By Nicola McFadzean Ducharme, ND

Chronic Lyme disease and mycotoxin illness are rapidly becoming more and more intertwined, with many patients suffering greatly from both maladies. It gets incredibly difficult to sort out what is causing what in terms of a patient’s health picture, given the overlap of symptomatology. For patients it is confusing, and for health practitioners it can also make navigating treatment planning very difficult.

The purpose of this article is to highlight some of the commonalities and distinctions in terms of both testing and treatment. We can utilize testing to evaluate which stressors are present, try to sort through which ones are having the greatest impact, and what the secondary effects on the body systems are. Such testing can help guide treatment choices.

Having said that, from a clinical standpoint, I have found in my clinical practice that rather than viewing these issues as two totally separate things to be dealt with one at a time, it helps to look at the whole person and find the common traits that come from both issues and addressing those. Yes, there are differences, of course—Lyme disease involves bacteria, mycotoxins are from mold exposure—and so of course there will be specific treatments that are needed for each. But in my experience, looking for treatment options that help with both things at the same time provides a better outcome for patients and is less overwhelming for them.

Some practitioners believe that you can’t treat mold toxin-illness until Lyme disease is treated. Others say that you can’t treat Lyme until mold is dealt with. To me, in the reality of how these two issues show up in the body, it’s simply not as black and white as that. I tend to try to chip away at both things, gradually and systematically, on the premise that every stressor, be it a pathogen or a toxin, is going to be impacting that individual’s health. We cannot separate them out. So where do we start?

A patient comes to my office. They complain of joint pain, headaches, foggy brain, pins and needles in their hands and feet, constipation, abdominal pain, dizziness, and terrible fatigue.

Is it Lyme? Could be. Is it mold toxicity? Could be. Is there something else going on? Possibly.

Obviously, we take a thorough history since clinical presentation is such a big part of the Lyme diagnosis, but since we’re talking labs right now, we’ll just assume that clinical presentation has been gathered and taken into account.

Also, most patients with chronic complex illness have been through the gamut of doctors before they get to our clinic and have had an extensive work up for all the other things that could be going on—autoimmune markers checked, MRI’s done, ultrasounds performed. They may even come with a previous diagnosis that reflects one of the many things that Lyme disease can mimic. Therefore, for the purposes of this article I am keeping our differential diagnosis to Lyme disease and mycotoxin illness.

Level One: The Basics

If a patient has not had standard bloodwork for a few months, I will ask for a panel of labs to make sure there aren’t any imbalances that we need to correct—any causes of fatigue that might be contributing such as low iron or ferritin. These labs are helpful to get a baseline and to show how to fine-tune treatment. The difference here is that if they all come back normal, we do not tell the patient that there’s nothing wrong with them and it must all be in their head! These basic labs are more an evaluation of “how is your body coping with all of this.”

Labs I might run include the following:

• Complete blood count
• Comprehensive metabolic panel
• Lipid panel
• Serum iron
• Ferritin
• B12 and folate
• Vitamin D
• Hemoglobin A1C
• Magnesium
• Thyroid (TSH, free T3, free T4, reverse T3, anti-TPO, anti-thyroglobulin)
• Reproductive hormones – estrogen, progesterone, testosterone (free and total)
• Cortisol (will run that through a salivary panel with morning, noon, afternoon and evening collections to assess the circadian rhythm)
• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (ESR).

Surprisingly, despite the massive inflammation in these chronically ill patients, CRP and ESR are frequently within normal range.

Getting a little more in depth on opportunistic infections and other underlying infections, I might also run IgG and IgM antibodies to Chlamydia pneumonia, Mycoplasma pneumonia, Epstein-Barr virus, cytomegalovirus, HHV-6, and Candida albicans. Those labs can all be run through large commercial labs such as Quest and Labcorp.

Level Two: Indicators of Neuro-Inflammation and Immune Dysregulation

Dr. Ritchie Shoemaker¹ has been a pioneer in the field of mycotoxin illness and chronic inflammatory response syndrome (CIRS). In developing his work, he compiled a panel of lab markers, which are indicators of mycotoxin illness. I find these markers to be useful; however, I would argue that they are not only influenced by mycotoxins alone, but by biotoxins, which can be created by mold or by pathogens in the body.  Mast cell activation syndrome (which may be more of a result than a cause) can also alter some of these results.

Therefore, in my opinion they are better used as tools to assess and evaluate than to actually diagnose. These markers can also provide a good baseline to be able to retest later and quantify progress on the treatment given.

While each marker has its own unique actions, they all have one thing in common—they influence immune activity and inflammatory processes in the body. Some of these markers are outlined below.

C3a and C4a are part of the complement system, which are proteins that travel through the bloodstream, and play a significant role in immune function and inflammatory responses. Elevations can be a sign of an overactive immune system that can’t regulate itself.

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Getting Specific, and considering the implications of a Lyme-mold situation