 1–2 chewables before meals · Perimine (perilla) 1 tab 1–2×/day
• PEA (Mirica or Vitalitus) — stabilizer + reduces neural inflammation — work up to 2 po TID

Pharmaceutical stabilizers

• Ketotifen (a favorite — leukotriene inhibitor + stabilizer + H1). Normal start 1 mg hs then before each meal. sensitive start 0.1–0.25 mg (rarely 0.05 mg); compounded.
• Cromolyn sodium — 100 mg vials; very sensitive patients open a vial and take 1–2 drops before meals, work up. (Oral Gastrocrom is the pharmaceutical form.)
• Montelukast (Singulair) 10 mg daily (evening) — a leukotriene-receptor antagonist; the accessible first step for leukotriene-driven symptoms (wheeze, congestion, post-nasal drip, GI), often tried before Zileuton. Watch the FDA neuropsychiatric boxed warning — counsel on mood changes.
• Zileuton (Zyflo) 600 mg BID — a leukotriene-synthesis (5-LOX) inhibitor for refractory, leukotriene-driven mast-cell symptoms; a more expensive option often used after resistance/tolerance to cromolyn; monitor LFTs.
• GLP-1 receptor-agonist microdosing (emerging) — e.g. tirzepatide ~0.5 mg SubQ weekly. Mast cells carry GLP-1/GIP receptors, and low-dose agonism reduces degranulation and NF-κB signaling; used as an adjunct in a treatment-resistant MCAS case once standard stabilizers plateaued. Off-label; start low, monitor GI tolerance.

Probiotics — choose by histamine effect

See the interactive MCAS Ladder in Tools.

Special sensitivities that masquerade as the "sensitive patient"

When a patient reacts to nearly everything, screen for these distinct, treatable overlays before assuming it's purely limbic/mast-cell. Each has its own fix.

• Oxalate overload — lower high-oxalate foods very slowly (a fast drop triggers "oxalate dumping" and a flare); support with calcium/magnesium citrate, and go easy on vitamin C (it converts to oxalate).
• Salicylate intolerance — reduce the salicylate load (aspirin, Pepto-Bismol, and high-salicylate botanicals like quercetin, resveratrol, curcumin, CBD, plus high-sal foods) and support the detox pathways that clear them (glucuronidation, sulfation, glycine conjugation).
• Thiamine (B1) deficiency and EMF reactivity — both are on Nathan's "sensitive-patient impediment" list; correct thiamine, and measure/shield/avoid EMF (Cornet meter) in the patient who flares near electronics.
• Carbon-monoxide exposure / secondary porphyria — chronic low-level CO needs oxygen (sometimes months); a secondary porphyria picture responds to IV 10% dextrose (D10) given when symptoms are worst.

Remove the exposure

Every framework agrees on exactly one thing: you cannot get well while still exposed. This is the deal-breaker. Handle it before, or in parallel with, the first steps of treatment.

• Act on the building testing from Step 1 — remediate or, when remediation isn't feasible or the HERTSMI-2 is >15, relocate.
• Re-exposure after improvement produces a rapid, measurable relapse — a useful confirmation when the source is in question.
• Reduce total load in parallel: clean air, clean water, avoid the moldy-coffee/dried-fruit contributors, support drainage.

Binders & detoxification

Match the binder to the toxin

Dosing by constitution

Two starting points: Sensitive (S) and Constitutionally strong (CS) — with form, brand, and milligram equivalents so there's no guesswork when a patient uses capsules or tablets instead of a scoop.

Use the Adult Binder Titration helper in Tools (now shows the mg equivalent for each). Constipation is common — add magnesium and buffered vitamin C; and remember chronic constipation here is often vagal, so the vagal work fixes it.

Detoxification & drainage

Liver logic: Phase I makes toxin water-soluble but more reactive; Phase II conjugates it (mold → mostly glucuronidation). A detox reaction (nausea, acne, feeling worse) means Phase I is out-running Phase II → support conjugation, don't push harder.

Drainage kits (very sensitive patients — start here)

• UNDA liver/kidney (Unda 120 + 243 + Ribes Nigrum): 1 drop qd–bid → up to 8 drops BID
• Pekana (Itires, Apo-Hepat, Renelix): 1 drop BID → 10–15 drops, except Apo-Hepat max 5–7 drops
• Pasco detox kit: 1 drop BID → up to 15 drops BID
• TUDCA: a couple caps at dinner/bedtime — lowers GGT/AST/ALT within a month

Depuration parameters

• Infrared sauna ~140°F, start 5–10 min, aim to sweat ≥10 min; follow with a binder (charcoal/aloe) to block reabsorption. Skip early in Babesia patients.
• Coffee enema after a bowel movement (boosts hepatic glutathione + bile flow); castor oil pack (~2 tsp organic castor oil over the abdomen) at bedtime; water ½ body-weight in ounces.
• Ionic foot bath (IonCleanse) ~30 min — robust patients 3 consecutive days then rest; sensitive patients 2×/week over ~4 weeks; add a binder 1–2×/week and cilantro tincture on footbath days. Peat / peloid baths (sensitive: start with 1 oz in a foot bath). Oil pulling (coconut oil, 10–20 min) and dry skin-brushing toward the heart.
• Lymphatic movement — rebounding, vibration plate, and the Perrin Technique of manual lymphatic drainage.
• Sole water — 1 Tbsp of unrefined-salt-saturated water in a glass first thing AM (replenishes Mg/Ca/K; caution in kidney disease / sodium restriction).
• Energetic drainage remedies when supplements aren't tolerated — the complex-homeopathy lines (UNDA, Pekana, Pascoe, DES-BIO), plus FSM / PEMF.

Diet: high-protein / low-carb to avoid feeding mold and Candida (paleo or keto). The strict low-mold-food diets make little difference in practice — protect compliance over purity.

Colonization, antifungals & biofilm

Most complex patients have colonized — mold growing in the sinuses and/or gut from prior exposure. Suspect it when the patient plateaus at 3–4 months and repeat numbers rise without improved detox. Binders alone won't finish these patients; you have to treat the reservoir.

Sinus protocol

Why the sinus matters: in the colonized patient the sinuses are a living fungal reservoir. With every bit of post-nasal drip they re-seed the gut and body — which is why systemic antifungals alone stall until you also treat the nose "at the source." Work it up like binders: gentlest agent first, escalate by tolerance.

• Silver first — hydrosol silver (Argentyn 23) nasal spray 2 sprays each nostril 1–2×/day: broad antimicrobial + anti-biofilm, gentle on nasal mucosa; primes the tissue before the antifungal.
• Antifungal, matched to sensitivity (same low-and-slow logic — sensitive noses react): sensitive nystatin (gentlest) → intermediate itraconazole 1% / ketoconazole 2% → strong amphotericin B. Start 1 spray/day → BID.
• Biofilm agent — BEG spray (Bactroban–EDTA–Gentamicin) 1 spray each nostril BID × 30 days (typical compounded course); many drop the gentamicin and use "BE" (Bactroban + EDTA) to avoid resistance/reactions. The E is EDTA — that's the biofilm-buster: it chelates the metal ions holding the biofilm matrix together and cracks it open so the antifungal (and the immune system) can actually reach the organism. This is why the spray goes alongside the antifungal, not instead of it.
• Gentle adjuncts (sensitive noses, or maintenance): xylitol nasal spray (XClear) — reduces microbial/biofilm adherence and moisturizes — and propolis nasal spray, alternated day-to-day, are low-reactivity options a very sensitive patient often tolerates before the compounded agents.
• Rehabilitate the nasal biome (once you've cleared — don't leave a sterile vacuum): humic acid and intranasal commensal probiotics Lactobacillus sakei / casei (e.g. Nasobiotex L. sakei powder, Lanto Sinus), swabbed/sprayed in the nose daily to re-establish healthy flora. Note: L. casei is on the oral "avoid" list for histamine producers — the nasal-recolonization use is a different compartment and purpose; L. sakei is the primary strain here.

Gut protocol

• Argentyn 23 ½–1 tsp daily.
• Nystatin — the gentlest starting agent (poorly absorbed, mostly luminal): work up slowly to 500,000 units (1 tab) once daily → target BID — especially with gliotoxin, high arabinose, or documented Candida. Milder, but often needs a systemic azole added once the patient tolerates it to fully clear.
• Itraconazole (Sporanox) 100 mg qd–bid for most (also covers Aspergillus/gliotoxin; check LFTs periodically at higher doses). Sensitive patients: start 50 mg every 2 weeks and work up.
• Diflucan (fluconazole) — Nathan's lecture use is a light dose once weekly as an adjunct to nystatin/itraconazole. For frank SIFO or positive Candida immunoglobulins, the therapeutic systemic course is heavier: fluconazole 150–200 mg daily × 30–60 days (the SIFO literature/Shoemaker-style dosing; baseline courses run ~3 weeks and are extended by response). Check LFTs; watch CYP drug interactions (statins, benzodiazepines, warfarin, etc.).
• Amphotericin B 0.06% solution (compounded) — oral and nasal, for the Candida-rampant patient (Michael Gray/Nathan).
• Gut biofilm: MCBFM or InterFase Plus 1–2 caps/day.

Biofilm — two origins, two tools

Biofilm is built two ways: the mold's own matrix (ECM / eDNA) and fibrin laid down by the patient's coagulation pathway. Mast-cell cytokines (TNF-α, IL-1, IL-6) drive that fibrin, and the ~20% with hypercoagulation genetics build tougher biofilms.

• Fibrin biofilm → fibrinolytics: lumbrokinase ~20 mg (≈1 cap) BID–TID on an empty stomach, nattokinase 2,000 FU BID (screen coagulation genetics first; hold if on anticoagulants/pre-op).
• Mold eDNA biofilm → liposomal cinnamon, clove, oregano; allicin dose per product label; start low and build by tolerance.
• Sequence (Crista's 3 phases): ① enzymatic + antimicrobial while infectious load is high → ② bis-thiol once load is down → ③ frequency therapies (Rife/FSM). Don't "poke the bear" until the current infection is controlled.

Persister cells are metabolically dormant (glycogen/trehalose-protected) and survive antifungals without any mutation — which is why biofilm disruption makes antifungals work and cuts toxin production.

Actinomycetes & endotoxins — treatment

When the water-damaged-building "soup" includes Gram-positive actinomycetes and Gram-negative endotoxins (suspect them in the skin/sinus-involved or won't-settle-MCAS patient — testing is in Testing §7), treat them on their own tracks. The rule mirrors mold: get the infectious load down before disrupting biofilm.

Actinomycetes

• Antibacterial: Usnea (Old Man's Beard) tincture ½ tsp TID; combine with garlic tincture ⅛–¼ tsp 2–3×/day to blunt resistance.
• Vitamin A ~5,000 IU/day (dose to labs; liposomal/emulsified — can be liver-toxic if pushed high) · Omega 3-6-9 2–3 g/day (↑ the DHA fraction if mold).
• BPC-157 500 mcg 1–2×/day · spore (Bacillus) probiotics — start very low, titrate slowly (die-off is common).
• Nose & throat: hydrosol silver swabbed/sprayed daily; intranasal Lactobacillus sakei / casei.
• Skin decolonization: dry skin-brushing (then vacuum), sauna followed by a cool rinse (<1 min), and a sage bath. For washing, castile soap is the gentle daily option; the broader actino hygiene protocol also uses coal-tar (Medicasp) and tea-tree (Defense Soap) washes, with castile soap as the tolerable alternative for those who react to them.
• Maintain drains (actinos love alkaline pH — acidify household drains with vinegar), then run the biofilm 3-phase sequence.

Endotoxins (LPS)

• Bind: Chinese sarsaparilla (Smilax) glycerite ½ tsp TID; SBI Protect (immunoglobulins) 1 cap/meal; lactoferrin 100 mg BID.
• Block absorption: mixed bioflavonoids (Color Guard) 1 cap TID; quercetin blocks endotoxin uptake.
• Restore bile / digest: ox bile — Bile Movers 1 cap BID with the largest meals.
• Rebalance the biome: berberine (Golden Thread Supreme) 1 cap BID with food; ↑ butyrate foods, ↓ simple carbs, fermented foods once tolerated; nasal L. sakei/casei.
• Protect the brain (if symptomatic): intranasal Synapsin (ginsenosides) 1 spray each nostril BID, dosed early in the day.
• Home: dehumidify to ~55%, and dry the hidden water reservoirs (CPAP, water bottles/straws, coffee machines, humidifiers) where endotoxin-producing bacteria breed.

Recovery — immune, hormonal & mitochondrial

As toxin drops, most systems reboot on their own. Where they don't, support them in this order — immune modulation and hormones before mitochondria.

Immune reboot

The inflammatory engine runs through TLR → NF-κB. To dampen it: block TLR signaling and quiet NF-κB.

• Low-dose naltrexone (LDN): start 1.5 mg hs → target 4.5 mg (sensitive: start 0.5 mg). Blocks TLR4; broad autoimmune benefit.
• PDE5 support (raises cyclic GMP): tadalafil 2.5–5 mg daily / sildenafil 20 mg up to TID, or botanicals (horny goat weed/icariin, grapeseed, L-arginine/citrulline, ginkgo).
• VIP (vasoactive intestinal peptide, intranasal) — later, once out of mold, VCS/MARCoNS clear and no ongoing exposure — 50 mcg (1 spray) QID, alternating nostrils; may increase to 100 mcg QID. Reboots immune transcriptomics; recheck VIP level and symptoms at follow-up.
• NF-κB herbals you're likely already using: curcumin, resveratrol, luteolin, boswellia, EGCG, quercetin.
• Track with the cytokine panel (sCD40L, RANTES) to confirm you're aimed correctly.

Cytokine panel testing — which one, and how to read it

When you need to see what the immune system is actually making — to tease apart mold vs. Lyme vs. long-COVID drivers and read the polarization above — a cytokine panel is the tool. The options differ by platform and by what you can actually order:

The A4M Lab Interpreter now carries a cytokine block (IFN-γ, IL-2/4/6/10/13/17A, TNF-α, GM-CSF, CCL4, sCD40L, RANTES) with the TH1/TH2/TH17 read built in — and the PDF auto-fill recognizes these names too. Ranges there are representative: read the pattern and confirm against your own lab.

Hormonal dysregulation (source deck dated 2021 — confirm currency)

Mold disrupts the pituitary, so measure and support thyroid, adrenal, DHEA, ADH, and sex hormones early — but you're aiming at a moving target that improves as mold clears.

Mitochondria — last

Give mito support only once the patient is well down the path, or it won't hold. Weight-based dosing (see the Pediatric Dose Calculator):

• CoQ10 5–15 mg/kg · Carnitine 50–100 mg/kg · D-ribose 0.5–1 g/kg
• Mitochondrial peptides Beyond the guide — SS-31 (elamipretide) 10 mg/day ×20 d — run FIRST (repair before demand) · Humanin ~0.5–2 mg SubQ daily (the HNG/S14G analog is more potent — dose lower; dosing not yet standardized) — pairs with SS-31 in the repair phase ·MOTS-c 5–10 mg 2–3×/wk — add AFTER mito repair, not before.

Sequencing & the master decision tree

In a patient with mold + Lyme + viral + MCAS, start with the pathology that explains most of the picture — usually mold, because it's often primary and gentler to treat than the others. But before launching any treatment, ask: can this body tolerate it yet?

1. Test (building + patient); read by ratio.
2. Is the patient sensitive? → prepare terrain (limbic + vagal, then MCAS). ≥6 weeks in the very sensitive.
3. Remove exposure — always.
4. Binders matched to toxins, low & slow; open drainage/detox.
5. Colonized? → antifungals (sinus/gut) + biofilm.
6. Reboot immune/hormonal; mitochondria last.
7. Re-test every 3–4 months; goal = "not present," then treat 3 more months (≈20% relapse otherwise).

The blocks you'll take home: in the sickest patients, ongoing exposure aside, watch for psychological/spiritual/energetic blocks and "illness/victim consciousness." When they're ready, ask: what would your life look like when you're completely well?

Teaching cases

Worked complex cases showing the reasoning, the fold-elevation lab reads, and the actual sequence used. Full visit-by-visit detail expands in the next build from the case decks.

Quick guides

Interactive tools

Genomics & the stuck patient

When a patient does everything right and still won't move, their genetics often explain why — and change the plan. A clinically-actionable panel (e.g. IntellxxDNA / Hausman-Cohen) turns "non-responder" into a specific, addressable mechanism. These are the variants that matter most in mold and complex illness:

Compounding pharmacies

Much of this protocol must be compounded — the nasal antifungal and BEG/BE sprays, EDTA, sugar-free cholestyramine, LDN, VIP, ketotifen, and the peptides. Use a pharmacy experienced with biotoxin/CIRS preparations, and confirm it is licensed to ship to your patient's state and can supply the exact strength and vehicle you want.

A starting list, not an endorsement — offerings, strengths, and state licensing change, so verify current formulations directly, and add your own preferred pharmacies. For peptides, source through a reputable compounder per the regulatory note in Recovery.

Resources & my documents

This is where my own reference documents live — the guides I've built over the years for things like cytokine-panel selection, ordering cheat-sheets, and patient handouts. Two ways to use it: open a document on your own device with the viewer below, or the ones I've embedded permanently into the guide.

My documents — where each one lives

The reference documents I've built are woven into the guide where a clinician actually needs them:

• A4M Master Lab Reference + Provider Ratio Reference Card → the Lab Interpretation (A4M) section (optimal values, the full ratio library, and the corrective playbook) and the live interpreter.
• ISEAI Binder Compendium → the evidence grid and fuller binder menu in Binders & detox.
• Patient Lab Report Template → the basis for the patient-facing lab report (report generator is on the roadmap).

Send me any other guides you've built (your cytokine-panel write-ups, handouts, protocols) and I'll embed each as its own page here so it ships with the product.

My original documents — embedded verbatim

These are documents I created, embedded exactly as I made them — page-for-page, original formatting — so they ship inside the product and open for anyone who buys it. Click to open:

Cytokine panels — what each one can and can't give you

My working summary of the panels, pending the fuller guide I'm adding here. The one rule that governs all of it: platforms are not interchangeable — never cross-compare absolute numbers, read each value against its own report's range (the Lab Interpreter now pulls the report's own ranges automatically).

Read any of these through the Yanuck TH1/TH2/TH17 lens and the Cell Danger Response rationale in Recovery.

Evidence & key literature

For anyone who wants the peer-reviewed footing — this is a newer field for most clinicians: a curated core of the mold/mycotoxin literature, grouped by claim. Not exhaustive — a defensible starting library you can share with a colleague or lean on yourself. (Compiled largely from J. Mather, MD's mold literature review, Sept 2025, plus the faculty decks.)

Symptoms & neuro-cognitive effects of mold exposure

• Empting L. Neurologic and neuropsychiatric syndrome features of mold and mycotoxin exposure. Toxicol Ind Health. 2009;25(9-10):577-82.
• Kilburn KH. Neurobehavioral and pulmonary impairment in 105 adults with indoor mold exposure… Toxicol Ind Health. 2009;25(9-10):681-92.
• Ratnaseelan AM, Tsilioni I, Theoharides TC. Effects of Mycotoxins on Neuropsychiatric Symptoms and Immune Processes. Clin Ther. 2018;40(6):903-17. (PMID 29880330)
• Bredesen DE. Inhalational Alzheimer's disease: an unrecognized — and treatable — epidemic. Aging (Albany NY). 2016;8(2):304-13. (PMID 26870879)

New-onset autoimmunity after water-damaged-building exposure

• Campbell AW, Thrasher JD, et al. Neural autoantibodies and neurophysiologic abnormalities in patients exposed to molds… Arch Environ Health. 2003;58(8):464-74.
• Pathak S, et al. Innate immune recognition of molds and homology to the inner-ear protein cochlin in autoimmune inner-ear disease. J Clin Immunol. 2013;33(7):1204-15.
• Lieberman A, Curtis L, Campbell A. New-onset CIDP following exposure to a water-damaged home with high airborne mold. J Neurol Res. 2017.

Mold/mycotoxin biomarkers & antibodies after exposure

• Vojdani A, Campbell AW, et al. Antibodies against molds and mycotoxins following exposure to toxigenic fungi in a water-damaged building. Arch Environ Health. 2003;58(6):324-36.
• Hooper DG, et al. Mycotoxin detection in human samples from patients exposed to environmental molds. Int J Mol Sci. 2009;10(4):1465-75. (urinary validation)
• Shaw W, Pratt-Hyatt M. Biochemical markers in the urine associated with GI mold-overgrowth linked with elevated urinary mycotoxins. Townsend Letter #436, 2019.
• Vidal A, et al. Mycotoxin Biomarkers of Exposure: A Comprehensive Review. Compr Rev Food Sci Food Saf. 2018.

Mycotoxins are airborne, enter the body, and associate with disease

• Brasel TL, et al. Detection of airborne Stachybotrys chartarum macrocyclic trichothecene mycotoxins in the indoor environment. Appl Environ Microbiol. 2005;71(11):7376-88.
• Brasel TL, et al. Detection of trichothecene mycotoxins in sera from individuals exposed to Stachybotrys… Arch Environ Health. 2004;59(6):317-23.
• Wu TY, et al. Prevalence of Aspergillus-derived mycotoxins (ochratoxin, aflatoxin, gliotoxin) in ME/CFS urinalysis. Int J Environ Res Public Health. 2022;19(4):2052.
• Brewer JH, Thrasher JD, et al. Detection of mycotoxins in patients with chronic fatigue syndrome. Toxins. 2013;5(4):605-17.  ·  …is naso-sinus fungal biofilm the culprit? Toxins. 2013;6(1):66-80.
• Arce-López B, et al. Biomonitoring of Mycotoxins in Plasma of Patients with Alzheimer's and Parkinson's Disease. Toxins. 2021;13:477.

Carcinogenicity, pregnancy & child development

• Magnussen A, Parsi MA. Aflatoxins, hepatocellular carcinoma and public health. World J Gastroenterol. 2013;19(10):1508-12.
• Shuaib FM, et al. Association between birth outcomes and aflatoxin B1 biomarker blood levels in pregnant women. Trop Med Int Health. 2010;15(2):160-7.
• Kadan G, Aral N. Effects of Mycotoxins on Child Development. Curr Mol Pharmacol. 2021;14(5):770-81.

Treatment evidence

• Brewer JH, Hooper D, Muralidhar S. Intranasal antifungal therapy in patients with chronic illness associated with mold and mycotoxins. Glob J Med Res. 2015;15(K2):29-33.  ·  Intranasal nystatin therapy… 15(K5):33-36.
• Campbell AW, Anyanwu EC, Vojdani A. High-dose IVIG + itraconazole in chronic mycotic demyelinating optic neuritis. ScientificWorldJournal. 2003;3:640-6.
• Pollock BH, et al. Intervention trial with calcium montmorillonite clay in an aflatoxin-exposed population. Food Addit Contam. 2016;33(8):1346-54. (binder evidence)
• Castro-Marrero J, et al. CoQ10 + NADH in ME/CFS: randomized, double-blind, placebo-controlled. Nutrients. 2021;13(8):2658. (mitochondrial support)

Quick reference & patient handout builder

Every treatment in the guide, in one checklist. Tick what you're prescribing, tweak the dose to your patient, add any notes, then build a clean handout you can print, save as PDF, download, or copy into your portal/email. Each item carries a plain-language instruction the patient will actually understand.

Faculty, sources & disclaimer

With gratitude to my teachers

This guide synthesizes what I have learned over years of mentorship and clinical practice. I gratefully acknowledge the faculty whose teaching informs it — including Neil Nathan, MD; Marie Matheson, ND; Jill Crista, ND; and Ruth Kriz, APRN — along with the broader functional and regenerative-medicine community (A4M). Named instruments and models referenced throughout (the biotoxin pathway, ERMI/HERTSMI-2, the Cell Danger Response, Crista's questionnaire, and others) belong to their originators.