Sarah was 49 years old when I first saw her. She was referred to me by one of her healthcare providers for Lyme disease testing because she had been experiencing symptoms consistent with multiple sclerosis for the past year. Sarah had seen multiple neurologists in the San Francisco Bay Area for proximal muscle weakness, primarily in her legs and arms, but there was no clear consensus, so she was told to return if her symptoms worsened.
Sarah’s Health History
Sarah was relatively healthy growing up. She played sports throughout high school and reported no significant health issues until her 20’s. In college, she had frequent strep throat and had a chronically swollen lymph node after college, which ended up being surgically removed. Lymph nodes are part of the immune system and enlarge in response to infection or exposure to toxins. In her 30s, Sarah began to experience recurrent headaches that eventually turned into migraines. Sarah started to get sick frequently in her 40s with chronic sinus infections, especially after traveling for work.
Interestingly, in her 20’s, Sarah’s boyfriend suffered from Lyme disease. She was concerned her neurological symptoms may have resulted from him transmitting the bacteria that causes Lyme disease to her.
Is it Multiple Sclerosis?
Sarah first noticed soreness on the lateral sides of her legs after a walk a year before she saw me. A few weeks after the onset of symptoms, her legs became stiffer. She did not worry too much about these symptoms because she was very active. However, a few months later, she started to experience difficulty standing from her desk chair. The muscle weakness in her legs was very concerning, and she requested a standing desk at her office.
As time went on, Sarah began to notice other symptoms, such as shoulder pain. She started to see a physical therapist in hopes of resolving her symptoms, but unfortunately, they progressed. She began waking an hour earlier than usual to stretch her muscles before going to work. Sarah also began to notice occasional urinary incontinence and muscle tremors.
Sarah became very concerned when she could no longer move her legs while lying in bed. She would have to use her arms to shift her legs throughout the night.
When I met Sarah, she could not get up from a seated position without using her arms and had to use a handrail going up and down stairs. This was a significant physical setback for someone who had a strong yoga practice just a year prior.
Neurological Work-up
Sarah’s general practitioner referred her to a local neurologist who performed a series of tests. An MRI of her cervical and lumbar spine demonstrated bulging discs but did not explain her symptoms. An EMG (electromyographic nerve test) was performed, which detected radiculopathy consistent with a pinched nerve.
Sarah’s thyroid-stimulating hormone (TSH) and thyroid antibodies were elevated on a blood test, indicating autoimmune thyroiditis. She also had positive autoantibodies for Sjogren’s syndrome, characterized by a dry mouth and dry eyes. The thyroid and Sjogren’s antibodies indicated that Sarah’s immune system was dysregulated and attacking her tissues.
A 24-hour urine collection yielded elevated arsenic levels. Arsenic is associated with oxidative damage and multiple sclerosis. The general inflammatory markers ESR and CRP were in the normal range. She was also tested for an autoimmune condition called myasthenia gravis, which was negative.
The neurologist referred Sarah to UCSF for further workup. Another EMG study was performed and concluded that Sarah had myopathy, which is a general term for muscle dysfunction leading to weakness. A biopsy of her leg muscle was also performed and showed “mild chronic neurogenic changes.”
Functional Laboratory Testing to Identify The Cause of Multiple Sclerosis
When I met Sarah, she had already been through a battery of diagnostic tests by neurologists. There was no conclusion about what was causing her symptoms. In addition to the Lyme disease testing that Sarah was referred to me for, I wanted to rule out other toxicant exposures contributing to neurodegenerative conditions. Sarah’s health history clued me in on a couple of environmental exposures I wanted to rule out.
She experienced recurrent sinus infections and reported that some of her colleagues at work frequently get sick with upper respiratory infections. I wanted to rule out mold toxicity as a cause of her symptoms. As a yoga practitioner, Sarah was mindful of eating healthy. She did not eat red meat or chicken, so she frequently ate fish. Larger fish are the primary source of mercury, and since Sarah had elevated arsenic levels, I wanted to rule out other toxic metals.
Mold and Mercury as Causes of Multiple Sclerosis
When I received Sarah’s lab results, I was shocked by the findings. Her urine toxic metal panel showed significantly elevated mercury levels. To assess the total body burden of toxic metals, it is critical to use a provoked 6-hour urine toxic metal panel. Blood, hair, and unprovoked urine tests only reflect recent exposure. Since toxic metals are stored in tissues, they will accumulate over time. Mobilizing the metals from stored tissue with intravenous EDTA and DMPS is the most accurate testing method.
Sarah’s urine mycotoxin results were remarkably elevated. Mycotoxins can cause immune suppression and autoimmunity, and are associated with neurodegenerative conditions. A comprehensive Lyme disease and co-infection panel from a specialty lab was normal.
What Causes Multiple Sclerosis?
The hallmark feature of multiple sclerosis is the demyelination of nerves that results in symptoms associated with neurological function. Myelin is a protective layer around nerves (similar to the protective rubber coating on an electrical cord) that increases nerve signaling. When myelin is damaged, nerve conduction is compromised.
Various mechanisms have been proposed as causes of multiple sclerosis. Mitochondrial damage is strongly associated with multiple sclerosis.1 Mercury and mycotoxins cause oxidative damage that directly impacts mitochondria. Likely, multiple mechanisms are involved in creating the perfect storm resulting in symptoms.
The interplay between genetic and environmental factors, such as toxins, infections, and subsequent immune dysregulation, ultimately leads to the development of multiple sclerosis.
Mold as a Cause of Multiple Sclerosis
Mycotoxins produced by molds have been shown to damage cells in the central nervous system, including the cells that support myelin. Mycotoxins cross the blood-brain barrier and directly damage nerve cells. The damaged cells release debris that triggers an immune response, creating more oxidative damage.2 The mycotoxin gliotoxin was shown to cause nerve cell death and demyelination in research studies.3
The review article, “Fungal Toxins and Multiple Sclerosis: A Compelling Connection,” describes numerous studies linking fungal toxins to nerve cell damage that can lead to multiple sclerosis.
Multiple Sclerosis Associated with Elevated Mercury
Mercury is known to be neurotoxic and has been associated with multiple sclerosis. One research study compared serum mercury levels in men and women with multiple sclerosis with matched controls.4 The results found that the multiple sclerosis group had significantly higher levels of mercury than the control group.
Another study found that astrocytes, the neurological immune cells central to the pathophysiology of multiple sclerosis, sequestered mercury in the brain of a man exposed to it.5 The researchers also found mercury in other neurological tissues of the central nervous system.
A Protocol to Reduce Mold and Mercury
Sarah began an intravenous chelation protocol to reduce her elevated mercury load. She stopped eating larger fish that contain mercury, such as ahi and tuna.
For the high mycotoxins, I started Sarah on an intravenous protocol of phosphatidyl choline. This treatment removes mycotoxins from cell membranes and repairs damaged cells and tissues that contribute to the pathology of MS. She had her house tested for mold by a reputable indoor environmental inspector (IEP), and the results were negative. My suspicion is that the building Sarah worked at in downtown San Francisco likely had water damage and subsequent mold growth. Water or moisture can come from various sources, including the HVAC in a large commercial building. She left her job when her health declined, so she wasn’t being exposed there.
Treat the Cause, Not the Symptoms
Within a couple of months of treatment, Sarah began to notice her muscular strength returning. She reported that she has been able to walk farther and do more yoga than before. She also said going up stairs was considerably more manageable.
A couple of months later, when I saw Sarah, she said her mobility was “night and day” better than before starting treatment. She still used a handrail going up stairs, and her arm and leg strength had not returned to normal, but she was able to do more activities around the house without muscular fatigue.
Following a visit to UCSF, a neurologist wrote in Sarah’s chart, “It’s possible that some of her prior weakness was secondary to fatigue rather than weakness. A prior exposure that has passed is also possible…” It turns out that mold and mercury toxicity were the cause of her MS.
At a follow-up visit, I noticed a significant improvement in Sarah’s walking. In the past, she moved slowly, and it would take some time to get from the waiting room to my office. Not this time. She stood up from the waiting room chair and walked alongside me at my pace. It had been a little over a year since I met Sarah, and a couple of years into her journey with a debilitating neurodegenerative condition. She had made changes in her life, continued to seek medical care until she discovered the cause of her condition, and committed to the treatments that helped her get her life back.
