78. CIRS 101 with Dr. Aaron Hartman

Dr. Aaron Hartman 0:02

A lot of these things we do to try to biohack people and do things. We're just trying to replicate what these things that people done for 1000s of years have been doing.

Dr. Stephanie Gray 0:12

Welcome to the your longevity blueprint podcast. I'm your host, Dr. Stephanie gray. My number one goal with the show is to help you discover your personalized plan to build your dream health and live a longer, happier, truly healthier life. You're about to hear from Dr. Aaron Hartman, who's going to share all about a topic I've been waiting to discuss chronic inflammatory response syndrome. And lastly, we're going to talk a little bit about long COVID Let's get started.

Welcome to another episode of The your longevity blueprint podcast. today. My guest is Dr. Aaron Hartman. His journey with functional medicine started when he and his wife adopted their first daughter from foster care. She has cerebral palsy and countless dietary issues. They went from specialist to specialist and even as a physician, he felt let down and confused. His daughter's health struggles forced him to confront an uncomfortable realization that our current health care system did not have all the answers. His wife, however, refused to give up hope.

She ultimately pointed him to functional medicine and his daughter and two other kids began to thrive. After years in family practice, he felt called to make a dramatic shift. Dr. Hartman currently holds the following positions principal investigator and medical director of Virginia Research Center President family practice associates, assistant clinical professor of family medicine at the VCU School of Medicine and founder of Richmond functional medicine. His fields of clinical expertise include CRS, which we're going to talk about today, post Lyme syndrome, chronic fatigue syndrome and long COVID. He now helps patients identify leverage points and key areas of their lifestyle and health at harness their body's remarkable power to heal, and begin living the vibrant life they deserve. Welcome to the show, Dr. Hartman, it's

Dr. Aaron Hartman 1:59

great to be here, I'm just really excited to share with you and share with your community and just learn together and grow together. And I'm just really excited to be here.

Dr. Stephanie Gray 2:07

Happy to have you. And chapter eight of my book, Your longevity blueprint, I'm comparing the home the roof specifically of the home to the immune system for the body. And this is where I mentioned invaders like viruses, bacteria, and mold toxins, which can some of which can cause something called sirs, I don't know how you say that are chronic inflammatory response syndrome. And so as I alluded to, in reading your bio, you made a big shift in your career. And so I want you to kind of expand on why and how you made that shift. And then how you became an expert in this service or chronic inflammatory response syndrome, which we're going to talk about today. So tell us about your big career shift and how you became an expert in however we pronounce it serves

Dr. Aaron Hartman 2:44

me my shift was being mainly driven by my my family, probably my my daughter, she actually was a patient, my wife, my wife's a pediatric occupational therapist, herself, niche was kids with special needs. And so my wife started taking my daughter on her caseload, when she got the hospital. And so about a year into it, her her foster home was closing down, and my wife was like, Hey, you want to bring this little girl in or house? Maybe adopter? Maybe? And I was thinking, Oh, being a guy, I'm like, you know, we can always give her back. Sure. Why not? We got nothing else going on. Right? So I'm brought in her house, I fell in love with her. And we have essentially adopted her and a whole process. One of the things with a specialist was She's small for her age, she needs to get bigger. And so how do you do that with kids with special needs, you put a feeding tube in them, but hold their stomach and you Singapore infant formula down their stomach so they can get bigger.

My wife and I discuss our goals were always great for her. My wife says, I see something in there. I know, she doesn't talk. She's not supposed to walk. She's not supposed to crawl, I see a person in there. And so I was naive enough to believe that my daughter would grow up to be normal someday. And so getting tips me know crawling effects, speech development shares, we We opted out of that. And six months later, my wife found a growth chart for kids with CP. And my daughter was right in the middle had the specialist whose field expertise his kids with special needs not know about this growth chart. And that was like the first time my eyes were opened up to the idea that experts aren't necessarily experts. You kind of have to like find your expert. Sure, use your specialists, whoever your team is, but they consult you they ultimately don't mandate care. And that was just the first time that my eyes were opened up the idea that experts might be wrong. And so I started researching things my daughter, you know, researching gene stuff on a whole host of things.

Yeah, but as time went on, my eyes were opened up to the environment and how environmental toxins she was she was exposed to on drugs in utero, which is one of the reasons why she was born with cerebral palsy but just learned about how environmental toxins affect health. It's just a natural progress you know, first food you know, cleaning your food up dealing with genetics, you know, it's as I learned, things, dealing with environmental toxins, stop using Roundup, all that kind of stuff. And the natural progression was to the environment. You know, it's interesting on the head of the Harvard School of Public Health has made a statement that humans are evolving into an indoor species. she's, you know, we spent almost all of our time indoors. And the indoor air quality is a big, big deal. The EPA has a massive statement about indoor air quality, and how negative it is

Dr. Stephanie Gray 5:11

isn't like worse, it's worse than the air quality outside. Yeah, what exactly,

Dr. Aaron Hartman 5:14

exactly. So it's, that's what just kind of naturally led me as I learned new things and applied them, I learned about all these different aspects of health, the environment, and ultimately, where you live, your home or workspace became a big, big issue. And so as a, you know, physician and inquisitive person ultimately being driven, I have this little girl who's like, it's nursing, like, I know that I've got a certain amount of time to help her health, and I've got a certain window of opportunity. It's amazing how, how motivating that is to get up at four and five in the morning and studying research and to get new certifications and new whatever. And so it just led down a pathway accelerated you know, a lot of people do this and take some 10 or 20 years, you know, I didn't have that much time with my daughter.

So it forced me to be a Quick Study and Quick Learn, and ultimately lead me down to chronic inflammatory response syndrome, which your half of all buildings in the country have water damage, your every school grout that has some form of indoor air quality issue at 23% of population has the gene that sets them up for CRS or sirs, right. So all of a sudden now it's like, once you realize that that data, you start saying we should be a lot of people out there with this problem. If half the buildings in the country have water damage, if 23% of population has the gene and you started looking for it and you start knowing what the what for all of a sudden, it's like you see it everywhere. And that's kind of what's led me down this pathway to study under Dr. Shoemaker and Dr. Heyman, you know, a for him and then basically the grandchild and studied under a bunch of other people in addition to my standard functional medicine, training and integrative holistic training, which I've done all that as well. It's, every time you learn something new, there's a new door opens up and you have a new thing to learn, which is exciting, but also challenging, you know,

Dr. Stephanie Gray 6:48

so can you define what chronic inflammatory response syndrome is? This might be the first time that our listeners are hearing a bit about this. So what is it?

Dr. Aaron Hartman 6:55

I mean, it's chronic, it's ongoing, which means it's been going on for six months or more, but it's inflammatory. Now, it's interesting when you think about inflammation, most people think about, you know, autoimmune diseases or elevated white counts, this inflammatory part of chronic inflammatory response is part of your innate immune system. So it involves things like your innate cells, dendritic cells, natural killer cells, cytokines. So it's a different type of inflammation that the standard lab testing doesn't pick up unless you know what to look for. Response to respond to something. What are you responding to? Well, 80% of crocking plantar sponsor is what are damaged buildings, but there's also a tight version related to Lyme disease is like post concussive part of chronic inflammatory response syndrome.

Your breast implants is actually vaccinates this according to Dr. Schoen Schoenfeld ZZ work, he calls it Asia syndrome, which is all immune inflammatory syndrome induced by adjuvants. But it's very, very similar. Um, so it's an inflammatory response to something and for our sake here, I focus mainly on the mold, but there's a whole host of other things that can cause it. It's a senator I'm going to send her means you have a listing of symptoms for research purposes, typically, that once you get the checkboxes, in the case of CRS, it's about 99% accurate and diagnosing that's called the cluster analysis, we have 13 classes of clusters. And if you meet a subdomain, you know, so many of those clusters, then you have a 95% chance 99% chance of having the syndrome. It's chronic, it's inflammatory, different inflammatory response to these things. It's a syndrome.

Dr. Stephanie Gray 8:24

So what I know you can't list all the symptoms, what are some of the most common presenting symptoms you see in patients that kind of then kind of alert you that oh, we need to be looking for for CRS in this patient?

Dr. Aaron Hartman 8:33

Well, I say the syndrome, the symptom, that skull starts sounding very familiar, a lot of people, you'll see brain fog, you'll see problems thinking on lack of concentration, ease, distractibility. You'll see weird pain, migrating pain around the body. Weird just aching pain, weird symptoms, tingling, burning, sometimes internal vibration, some kind of weird stuff, you'll see. Mood lability mood swings, okay, so there's a whole host of things. A lot of times people have gut issues, particularly diarrhea, for example. So that those are kind of the major high ones. And then there's secondary epi phenomena we call them which are secondary phenomena that are not primary.

So you'll see antibodies like positive celiac and unbias, positive lupus anticoagulant antibodies within that with lab testing. But the main thing I think that brings a lot of people to me is the fatigue is like the brain fog, which includes fatigue, and loss of energy, poor sleep quality, non restorative sleep, which sounds very much like chronic fatigue, right? Fibromyalgia. And actually, there's an opportunity finder that actually our CRS, and it's really cool to find those people that diagnose their CRS and now the fatigue and brain fog gets better because you're dealing with the recalls, not just symptoms. That's like, there's a lot you know, there's 3637 different symptoms in the cluster. But again, there's, there's hundreds of different symptoms, but those are the major ones people deal with. And the thing that brings people to me most often are like blood, brain, mental cognitive kind of things. Yep.

Dr. Stephanie Gray 9:56

So you kind of already alluded to this, but what other diseases fall under The title of CRS. So you mentioned mast cell activation syndrome. And I had a wonderful guest Beth O'Hara, who talked a lot about NASA last year. Let's talk a little bit about that and the overlap, or I guess if you'd call it the SIRs umbrella, kind of what falls underneath there.

Dr. Aaron Hartman 10:13

Okay, so 80% of it is water damage building within water damage building. It's actually mostly not mold. Okay, it's actually ended my C's, like I took 10 of my C's and endotoxin so that's where you have the crawlspace and the beautiful house that has a CRS patient because it's the endotoxins and actinomyces from that crop right? That's another conversation for you. Oh, but anyway 80% of there's a water damage building then you've got a post Lyme you got concussion syndrome Yep, hysteria. Actually this area and like the blue green algae was actually held Dr. On Shoemaker first discovered this with Waterman I'll pick up in Maryland was actually efficient manner being exposed to this. Basically, overgrowth, these blooms related to run off of pesticides and agricultural chemicals into the Chesapeake bear.

She got green out blue green algae, but then there's like there's a post actually, there's actually exertional CRS, where people over exert themselves they over exercise, overtraining, overtraining one and they get a lot of muscle breakdown over time that causes low grade inflammation that eventually can trigger a CRS phenomenon. There's post concussive people can get a concussion and getting a concussion also you get leaky brain and leaky gut, you get endotoxins basic and easy endotoxins. Again, yes, actually, bacteria in your gut, you get a massive load through concussion induced leaky gut that can lead to a TBI or concussion induced CRS, where it gets a little controversial because this is where I can combine different experts opinions, if I look at some of Dr. Schoenfeld to work with the Asia syndrome, which is all new inflammatory syndrome induced by adjuvants, it's like 80%, similar to CRS, except he focuses on things that activate your immune system like the adjuvants of vaccines.

So whether it's a petroleum distillate foods adjuvant or aluminum, other metals, he also mentioned silicone as an adjuvant and mainly in, in, in plants. Right. So I think personally, based on that a lot of implant disease is actually a different version of CRS, and that's gonna be controversial. By the way. It's interesting when you look at the experts with implants, they're doing the exact same labs, right? See for AC 380 TGF beta, the symptom clusters, almost the exact same, and that's where the more more learn about stuff. I'm getting a bigger, bigger, bigger umbrella.

And a lot of people with a lot of symptoms of CRS also have a lot of pots, dysautonomia symptoms, right. rapid heart rate, you know, dysautonomia, and you start talking to patients, a large part of them are hyper mobile. What do you say hyper mobile one in 30. Americans is hyper mobile, and hypermobility increases your risk for elevated TGF beta, which if you know your labs for sirs, TGF beta is one of the secondary lab markers. And if you're hyper mobile, you're more prone to have a th 17 imbalance. All of a sudden now the CRS thing which people are thinking is a narrow rare thing is like a very, very, very big feeling every month or two. Well, I'm learning more information about this umbrella is getting bigger and bigger. And the cool thing is, is that as I learned this, I'm not gonna apply it to patients like long COVID patients, people have been healthy, got COVID now are sick. Three months out, I'm actually learning how to apply these principles to help them get better as

Dr. Stephanie Gray 13:11

well. And I want to come back to that want to come back to that but I want to echo what you said about breast implant illness because I don't know maybe five years ago I had my first patient who came to me thinking like I have breast implant illness, how can you help me and she had brain fog and fatigue a lot a lot of the symptoms you're referring to. And the only labs I knew to order were okay, let's check a C three C four a and TGF beta one and TGF beta one was high. And right years later, post X plant a lot of healing and recovering or TGF beta one is now normal. So it is very interesting. If you're listening and you think you could have breast implant illness, I think some of the labs that we're going to about to talk about could very much apply to you so so let's go to the lab. So how is SIRs diagnosed? What labs do you order? And then how can this affect treatment?

Dr. Aaron Hartman 13:51

Well, first you have to have the symptoms, right? It's by definition, it's a multi system, multi symptom disease and multiple different Bice, sometimes multiple, multiple different symptoms. Okay, tongue twister, and so you person and I did a big blog, actually series on my website, actually talking actually walks people through how to diagnose this actually. So if they want more information, they can look at that on my website, but you go to this system, the symptoms. If you meet the criteria, then that you have about 95% likelihood of having CRS these are the labs and there's a gene lab on HLA dr. D Q, which is a gene risk for getting us now the generous doesn't mean you won't get it. You know 23% of population has the gene but not 23% of population has this. The gene represents actually your body's ability to detoxify a lot of people don't realize your immune system actually uses antibodies to tag toxins to your body to remove them. And so it's not just liver health and gut health and sweating. It's also your immune system is an active participant in detoxification if you had these genes, you buy as a little bit of difficulty making antibodies to these toxins you're exposed to so you can build up over time. What's the one one lab?

Dr. Stephanie Gray 15:01

So this is a gene. And unfortunately I have this, I've admitted that on another podcast, but these these specific genes are not something you're going to see on a 23andme test, like my patients are bring me in their genome and say, hey, you know, Can you can you tell me if I have such and such a gene? And unfortunately, no. So this is a different panel that an experienced practitioner would need to order on you to kind of see if you have that HLA typing, just FYI.

Dr. Aaron Hartman 15:25

Absolutely. Yeah, sorry. Absolutely. Yeah. And only only LabCorp does it and when you get the results back, you have to put it through this thing to interpret and most people don't even know how to Yeah, you have to see. So here's what we're doing. Basically the basic jest, but it's also lab, just six different major groupings of labs. The next group is you look at you look at brain function through your hypothalamus and pituitary. So you do an ADH, and osmolality, which is basically your brain's way of controlling sodium and water concentration. There's a ACTH and cortisol, you know, a lot during adrenal fatigue, which actually is not a real thing. It's HPA Axis dysregulation. They'll have an abnormality in their ACTH and cortisol, and how many people you know, so called adrenal fatigue, it's not a version of CRS, right?

You look at C four a, which is as a part of your innate immune system. Again, we talked about this being an innate immune system issue. It's a part of your body's most primitive immune system that actually is pre programmed to react against external threats. So it doesn't even require antibodies. It doesn't require B cells or T cells by itself, it can recognize things make these little attack complexes called Mac complexes and make cells spontaneously explode that gets over activated like it does and CRS, you can have this over activation of their immune system MMP nine telemetric protein is a tissue inflammatory marker that said that's elevated and these can be elevated not always in these patients. There's a whole host of secondary labs TGF beta, you can use C three A, which you see in patients with chronic infections like Lyme antibody testing a whole host of other secondary tests. But the main six tests are the ones you mainly look at like diagnosis, you will do the secondary tests, if you're trying to like ferret out all you know autoimmune spectrum issues.

And sometimes I'll do like an infection panel on patients homes of things lining up and just it's more of a reflection of their innate immune systems, inability to keep things suppressed. And then as a BCNF, I'm sorry, I didn't mention the BCS test, which is super awesome test Visual Contrast sensitivity test, it actually is a test that looks at blood flow to the back of your eyeball, the Air Force actually use this test, you know, decades ago to determine if people on flight lines were getting exposed to too much jet fuels. The jet fuel is actually causing neurological issues for some seizures. And so they want to figure out how can we figure out if someone's blood flow to the brain has been negatively impacted, and they figured out this VCs test, if you fail, that that can be a lot of different things. It can be other toxins and chemicals. But if someone has mold, and you're detoxifying them, and then you do your mark cons test, you want to basically keep them on treatment for that until they're VCAs normalizes and they clear the mark ons. And the last one, it's not part it's not a diagnostic test.

But it's a hugely, hugely important test is the mark cons test. It's a bacteria on a multi drug resistant staph, that actually creates these chemicals called human license. And they break down that seat which makes melatonin Msh is one is master regulatory peptides in your brain that helps regulate sleep wake cycles, pain regulation, it helps with gut health leaky if you have leaky gut and Msh issues, because it helps repair leaky gut. So all of a sudden now that was the one other lab I didn't mention in the diagnostic ones. Msh sorry about that. That's like the introductory stuff if you want to do that basic labs VCs Mark coms, but then their environment, you know, you could have had a past exposure 5678 years ago, it might not be a current exposure. That's where for my patients I want to figure out is the place you living safe now, it could have been last place you live live two years ago come in your action, one patient who lived in a moldy environment for years and years. And this CRS start after tick bite, you got tick bite got Lyme develop Hashimotos thyroiditis.

And so much of storage experts don't get him better, because they don't want to dress to CRS and the trigger was this tick bite from the place he lived. You know, what, 10 years before that, right? So sometimes tricky when you look at the environment to figure out if it's a just a past or past in the present. But one of the one of the key things I want to focus on when I see the patient is is the place you're living now as a place you're working now, school is a safe place.

Dr. Stephanie Gray 19:17

Yeah, let's talk about that. Because I run all those labs in my patients. And I think one of the most difficult things for me is determining if they have acute exposure or if we're looking at as a result of exposure from five years ago, if they know I was in a really moldy apartment in college or whatnot. Kind of difficult to determine I do I use the blood testing that you're you're recommending. I also use urine mycotoxin testing. Do you also use that or no, I don't use

Dr. Aaron Hartman 19:39

urine mycotoxin testing. Based on some research from Dr. Heyman and Shoemaker. The urine mycotoxin testing represents more foods you eat mold and foods. And so that's one of the things you'll see people who ate like corn, for example, they'll have tons of fumonisins or the mycotoxins from the end corn is crazy moldy. A lot of grains are moldy and so it represents more. It doesn't also replicate Your immune reaction you might, you know, live in a moldy building, you know, I've got the genes, okay that you're missing, I got the genes. I have more cons, but all my testing is negative. I don't have CRS because my innate immune system has not been activated. Sure. So you might have exposure and have have the mycotoxins new urine, it might not mean you have CRS, and that's where the urine testing.

The other thing about the urine testing. For my understanding of it that's a little tricky is you might be a poor detoxifier you have to do chlorella and a sauna and other stuff to basically do some kind of like jogging to get things out, or you might be amazing detoxifier and you have tons of mycotoxins coming out and it's because you're doing such a great job detoxifying that's that's I think that's where I'm in this is the urine testing is a little controversial in the CRS world and there's different labs do it different do the chromatography difference there's a difference between the real time labs the way they do it versus um Great Plains cleanser they don't they don't do the testing quite the same sizzle little discrepancy between there but um yeah, I started doing a lot of urine mycotoxin testing and got into and just it wasn't super helpful to figure out how sick a person was it wasn't they couldn't really track them like were you getting better or not. And then as I did my like training with Dr. Shoemaker and Haman, the literature the way they described it and the research I was looking at, it doesn't really tell me if the immune system has that whole chronic inflammatory response syndrome sub just kind of don't really a lot I use the money more for doing expensive see for that has to go to Jewish nationals and I contrast

Dr. Stephanie Gray 21:27

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One of these machines would be a great Christmas gift for a loved one stopped by the integrative health and hormone clinic if you'd like to see different sizes, or visit the bonus tab of my website, your longevity blueprint.com to find a special link for $280 off the 83,000 using code Gray 15. That's capital gra Why 15 And watch for even greater promotions during Black Friday and Cyber Monday. But you must use my link which we'll post in the show notes. That makes me want to come back to the labs again. But for the listeners because they know I do use urine mycotoxin testing, I think there is clinical utility. I do both. And I think you have to find a provider who knows what they're doing that you click with. Right, who was able to help you? So I think there are different trains of thought for sure on this topic. And I think but I think there's utility in both in blood testing and urine mycotoxin testing. I do a question though. So what I have found, I would say the limitations of blood testing for me are when patients are on steroids. So I have patients who may come to me on 30 milligrams of prednisone and I feel like that's gonna skew their some of their blood tests. How do you approach that? Do you still run the labs? Do you not

Dr. Aaron Hartman 24:10

run the labs? No, I see the exact same thing. I'm not sure if you're seeing mom seeing where their adrenal issues are being treated with steroids. And it's like I takes me a year to like wean them off of it. Yeah. But they're they're being treated symptomatic of the thyroid. And so the game, tons of thyroid hormone put on board, and they come to me just totally crashed out because their adrenals are a mess. And they're on tons of thyroid and no one's addressing their CRS everything else? Yeah, your that's difficult. You know, I'm, you know, I know what I know, and I don't I don't know what I don't know, my my response to that is like, you know, I just kind of stick with the, you know, the symptoms, you know, the good news of the symptoms account for the 95% diagnosis, right. And the labs are kind of helping guides me to stuff I still do the labs. The reality is, is most of the patients that I have, you know, Washington say most almost all of them that needs symptom criteria to meet the lab criteria, about 80% of them fail to VCs them in my data, my client mine in my clinic is roughly equivalent to what Dr. Shoemaker saw is seen in his research.

I think he's got over 1000 patients at this stage. But you know, about 80% of people will be positive for Mark ons. So I haven't really had a hard time quantifying how Trium it gets a little tricky when you get positive Lyme testing back. And the question is, do they have chronic Lyme? Or is it their innate immune systems messed up and they can't clear the Lyme and so you have to treat that before you even dress. Ultimately, you have to individualize this for a patient. It's not just absolutely critical driven. It's not I do this way or that way. Or I do the functional medicine integrative you have to like look at the patient where they're coming from when my patients right now, this is blue, it blows my mind. Okay, she came to see me with adrenal fatigue and not upset with Madison's diagnosis. Addison's Okay, on hormones, diagnosis of type one diabetes, she had a positive God and by testing at the local university, crap style, just terrible, right. I diagnosed a CRS, I think or type one diabetes was type one and type two though things start treating that diagnose your sleep apnea, diagnosed or hypermobility. did all these things right when it came down from 10 to six, got got an offer prednisone retests or G antibody D again, it's normal, right?

And she's positive for all the CRS labs. She's still living in her moldy house moved, and it's just like a splint on mine. And she's doing so and she's had tons of reports of people making food for her to her sleep apnea, like all these kinds of things, now dressing with nutrients or hypermobility, but it just is just like crazy that she still was in a moldy house has not left and she's doing so. So well. You got to individualize it first. She can't. She can't afford to do it house. She's in a community with her own local Korea fake they're basically provide food for her and taking care of her. Yeah, great supports. It just reminded me how important those basic things are like support, and community. And she can still live in moldy house.

Dr. Stephanie Gray 27:07

She's made strides. She's made strides, yes, still in a moldy environment.

Dr. Aaron Hartman 27:10

So that's where that's where individualizing. Ultimately, we have these criteria. And we have these labs, but you got to ultimately see the person in front of you and take care of them as

Dr. Stephanie Gray 27:17

a person. Yeah, I want to stick on topic of labs for a moment, you mentioned see four has to be sent out to National Jewish and I would say the most well the second most frustrating part of treating Saras is getting labs to run the correct labs. If you're listening and you want some of these labs run, all of which I'll post in the show notes, all of which are listed in my book in chapter eight. It is important that you find a provider who knows where these labs need to be sent out to do you want to speak to that just for a minute?

Dr. Aaron Hartman 27:43

Well, the labs are kind of you know, we can talk about TGF beta for example, yeah, which can be easily contaminated with platelets, so you have to double spin it. And most labs don't double spin it um, if you're drawing in your office to C three, A and C four, you have to have a special freezer, that gets told below native 40 degrees. And you have to make sure it's shipped frozen on dry ice to where it's going in the way that the data is actually from. They do it differently at Jewish nationals quests sends all their stuff to Jewish nationals and LabCorp does theirs in house. And that's where it's important like how the processing it a lot people rely on a patient in Northern Virginia that I tried to order the stuff at at their local quests, they'd have drives there. And so that's I've kind of taken all things in house and like, you know, I'm drawn patients labs, I got the stuff in house to give the right way. It's just so so so hard, whether it's pletely contamination or whether it's the oil not being shipped on dry ice or whatever. It's a frustrating thing. And that's where I think things like the VCs, Mr. Cons and having other secondary markers. And you'll have to see these patients for a bunch of you kind of can smell them almost you kind of person. Yeah,

Dr. Stephanie Gray 28:46

let's go back to the only home for a moment. So let's say someone has a patient has come in to see you. They're meeting the criteria for the symptomatology. The labs are raging positive, let's say they have the gene even so what is the next step is are you having someone test their home for mold to see back to our conversation on if they have acute ongoing exposure? And if so, can you discuss the difference between like Urmi testing versus air testing? What's the difference in quality is can you speak to that for me?

Dr. Aaron Hartman 29:13

I can so the how it gets kind of tricky. This we could talk about this for an hour by itself or hour is actually your early testing, and hurt speed which actually hurts me too, which is the actual symptom. What is actually really, it's super accurate. It's looking for DNA in a home. So do you have that or me it hurts me too. It's if it's normal, your house is fine, right? The problem is, is you could have had a water damage event three, four years ago, and you've got these fine DNA particles and your furniture, the carpet and stuff like that. And the event is gone. But you still the small particles and the testing will be positive until you do a thorough cleaning.

That's a personal problem I've had and one of the reasons I've become an expert. This is a test of my own home and my own place to work. I know my house and I know my builders and I've learned all these things and it's really not I like the testing because it's if it's negative, it's great. But the problem is, is then like, what's the source? You know, because you can have like a Wally and he comes back and you say, made some duct work or if Stuckey boxers comes back and say, Hey, this, you know the W, which is the water index for the mold or like hire for that maybe got water sitting somewhere if it's your Aspergillus pestle, Ortiz or whatever it's like a little drier stuff. So start looking, you know, for other crawl space issues. The problem is that even when you do the testing, you still need someone, most people still need someone to tell them where it's at.

Dr. Stephanie Gray 30:25

Right? I want to get to that. But let's for a moment, let me go back so that the Urmi test environment relative mold index test that we're referring to is looking at 16 Different or 36 Different mold species through dust, this is a dust collection test. This is not an air test. This is a test, you order a cloth to ship to your home, you go around, wipe various surfaces. And again that like he said, The lab is analyzing the dust for organisms, the DNA of certain organisms. Is that right? Am I saying that right? Yes, yeah. Okay. So Urmi testing is different than air testing. And the standard, I would say is air testing. And what I find is that the large majority of air quality testing comes back find that it misses a lot of contaminated homes. Would you agree with that,

Dr. Aaron Hartman 31:08

with every sport in the air that they trap on a sport drop testing, there are 500 particulates. So what that means is that you have a low spore count still have lots of particulates if the word count is high, that absolutely have an issue. But the problem, like you said is you you might open just open the house, you just got fresh breeze through your house. And the spore counts low right. But the other thing to remember is what did that say initially 80% of CRS is not mold, it's the company mold keeps its actinomyces and endotoxins. And those tests do not take that into account. And that's we have to realize, as well as you can have a beautiful brand new house and amazing environment, you have an unencapsulated crawlspace. And so what happens is three to 4% of air in your house comes from your crawlspace. And so now you have these endotoxins actinomyces coming from the soil. And though you have no spores in your house, per se and you have no mold anywhere, you have a basic gassing from your soil. And that's why I think the air testing is hugely, hugely weak. Now, just because ultimately 80% of the CRS patients and the 80% of the mold is actually the endotoxins actinomyces, not the actual, it's the company mold keeps that's where these aircraft these testings are hugely, hugely weak, they don't take any of that into account.

Dr. Stephanie Gray 32:19

Thank you for clarifying that. Okay, so let's go back to what the direction you were then heading. So obviously patients can do air testing, they can do Urmi testing, if either finds mold, you know, then the question is, where's the mold? Or that? Where are those toxins coming from? And that's also frustrating with my patients, if they know they have had water damage in the master bathroom or in the kitchen or whatnot, right? They obviously look there, let's look there. But if there isn't any visible or known water damage, then the patients looking at me like what do I do? You know, where do I Where do I look? So how do you respond to that? How do you help your patients determine where they're,

Dr. Aaron Hartman 32:52

I think you you alluded to this, this is the practice right practice of medicine. And if I'm doing the exact same thing a year from now that I'm doing now, I haven't learned anything, right. And so I used to order lots of lots of meat tests on patients. And I've kind of gotten to a point that I work on getting them to have someone get an indoor air quality specialist to look at their house. And the reason is, is ultimate price point. You spent $500 on the testing, you spent a specialist you spend them 789 $100 To come out, it's about the same price range and so, no, so I've kind of gone more to actually get that 40 page report from an indoor air quality student IEP that actually looks at the air, he looked at the air handlers a lot people realize as well, you might have like na mo it might be your air handler, sitting your house from condensation in the coral, or when my patients actually when their house was made. Anyway, so they had many issues in the house. As you went up in the house up it went up not down. So say your relative humidity is 50%. Your first level in the summertime, it should be 40%. It should go up, go down to go up. Theirs went up. And so he was like this is kind of weird. He actually drilled a little hole under their staircase. They did not have the tight back wrap on their house. The wrap on their house was not put on it. How do you figure that out because he knew his stuff. And that was something that I noticed.

Dr. Stephanie Gray 34:05

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Dr. Aaron Hartman 35:38

I would just say you have to know your local environment. Like I've just tried and found a couple in local area you it's almost like whoever the practitioner you're working with, you kind of have to like say Who do you use, you know, or some like websites that have national people but ultimate like anything, there's a 20 rule, you know, a percent of work is done by 20% of people in specialist, you know, plumbers, any specialty, there's about 20% of the people in that specialty that are really good at what they do, and even less than a player's. And so there's a lot of mold inspectors that cut corners, they get the free inspection, right, you know, free this free that it's probably there's a reason why it's free, you know, so that's where it's best to Like, who do other people use. And so I originally had someone driving down from DC. So I'm in the Central Virginia Richmond area and eventually found a local person that would actually do the testing for my patients.

Dr. Stephanie Gray 36:24

That's great. That's what I need. Uh, hopefully, listeners are able to identify right where the water damages because the home needs to be appropriately remediated. It absolutely needs to be appropriately remediated. But aside from that, how do we treat these patients? So what what are kind of your step two, three, and fours? Like what? What are you doing for these patients?

Dr. Aaron Hartman 36:43

Right, first and foremost, you make the diagnosis, then you start just treating them, you know, in the best binder. I know, it's it's one of the controversial things, but the best binder to get these mold toxins out of your system. And then mold toxins are tricky because they have like a polar head and the nonpolar tail, which means they can float in and out between fat soluble water soluble compartments. And so it's really hard to get out your system. The Best Buy underneath these are bile binders, bile acid, sequester binders. So I start patients with Costantino well call if they tolerate it, I try to help their bio that's really issues with the immune system with the whole gene thing is they don't do a good job detoxifying these things the body was designed or made to take and put in bile and to read the bios, I started binders. It's really interesting. Some patients if they're really really sick, they will actually have an acceleration response which is a kind of cytokine response response.

Strangely enough, we've actually get a lot sicker on your colostomy that tells me that pretty sick, sometimes your your line patients as well will have acceleration response as well. So that's where we're using different binders, the buyers I use will help me figure out other nuances of their of their care. I started the binder if they if they got if they got more cons I start treating them our cons you know that's a nasal spray, you know, initially we're doing BG spray, then we went to BG then we went away from that EDTA and Colloidal Silver now I think most people are transitioning to straight EDTA which is a biofilm Buster, nasal spray work on the basics diet, you know, I also do you know, not just the old person and also I do a lot of other things I'm doing nutritional analysis on them and nutrient deficiencies they have. Some of these people are vitamin D deficient. So so many have low D levels because they're chronic inflammation and you got to get that up you know vitamin D helps translate that innate immune system response to an acquired or adaptive immune system responses. So what that means is if there d is low at the bottom have a hard time making antibodies, which is one of the issues with COVID Long COVID If your D is low, you have a hard time making antibodies and so I do nutritional analysis look at these things almost a quarter of patients with CRS how they an illness or sickness syndrome, it's a it's a trauma from their illness.

It's amazing how many of my patients who have trauma from the illness of the past that sets them up for this neuro inflammatory syndrome. So I don't just like talk about that the first visit but also make make notes on it. Right because a good percentage of our population six months eight months later we'll get some progress we get stuck it's like okay, let's look back at some trauma either from your illness or from your past you know, the mind body can really really huge in these patients by basically binders nasal stuff and now we just walked the stepwise process of the the triangle so to speak of treating these patients. There's also things like Masel activation syndrome hypermobility patients are hyper mobile is actually a gene one of the HLA Dr DQ genes actually associated hypermobility, it's associated with HPA damage, disease, you know, vaccine Gnosis and so I'll look for hypermobility my patients because they are hyper mobile. I know they need more collagen. I know they need more vitamin C and trace minerals.

So there's a lot of other nuances as I'm looking at these patients that I'll kind of ferret out but the basic The first thing is your binders your string your markup, if they've constipated guy get pooping. You know, some of the large patients that have like if you're like detoxification of these things, and you put it in the bile and gets reabsorbed because we're not pooping, then you got to poop, right? And so on. That's where fibers know things to help them poop and that's one of the downsides of cold styrene is it can be constipating. And so Sometimes there's balancing how patients respond to everything. That's where this all becomes individualized care. Sure,

Dr. Stephanie Gray 40:07

and how long? I feel like this isn't even a good question, but I'm still gonna ask it. How long does it take for some of these sick patients to start feeling better?

Dr. Aaron Hartman 40:14

It really depends. Yeah, I've had some patients that treated the mark cons, they made them like night and day. I've had some patients that I want things to do as well, based on some of them. Dr. Patricia Kane's research, she's the big lipid person is Lipitor, yes, yes. Also calling ox bile. That Tub Cut helps burn off on these lipid wraps that are part of this whole inflammatory syndrome actually burns or chars your cell membranes using lipids. I've had some patients who couldn't tolerate Colas tyramine, who could tolerate the nasal spray dyes focused on lipid therapy, which helped the liver detoxify, and also helped change out the fascial choline. And their same thing as allies, people that the sympathetic overdrive, right, it's fight or flight response, which I'm sure you see as patients and proving phosphorylcholine actually helps you balance that parasympathetic sympathetic balance, but just by giving them PC. And so I just kind of walk people through this.

Dr. Stephanie Gray 41:01

And then when you're saying lipid therapy, just for the listeners, he's talking about phospho lipids, right, so think phospho, tidal, choline, is that something you're giving orally? Are you giving it IV? How are you dosing that

Dr. Aaron Hartman 41:13

I started early, I don't IV is really expensive. And so I usually reserved that for patients who like you know, can't do anything else. I'm really getting early, I'm doing balanced omega threes and Omega sixes, you basically, basically they need an oil change, you replace their their lipids, and it's a process. They're mostly using a lot of butyrate. It's they're seeing how much butyrate helps your gut makes butyrate This is gut brain connection. And your gut makes butyrate which helps clean off your cell membranes. And so all these people because their gut issues to start making butyrate and then the teken ox bile are basically things your body makes and puts in bile that actually help scrub off your cell membranes. So I'll use that as part of lipid therapy. Sometimes we'll add module care ones will add other anti inflammatory things

Dr. Stephanie Gray 41:54

LDN was yeah, we started talking about that before we were recording please mention Yeah, LDN LD has another

Dr. Aaron Hartman 41:59

another kind of thing that I started people in earlier and earlier earlier. Now it's an immune modulator helps bounce a th one th to help them through natural killer cells. Most these patients have blue natural killer cells. If SIBO how many patients do you see up SIBO? Yeah, but Tilty issues, you know, LDN helps with that. And it also interesting, you mentioned the chronic fatigue and fiber, I guess, before we started recording, but I'll use a lot LD on those patients because that that effect of lowering that neuro inflammatory process, the brain on fire process LDN just helps with so many things. It's a super, super, super safe on prescription medication. The biggest issue I've had with LDN is just people it helps sometimes affects their sleep. And sometimes people get anxious about it. But if people take either earlier in the day, we've been micro dosing, I should be doing micro dosing, micro dosing where they were like 1.5, even topical, because they can't tolerate the oral. So again, it's this is all the art this is all the art of this, these kind of complex patients,

Dr. Stephanie Gray 42:52

lots of lots of nuances. As you mentioned, another one I want to get to is EMF, so how do EMFs affect sirs?

Dr. Aaron Hartman 43:00

Okay, so the way I think about EMF, so we're all exposed the maps all the time, you know, your car, your cell phone, they're, they're everywhere. When you when your brains on fire, if you have a pinched nerve, or the neck or your back, like all of a sudden, like I remember I did this my neck, I could feel the pebbles on the road for the steering wheel, I could really feel the vibrations of the road. It was like, Oh my gosh, this is no wonder people are so miserable, right? This is so crazy. Oh, my brain, my skin is buzzing a little twinge in my neck. And the way I kind of compare that is like when you when your brain is on fire, you're now reacting with electromagnetic fields, you know that not every patient is that sick, not every CRS patients that sick, but there's a subgroup that are so bad off that fluorescent lights bother them cellphones bother them, computers bother them. And so that grouping is really difficult because of that degree of neuro inflammation.

That's also a group that a lot of the trauma therapy, whether DNRs can be helpful by therapy, cranial sacral work can be helpful, because that's what I kind of use all my integrative tools with those patients because they're so on fire. And I like I can't give you Goldstein, I can't give LDN you're still on fire came to my office half the time, right? It's like, how can we work on that, that just your brain is so on fire that you're literally reacting to emf in your environments. That's those patients are super tricky. It's all a small subset of my population. But yeah, it is a when people have those issues, it is difficult. And to date, they've already had Lyme mold, something like that going on, and we've had to address to help with all that sensitivity.

Dr. Stephanie Gray 44:25

Yep. Last few questions here. I do want to talk a little bit about long COVID or post COVID syndrome, because that is also something you specialize in. And so before we started recording today, we talked a little bit about I was just asking your professional opinion on if you felt like COVID are patients who had long COVID In these situations if some other underlying issues were kind of being revealed with these cases. And and you said absolutely, yes. So do you want to talk a little bit about how functional medicine practitioners are kind of set up to be able to better help these patients and then what you have found in these long COVID cases

Dr. Aaron Hartman 44:56

up so that's a great point like when this all started last year, it was just interesting to see like how infection create a cytokine response in this post infectious inflammatory syndrome sounds a lot like chronic Lyme, or post mono chronic fatigue and Fibro or CMV it's something a lot of things in the functional world we've been dealing with for decades. Right, right. So as the research start coming out and showing D and see and while he sings, you know, um, air quality, there was interesting data came out last summer showing the about micro particulates in the air, air quality affects your risk of severe COVID. Wasting air quality, didn't we just talk about air quality? Mold, right? It's all of a sudden, that's a functional medicine doctor, I was already connecting these dots, you know, last April, May. So as I started seeing these patients, I started saying, Well, okay, how many of you have mold exposure? How many of your hyper mobile you have, it's really interesting, I was talking with this one on lady online and some chat room, and I was talking about long COVID. And I described SIBO, which is small intestinal bacterial overgrowth.

And she was a long COVID patient, she like, oh, my gosh, I've had this for 20 years. No one's ever told this to me before. And she was working with, you know, a non natural kind of health practitioner, and she had this for 20 years. And so, so what I'm seeing with a lot of patients, as are people had something going on, you know that the primary nutritional deficiency is vitamin D, which I think everybody knows, at this stage, zinc, a whole bunch of trace minerals, deficiencies, but there's also all the mold stuff, you know, I've had a number of long COVID patients who were living in a moldy house that are hyper mobile, and actually, the COVID calls their CRS, there wasn't a tick bite. It wasn't concoction or mold. It was actually the setup was these things, but the trigger was the COVID. And something I haven't mentioned yet, sleep apnea, I'm seeing a lot of long COVID slender females athletic looks healthy look, great, yada, yada, long, slender face sees a look in the mouth, I see a narrow dental arch arch palate, I see some grinding the teeth, maybe some Torah in their mouth. I'm like, interesting. These are the facial stigmata of sleep apnea.

But you're right, you were healthy. They always patients. Also for sleep apnea, all mission now to find one of this to find someone with long COVID, who was a slender female not have sleep apnea failed today. And that's something else that I this whole thing applies of just how common and how to diagnose Sleep apnea is I used to only do sleep apnea testing on my post stroke or AFib patients or, you know, but now all my long coma patients, I'm getting them sleep apnea testing, and together about 89 Positive. So when someone says they were healthy and got long COVID My question is, show me because I've not seen one of those patients yet. They've all had something under undiagnosed on seeing. And when your healthcare model that deals with only acute issues, not chronic issues, you're healthy, but you come to the functional medicine world where we looked at recalls, we look at maximizing health all of a sudden, a little bit of sleep apnea, a little bit of I'm D deficiency a little bit I'm old. Yeah, I'll see. You that up and these people are getting get COVID and they develop welcome in

Dr. Stephanie Gray 47:52

very interesting. You've given us so much to think about today. I always conclude every episode with asking my guest their top longevity tip. So if you had to pick one, what would your top longevity Tip Be?

Dr. Aaron Hartman 48:04

Oh, man, this this has actually changed in the last couple of weeks. By Top longevity tip is interesting. Read all about peptides. I'm not sure if you do peptides.

Dr. Stephanie Gray 48:14

I would have loved to talk to you about them today. But I know our time was limited. A lot of

Dr. Aaron Hartman 48:18

cool things. You look at curcumin or fish oil or all these things are trying to replicate what exercise and fasting do and truly interesting to start diving into how exercise creates muscle induced anti inflammatory muscle induced growth factors. How fasting actually helps your liver detoxify better how fasting actually changes your microbiome, they can help treat your SIBO it's amazing how a lot of these things are trying to represent reproduce what exercise and animal and fasting do automatically. And so if you'd asked me this question, a month ago, I said lipids and talk about lipids and lipid membranes and how amazing lipids are. And now I'm just like, You know what, I've kind of coming full circle back to like the basics again, like, you know, fasting exercise, a lot of these things we do to try to biohack people and do things. We're just trying to replicate what these things that people have done for 1000s of years I've been doing so I can talk about lipids how love lipids and I'll do lipid therapy and how amazing they are.

But you know, I would have said that a month ago now just say no one. Interval fasting and exercise are absolutely amazing as far as what they do for longevity, cancer reduction for my diabetics, I'm trying to get most my diabetics now in fact, I've had them drop the Raven see Dr. Williams, tell me about it. We'll fast as a part of the way we got an agency from 10 to six, you know, a period of two or three months sure, you know, just incredible that just It's just amazing how that affects Grella levels affects leptin levels which is the hormonal aspect of hormones and obesity how affects your growth factors, how affects Msh you know how to fix your gut you know, people feed their GI tract all day night long. You need to rest your GI tract. If you look at the anatomy delivered like the there's two things there's the hepatic artery from the GI tract goes and deliver.

There's the hepatic artery Your liver is supposed to filter your blood and then your GI tract, right? Well, if your liver is being fed all day long and only rest eight hours at night, it can't focus on filtering your blood, which is what it's supposed to do. When you go to bed fasting at night, you know, about eight to 10 to eight to 12 hours in. That is a simple thing to do that can actually massively impact the livers ability to do its job while you're sleeping. So that'd be my second exercise. So crazy simple and so basic. Anybody can do it. And I can give you tons of cool supplements and do your peptides and do your CJC Knepper, Merlin and all that kind of BPC. 157, all kinds of cool stuff. I'm just trying to do an exercise of fasting dude.

Dr. Stephanie Gray 50:35

Yeah, love it, love it, love it. Well tell us where listeners can find you where your practice is, and then what your free gift is, as well.

Dr. Aaron Hartman 50:42

There's one more information on my websites, Richmond functional medicine comm. We've got a whole educational platform there. We've actually have a community we've created, where people can come and be a part of my team. We have like courses we offer within the community. We have health coaching within the community as well. And then also the free gift is just basically in my roadmap to resilience. It's actually something I put together during COVID Realize resilience was like the big deal, which resilience is ultimately the foundations of functional medicine, right? So he bought for patients to kind of prefer for people like walk through the foundational thing is because the foundations are still the foundation, we can do all these cool things that we talked about. If you're not doing the basic stuff, all the fancy stuff doesn't quite work as well. So I got that that ebook as well.

Dr. Stephanie Gray 51:21

Awesome. Thank you so much. Well, thank you for coming on the show today and sharing all about a topic. I wanted my audience to hear more about sirs. And I hope the audience connects with you and checks out your free gift. So thanks. Thanks again for coming on the show.

Dr. Aaron Hartman 51:33

Thanks for having me. It's been great really enjoyed.

Dr. Stephanie Gray 51:44

That interview was exactly what I was hoping it would be Dr. Hartman shared many nuances of chronic inflammatory response syndrome. This is a very complex topic and one we could have talked for another hour about. So if this is something you think you could have, please find a provider like Dr. Hartman or myself who can help run the correct labs on you and get you the help you need. Be sure to check out my book your longevity blueprint. And if you aren't much of a reader, you're in luck. You can now take my course online where I walk you through each chapter in the book plus for a limited time the course is 50% off. Check this offer out at your longevity blueprint calm and click the Course tab. One of the biggest things you can do to support the show and help us reach more listeners is to subscribe to the show. Leave us a rating and review on Apple podcasts or wherever you listen. I do read all the reviews and would truly love to hear your suggestions for show topics guests and for how you're applying what you learn on the show to create your own longevity blueprint. The podcast is produced by the team at counterweight creative as always, thank you so much for listening and remember, wellness is waiting.

The information provided in this podcast is educational. No information provided should be considered to be or used as a substitute for medical advice, diagnosis or treatment. Always consult with your personal medical authority.

Transcribed by https://otter.ai