 everybody we are live with Dr. Jeanette Hope and Dr. Hope doesn't necessarily know this but I've been a fan of hers for quite some years. She's just a leader in this field and I've always just admired she's been someone on the cutting edge of just writing research and actually getting things published which we really need to advance the topic of mold and environmental toxicity and we're going to dive in today to some of those topics which you know I love to talk about and I'm so excited to have her on. She's just a gem of a person and really has been involved in so many levels in this field so you will get to hear her expertise. Before we get started I just want to remind you that if you want other resources you can always go to my free blog on the website just my name JillCarnahan.com there's weekly all free stuff on there for you about mold and environmental toxicity and be sure and sign up for my newsletter while you're there and then we have a brand new free YouTube channel with videos like this it's just in the YouTube and you search my name and you'll find that channel so go there to find other videos as well. So today I want to introduce my friend Dr. Jeanette Hope. I'll give you just a little background and then I will ask her to tell her story which is always fun to hear. She's like me she's a family medicine background so she's board certified in family practice and completed training and certification to become a diplomat in the field of environmental medicine and she has a certificate through the American Board of Environmental Medicine which you also served as president is that correct? Yes that is correct and then the American Board of Integrative Medicine like myself 2016 I think we did the same year maybe that I think of the first year they actually became the official board through the AMA. She's also a fellow through the American Academy of Environmental Medicine since 2012 and she graduated from the University of Hawaii in 1995 and earned honors and I love that she has that background in family medicine because I do as well and it just what's neat is we got this really great basic training I'm sure you delivered babies like I did in the beginning yeah so we did all of it and what's great now is I usually treat patients above too but I know how to treat infants too and I treat all ages there's just great pediatricians that do holistic medicine so I tend to give the you know zero to two years old to one of them who does a great job but I love having families especially with environment because often their whole house is affected and then the mother and the son and the daughter and everybody and we can treat them and we know the genetic patterns and stuff so that's really fun to share so welcome Dr. Hope I'm so glad to have you here. Yeah yeah so I you want me to yeah so how I got this field or yeah so I always love to start story because I really think that frames like people don't really care how much you know until they know how much you care and a lot of times that comes from where we've been in our own journey so I'd love you to start on just telling us your kind of journey into environmental medicine from family medicine. Yeah absolutely so yes I did my residency at Santa Monica UCLA and was practicing general family medicine for first let's see 10 years or so and I would probably the one thing that I had the hardest time with were the patients that I knew something was going on and I didn't have the tools to figure it out I believe them I listened and and I you know didn't just prescribe the antidepressant unless it was appropriate but you know I was I was listening I wasn't and and then in 2005 I started to get sick as did many family members and for me it was sort of dramatic in the sense that I had a fever every day of 101 to 102 which is not typical I found out that that's actually not typical but that combination of what was going on in our house in my immune system did that so that sent me on a journey of many many specialists and countless tests including way too many CT scans and other you know imaging studies that involved additional exposures so this went on for about 10 months there was there were two hospitalizations actually and had I forget it was eight organs biopsied everything wow to esophagus to bone marrow and everything was abnormal with you know some inflammation they would see you know abnormalities at that point it was even severe esophagitis even a ferrous diagnosis and I but we couldn't figure it out you know we knew something was wrong and along with the fevers I you know ended up experiencing symptoms in practically every part of my body so I saw specialists of all types and and in the process of looking for this at the time with the knowledge that we had we were pursuing the things that we knew including you know weird infections and cancer and you know just that's what you know we were looking for and then it became clear that some other family members were having some problems including our young daughter at the time who got a pneumonia and and and you know that was and then she would also get fevers that were kind of unexplained so I guess as the universe kind of works there'd be people here or there that had thrown out mold you know they talk about physician families actually locally even and you know they throw it it's like yeah I was really starting to suspect something environmental but I still didn't have mold on the brain you know I thought maybe we put in some flooring and you know what and then there was the day that I come back from a trip and didn't they really think about it it was a conference in san francisco and came in the house and practically immediately got a bad headache and it was later that day that I was in a room and something smelled a little off and I moved a bookshelf and we saw a black spot behind that bookshelf that was really hidden and in our case all of the mold was hidden because it was all trapped in the walls the balconies hadn't been put on properly and it was you know kind of pretty close to an envelope of stackey botrists which could be why had such a severe reaction and I also had spent the most time in moldy environments because my workplace was moldy as well so I I really got very little break other family members at least got breaks you know going to work in school so um so that was we happened to have on our bookshelf a book written by our co-authored by Eric Elliott I don't know if you're familiar with that book prescriptions for healthy house we'd had a neighbor when we lived in Hawaii who had gotten sick from mold and she'd given us that book and it was on our shelf we hadn't thought much about it and we were able to get into Eric Elliott that week it was our daughter spring break and that's sort of where my you know education and environmental medicine started really it was to try and help my family and myself so I had no idea how much was out there this was not anything we were taught um beyond you know if somebody had a rash you'd ask about shampoos or something I mean that was about all you know we would we were trained with an environmental medicine so I started attending any conference I could find and you know sort of went through the process that you described of getting additional training wow that is such a story because it highlights so many things that um we're both conventionally trained and I love that because I feel like I have a great science-based foundation like you and the very best of conventional medicine but our toolbox is now bigger and I love that because it's not that we're not I don't even ever or like the term alternative I never use it I don't consider myself alternative it's not true we are like the best of conventional plus more tools but what happened is both of us we were trained in conventional allopathic medicine which is a great foundation um but there wasn't a lot of training about this innate immune response that you're describing um we were taught about mold allergy and that's about the extent of it and even that was probably like mentioned in passing in a class um so what's what you're describing is so real to all of us and what I also love is um somehow the divine or the universe was which we were chosen in a way because I always say I didn't choose mold I would have never picked this complicated but a topic to know and understand and help patients but it chose me right and it chose you because we had to survive to I mean in order to survive and save our family and um those that we loved we had to learn about it so so interesting now what's really interesting to me is um I look back and of course my big exposure was 2015 in an office that was moldy with starchy batteries very similar but then like you I look back you mentioned Hawaii I wonder if there was previous priming events of exposures over the years prior to get my immune system and what's interesting to me when I hear your hear your story is when I presented with Crohn's disease in 2002 right after my cancer the only symptom I presented with was a cyclical fever is exactly like you described and they were like one of one they were like the hot they weren't like a 995 and I always wonder in the hindsight if there had been some mold in relation to that diagnosis of Crohn's because we know that with mold can lower msh and msh is critical for tight junctions and we actually see some models and animals um of an induction of inflammatory bowel disease from mold exposure so it's very interesting to me I have no idea but those fevers are something I've never heard anyone else besides you and I like present with the fevers um in part of it and and what happens in conventional medicine they call it fever of undone origin they don't know where it comes right yeah so they try to see everything they x-ray everything they see oh and here was in your house right like um wow some of the fevers so then you started to give so you probably obviously had to remediate tell me a little bit about the beginning of your journey to get well how did that go for you yeah so it started with a trip to new Mexico with I then six-year-old daughter to see Dr. Erica Elliott because she you know was the person I knew she was able to get us in and that was awesome and learned so much from her and um already you know when you first get out of a moldy environment some symptoms lift quickly and but but it takes a while to really restore everything that's you know been thrown off nutritionally and you know the inflammation and everything so it was very clear that getting out was the right thing and it was it was a huge relief actually because you know I had been down this path that was getting worse and worse and we were about at the point where I'd gone to see a sarcoidosis specialist a USC very very kind man and um because of uh there were pulmonary nodules and eye symptoms and he concluded I didn't have um uh sarcoidosis but I likely had chronic fatigue syndrome and I should just apply for disability and you know pretty well that was it you know he he shared his wife had that too and he was very kind and that was that was great except it didn't ring true to me it didn't make sense that I was who I was before uh which was healthy and very active and then all at once you know a switch flipped and you know now I uh you know was going to sort of check out uh of being able to be healthy and and work in function and um and I didn't have the answer yet but I I knew that that although clinically I would have met the criteria for that nobody was really talking about looking for causes and that's the part that didn't ring true for me you know I appreciated that you know someone could understand how profoundly fatigued and sick you feel but I it just wasn't it wasn't over yet I you know that wasn't the answer I I couldn't just accept that something would come out of nowhere and just floor me for the rest of my life um so that part you know so we kept looking my husband's a physician as well and so we would research everything and you know and talk to the doctors and um and you know I always say I was very fortunate that doctors took me seriously medically because I had a you know a very clear objective symptom which was a fever that could be measured so um there was no dismissing it or you know sending to psychiatrist or anything however that put me through a lot of medical tests um and a lot of radiation and you know so it's um you know a lot of folks are really really discouraged because they've been dismissed and insulted and you know it always amazes me how nervous they are when they come in to see me and I feel like you know I'm not a scary person but you know I think just the act of having to go to a doctor and tell your story again and you know and then have to see you know what you know what they're gonna say you know you can you probably experience that as well they've been traumatized by you know sort of going through the medical system and so that was interesting so yeah in um in my case I just wanted to mention uh one of the last biopsies I got was when there was a skin lesion that had kind of popped up a weird looking nothing very exciting but we were fishing for answers and they biopsied and they saw leukocytoplastic vasculitis which is kind of a you know could be caused by a number of things um uh some meds but nothing that you know I had been on and um so that was kind of a clue that something was going on but what was interesting about that is a few years later I sent that tissue for mycotoxin analysis and it was I think the ochrotoxin level was 18 parts you know and the um and then there was aflatoxin in that lesion as well so that wasn't after the fact thing but it was kind of interesting so so fascinating because that's part of the problem is our testing and a diagnosis now we know you and I know how to make a diagnosis and it starts with clinical history and like your story of this environment and then being you know better out of that and that that's where it starts asking the right questions and then we can do visual contrast we can do um you know just symptom analysis and then we can go into the testing um and then we can talk a little bit about like how you approach it um but what's interesting is a lot of the labs I used for an innate immune system I was never taught those um in medical school either so yeah we've gotten a lot more information now because if you do a normal um chem panel with the liver the kidney a lot of times now that can be abnormal it can affect the liver but a lot of times those basic labs even inflammatory labs like CRP or ESR are totally normal in these patients and yet they're very very sick so it's a like a different pathway that we're looking at it's not common um now interesting do you have any um hypothesis about the fever and about I mean I know trichocythings can affect immune system and cytokine so I'm guessing you had an actually overactive kind of cytokine response but what are your thoughts about that fever and how it relates? I I've always wondered about endotoxins being significant in the mix because you know when you have water damage buildings um we focus a lot on molds and mycotoxins because you know through um you know the animal and you know agriculture literature we know a lot about mycotoxins and how toxic they are so that's always a focus but you know I always go back to some of the writings of Jack Thrasher and Kay Kilburn and they would talk about all the elements in a water damage building as did the World Health Organization report so um so you know what we definitely know is that man is not meant to live in wet moist indoor environments um and when you're in those uh any number of things go wrong with the building and with your health so um but the fever pattern made me think of endotoxins and we had had another interesting thing um with that after we'd moved and we were working with the remediator and and the entire home was gutted pretty well taking the studs and you know really extensive remediation um but there was a piece of sort of a beautiful antique dresser that he had assured us had been cleaned inside and out would be brought it into the home uh where we had been doing well that night um I woke up but you know I sweated all night I woke up feeling drunk and our six-year-old daughter had spiked the 104 and a half fever and we figured it out it was very easy you got a little bit of fresh air you know I got some fresh air she was you know I think she was you know in soccer practice that afternoon I mean this was not a flu or an illness it was just an immune response to something we had become very sensitized to and it was in that case it's because the inside of the drawers were not sealed would yeah yeah so um okay permitted I share that lesson because you know people always ask what can I bring and you know the the honest answer is we don't really know what you can bring or tolerate but what we know you know what I tell people is nobody has ever come back regretting bringing too little into their new environment you know a lot of people have you know regretted bringing too much so um and that was you know very fortunate because we had only introduced one item and um we had a very impressive reaction that resolved by removing that item so um so that's you know that the immune system is complicated I mean it is and it will kind of if we're listening and like you said sometimes there's so many variables I love that you bring that up because I walk such a careful line I don't want to be the doctor says oh my gosh you have to leave your house 100% of the time and you have to be rid of everything because that's just not true but things like mattresses that you sleep on I'm pretty adamant about yeah you know what it's a few thousand dollars but you're sleeping on that for eight hours I don't want you to take that risk and books papers mementos um we don't know for sure but I always say store them because you can always pull them back into your environment but you and I both have those experiences where patients don't get well because they hang on to things that could be contaminating their environment it's so hard because you don't want to be that person who says number one you have to leave your house because not everybody does and number two you have to get rid of all your things because not everybody does but that's a real example I had the same with my medical textbooks 20 years of you know 15 years of a library I love books so that was really hard but I had to store them and when I opened up the ben immediately I had horrible symptoms headache and rashes and things so I knew that those were contaminated I have had since then some special remediators say there's some ways that you can clean paper I don't know I mean ozone they say some of those I haven't found a consistently great way to clean porous items like paper I don't know about you but I don't think there is my husband was the first to kind of go through that because he really enjoyed books yeah you know this was you know this was 2006 that we discovered the problem and but he had looked into options then and he concluded you know wasn't going to work there's been a study since then that I referred to a lot the Scandinavian remediation article it's referenced in my papers and it's available online but they tested they deliberately contaminated materials with aspergillus and stachyboterus and tested all the normal things to see if it would kill the mold and destroy the mycotoxins and nothing adequately did both even I was surprised because I always thought mold is pretty easy to kill but the problem is the chemical mycotoxins have now been created but nothing worked the the best was boric acid and ammonia but that still wasn't great so whenever I hear these stories of you know you're going to wipe it down with this or you're going to you know you might be able to wipe it down to a level that you will tolerate I don't know the answer to that but you know it's not going to remove everything but what you say is very important because you do not want to create people who are afraid of everything you want to empower them to have a problem solving approach you know our problem solving brain is much better than our panicked brain and we really cannot help be panicked when this first happens both I think there are effects of the toxins but also just all at once you know everything you've ever thought about life and you know safety and security at home or at work you know is now shot and and so it's a very tense time and I think if you can coach people through the initial process in a rational calm problem solving way it's much better for healing because if we're in crisis that's all our body can do is kind of stay there you know it can't really relax and heal and I totally agree about the bedroom that's really a healing place and that's the place to keep really clean you know sometimes people are moving to places with more than one room and if they can you know shut the sanctuary yeah have their sanctuary and maybe have their iffy room yeah yeah like a garage you can always put stuff in the garage if you are concerned and so I love that because again I oh totally agree with what you've said my that's my experience too that part of why I got well was I really got rid of the porous materials not again not everybody has to but I think that there's there's a spectrum of vulnerability that we see and we see this with chemicals and other environmental toxins and you and I are probably a little bit more the canaries that are slightly more sensitive than average and then most of our patients are as well but there's a whole range and so depending on the sensitivity and even the mass cell activation and some of these other things that are playing into this or the limbic system they all play into the reactivity some people can't even tolerate the slightest twinge of exposure and the sad thing is we live in a world that there's mold indoors and outdoors and certainly because of some of the fungicides that have been used in things we actually have a lot more toxicity now indoors than we used to because we're having off-gassing you know maybe I'll ask you to talk a little because you are an environmental toxin expert what are some of the other things that could be in the environment besides mold and the water damage slew of toxic soup there's also VOCs from building materials and other things what else do you coach your patients on avoiding or being cautious about in their home well the VOCs are a biggie because I don't know if you've had patients like this but patient who's gotten sick from a moldy home is now determined to not have that problem again so they find the absolute newest you know freshest home they can find that is off-gassing and so then they're in a non moldy home that is off-gassing from alvehi and other VOCs and they're not feeling great they may have a different set of symptoms a lot of times respiratory symptoms and so that's really the hard part you know it's the the million dollar question is how do I know this next place is safe and the answer is you will not know for sure however this is I think also maybe similar to how you coach your patients but that first environment that really got you your immune system had quite a bit of time to really like respond to that sort of stew of things in that environment so it's got a hair trigger for that you know we talk similar to a peanut allergy even though the mechanism is a little different but so even a little like that dresser that you know we weren't even that close to you know you don't you just open it once in a while that was enough at that time for our immune system to really overreact and so you know as a general rule making as clean a break as you can the first time while not making any permanent decisions while you're in stress you know but just taking these things out of your breathing living space until you can sort it out and and then after that it's very rare that you're going to have to you know avoid materials even if you get another exposure because it you know and I look back on that too you know I've gone traveled all over the place and I haven't thrown anything out or you know since that first exposure so if you keep doing that then it's very stressful it's just very stressful if you're you never feel safe so you know you really have to balance that reality that the immune system is very very sensitized initially and that you know getting away from that and treating you know for at first the sensitivity increases yes you know for somewhere six months to a year I remember you know wanting to live on Santa Cruz Island or anywhere just get away with everything because you're really really wired to respond to just about everything but that improves you know in time and so you it's you know you just have to give people the confidence to you know know that this is real and their immune system is reacting but that also sometimes it could react just sort of like oh this could be bad you know and then it seems to calm down too so you know if you chase every reaction and every feeling that keeps you out of getting in a more relaxed state that's more conducive to healing gosh I really appreciate you mentioning that because I always describe it as my simplistic way of thinking of it but it's almost like our buckets our toxic load is like a bucket that we're born with and some of us have a smaller capacity to detox because of genetic polymorphisms and things just some genetic variants and because of that then our bucket starts to fill up and you and I both had an experience where we got sick because our bucket started to fill and overflow to manifest and symptoms brain fog fatigue for you the fevers and all of the other skin rashes irritation all the other stuff and so then as we start to find out that's the issue and we get out of the environment we start to detoxify and next we'll talk about what kinds of things you do for patients who are in their detox but you're doing that stuff and then your bucket level of water is going down and when you start to give that margin back that's when you can start to heal but you also I've heard the term unmasking where you in that beginning like you said six months or so super common to be hypersensitive and extrasensitive and I was like you I actually had a lot of trouble that first year and now I travel well used to before COVID but I traveled all over and lots of times in moldy places and I would just take some charcoal and maybe fill a little down for a few hours but no big deal it didn't take off my course at all and I knew like you what to do to get me back on track really quickly like binders or glutathione so how do you start with patients say they have a moldy environment they've moved or mediated and they're in a more safe place what would be some of your very basic things that you would do to help them get well so the initial thing yes they're in a new place and it's you know what would I look for is good enough to heal yeah because you know perfect is you know you're not going to find perfect and you know a place where when there's not fires or outdoor problems that they can spend time outdoors and depending on you know how sick they are when they they come in you can you know adjust what you're what you do initially but if somebody was sick but able to do treatments the things I would do would be binders usually usually charcoals enough but you know you can certainly add in colostyramine clay things you know if they need more binders I really really encourage and spend a lot of time coaching people through getting a liposomal glutathione on board because yes there can be detox reactions but you know like with all of us if we expect something it is much easier to take than you know if we don't expect it so I probably over emphasize that you know so that when it happens and it doesn't happen to everybody some people can you know get the glutathione going and just get better without ever getting that but a lot of people they're just so backed up that you know even a little bit all at once you've got this you know flood release of toxin you know mainly into the gut which is why the binders are such a big deal so you know having the binders for me twice a day is enough for binders four times is how many people could do anything four times exactly just not gonna happen but the difference between once and twice a day is a biggie you know I found that the actual dose of the binder is less important than getting it twice a day so so then the liposomal glutathione then if there's you know nasal and sinus symptoms or cognitive symptoms I'll encourage nasal glutathione because that you know if you lay with your head back you know that least all the evidence is that gets into the brain and it also helps with the nasal and sinus symptoms and then for some people a nasal antithungal like a nasal intraconazole because you know as one of my mentors Dr. Alan McDaniel said it's like being allergic to cats and having cat hair in your nose you know it's not invading it's not doing anything but your immune system is just constantly you know wanting to fight that and so if you can you know ramp that down then that can help too you know skin lies since you're going to be trying to get people sweating more charcoal soap can be helpful because you know they're just sweating more out and you know a lot of people get skin irritation initially when they detox so helping with that can help sometimes there's rashes that are kind of unclear and using the ketoconazole like a two percent shampoo as a body wash in the shower where you just leave it on about 90 seconds can help with that and it's very obvious if it helps it helps they can stop they can go back on it and then there's like the lifestyle things that are important and that is initially depending on where a person is they're fatigued they're mitochondrial not at peak form you kind of gauge you know what they can do without causing post exertional malaise and but everybody needs to move because our venous and limb system do not have a pump they rely on musculoskeletal activity so i um you know i find a way of you know getting them to move stretch bounce on a rebounder you know whatever it takes initially to do that uh sauna you know since public saunas are probably not going to be a thing for the foreseeable future i've been encouraging people to get um you know there's there's a good one that's um that's fairly inexpensive and plugs into a regular outlet and works really well so saunas are biggie um so that you know at this point um that was even what dr elliott uh told me at the beginning she had a sauna in her office and i you know asked her what it was and she thought that would be probably one of the most effective and cost effective treatments it could do and and that was true i did a lot a lot of sauna initially and i still do it but not as much because they also can sweat from sports so yes but um and you know things like that epsom salt baths if if they can do that diet i kind of focus on a few biggies if people you know because this is such a bummer and you're so restricted anyway so if you really really restrict the diet extremely then you know the people who have to do that already know they have to do that you know it's because they've reacted to things and then you can find things they might react to on testing but uh gluten and dairy are kind of biggies that are probably worth a try you know to to stay off of and then i actually encourage fermented foods for those who can tolerate it because we know that those foods are alive and it's the way our ancestors got probiotic you know it's just that you know it's it's just a good way to get the probiotics and then you work on trying to correct some of the nutritional deficiencies that have just built up over time like magnesium b vitamin supported this almost everybody needs that um the even you know injections of b12 like amount of b12 injection because um orally or sublingual doesn't work as well and you just kind of you know work through that vitamin d saying fish oil some coq tet you know whatever they need and and you understand that some things you're going to feel a result from really quick like a methyl b12 shot if you're going to feel it other things like magnesium are just long term players kind of probably forever players to some degree you know that you're just going to need and they will take a while to build back so um you know a general approach that um uh you know works for the majority of people and you know that of course you have some people who have you know different problems they have to address what a great i mean that's a fantastic overview and i agree on all points and a couple things i just want to mention you and i both agree that the sinuses can be a reservoir not all docs do but i have found um a lot of the patients who've come to me and had some old treatment have never addressed this biofilm and this reservoir and not everybody is colonized but some people are and like you mentioned it's just this irritant that's possibly there and it's pretty darn close to the brain so you you know it's a really good thing like you said i often use antifungals sometimes i'll even use like over the counter gsc nasal spray which is a great film yeah exactly exactly and then also gsc ointment is awesome for the skin oh that's a great that's very heavy any impati goi looking thing or skin even fungoli looking thing yeah that's it and i love your ketoconazole topical i've done some topical lamacil same thing um uh for the antifungal effect on the skin and then like you said the glutathound one little pearl that's interesting because i was one of those as well that didn't tolerate the glutathound very well in the beginning so a couple things uh related to that first of all your glutathound is depleted with mold exposure that's one of the things mold does is just tank the whole detox system so you are going to be deficient when you have a mold exposure you need that if in the beginning you don't tolerate you can do precursors like nac vitamin c glycine glutamine sometimes those will be enough to get you started and then like you said dr hope the small doses sometimes just minuscule pumps or pinches or whatever to get you going but the other thing um and if you haven't seen my um video with dr bob miller most recently i don't know what episode but we talked about nad ph being depleted in the process of treating aspergillus and mold toxicity and so one of the things and that is a key for recycling glutathound from the oxidized from the reduced to oxidized form and so because of that sometimes giving a little bit of nad um can help that glutathound be better tolerated especially as people get into the detox and that was kind of a pearl that i've learned in the last few years that i didn't know in the beginning super helpful and like you said b vitamins in general because methylation is part of the detox while these people have impaired methylation so giving methyl donors in a good general b complex is good and then magnesium so key to every function i mean if i would like one multi or one vitamin a probably magnesium or vitamin b but those two and you know part of our problem is our soils are so depleted that an apple today even if it's organic and beautiful and from the farm it's probably a fifth of the magnesium content as it had 100 years ago so where most of us are walking around depleted in magnesium so that is so helpful um and then you mentioned a little bit about rashes and stuff have you seen to me with all this environmental toxic load one of the consequences i've seen is more irritation like mass cell activation on top of everything else we see do you see an increase in that in your patients nowadays yeah i'd say over the years yes more and more that load because of like you if you think about 10 20 years ago i used to get them very simple autoimmune cases that would resolve in a few months and now i rarely see i feel like there's layers and it's part of our environmental toxic load maybe you could just speak a little bit of that to that because you have been the president of the american academy of environmental medicine and very very involved on the front lines of environmental medicine and i wonder what your just overall thoughts are about our toxic load like how is that affecting our patients i well i think you described the rain barrel perfectly and that's sort of how we describe it in terms of how people get ill because you know most of us don't really feel as we're building up with toxins and stress and infection and and then not keeping up draining our rain barrel with right nutrition and glutathione so um so most people you know don't notice anything till they're overflowing and just like you said as you're first getting better it's always up and down because if you're just a little bit above you know your your theoretical rain barrel right but you feel okay you feel good you just don't have a reserve right and anything happens and you know yes the world has added as we all know tens of thousands of toxins in a relatively short period of time um and you know the encouraging side is people really now seem to be getting it like kind of get it like you know it's just a different you know we're not in the better living through chemistry mode right like go on santo mode we're really not there anymore you know they may not know or think of everything that they're doing and you know we can kind of help them you know go over that but um but it all contributes and that's why I you know recommend avoidance of other toxins um because you know anything that your detox system doesn't have to deal with freeze it up you know for the things you can't avoid so you have you know so you have some resilience there and you know and as you sort of restore and get everything optimal nutritionally you'll have more reserve but um I think the question was more toxins or I think there are more yeah I think there's more awareness too so I think um you know I think there's a little bit of both good you know I think we're kind of switching from just more and more and more and more chemicals you know to um you know and I'm sure you know probably the the market supports that that less toxic products are probably doing a lot better yeah people are starting to well I grew up on a farm in Illinois so I know well before we ever knew about glyphosate and atrazine and I was exposed to all these I actually think there's a good chance that some of those contributed to my breast cancer and endocrine type of thing at 25 so that's all connected but what really neat what happened is this is conventional farming in Illinois in the 70s and 80s and my family now um they actually have completely gone GMO free on all of their corn and soybeans and they're partially organic which is kind of unheard of in the Midwest and it's kind of neat in the sense of my cancer it wasn't the cause of all the changes but it definitely opened their eyes to start to look and my brother's pretty progressive he's kind of like the functional soil guy like he understands nutrients and soil quality and so we talk a lot and it's kind of fun because he does farming and agribusiness and I do medicine but there's actually correlatives of the quality of the soil and the chemicals used in all of these things as well and it's to me it's fascinating because really the soil health is a reflection of our microbiome so when we start you know getting the good soil and the healthy soil and the more organic crops and then like you said people are starting to demand with their dollars so if you're out there listening one way you can improve this and change this is actually choose to buy organic and it's better to I always say it better to pay the farmer than the hospital so people think they can't afford it but how can you not afford it you know so choosing those clean air clean water clean food is really really critical um what about air quality we talked a little bit there's so much more than just mold in our air do you recommend air filtrate filters for your patients or anything like that oh yeah those help a lot indoor air for you know having a filter usually with a hepa and a carbon component and that's all you know you you don't want ozone in your air you know I know some physicians treat certain things with ozone and that's different but you definitely everybody agrees it's a respiratory irritant and you don't want it in your air so um so yes filters are very helpful um both measurably you know people who have particulate meters can actually see the the particulate counts going down and just the stories from patients you know it's very helpful and um you know I tell people you know I just run filters all the time but I also get a lot of fresh air and is that perfectly efficient no but you know it's um you know I it's okay it doesn't use that much electricity it really doesn't and um and so you know I think you get some people get hung up on well if I'm gonna have fresh air and a filter and you know it's you can manage that yeah I agree 100 with you I have two air filters at home and five in the office and it's funny because you and I both with California and Colorado we've had a lot of smoke that's really affected ourselves and our patients but I can honestly say and I actually have some lung inflammation permanent damage from the mold I will always like my pulmonary function test are never completely normal and they may never be because of that um inflammation damage I function fine but I should be someone with the smoke that would be highly affected by it but because I have air filters everywhere I haven't really noticed a whole lot except if I hike on a really bad day which is amazing to me because it's such a big inflammatory trigger and in the smoke like according to Dr. Klinghart there's aluminum and heavy metals and all kinds of other toxins in the smoke besides just burning of a tree so we're getting lots of exposures that way yeah and they're actually you know there's some people here locally where we had a really big fire and they ended up with a bunch of ash in particulates in their attics and they haven't filmed them so I had a patient who knew you know that he was having a reaction and did eventually find it but there's there's you know many others that you know even though the insurance you know help clean and stuff they didn't really you know find it all so you know getting that all cleaned out of the attics and the nooks and grannies even after long after the fire is over is important oh I couldn't agree more because that building area is so critical to have a good and like we said it doesn't have to be perfect perfect can be the enemy of the good but wanted you said yeah right and so some people are like paralyzed because they're like oh I can't get a perfect you'll never get a perfect because there's going to be mold in our environment but you want a place that's good enough for your body to start to calm down and to heal this is so fun and we're so in line one thing you mentioned that I wanted to just ask you about because I've used it before but you mentioned nasal glutathione is that something you prescribe or do patients get that themselves and use a certain form I mean you don't have to give doses or anything but what's your general principle about nasal is it rinses or um no it's it's um a spray and it is prescribed through a compounding pharmacy or you know various compounding pharmacies and um it's you know I mean dosages are you know use about 100 milligrams per ml and then you know you do a few sprays and you just suck enough you breathe in enough to hold it and then lay back and when you really get it in the right spot you know after that five or ten minutes you you will feel head clearing and you'll feel different and I usually tell people to experiment a little bit with the right position because everybody's anatomy is a little different and um you know they can do that three times a day and with exposures for some people it's a biggie to kind of pull them out of exposures as our trisalts um trisalts also be a biggie to get somebody out of an acute exposure and you know the thing I've been kind of mentioning to people now once they're kind of on track is to write kind of their you know crisis list like if their symptoms are coming back because when they come back a lot of times they are we are thinking clearly you know so two things happen you just subtly start to slump more about a little by little every day and you know and then people you know any kind of forgot to do whatever the b12 or the glutathione but also it's good to have something available to go to when you know if you did have an accidental exposure in your body's doing all the immune things it's doing and you know that's not the time when you're thinking the most clearly so it's good to kind of have your little okay this is the things I do yeah I used to have an emergency travel pack and it contained charcoal and I would create my own biocide and nasal spray which is a great biofilm disruptor you can also buy gsc nasal spray or I'm sure you can take the glutathione but those were kind of like rescues if I got into this whole room and then you can actually get products or little um I know haven missed has a and again I have no association with any of these products has a travel like little fogger and then sometimes you can do the home biotic or you can do the surface guard or you can do the there's a bunch of different products out there that you could actually travel with a little spray bottle um so because it's interesting I went to Maui last year and had a terrible mold exposure and I was in there for seven days but of course with the windows open and knowing what to do I was actually I stayed there I had a massive exposure and I was overall okay because again you and I kind of know now and that's the great thing what we want to do is empower our patients because we are going to get exposures and what we want to do is decrease reactivity and then empower you guys to have tools um there so doctor hope this has been so much fun and such great information one thing I want to be sure people can find is your website and then also you've written a lot of papers that are so wonderful you've made a real difference in the literature by publishing um are those on your website or where can people find they are and I learned a lot through writing those papers and I just very quickly wanted to mention early on in this process um I often did travel with one of those desktop air filters yeah and um and I just saw in CVS you know because of COVID there's more awareness and they're they're selling little desktop so um you know I don't need to travel with those anymore but people in the early stages of recovery and you know if we get back to being able to travel um that can be helpful you know taking it to your hotel room or wherever you're going so I love that and I have to just tell a funny story because I now again now we're not really traveling but in the days when we did travel I would always joke because I would have like two suitcases sometimes for a weekend and and I said it's okay to be high maintenance of your high performance because one of the yeah one of those suitcases would sometimes contain a small blender and an air filter and some food like so literally like one suitcase might be just my supply so that I wouldn't get yeah and that's okay I mean you know an air filter and you know if you're stuck in a place for a bit you know that you know get the air the best you can so exactly I stopped apologizing for my lot of because it wasn't all shoes I know I would have TSA I had a metal style desktop and that always got looked at yeah yeah oh yeah but sorry my I do have a website it's jenethopemd.com okay and you said the articles are all on your website so people can look you up there and you are you're in Santa Monica or Santa Barbara okay but one of my favorite places to visit wonderful well thank you so much for your time today it has been just a pleasure to talk to you I really appreciate all the great information you've shared yeah thank you so much for doing this I appreciate it you're welcome