Dr. Sharon Hausman-Cohen is a family and integrative medicine physician and medical director of Resilient Health in Austin, Texas who specializes in treating chronically ill patients, including CIRS and those with cognitive decline, with multiple modalities highlighted by genomic and symptom driven detoxification enhancement and enhancement of mitochondrial energy production. (Listen to Podcast Watch Kirk Hamilton's Video Overview of Dr. Hausman-Cohen Interview )
CHRONIC INFLAMMATORY RESPONSE SYNDROME (CIRS)
Dr. Sharon Hausman-Cohen is an expert in evaluating and treating chronic inflammatory response syndrome (CIRS). She has been treating CIRS for 4-5 years. She learned from many people but in particular from Drs. Mary Ackerley and Richie Shoemaker.
CIRS is a massive immune response to a wide variety of things including mold toxins (mycotoxins), or toxins in fish and Lyme disease. People with CIRS cannot properly present mold to their immune system. Mold gives off mycotoxins that can get into the nervous system. Mold itself can go only as far as the mucous membranes, but the mold toxin can get into the blood stream and then into the nervous system. Not everyone that has the HLA type that can’t “clear” the mold toxin gets CIRS. There is more than one gene involved. The genes that make you susceptible to CIRS are involved in multiple pathways, including detoxification pathways. While 20-25% of people have the HLA type that creates difficulty in clear mold, only less than 1% of the population get CIRS. Some people will initially feel bad when exposed to mold but their symptoms resolve quickly (within hours to days). When CIRS patients are exposed they can have symptoms for years.
DETOXIFICATION PATHWAYS AND GLUTATHIONE
Glutathione detox pathways are critical to helping CIRS patients. They involve removing toxins in the urine and also in the fat, especially important in removing toxins from the brain and nervous system. If mycotoxins get logged in your nervous system and you can't clear them this can cause severe problems, including cognitive dysfunction.
Mycotoxins turn off the production of glutathione production via Nrf2 pathways.
You can assume the glutathione pathway needs to be addressed since mycotoxins turn off glutathione production. So you want to augment the glutathione pathway in CIRS patients. Dr. Hausman-Cohen doesn’t test for glutathione function or levels regularly, but assesses the glutathione need through genetic testing, 23andMe.com and then she uses a software program from DNAsupplementation.com (Bob Miller, ND) that helps interpret the glutathione pathways (and other pathways). (MethylGenetic Nutrition AnalysisTM Video)
Dr. Hausman-Cohen doesn’t use IV glutathione because she feels it is a short-term solution. Avmacol 2 x day (sulforophane, broccoli sprouts 3 days old) can turn back on the Nrf 2 pathway and enhance glutathione production. N-acetylcysteine 600 mg 2-4 x daily provides cysteine to enhance glutathione production.
She has used Real Time Laboratory for urinary mycotoxin assessment but she feels a better value in assessing for mold affected patients is the Neuroquant computer program data from a brain MRI. The Neuroquant evaluation of brain structure size can delineate between an Alzheimer’s brain versus a mold toxic brain. Sometimes she uses intranasal glutathione at the beginning of treating a patient with brain symptoms along with Avmacol. She also uses oral liposomal glutathione on occasion, usually for the short-term.
Take Avmacol and glutathione before the urinary mycotoxin test to stimulate mycotoxin spillage is an important thing to do if you use this test.
If someone doesn’t have symptoms she wouldn’t call it CIRS even if they had mycotoxins in the urine.
She doesn’t use all of the Shoemaker Protocol because she has had success with enhancing the glutathione pathways (and mitochondrial function) and general symptom improvement in CIRS patients. She does/did use the C4a test on occasion when she can get it in Austin, Texas. She will use TGFBeta, MMP9, VIP, a.m. cortisol and ACTH as an initial assessment at times but doesn’t retest with treatment because she is going more on clinical improvement. The C4a and TGFBeta are indicators of CIRS, but by themselves in patients without concurrent CIRS symptoms yet they are not diagnostic of CIRS.
Dr. Hausman-Cohen stimulates mitochondrial function by two products KPpax™ (Integrative therapeutics) and Mitocore (Orthomolecular Products) especially if the patients are tired and with neuropathic symptoms such as numbness and tingling.
USE OF NEUROQUANT PROGRAM FOR MOLD, CIRS AND ALZHEIMER'S ASSESSMENT
The Neuroquant is a better diagnostic test which measures variations in brain structure volume in CIRS and Alzheimer’s patients. It can help delineate between the two.
In cognitive decline patients she will look at the ApoE4 status which is found in only 20% of the population but 80% of patients with cognitive decline before the age of 80.
The Neuroquant was developed to evaluate hippocampal volume in the Alzheimer’s brain. The hippocampus shrinks in Alzheimer’s disease and the ventricles enlarge. In CIRS the caudate nucleus shrinks and brain structures swell due to inflammation.
CIRS patients will have a Neuroquant 6 or 8 score which is positive for mold. Alzheimer’s patients will have a score of less than 3 as will normal patients.
If they have both Alzheimer’s and CIRS they will have brain swelling with a shrunken down hippocampus.
MARCONS (multiple antibiotic resistant coagulate negative staph aureus) Testing
She does do MARCONs testing (multiple antibiotic resistant coagulate negative staph aureus) of the sinuses but not on everyone. It is valuable to evaluate biofilm resistance which may affect how certain intranasal medications are absorbed (i.e. VIP (vasoactive intestinal peptide), glutathione, etc.). The sinus culture for MARCONS will also test for the biofilm presence. This bacterial infection in the nose may affect the immune system and reduces MSH (melanocyte stimulating hormone) secretion which can effect multiple metabolic pathways effecting sleep, pain, gastrointestinal function, hormones, inflammation, etc.. Also, coagulase negative staph aureus, which is staph epidermidis, is a normal bacteria on the skin. It is not an invasive staph. You don’t want to get rid of all of it.
DETOXIFICATION AND MYCOTOXIN IMPORTANCE
The most important things Dr. Hausman-Cohen focuses on is getting rid of the mycotoxins with Avmacol, cholestyramine and diet. She will treat patients before they get away from the (mold) exposure. She will do the Mycometrics DNA PCR test for mold assessment of the home (work environment) for dust containing mold (www.mycometrics.com).
She will start with Avmacol for 1-3 weeks to start pulling out some of the toxins. A high fat diet is needed to pull out the toxins using the Cholestyramine and Avmacol. If you don’t have enough fat in the diet you can’t pull out the mycotoxins out via the colon.
DIET RECOMMENDATIONS AND MILD KETOSIS
She doesn’t put someone on a mildly ketotic diet unless they are an ApoE4 with cognitive impairment. If they are a CIRS patient she can use a higher fat diet but she won’t use a mildly ketotic diet. That fats that she uses are generally unsaturated fats and omega-3 fatty acids to reduce inflammation. Saturated fat is not a beneficial fat for cardiovascular health. It tends to stimulate the liver to make more cholesterol. Coconut oil may be used because it provides beneficial medium change triglycerides. The ApoE4 patient is at risk for cognitive issues and cardiovascular disease so she uses a higher fat diet that is lower in saturated fat. If they are “just” a CIRS patients they can use more saturated fat. But she encourages them to take lots of unsaturated omega-3 fatty acids from fish oil, eat more fish, in particular the SMASH fish, which are lower in mercury and high in omega-3s, and she also increases their plant fat intake. The goal of the omega-3 fats is to reduce the inflammation in the body and brain. Also it is recommended to eat a low glycemic index and low sugar diet to reduce inflammation and eat LOTS of vegetables.
For detoxification she starts off with Avmacol and high dose omega-3 fatty acids (~6-9 gm EPA/DHA per day is ideal) from fish and supplements to decrease brain inflammation. More is better at the beginning to “settle” the brain down. EGCG (green tea) and quercetin both reduce inflammatory cytokines and TGFBeta (TGFBeta goes up with inflammation). Occasionally she will do an omega-3 fatty acid assessment. She does less testing on follow-up if the patient is doing well.
Hormone replacement may be beneficial in the classic ApoE4 Alzheimer’s patient and CIRS patient because the hypothalamic-pituitary axis (HPA) gets “off” do to mycotoxins affecting the HPA axis. Many times testosterone will be very low in female CIRS patients (and estrogen can be high). Testosterone is involved in anxiety, sleep and cognition. So is estrogen. Hormones are not the first thing to address because people are initially overwhelmed. Dr. Hausman-Cohen addresses the inflammation first. Sometimes, though, testosterone replacement by creams or pellets is what really gets the patient back to normal. But you don’t want to start first with hormone replacement in general in CIRS patients. Sometimes testosterone replacement may increase estrogen levels and increase estrogen dominance symptoms. Dr. Hausman-Cohen tries to normalize other metabolic abnormalities first. Then she will replace testosterone and other hormones along with iodine supplementation to keep testosterone from being converted to estrogen. A good screening for HPA axis deregulation is an a.m. cortisol and a.m. ACTH. If your a.m. cortisol is low the a.m. ACTH should be high. If you’re a.m. cortisol is high your ACTH should be low. If not that is a sign of HPA deregulation and you may need to address adrenal insufficiency or exhaustion which is another approach.
TOXIC METAL ASSESSMENT
Dr. Hausman-Cohen evaluates toxic metals by patient history initially or if the patient isn’t doing well. She may do a “Quick Silver” test to evaluate for mercury. Using Avmacol, which stimulates sulforaphane production and helps push detoxification pathways that gets rid of the mercury, is an effective means of mercury detoxification. Sometimes she will do urinary mercury screens.
Dr. Hausman-Cohen refers patients to other practitioners for intravenous nutritional therapy. Usually if she recommends it, it is done initially for fatigued or to enhance the detoxification processes. But she finds it is not necessary for long-term chronic management because her patients do well addressing the CIRS with reducing inflammation and enhancing detoxification by modalities mentioned previously.
CONCLUSIONS FROM DR. HAUSMAN-COHEN
If you have CIRS or any other chronic syndromes like chronic fatigue, fibromyalgia, unusual brain symptoms or unexplained symptoms you need to NOT JUST TREAT OR LOOK AT THE SYMPTOMS, but you need to ASSESS AND TREAT THE UNDERLYING PATHWAYS that are not optimal, such as detoxification pathways and enhancing mitochondrial energy production to start and then remove any offending environmental stimuli when possible, i.e. really getting to the cause. Dr. Hausman-Cohen notes there is much hope. Many of her chronically ill patients get well over a year or so and when they do relapse they hopefully know some of the parameters to address to get them back on track. Bottom line...look for the cause and don’t just have your symptoms treated and there is much hope for these CIRS patients to get well.
Sharon Hausman-Cohen, M.D. Board Certified Family Medicine and Integrative Medicine, Resilient Health Austin, 3410 Far West Blvd Suite 100 Austin, TX 78731 512-231-1901 / 512-231-1902 (FAX)
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