Are Mast Cells Driving Autism? with Dr. Pejman Katiraei (Ep 145)

Transcripts are auto-generated and may contain errors

Dr. Pejman Katiraei: [00:00:00] When I would put these kids on these products early on, they would just flare and literally be like one drop or two drops, and then just all hell was breaking loose and the kid that was already anxious was like completely losing it. And after stepping on a few of those landmines, you know, I'm like, okay, I don't, I don't wanna lose anymore limbs.

Uh, that was enough. And that is where I started really asking, well, God, if this isn't really working, and occasionally things blow up in my face, what else is out there?

Dr. Linda Bluestein: Welcome back every bendy body to the Bendy Bodies podcast with your host and founder, Dr. Linda Bluestein, the Hypermobility md. I'm so excited to have this conversation with Dr. Pejman Katiraei. [00:01:00] Autism is so prevalent in our society, and I feel like we need so much more information about how we can evaluate these kids, diagnose and treat them.

We know that mast cells are so important in mast cell activation syndrome and other conditions that people with joint hypermobility, so this is a very interesting intersection. Dr. K is a board certified pediatrician who has completed two fellowships in integrative medicine and has over a decade of clinical experience helping children with severe learning and behavioral challenges.

He completed a fellowship under Dr. Andrew Weill at the University of Arizona, and then started the Loma Linda University Holistic Medicine Clinic, of which he was the medical director until 2014. Dr. K is now in private practice in Santa Monica, where he focuses on helping children with mold related illnesses, autism, and other mental health challenges.

I'm so excited to have this conversation, and I think you're gonna find it really [00:02:00] helpful. As always, this information is for educational purposes only and is not a substitute for personalized medical advice. Stick around until the very end, so don't miss any of our special hypermobility hacks. Here we go.

Okay. I am so excited to be here with Dr. Kaari. Um, thank you so much for joining me today. 

Dr. Pejman Katiraei: No, it's my pleasure. Happy to be here and happy to share what I can to, to just bring more awareness. And, you know, at the end of the day, for me it's, I'm acutely aware of how many families and people are struggling and, you know, as a pediatrician, how many kids are struggling.

Mm-hmm. 

Dr. Linda Bluestein: And 

Dr. Pejman Katiraei: if this conversation can help even one child and family just at least understand what's going on, if not find some answers and solutions to make that child's life better, then this conversation was all worth it. 

Dr. Linda Bluestein: Wonderful. Wonderful. And I wanted to start out by saying you and I have a couple things in common.

So we're both UCLA graduates, [00:03:00] I went there for medical school and I think you were there as an undergrad. And also I noticed that your clinic is on Wilshire Boulevard and I lived on Wilshire Boulevard the first year of medical school at UCLA with my grandmother and my grandmother and my grandfather were critical in forming the hospital St.

John's, which you might be familiar with in Santa Monica. So I am 

Dr. Pejman Katiraei: Wow, wow. Yeah, so lots of, 

Dr. Linda Bluestein: lots of connections there. So I'm really excited to, to uh, chat with you and also we are recording this on World Autism Awareness Day, so that's kind of cool. And also we're recording this in between parts one and parts two with Dr.

Theo her. So, um, so that's cool 'cause we'll have him back and this is gonna probably help me formulate some additional questions for him. So yeah, so I'm really excited to, to dig in. So. In terms of autism, let's start with like just general definitions and also the prevalence. Like is it actually increasing or are we just more aware?

Dr. Pejman Kateraei: No, [00:04:00] for sure. It's been increasing and there have been several studies that have been done where they have definitely looked at how much of this is, is increased diagnostic accuracy mm-hmm. Versus actual increases in prevalence. And they've all found that the rates of autism have continued to increase despite diagnostic, uh, protocols and models.

Uh, not really changing over at least the last several years. 

Dr. Linda Bluestein: Okay. And I also want to make sure that people know if they're interested in the subject of autism, which is mo gonna be most of our conversation today. Autism, mast cells, other things that Dr. Katai, uh, specializes in. Um, also please check out those episodes I mentioned with Dr.

Theo Es and also episodes 47 and 32 with Dr. Jessica Eckles. Um, um, okay, so the other thing that I think is so important is there's this huge dichotomy between what mainstream medicine says about autism and what people like you who have special training in integrative medicine, you know, are thinking in terms [00:05:00] of possible etiologies risk factors, you know, root causes and things like that.

And, you know, I feel like in mainstream medicine it's like, oh, we don't know what causes autism, but we have a lot of clues, right? In terms of what yeah, some important factors are. So, uh, what do you think in terms of root causes for autism? 

Dr. Pejman Kateraei: You know, from everything that I've learned at Dr. The has actually helped shape part of that conversation.

I mean, if I was to distill autism down into two things, it is a inflammatory condition compounded by toxins, which then explains, you know, all the gastrointestinal issues because toxins and inflammation induce those changes. Uh, the toxins induce the mitochondrial errors. And, you know, my friend and mentor, Dr.

Richard Fry, has published extensively on how there are a very large prevalence of all kinds of complex metabolic issues, which also inform the processes of autism. But if I was to distill it down, it, it's [00:06:00] really a inflammatory issue compounded by toxicity, that that is really at the root cause of it.

Dr. Linda Bluestein: There's some fascinating data. I know I, one study I came across talked about that people with mastocytosis, which we know is different from the much more common mast cell activation syndrome, but the children with mastocytosis are at 10 times increased risk of of autism, which is, of is of course we know when you're doing a study to actually get a result that shows that huge of a difference is really significant.

Right? Yeah. Yeah. So in terms of hypermobility, which we know there is overlap between hypermobility, mast cell activation syndrome, um, you know, and mastocytosis, although that's less common, how are hypermobility and EDS tied to autism learning disabilities and mental health conditions? 

Dr. Pejman Kateraei: Uh, great question and you.

I find a lot of times, whether it's learning disabilities or autism, people are so caught up in the diagnosis. Mm-hmm. And they have a hard time kind of stepping back and say, well, [00:07:00] what the heck are these things that we called autism or learning disabilities and so forth. And, you know, when you look at the different subsets of autism, there are, there are these, you know, level one, level twos kind of higher functioning children mm-hmm.

Who tend to have difficulty with sociability because they get overwhelmed. Like if you were to distill it down, they, they do have other things as well. But like, if you were to distill it down to what keeps this larger subset of children with autism, and we can kind of talk about the more severe cases, but what keeps these children stuck?

What keeps them from struggling to socialize, struggling to connect? And if you were to kind of distill that as, as one of the foundational things, then we ask, well, if that is a significant contributing factor, what causes that? That's where the mast cells, uh, and the neuroinflammatory component come in.

Uh, what's so fascinating is. Because of the [00:08:00] histamine reaction that mast cells induce, right? Mast cells and the microglia actually regulate 50% of our total histamine levels within the central nervous system. And when then you ask, well, what does histamine do? And, uh, you know, part of why I know this is I've kind of had to back up into this with the children that I take care of.

So I started giving them some supplements and treatments to modulate the mast cells. And then all of a sudden like, oh my God, their, their sensory issues improved dramatically at times. I've had children where as I've regulated their inflammatory response, part of the microglia. These children are now social butterflies and they're going up to other kids and making, like trying to engage.

I mean, even some of the nonverbal autistics, like literally within a month or two are at school and the the teachers or aides or the parents that are there watching, they're like, it's crazy. He started going up and started trying to talk to the other, even though they can't talk. Mm-hmm. Right. So when we say, well, where do these things come from?

It turns out that [00:09:00] histamine. Plays a really, really important role in the regulation of sensory pathways. There's this incredible article, uh, it's like 50 pages by a ha at all, uh, 2008. And if you type in histamine and sensory, uh, processes, I think sensory pathways, uh, it'll come up. But part of what Haws talks about, I think the title of it is actually Histamine in the nervous System, but what he talks about, and this was the first time my eyes got opened up to it, is how important histamine is in the, really the regulation of multiple centrally central nervous system pathways, especially the sensory.

So it modulates the vestibular function or middle ear, and. Vestibular function regulates a lot of the sensory pathways. And then in animal studies, they have found that histamine also changes auditory pathways, olfactory pathways, [00:10:00] tactile motor planning, et cetera, et cetera. And when we see these kids. You know, these kids that get overwhelmed in loud and crowded environments, the kids that can't tolerate having clothing, right.

The mm-hmm. 

Dr. Linda Bluestein: The 

Dr. Pejman Kateraei: child will only wear one t-shirt and one pair of shorts, even if it's like 40 degrees outside. Right? Right. Or 20 degrees outside. Right. They're extremely picky, like the pickiness, where does the pickiness come from? Right. We, we associate restrictive eating and weird patterns of pickiness with autism, but no one says, well, how is that tied to everything else?

And I'll, I'll give you an example. There was actually a mom that I was talking to the other day whose child is on the spectrum, and she's like, it's crazy when, uh, when he got sick. His ticks got worse. He started stimming and getting hyperactivated. Mm. And then all of a sudden he stopped eating broccoli.

He stopped, he started rejecting so many of the foods, started becoming really picky and had sleep issues. And then as soon as everything calmed down, he started [00:11:00] wanting broccoli again. It's crazy. And I'm like, well, it is, but that is actually inflammation showing up in real time. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: So the pickiness, the restrictive eating, the, sometimes these kids have intense, uh, olfactory sensitivity.

They, they can't tolerate the smell of things. I've had families where literally the child can't eat in the same room as others because the smell of the food is overwhelming. All of that, all of that is histamine and inflammation. And, you know, if you were to imagine stepping into these kids' shoes. And the entire world is overwhelming to you because like just from a sensory standpoint, you're, you're, you're in a battlefield and you're just dodging all of this sensory information that for most other people is not a big deal.

That helps explain part of it. Mm-hmm. And then if you layer on top of that, some of the brilliant work that Dr. Theor edis has done where I, I don't know if he's already shared, but how [00:12:00] mast cells and microglia also mediate the fear pathways, right? It changes the limbic system, changes the amygdala. So literally our perception of what is a threat in the world is distorted.

And then if you add to that, the microglia also influence quinlin acid. They influence serotonin, they influence dopamine. They influence the host of other neurochemical pathways that then also. That kind of the neuro excitatory sympathetic response, right? So you've got your sensory overwhelm. Everything in the world kind of seems disproportionately threatening to you and your hyper action, you, you're hyper alert, right?

You can't relax. And then if you say, well God, that sure as heck looks like a lot of the autism we see in these kids, what? What is so abstract suddenly becomes so much more logical. And then if you say, well, God, EDS [00:13:00] is driven by mast cells, right? That connection suddenly starts making a whole lot of sense.

Dr. Linda Bluestein: And I remember when I first came across the article by our, our friend, uh, Dr. Lawrence Rin, who wrote this incredible article, um, some cases of hypermobile EDS may be rooted in mast cell activation syndrome. I imagine you've seen that article. And we'll link it in the show notes. And by the way, we'll link that article that you mentioned too from, uh, 2008.

We'll also, uh, link that as well so people can look at all these things. So, you know, when I first read that article, I was like, oh my gosh, this makes so much sense. So this interaction between the autonomic nervous system and connective tissue and the musculoskeletal system and the, you know, the GI tract, we haven't even gotten into that really yet.

And the nervous system is just really so fascinating. And of course, in medical school, like we're taught that, you know, these things are. Working in isolation. So it's, it's no surprise that a lot of our colleagues, especially [00:14:00] that, you know, you were probably classically trained like I was, but then, you know, we've obviously done a lot of additional training, but it's so hard, I think, for a lot of people to wrap their brains around.

Like, so much of what you've just shared, which was really valuable information. 

Dr. Pejman Kateraei: It's, but, you know, when I, I was classically trained and I, I've, you know, had to kind of find my way through this and mm-hmm. You know, part of it was like a lot of the things that I've described, I've had myself, like, for, for a very large percentage of my life, I had what I thought was anxiety, but it was actually central mast cell activation.

And, and like my brain constantly misperceived threats, which was a big part of my anxiety. I've, I've had all kinds of weird sensory issues. I, I didn't know this, but I. Oxytocin and dopamine were not firing normally in my brain. So the way I was able to connect with people, the way I experienced reward, like all of these things were [00:15:00] distorted.

So, uh, you, you can make some argument that I, I probably was, and to some extent maybe still am, uh, somewhere on the spectrum. But you know, a lot of times, uh, whether it's dogma or we just like to hold onto our way of seeing things, it becomes hard for people to. A little bit further back and say, well, God, if, if we can't understand that this what's going on, maybe there's another way to look at this.

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: And I think like that's one of the things that, that holds so many people back, right? They, they have their way of seeing things and that's the only way they want to see things. And, and this, this, this is not just the conventional docs. I mean, I see a lot of my integrative colleagues that do the same thing.

It's like they get trained in one model and that's the model they use. And it's like, that is the only way, which I don't think is, is ultimately helping these children, right? Mm-hmm. Uh, the better we can understand what's going on, and it's [00:16:00] not about me, it's not about you. It's about these poor kids that just can't be in the world and they're struggling.

Dr. Linda Bluestein: We definitely need to be open to new information and you know, really understanding the science as best we can so that we can help people, especially like you said, with these children that have their whole lives in front of them. So it's so important to get to the root of the problem. And speaking of the root of the problem, what about the role of the gut?

What should we know about that? 

Dr. Pejman Kateraei: It's huge. Uh, it's, it's huge. And I mean, we know that, that there was a recent article, literally just several months ago where they looked at the total, uh, physiology of the gut, right? It wasn't just a microbiome, but really all of the. Chemical milieu and, and metabolic milieu of the gut.

And they found a, I think it was a 95% high, uh, like plus predictive ability of if everything in the gut becomes a big hot mess, metabolically, chemically, you know, meta [00:17:00] inflammatory, et cetera, that its ability to predict autism is incredibly high. Mm. 

Dr. Linda Bluestein: Uh, 

Dr. Pejman Kateraei: i, it it's huge. It, it's huge. Uh, the thing that I find though is a lot of people get stuck within the gut.

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: And they fail to step back and say, well, what created the mess that is in the gut? And I see a lot of my colleagues who have incredible intentions, they're great people, they've done a lot of training, but they dive right into, well, let me use probiotics and this. Mm-hmm. And that to. Without asking, well, what caused the gut to fall apart?

Mm-hmm. And they miss the, the actual trigger that created the situation. Uh, and I find a lot of times, while the gut is playing a very important role in the manifestations of things like autism, it's actually downstream from the initial trigger that created that imbalance. Mm-hmm. 

Dr. Linda Bluestein: [00:18:00] Yeah. And getting to the root cause is, is so important.

And, uh, we know our, another one of our colleagues, Dr. Claudia Miller, has done excellent work in the space of multiple chemical sensitivity and tilt, toxicant induced loss of tolerance. So I'm sure that that plays a role here, as well as things like dampness and mold. Um, and we're gonna get, we're gonna get into treatment and things like that later.

But in terms of, you know, etiology and causes, what should we know about that? 

Dr. Pejman Kateraei: Great question. You know. I think with everything that we have released into our environment, right? The phthalates, the glyphosates, the metals, air pollution, the particulates, all of these have created the, really, the perfect storm.

Mm-hmm. It, it, it's kind of like we, we have borderline handicap the gut physiology of these kids and there are x percentage of kids who are genetically vulnerable with all of these different toxicants. We have [00:19:00] further made their guts vulnerable. And, and, and if you look at it, you know, air pollution impacts the microbiome, causes gut inflammation.

You know, phthalates, glyphosates, all of these things do the same thing and, and they influence the mitochondria and so forth, but they create the susceptibility that, that's like a car that is waiting to fall apart. But it hasn't yet. Right. The, the engine is kind of shaking. The yellow warning light comes on.

You know, the, the, the, sometimes it doesn't start very well, but it does. And if you look at a lot of the kids that present with autism, and there are some kids that were perfectly fine and they fall apart, but the vast majority had subtle issues that just never came to light. They had some sleep problems, they had some sensory issues, they had some digestive issues.

They have a little bit of eczema, they have a little bit of food allergies. The poops are not totally normal. They're either diarrhea or constipation prone. So they have these things. They've had X number of ear infections, car kind of doing its [00:20:00] shake, yellow warning light, come on. No one notices all of those things.

And then there's this tipping point where now. System falls apart. I think that's where the gut complete completely falls apart, which then triggers more inflammation, more toxicity because of the gut itself, which is where that regressive moment comes from. And if we're to ask, well, what is the elephant in the room?

What is the most potent, significant, uh, toxin, and it's more than the toxin, that's where dampness and mold come in. Hmm. And treating thousands of kids, and, you know, I've been at this since 2008. I'm kind of aging myself here, uh, since 2008 in, in the thousands upon thousands of kids that I've seen. Not to say, you know, metals and plastics and glyphosates don't matter.

They obviously do. The thing that I have seen that has been single handedly the most [00:21:00] dangerous exposure hands are none is, is dampness and mold. 

Dr. Linda Bluestein: Mm. 

Dr. Pejman Kateraei: Uh, the inflammation it causes, it, it can directly trigger microglial mast cell activation in the nervous system directly just through inhalation of, of the particulates and the molds and the toxins.

But the most concerning part is how these toxins, once they're inhaled, influence the microbiome in the gut and the damage that they cause I see is, is, is far more concerning than anything else. 

Dr. Linda Bluestein: And we're definitely gonna talk more about, uh, how you establish a diagnosis for, for that 'cause that's so important.

We know there's no biomarker, right. For autism itself. Um, at least that's. From what I understand, you might find some increased inflammatory markers, but there's not like a single test that is really specific. Um, so what kind of early signs should parents be looking for? [00:22:00] 

Dr. Pejman Kateraei: You know, I don't think there's one early sign.

It's not like if you just see this, this is a, a sign that your child is going to develop autism, autism, there's really a constellation of things and it's really more of a pattern that when that pattern starts coming together, you know, the risk, if you want to say of bad things happening goes up. 

Dr. Linda Bluestein: Mm-hmm.

Dr. Pejman Kateraei: Um, so, you know, one of the things is significant sleep disruption. Mm-hmm. Uh, the kids that have a really hard time falling asleep and they're not just being a little annoying and, and, and your, your bedtime routine is not perfect. It's like these kids truly have insomnia. You give a melatonin, they kind of fall asleep, but then they wake up at two o'clock in the morning and they're just wide-eyed.

Or you, you'll. Get them to sleep, but then they're up at like four 30 in the morning and you can't get them back. And it, it's like they're just hyper caffeinated all the time. Sleep disruption is actually a sign of central mast cell activity, [00:23:00] right? Mm-hmm. Histamine, modulates, our arousal centers, right?

And if you flip that around, like why does Benadryl work? Benadryl works because it drops central histamine, which causes us to knock out excess levels of histamine, change our circadian rhythm, increase our arousal center, so we're just wired, awake. When you compound that with what, just what we talked about before of how histamine also influences the sensory findings, right?

Or pathways. And it's like, oh gosh, we've got a kid that has all kinds of weird sleep issues and they've got weird sensory distortions. They, they get overwhelmed and crowded environments. They're, they're having issues with their hair being washed. They've become more picky. They're, you know, et cetera. And then you add to that, some of the gut findings, right?

They're, they're starting to have chronic diarrhea. They're starting to have constipation every now and then. They have abdominal pain for no reason. And because the gut influences our [00:24:00] tolerance of foods, right? When you get intestinal permeability, gut inflammation, that's where a lot of food allergies and food sensitivities come from, right?

So you've got a kid who's got sleep issues, they've got sensory issues, they have some digestive problems, but oh my gosh, yeah, he won't tolerate gluten, he won't tolerate dairy. Every time I give her, you know, corn, she starts breaking out in hives. This all, and there's more to it than that. But this all becomes part of this picture of we've got gut disruption, we've got central nervous system immune dysfunction, and this child's system is in a very vulnerable place.

And when you add to that an antibiotic, you add to that covid, you add to that RSV, you add to that, you know, injectable biological stressors, and I won't say what those are, but you add to that any additional stressor that causes the immune system and the gut to now falter further when that happens, [00:25:00] then.

All of a sudden that child system that was kind of teetering on the verge of not being in a good place falls apart. And now you've got this child that, that's really struggling neurologically. 

Dr. Linda Bluestein: And what about babies that have colic? Is that related in any way? Yeah. 

Dr. Pejman Kateraei: Yeah. That, uh, absolutely. Uh, you know, colic I originally thought was just a gastrointestinal issue.

And you know, what I found in my general Pete's practice was there are kids that have some colics. So around three weeks of age, they start getting a little fussy. Mom cuts out gluten and dairy, and then they're fine. And then there's this other subset of colic, which is far more gnarly. So it just, the intensity, the severity of it is much more, these kids can't be console.

Parents are, you know, having to bounce them, rock them, put them in a car, drive them all over the place, and, and their ner their little [00:26:00] nervous systems just cannot calm down. Mm-hmm. And what I came to realize is that is actually one of the earliest findings of this central histamine, mast cell activity.

Uh, and what's what's really crazy is in a handful of the kids where things were so bad, the parents are like, just do frigging anything. We don't know what to do. We're losing our minds, do anything. I put them on some supplements. To downregulate the mast cells and to break down the histamine, uh, within the gut.

And we were giving these kids, you know, quarter capsule doses, like two or three weeks later, kids start sleeping. They're more calm. Mm. Their colic is gone. And that, that, that was when, you know, it kind of really brought it together of like, oh my God, the, these poor little babies are actually having the first sign of inflammation in their poor little nervous systems.

Which is really sad. 

Dr. Linda Bluestein: Oh, really sad. Yeah. Really, really sad. Um, so that is so fascinating, and I'm sure it varies [00:27:00] depending on if you're, uh, treating a, a small baby or an infant or you know, an adolescent. Um, but in terms of the lab tests that you do, what are the things that you are most likely to be looking at?

Dr. Pejman Kateraei: Great question. Um, a lot of people do testing to see if there's inflammation within the nervous system. And, and there's, there's all kinds of fancy tests to do that. Maybe because I've seen so many of these kids, you know, and the parents are like, well, what about this test? What about that test? And what I tell them is like, your child has all of the signs of a neuroinflammatory response.

What we need to do is figure out what the heck is causing that inflammatory response. Mm-hmm. So what is the trigger? And that is where the bulk of my focus goes. So depending on the history of the child, you know, what I have found is dampness and mold is one of the most significant contributing factors.

And usually when [00:28:00] it's there, I. You know, the, the pattern of allergic findings, so food intolerance is eczema, chronic coughs, chronic congestion, adenoids, ear infections show up, whether it's in the child that is of concern, or sometimes it's not the child, but their sibling, you know, like I'm talking to them because the child's come in with autism and I, I started asking these questions and the parents like, stopped for a second.

They're like, well, it's not him, but his sister has had six ear infections and she's only like two years old, and the doctor said that her adenoids is, are really large and we may need to take them out so that that allergic pattern. Is very highly indicative of dampness and mold because frankly, no other toxin causes that.

And when I see that, you know, my first question is, is this actually real? And I have found the most sig, the most sensitive and accurate way to assess that is through antibody testing, blood antibody testing, where [00:29:00] we're asking has this child's immune system encountered mold or the mold toxins at some point in time?

And I, I wanna differentiate this from, you know, a lot of the other, uh, modalities that people use because I was trained to use urine, multi toxin levels, mycotoxin testing. And what I found was these tests were highly unreliable in the kids. They may, they may be useful in adults. I don't have frankly much experience, but in the kids.

We get these like scenarios where their, their house basically was so contaminated that it, it was like going to be condemned. They're like, you need to leave this house. No one should be living here. Like, horrific levels of mold. But then you look at the urine, you're like, God, that doesn't look terrible.

Hmm. Uh, and then conversely, I would have cases where the urine levels were so high that I would be freaked out. Like, oh my God, this has to be mold. And we would check, like there wasn't much in the house. It turns out the kid was eating peanuts and gluten and [00:30:00] dairy, which happened to be high in these levels.

And, and my mentor and friend Dr. Uh Campbell, Andrew Campbell was the ones like, Hey, Pejman, like these tests you can't rely on in these kids. Uh, a lot of colleagues also use organic acid tests. Uh, I still use them, I love them. But one out of two times, literally 50, maybe 60% of the time, you get a false negative when it comes to assessing.

Dampness and mold in its downstream effects. So for those people that are strictly using the organic acid fungal markers, those are highly unreliable in a sole method of assessing these kids. And that's where the blood testing comes in. Um, so that, that's one thing that I look for. 

Dr. Linda Bluestein: Okay. Are there other, uh, lab tests that you find can be helpful?

Dr. Pejman Kateraei: Yeah. So, uh, there, Dr. Shoemaker, uh, found this wonderful biomarker [00:31:00] matrix Metalloproteinase nine. MMP nine mm-hmm. To be one of the things that seems to be correlated with, you know, mold related illness and dampness and mold. And basically, MMP nine in an overly simplistic way, is an enzyme that gets activated when there's a lot of tissue repair.

Right? Tissue gets damaged at the matrix level, the body comes to repair it, MMP nine goes up. And it's, it's more sophisticated and complicated than that. But that's an easy way to remember it. And one of the, one of the most sensitive markers that I have found. It's also easy to draw, easy to process because there are other ones that are good, but depending on the lab, and some of them need to be spun down a certain way.

So there there's a lot of variability that creates complexity. MMP nine is easy to get. Most labs can run it. You don't need to do fancy footwork to get it. And it is fairly sensitive to dampness and mold exposure. And with that, you know, on all the [00:32:00] kids that I check for, I check them for celiac, I check them for thyroid antibodies because sadly these are fairly prevalent.

One of the things that I've also started using as a biomarker is actually. Croce are vaca antibodies. Mm. Um, which is specifically for colitis and Crohn's. But when you look at what those biomarkers, if you wanna say, or antibodies check for, they're checking for, is there some kind of gut inflammation and gut disruption?

Right. And is the immune system interacting with some kind of funky yeast, which is the brewer's yeast? Except it turns out that candida in certain molds, from an antigenic standpoint, happen to look just like these brewer's yeast. So it could very well be that these antibodies that are popping up positive are actually being activated by Candida or other Easter mold that are there.

And I find that while most of the kids don't have [00:33:00] actual Crohn's and colitis, this becomes fairly easy to get. Again, insurance covers it. It's easy to get and it gives some valuable information. And sadly, I'd say about 30% of the kids, maybe 40% on the spectrum, have these elevated but not significantly elevated levels of these ASCOs, primarily the IgG that comes up, which is another sign that, gosh, we probably have got inflammation, we have got disruption, and it's probably being driven by some kind of yeast or mold.

Um, so tho those are the, the, if, if you were to just kind of keep it in the conversation of, you know, dampness and mold, those are the things that I look for. And then, you know, depending on the history, sometimes we go searching for Lyme and, you know, other things that could be, you know, contributing factors as well.

Dr. Linda Bluestein: Okay. Um, we are going to take a quick break and when we come back we're gonna talk a little bit more about diagnosis, uh, comorbidities and [00:34:00] treatments. So we will be right back.

This episode of the Bendy Bodies Podcast is brought to you by EDS Guardians, paying it forward in the Ehlers Danlos syndromes community patient to patient for the common good. I'm proud to serve on the inaugural Board of directors for EDS Guardians, a small charity with a big mission and a big heart now seeking donors, volunteers, and partners, patient advocacy and support programs available now.

Travel grants launching in 2025. Learn more Shop for a cause at their swag store, and join the revolution@edsguardians.org. Thank you so much for listening to Bendy Bodies. We really appreciate your support. It really helps the podcast when you like, subscribe and comment on YouTube and follow rate and review on all audio platforms.

This helps us reach so many more people and spread the information to everyone. Thank you so much again, and enjoy the rest of the episode. I.

Okay, we [00:35:00] are back with Dr. Kateraei and learning so much great information. This is so fascinating. Are there any kind of brain imaging studies that can be helpful or is that something that is not there yet? 

Dr. Pejman Kateraei: So you can do, I mean, if, if you can get someone to do it, you can do functional PET scans. Mm. Which can actually look for signs of microglial activation.

Are those scans easy to do and can you get a child into a scanner easily to get it done? Especially if they're already overwhelmed and mm-hmm. You know, the typical autistic kid, probably not. Um, you know, outside of that. Neuroimaging, like, while it can give information to me, if you just look at the child, you know, they're, they're constantly overwhelmed.

They're, they're stimming, they're, they're, they're just overwhelmed. All of that is inflammation, period. Hard stop, end of story. Like that piece of, you know, the child that, that just can't handle being the world. And [00:36:00] pans and pandas. If you look at those kids, like they're talking to you, they're interacting with you, but their overwhelm is in the patterns of fear, right?

Their perception of fear is completely off, and we think of that, we think of pans and pandas as just the basal ganglia being inflamed, but if you. Zoom out, and there's a handful of articles that are now diving into this. Microglial activation is being argued as being a part of that, and the microglia can also influence the basal ganglia.

So when you look at these kids and it, it almost looks like your nervous system is, is on fire. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: Right? If you just kind of, in a very simplistic way, translate well, what's happening to this chick, to, to these children? Well, their brain is on fire. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: And their brain is on fire, and that's why they're so overwhelmed.

Well, if their brain is on fire, that, that, that's inflammation. Right? So we need to create a different model where, like, we don't [00:37:00] rely on these tests as much because at the end of the day, like parents will do whatever for their kids, right? Mm-hmm. If they have to finance their home and put thousands of dollars of debt on a credit card to help their child, they'll do it.

But if you can see the signs of inflammation in a child. Do you need a thousand dollars test, a $600 test to confirm that? Wouldn't it make more sense just to treat the inflammation with a hundred dollars worth of supplements and if four weeks later that child is more calm, isn't that, or better use? So that, that, that's where, you know, I've started pushing back against, you know, kind of the, the convention that is being established in the holistic kind of functional medicine community where everyone is enamored by testing.

And don't get me wrong, I, I think tests could be helpful, but I also think there has been such a powerful marketing influence. Where physicians are just tossed to, let's test, let's test for this, let's test for that. And [00:38:00] there are some families that have endless resources and $3,000 of testing, no big deal, but there are also families that don't.

Mm-hmm. And that those 2000, $3,000 worth of tests could potentially be better spent in other ways. Mm-hmm. 

Dr. Linda Bluestein: Yeah, definitely. We don't wanna be doing things. If, if it's not really gonna change the treatment plan, then, you know, why, why put that child through the tests and, and everything also, so, you know, in addition to the, to the money.

So, definitely, uh, that makes sense. And just to quick take a little diversion before we go into treatment, are there other conditions that we're seeing more of in kids that we should be aware of that, that you treat? 

Dr. Pejman Kateraei: Um, I mean, I, I think as part of this spectrum, uh, a lot of learning disabilities. Mm-hmm.

Right. So. The learning disabilities. So the A DHD, and if you look at a lot of children who have the A-D-D-A-D-H-D diagnoses, it's not a straightforward inattention, [00:39:00] distractibility, hyperactivity. These kids have processing issues. They, they have issues in working memory, they have issues with executive functioning, which also crosses over into autism.

Like that, those constellation of learning challenges are very prevalent in this population. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: And with some of these kids who have a DHD, it's actually, they essentially have a similar, perhaps less intense version of the same neurophysiology. That that is impacting their ability to learn. And I mean, sadly, like I've got a 8-year-old and a five-year-old, so she's in second grade, he's in tk.

Like every classroom seems to have at least one, if not three or four kids who are just completely struggling to learn. And you know, some of them have regulation issues, some of them are having panic attacks and anxiety issues. And then, you know, we've got the children on the spectrum, but like we have this epidemic of just [00:40:00] pediatric mental health.

1. And we're, we're completely missing what are the things that are, or missing parts of the, the factors that are driving all of this. And, 

Dr. Linda Bluestein: and, and I wanted to also circle back to when you mentioned pans and pandas. I know what that is. But for the people, uh, who are listening to this, who, who don't know what that is, could you explain what those are?

'cause that's really important 

Dr. Pejman Kateraei: as well. Yeah, yeah. Thank you for clarifying that. Uh, so PANS is pediatric acute neuropsychiatric syndrome, and pandos is basically the same thing, but specifically tied to a infection. And these poor kids basically present with this relatively sudden onset. So a kid was doing pretty well, like no big issues.

But then out of the blue, sometimes within a matter of days, sometimes weeks, maybe a month or two, they start like cognitively falling apart. So first, high degree of anxiety, weird patterns of [00:41:00] restrictive eating. A lot of times they have developmental regression, so handwriting goes weird. Some of them start doing baby talk.

Uh, and then with that intense degrees of OCD ritualistic behaviors, compulsion, obsessions, uh, intrusive thoughts, um, as, as part of that and neurologically these kids just get like, thrown under the bus is, is like a very simplistic way of putting it. Um, and a lot of the community has been entirely focused on.

Strep. And then with that mycoplasma, various viruses. Some people are looking at Lyme. Not to say that those are not an issue, but what's really weird is you see in the literature this discussion of, well, not every child actually needs to have strep to have this thing. And they should still be put on antibiotics and treated, even though they don't have antibodies against strep.

Some of them do [00:42:00] have culture positive strep, but you kind of have to go searching for it. 

Dr. Linda Bluestein: Hmm. 

Dr. Pejman Kateraei: And when you zoom out and say, well, what heck. Creates the immune susceptibility for all these weird things to happen because I mean, kids get strep infections. Mm-hmm. And they don't go neurologically sideways.

Dr. Linda Bluestein: Right. 

Dr. Pejman Kateraei: Pretty much every human being that's alive on this planet has had EBV and probably CMV at some point, right? These are common viruses that literally every single person has mycoplasma. You know, walking pneumonias. If we didn't get a full blown pneumonia, chances are if you took a hundred people off the street, like 80% of 'em have antibodies against mycoplasma.

Like everyone is looking at these triggers because it's easy to point the finger at them. But very few people are asking, well, God, if these things are so common, 30% of kids, 30% of just kids off the street are carriers for strep, but they don't develop these neurologic neuropsychiatric [00:43:00] issues. Mm-hmm. So what causes your immune system to go so haywire?

Now it starts reacting to all of these common things, and that is where dampness and mold come in because the, the degree of inflammation and immune incompetence, so on one hand the immune system is on fire, on the other hand, it is literally lost its ability to protect the host that is dampness and mold.

Dr. Linda Bluestein: And that those are questions that I asked of, uh, our other colleagues, Dr. Ruy and Dr. Kaufman, because I know they also, you know, do a lot in the space of, of infections and, you know, why do infections affect some people so dramatically differently? Some people just breeze through it and it, and we're not just talking that people write who have a documented immune deficiency.

We're talking about people who, you know, appear to have a fairly normal immune system. So it's, um, if we could figure that out, I think that would be a really huge thing why some of these infections are, [00:44:00] are so dramatically different. Um, and, and speaking of infections, so obviously we know infections activate the immune system, activate the mast cells, which then cause inflammation and allergic type phenomenon and variety of other.

Re release mediators, which obviously have effects all throughout the body. Right. Um, and we also have vaccines which are designed to help us, uh, you know, tolerate those infections better. Um, obviously there's some people that think that vaccines cause autism, um, not to like, you know, put you on the spot.

Uh, but do you have any particular thoughts on, on that, how that's evolved? And, you know, for people that are worried about vaccines and their kids, 

Dr. Pejman Kateraei: I, I wanna present it like this. So, as a consultant that takes care of kids on the spectrum, it is sadly not uncommon for parents to report that the child got in an inoculation and shortly after that time is [00:45:00] when they started really struggling.

So there's, there's no doubt in my mind that that connection is there if we ask. What was it about that child that immunologically created their susceptibility to have that reaction? The conversation completely changes, right? It's the same thing as the pans and pandas in, in all of these infections, because there are plenty of kids who get the inoculations and their immune systems don't even blip, right?

Mm-hmm. They don't even get a fever, like literally, it's just okay. You know? And then they move on and, you know, you check in with them afterwards like, Hey, are they fine? Oh, they're absolutely fine. Did they get a fever? No. Did they did anything? No. Right? So we, we we're still in this model of, we're so hyper-focused on the trigger, whether it's an infectious trigger or whatever else, and.

What has [00:46:00] created this, this undermining of the immune system. Mm-hmm. And, you know, you said something really fascinating and important, which is, you know, these people are not, these children are not known to be immunologically vulnerable. Right. They don't have a known immunodeficiency. And what's wild is, in the children that I see who have been exposed to dampness and mold, they actually do have immunodeficiency.

So there are several articles that have talked about how these various toxins in their bacterial toxins, mold, toxins, microbial, volatile compounds, et cetera. So it's, it's a super of stuff. This combination actually starts creating a deficiency in the immunoglobulins. So specifically IgG, to some extent iga, actually, you end up getting immunodeficiencies because of these toxins.

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: And one of the things that I see commonly enough in the kids that come in for a second or third medical opinion, they've seen [00:47:00] someone tho, tho those other individuals ran. You know, for instance, pneumococcal titers, right? The kids got the pneumococcal vaccine, which is to protect them against ear infections and pneumonia and so forth.

But then when you run their titers, like there's no immune reactivity against any of these vaccines. Some of the kids, uh, when I check their gut immune response, uh, specifically looking to see if their gut is reacting to candida or you know, the OC clued in zonulin proteins because of the leaky gut, then that's one way to check for it.

Some of these kids literally have the lowest measurable levels of these immunoglobulins at the gut level. I. And I've talked to the lab director at times and they're like, he's like, this is crazy. Like, I've never seen such low levels. And all of this is, is really a reflection of how much of an induced immunodeficiency these kids [00:48:00] develop, right?

It's not a congenital immunodeficiency that we see in some of the kids, but it really becomes a toxin mediated immune deficiency that's a reflection of all the toxicity that is modulating their immune response in a really profound and significant way, which is the part that, I mean, frankly terrifies me, uh, for these kids.

Dr. Linda Bluestein: And so the way that you're detecting that is, is like you said, looking for the antibodies against a vaccine that they, that they got, so they should have antibodies. That's one way that you're detecting it. And then with the zonulin, is that through a stool test or how are you, how are you looking at that?

1. Um, when you mentioned about the 

Dr. Pejman Kateraei: gut, those are also through blood tests. Mm-hmm. Uh, so there's a few different labs. Cyrex is one. Uh, there's another company called KBMO. There's a third one that I'm blanking on the name of. Uh, if you get, if you ever wanted to, you go on RPA and type, type in type gut permeability test and that they have a few different ones, but [00:49:00] essentially any company that checks for antibodies against, for instance, LPS or lipopolysaccharides, and that, that's how I came to all of this, because I got to a point where I'm like, oh my God, these kids have a.

Who run this gut permeability, let me start checking them for antibodies against LPS and Occludin, because that, that's a way to measure how good or bad their gut function is. So then I started running a whole lot of these tests on the kids and, you know, after like six months of doing it and like 40, 50 tests come back, all of a sudden it's like, oh my God.

Like these kids are just completely immune compromised at the gut level. Whi, which then influences their ability to mediate the gut permeability. It influences the, the microbiome. Um, 'cause it turns out iga, IgG actually influenced the health in variety of the microbiome. So it has all of these downstream consequences, which is what makes their gastrointestinals, uh, tracks a sitting duck for any stressor that shows up.

Dr. Linda Bluestein: So, so the gut is [00:50:00] so important for the, for the immune system then, right? That's just plays a critical, critical role there. Okay. So I, uh, was doing some reading about the different, uh, approaches that you take and things like that. So I definitely wanna address treatment and there's, uh, a method that I have, uh, coined men's, PMMS, and it seemed like you were using a lot of kind of similar elements.

So this is movement, education, nutrition, sleep, psychosocial modalities, medications, and supplements. So definitely, I've heard you talk about supplements. I've heard you talk about medications. I've heard you talk about a lot of other things that we can, uh, do for autism. So, so what things are you finding most helpful?

And I know that you've had years of training in plants and botanicals, but I've also heard you say that your approach is a little different now. So what are your top treatment tools and, and how did you derive and arrive at that place? 

Dr. Pejman Kateraei: Uh, wonderful question. Uh, yeah, I, I spent, you know. Five, four or five years, [00:51:00] uh, in a pretty intensive, uh, fellowship actually to get trained as a medical herbalist.

And mm-hmm. There, there was a period that I was literally custom hand, custom blending tinctures, you know, of, of five to seven different botanicals to do all kinds of fancy stuff. Uh, so I, I had a love affair and I still have a love affair with plants. Uh, I think they have tremendous, uh, potential. But, you know, what was staring me in the face with these kids with autism and pans and pandas was I would, I would put these kids on botanicals to try to restore the integrity of their gut.

And then six months later, nine months later, you know, I'd look at their clinical progress and they were making some progress, but it was like, at some of them, at a snails pace. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: And then I would check their levels do testing, and it's like, well, God. Nothing has changed. Like everything's kind of the same as it was before.

And the part that I think [00:52:00] was even more concerning was I would find that 30% of the time, maybe more when I would put these kids on antimicrobial botanicals, Biocidin, micro region, you know, whatever. Uh, and I, I still like those products a lot, don't get me wrong. But when I would put these kids on these products early on, they would just flare and literally be like one drop or two drops, and then just all hell was breaking loose and the kid that was already anxious was like completely losing it.

Uh, and after stepping on a few of those landmines, you know, I'm like, okay, I don't want, I don't wanna lose any more limbs. Uh, that was enough. And that is where I started really asking, well, God, you know, if, if this isn't really working, and occasionally things blow up in my face, what else is out there?

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: Uh, and that's where, you know, Dr. Campbell comes into the picture because for the [00:53:00] longest time he's like, Pejman, use Itroconazole, use Itroconazole. And he's, he's kind of like the Itroconazole king. And, and he's been talking about this long before I came into the picture. Uh, so I started using Itroconazole, which is a pharmaceutical antifungal in these kids.

And holy moly, the changes that I have witnessed have been staggering. It's, it's almost a little bit beyond belief until you witness it for yourself. Now it's important to say that. Not every kid is ready for itraconazole. And if you use it in the wrong child or the right child, but the wrong time, it can still cause them to completely flare.

Hmm. So it's not one of those things where it should be used haphazardly. It it, you need to work with someone that knows what they're doing. Because if you ask, well, what is this darn medication doing? And obviously first and foremost it's an antifungal and it kills candida. It [00:54:00] can kill aspergillus, it can kill, you know, pretty much most molds in fungi.

And if you have a boatload of fungus in the gut and you have an immune system that is basically paranoid, right? So that immune system is just waiting to get triggered for any reason. And now here you come killing off a whole bunch of these fungi and mold, and God only knows what toxins they're releasing.

God knows how they're interacting with the immune system, which they are. They're, they're literally talking to each other. So here you come wiping out this population of, of fungi and mold and that immune system that basically has paranoia. You know, delusions, uh, is now flipping out. Because of this change, you can get a horrendous flare.

Dr. Linda Bluestein: Mm, 

Dr. Pejman Kateraei: if you time it perfectly. Uh, and you gotta get the kid ready. You've gotta control the exposure. Uh, just bring their immune system to a place where now the p immune system's paranoia has calmed down. [00:55:00] Itraconazole is insanely effective. I've had kids that had full blown pans. Pandas, anxiety, OCD literally couldn't leave the house, like to go to school.

And these are school age children. Uh. Intrusive thinking, you know, intense fears. And then literally within a month and a half of Itraconazole being slowly dialed up, they're going to school by themselves. Like, it's, it's not, the parent needs to walk. Literally, the mom's like, it's crazy. We went to school and she got out of the car and just walked into her classroom by herself, and I asked her like, do you want me to come with you?

No, mom, I'm fine. You know, and the mom's like, she wasn't leaving the house two months ago so much as going to school by herself. I've had kids with level three autism, severe autism, you know, no eye contact, no speech, you know, you know those poor kids that are in the corner just stemming and mm-hmm. And shaking and just overwhelmed.

We, we dial a few [00:56:00] things in. Again, stabilize their immune system. Two months into the itraconazole, kid is making eye contact. They're not overwhelmed, they're calm. I mean, it, it's the most. Beautiful thing you can possibly imagine. I've had some of these kids now actually going and engaging with other kids.

Dr. Linda Bluestein: Mm. 

Dr. Pejman Kateraei: Uh, they can't talk, they can't communicate, but they, they're wanting to engage with others. And, you know, for myself, like when I started seeing this in some of the kids, you know, I looked, I'm like, well, I've had lifelong gut issues. I've got funky stuff. Let me try it. But this was June of last year. If, if I could say Itraconazole changed my life, uh, it would be an understatement 

Dr. Linda Bluestein: really.

Dr. Pejman Kateraei: When I took care of myself, my anxiety and OCD were manageable. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: But it was always kind of humming in the background. You know, it's like you're in that room and there's that zz, you know, it's like the light that, that was OCD kind of fear, constant fear of, oh my God, what, what if this [00:57:00] happens? What if, what if this happens?

What if that happens? What if these patients leave? What if this, you know, all of these irrational fears that, that had no basis in reality, but it was my mind constantly. Mm-hmm. And then with that, there were, you know, self-esteem issues I didn't realize, but oxytocin wasn't working. So like my wife, my kids, like I had formed mental images of what love was, but like my heart never truly.

Uh, experience that connection. Mm-hmm. Because literally there, there was a hormonal gap between emotion and experience and, you know, I would create these constructs of love, but my brain literally could not feel that emotion. Wow. Uh, serotonin, dopamine, you know, like I, I, I wouldn't call myself depressed or back then, but like, life was flavorless, literally, like I, there, there was no joy.

There was no flavor in life because [00:58:00] my brain literally was not processing serotonin, dopamine. Like, I, I didn't enjoy reward the same way as others. And I just thought, well, this, this is how I am. This is what is. Mm-hmm. And I thought other people were like this until, you know, a month into Itraconazole.

There was literally one night, like I started crying when I was cuddling with my little guy because the, the overwhelming sense of connection and love that I felt towards him. Mm. And the moments where like, I would just be walking down the street, walking our dog and like just the joy that I would have in the beauty of that moment.

Mm-hmm. You know, people say, be in the moment, enjoy the moment. Well, if like you can, you mentally, you could force yourself to be there, but if you literally chemically cannot experience those things, then how much in the moment can you really be? And you know, this is where all of a sudden it's like, well holy crud.

Like that's kind of autism, right? Mm-hmm. And this is [00:59:00] all, I share all of this not because of myself. This is what these poor kids experience all the time. And then on top of that, they're overwhelmed. And on top of that, they're bombarded with fear and they've got sensory issues. And I mean, when, when you look at their experience like that, I mean, it, it's so heartbreaking.

It's so heartbreaking to think of how many of these poor kids just go through life feeling this way. And with just a, a one silly little pharmaceutical, we can literally change their lives if we just get a few things dialed in. 

Dr. Linda Bluestein: That's really amazing that with an antifungal to have that kind of, uh, effect.

It's just really incredible. And I love that you, you know, had this, uh, transformation and this incredible, uh, rich background that you had gone through all this, the herbals and everything. Are there supplements that, because you've mentioned supplements a couple of times, are there certain supplements that, um, [01:00:00] that you find helpful maybe before you use the antifungal or afterwards or alongside it?

Dr. Pejman Kateraei: Yeah, absolutely. Do you mind if we circle back to Econazole for a second? Yes. 

Dr. Linda Bluestein: I mean, no, I don't mind. 

Dr. Pejman Kateraei: Uh, so, you know, as I witnessed this change in myself mm-hmm. And I started seeing these kids evolve in, in a fairly rapid way, I really started questioning if Itroconazole was just an antifungal. Because, you know, when you ask, well, how quickly can you modulate the gut?

How quickly can you shift the microbiome or the fungal makeup of the gut to influence change? It doesn't happen that quickly. Like it becomes not impossible, but it, it really doesn't make sense that it's just because you took care of the fungus in the gut. Mm-hmm. And this is where I started digging into what else does this.

Do. And then that's where all of a sudden you get into the cancer [01:01:00] research and the autoimmune research where you know, they're used looking at femazole, they're looking at all of these different class of azos and some of 'em are antiparasitics, some of them are antifungals for cancer, treatment for autoimmune, you know, for all of these different things.

And then like all of a sudden the picture opens up and it turns out that itraconazole is actually a very potent anti-inflammatory. It's an immune modulator, first and foremost. And actually an antifungal is kind of a secondary effect, and it literally is shifting multiple systems within the immune system.

Simultaneously there, there's this pathway, cell cell signaling pathway called Sonic Sonic Hedgehog. I don't know if you've ever heard of it. I 

Dr. Linda Bluestein: haven't. 

Dr. Pejman Kateraei: Uh, so we, we think of it as the cartoon character, but it turns out that Sonic Hedgehog actually literally [01:02:00] orchestrates this entire complex cascade of immune behavior.

And it turns out that one of the things Sonic Hedgehog can do is profoundly influence the microglia 

Dr. Linda Bluestein: and, 

Dr. Pejman Kateraei: and literally, it, it orchestrates and dictates microglial behavior. It can influence the blood brain barrier, so the integrity of the blood brain barrier, and if Sonic Hedgehog is overactivated, it disrupts the blood brain barrier.

When it becomes regulated, it starts improving the blood brain barrier, which we know is a part of autism. Right? Uh, it it, and there are, there are multiple cascades and pathways beyond this. Part of what's so fascinating about this drug is that it's getting rid of the fungus and mold. It's improving gut integrity.

And I've had multiple families where their kids have two or three years of chronic constipation or diarrhea, and then like literally three or four weeks later, like, oh my God, like this is the first normal poop she's had her entire life. [01:03:00] You know? Uh, so it, it improves the gut. It improves, I think the microbiome.

It gets rid of the fungus and simultaneously it's actually influencing multiple cascades of immunity within the systemic and nervous system all at the same time, which to me is, is so fascinating to reflect on, and I think it holds a lot of potential in helping a lot of these kids who are struggling.

Dr. Linda Bluestein: Do you think it's helpful in adults as well? I know, I know you're a pediatrician, but from what you know, do you think it would be helpful for adults also? We just said you took it. I think so. So, yeah, 

Dr. Pejman Kateraei: I think so. I, I think so. And you know, a lot of these adults that have MCAS and you know, there, there's all kinds of complex nervous system and systemic immune, uh, issues.

I think again, it has to be used meticulously. You don't want to just throw it in there, but when it's used in the right time, uh, I [01:04:00] think it can be a game changer. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: Absolutely. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: Um, and then what other supplements, uh, to, to kind of set the stage? So, you know, for me, the first thing is before I treat, I try to understand the environment.

And, uh, I think that this is something really important to highlight and this is a huge thing that I see missing from most of what my colleagues do. You know, they dive into treatment and they miss. Exposure that's ongoing. And part of that is not their fault, it's lack of training. And then we get into all of the issues with how mold testing is currently done.

Uh, New Hampshire is the only if, if I remember right, New Hampshire is the only state in the entire country that actually requires mold inspectors to become certified. 

Dr. Linda Bluestein: Oh, wow. So, 

Dr. Pejman Kateraei: uh, there are other states that have passed laws, but when you look at what those laws have in terms of licensure, a lot of times it's, you submit a, literally you submit an [01:05:00] application, say, yep, I'm a molded specter.

Thank you for the $80 or a hundred dollars or whatever. You get your licensure and then you're now a licensed mold inspector. Except you could have done a entry. Literally, I can go do weekend training, become licensed. Right. Like that. That is how low we have set the bar. Mm-hmm. And the way we're testing currently is missing it so often.

So a lot of times, you know, someone will say. Do you have mold? No, we tested our house. We don't have mold. And then the provider takes that at face value and says, okay, mm-hmm you don't have mold. Then they move on. Except the way that home was tested was completely flawed, which continues to cause the exposure, which continues to cause the inflammation.

And then provider comes to try to treat and either the child flares or they treat and then everything slides backwards because all of that ongoing exposure was there. So one of the things that I've learned to do is get really OCD about making sure that the child's environment is controlled or the adult.

Mm-hmm. Uh, so [01:06:00] there's a test called the dust test. I have no affiliation with them, but I use that as a way to, so it's an IRMI test, but it comes with better instructions and it's a, a little easier to interpret. Uh, but basically it's a DNA probe on the dust, which tells us like, is there fungi amounts of mold in the house or not?

And if there is severe amount of mold, like that's like you are on the Colorado and you're trying to paddle upstream and you can't understand why you're going down river, right? Mm-hmm. You can't fight that current of force when there is significant levels of mold in the dust test has code. So it's code five, code four, and then 3, 2, 1, 3, 2, 1 is like you're golden.

Four, maybe there's an issue. Five is like red flag. Uh, really hard to detox and heal. Um, so my first step is, do we have a mess? Is this from the past? Right? Some families come to me, they're like, we [01:07:00] had mold in this house. We moved out. We're good. Child is already doing better, which is a good sign. Mm-hmm.

In which case then we can treat. But there are also times that. Again, there's the exposure that's ongoing. People have missed it, and the child keeps circulating and having issues because of that. Once we control the exposure, then the next step is using some supplements to calm down the mast cells and microglia and basic, basic things just in vitamin D and zinc.

Mm. The reason why I don't do more is I found in these kids, citric acid is a kryptonite. Mm. Uh, because citric acid comes from aspergillus and immunologically, it turns out you might as well just throw mold in their gut. 

Dr. Linda Bluestein: Mm. 

Dr. Pejman Kateraei: Because as far as their immune system is concerned, it's seeing mold. So you are adding to the immunological antigen load, right.

That, that the way the immune system is seeing, it's like, okay, I'm getting bombarded by mold, except you are giving them the supplement [01:08:00] to help them detox. So I started dialing down how much I do. 'cause of that, and now it's limited to a handful of things. There's a supplement called mi, M-I-R-I-C-A. Mm-hmm.

The main ingredient in it that I really have come to like is the PEA. Mm-hmm. Uh, which happens to be really good at, I think, downregulating, the gut mast cells. Mm-hmm. So it starts stabilizing the gut. I know Dr. Theor Rades has talked about Eoin and his neuro Protect, I think is another great product, which is more for the central nervous system because it's so good at absorbing that, it just kind of bypasses the gut and goes right into the brain.

Whereas the miracle kind of lingers in the gut for a little bit and then slowly makes its way up. So neuro Protect Mira are great. I am a huge fan of DAO enzymes. Diamine oxidase, enzymes. Mm-hmm. Because histamine at the gut level causes intestinal permeability. It triggers dendritic [01:09:00] activation. So the dendritic cells, which are kind of the main guards, become paranoid.

So part of what I try to do is not reduce histamine in the nervous system, but it's to reduce the histamine in the gut, which is perpetuating a lot of the gut inflammation. And I find the DAO enzymes to be really helpful for that. And then literally just some din vitamin, uh, some din zinc. If the kids respond and they start calming down, they're more chill, they're sleeping better, they're eating better, and that that happens probably 40% of the time.

That, to me becomes a green flag of like, okay, we're, we're in a decent place. This, this kid's immune system is not completely going haywire, and we can start moving forward to the antifungals and start treating. There's about 20% of kids who are so immunologically averse, and these are the kids who have typically very high MMP nine, so they're MMP nine, like happy levels are like 380 according to Dr.

[01:10:00] Shoemaker, which I've followed. A lot of these kids will have MMP nines, 600, 900, 1100, and those are the kids who have like an immunological equivalent of a ticking time bomb. 

Dr. Linda Bluestein: Mm. 

Dr. Pejman Kateraei: A lot of times simultaneously they have the positive colitis antibodies, so they have the asca, the Sacro Vee, IgG, so like the immunologically, you see the correlation where it's like, oh gosh, this is positive, that's positive, that's positive.

And then you give them the supplement and it's like, no, thank you. Hmm. In those kiddos, when you, you see like this immune system is not behaving logically, I have found peptides to be, you know, my, my, our next best friend, uh, so outside of the Itroconazole Liraglutide, KPV, and I'm, I'm starting to understand how BPC 1 57 comes into the picture, so I'm kind of doing side by side [01:11:00] tests, but.

My goodness. The way these peptides are able to stabilize the gut immune response and the systemic immune response to then allow us to move forward has been beyond extraordinary in some cases. Uh, so that, that is my general approach. And you know, it, it seems so simplistic because it's like, well, what about the liver and what about this and what about that?

Right? What about the probiotics? But when you look at it as what does the body need to detoxify, right? Like how does the body detoxify? It's through a stable microbiome and a stable gut period, right? If those two things are there, the body's able to detoxify. If those two things are not there, you could do backwards, somersaults, and support the liver and everything else as much as you want.

The detoxification is not happening, right? If there's gut inflammation, the microbiome cannot. Start healing and you can pour every probiotic prebiotic under the sun. The inflammation keeps those [01:12:00] things from working, whereas you control the inflammation, the microbiome starts normalizing. So not to say all of these other things aren't helpful, but I believe a lot of those things come after this basic protocol, which then allows them to work so much better rather than you're fighting the inflammation that is being triggered by all this other stuff, which keeps things from moving forward.

Dr. Linda Bluestein: Oh my gosh, this is so much amazing information. I, I, I'm making notes. I have, I have notes on, on a piece of paper. I'm making notes in the, in the spreadsheet here. Yeah. I have a couple of quick follow-up questions, um, because I, I wanna be respectful of your time and, uh, I wanna get to the, like where we can find you and things like that.

Yeah. So, uh, so really quick though. I have a couple quick follow up questions. So, um, uh, I do love those same supplements, the America PEAI personally take it, and I also, uh, prescribe it, DAO, neuroprotective love, [01:13:00] all those things. Um, with the citric acid, is the concern there that it's used as a preservative in some of these supplements?

And then if you could tell us, uh, that the dust test, if there's a specific, uh, I could put the link in the show notes, but if there's a specific name of the company, or maybe it is just the dust test, but if you could just let us know that really quick. 

Dr. Pejman Kateraei: Yeah. So citric acid they use as a filler, uh, additive and preservative.

Okay. And if you look, 60 plus percent of supplements actually have that in there. Mm-hmm. So those are supplements that, especially in these kiddos, and you can argue in adults with, you know, MC, they should also avoid 

Dr. Linda Bluestein: mm-hmm. 

Dr. Pejman Kateraei: Um, because the, the, the, the fungal and immune imbalances in the gut can make that become a big problem.

Um, the dust test is literally the dust test. Okay. Um, so they, they made, they made the name super easy. Uh, if you just type in literally the dust test, it, it comes right up. Uh, it, it's super easy to do like that. Like part of why I've become a [01:14:00] huge fan of them. And again, no financial affiliation with them at all.

Um. They make it so easy, they make it so easy to do the test. It comes with really detailed instructions and the interpretation, and they've got a free phone call you can have with someone to also help you make sense of it. So it, it's, it's just, they make every part of it easy and you don't need a PhD, HD and, and, you know, fungal microbiology to be like, well, is this, is this bad or not?

You know, it's like, right, right. Oh, level five. That's probably not good. Uh, so yeah, they just made it so scalable and easy and I, I've really become a big fan as a result. 

Dr. Linda Bluestein: Fabulous. And we will have links to those supplements that were recommended. We're, we're gonna have a lot of links in these show notes.

A lot of, a lot of super fabulous things that you've shared with us, so thank you so much. My pleasure. And the last thing that I usually like to ask, um, is for a hypermobility hack, do you have a hack that you can share with us? 

Dr. Pejman Kateraei: I think the hack, [01:15:00] which may not be such a easy hack, is. Find out what is the trigger, the actual root cause trigger.

It's easy to take supplements, it's easy to look for the superficial things. If you can find what trigger like caused the issues that then led to the hypermobility, and we can argue, you know, mast cells may be part of that and you take care of that root cause, which is my approach, you know, with autism and all of these kids.

Mm-hmm. If you identify the root cause and take care of that, the, the change that becomes possible is, is almost sometimes beyond imagination. Um, and it's not to say supplements can't help, it's not to say treatments can't help all of those things For sure. But stand back and say, why did this come about in the first place?

Mm-hmm. What created it? Understand that and treat that. And I think [01:16:00] that will go so much further, even though it's going to require more work upfront. 

Dr. Linda Bluestein: Mm-hmm. No, that, that makes perfectly good sense. And I think that's probably applicable to a lot of different things, you know, so I think that's really valuable advice and I can't tell you how much I appreciated this conversation today.

It was so, so informative, and I know that you're very, very busy, so I really appreciate you taking the time to, to chat with me. Um, before you go, can you share with us where we can find you? And I know that you have, I think it's, it's wholistic minds and also wholistic with spelled WH right? You, you have a, you have a practice, but you also have something else that you're working on.

So if you could share that with us and also, uh, any other information that you want us to have. 

Dr. Pejman Kateraei: Sure. Uh, so my practice is called Holistic Kids with a w, so W-H-O-L-I-S-T-I-C Kids. Holistic Minds is something that we've been working on, uh, to ultimately help empower more providers. Uh, [01:17:00] so ultimately it's going to be an AI portal that, you know, physicians can plug into the system.

Crunches all the data. Gathers all the data, and starts highlighting where, you know, the areas of focus they need to pay attention to will be. And, you know, that really came about because a lot of providers are like, I don't have frigging 10 years to get into all of this, you know, crazy nuance that, you know, you have.

Uh, so, but they want to help. Like, there's so many people that want to help. There's, there's so many wonderful providers that just, they just wanna help, but. It's hard for them to get to understanding some of these, you know, weird nuances. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pejman Kateraei: And that's where Holistic minds comes in. It. It's meant to empower providers to be able to do this job easier and more efficiently and effectively.

Um, I have, uh, I'm on Instagram that's. Right post most of my videos and that Instagram is, is on holistic kids. Okay. And I'll, I'll share with you the links there. Uh, [01:18:00] I'm also, I have some videos, more technical videos on YouTube. Uh, and that YouTube is, is actually, uh, now pca, so my first initial last name at YouTube.

Uh, so, uh, those are all places and the YouTube channel really has the more technical videos on environment and testing. So for those families are like, well, why are these tests missing? It, like, it's an hour and a half video. Mm-hmm. That gets into some of that and some pain painful detail, but it's there.

Um, so yeah, those are some of the places where people can find me. 

Dr. Linda Bluestein: Fantastic. We will be sure to put all those, uh, links in the show notes. And I wanna put in a plug for the holistic minds if that could be available for adults as well. That would be fabulous. 

Dr. Pejman Kateraei: I I, it, it's something that we wanna work towards Right now.

We're actually doing another round of fundraising too, to really build everything up to a place where we can do a release. So we're, we're, uh, kind of in a holding pattern, but, uh, it's, [01:19:00] it's definitely something we want to do for sure. 

Dr. Linda Bluestein: That would be really, really great. 'cause you have, we need as many tools as, as we can because, you know, things are getting so complex and it's hard to absorb a lot of information.

And so the more help that we can have, the better. So. Well, thank you so much for chatting with me today. This has been such a, such a great conversation. I know I've learned a lot. I'm sure the listeners have learned a lot and, uh, this is just really fun. 

Dr. Pejman Kateraei: Well, thank you for creating the space and having me here and.

You know, as, as I started, like, part of why I am happy to be here and share with you is I just look and it's just, there's so many kids, there's so many families who are struggling. Mm-hmm. And so many, you know, parents, I, I have some parents that are like, I, I would literally cut off my right arm mm-hmm. If, if my kid could get better and, 

Dr. Linda Bluestein: right.

Dr. Pejman Kateraei: I know there are a lot of parents in that boat, and if this conversation even helps a handful of them, [01:20:00] you know, just, just understand what's going on and, and feel comfortable in taking a few steps forward, it's all worth it. 

Dr. Linda Bluestein: I, I agree. It's, it's, uh, so rewarding to get messages from people that say that they listened to a particular episode and it really, you know, changed their life in some meaningful way.

So that always makes me feel good 'cause 

mm-hmm. 

You know, it's obviously a lot of work and, you know, time consuming and, and, you know, getting. Wonderful people like yourself that are doing really good work is, you know, you gotta work out the schedules and everything, so, but yeah, I'm sure a lot of people are gonna really appreciate this and find it really helpful, so thank you.

Dr. Pejman Kateraei: Most welcome. Thank you.

Dr. Linda Bluestein: Well, that was really a great conversation with Dr. Kateraei and I hope you really enjoyed it and found it really helpful. I feel like there's such an interesting dichotomy between the traditional medicine world and the [01:21:00] integrative medicine world, especially when it comes to something like autism. So this is really important information, so please do share this episode with other people that you know who might have kids that are suffering from autism and related conditions.

Thank you so much for listening to this week's episode of the Bendy Bodies. With the Hypermobility MD Podcast, you can help us spread the word about joint hypermobility and related disorders by leaving a review and sharing the podcast. This really helps raise awareness about these complex conditions.

If you would like to dig deeper, you can meet with me one-on-one. Please check out the available options on the services page of my website@hypermobilitymd.com. You can also find me Dr. Linda Bluestein on Instagram, Facebook, TikTok. Twitter or LinkedIn at Hypermobility MD you can find human content reproducing team at Human Content pods on TikTok and Instagram.

You can also find full video episodes of every week on YouTube at Vendy Bodies Podcast. To learn about the Vendy Bodies program, disclaimer and ethics policy submission verification, and licensing terms [01:22:00] and hipper release terms, or to reach out with any questions, please visit bendy bodies podcast.com.

Bendy Bodies podcast is a human content production. Thank you for being a part of our community, and we'll catch you next time on the Bendy Bodies Podcast.

Thank you so much for watching. If you enjoyed this video, give it a thumbs up and leave a comment below. I love getting your feedback. Make sure to hit that subscribe button and ring the bell so you will never miss an update. We've got plenty more exciting content coming your way, and if you're looking for more episodes, just click on one of the videos on the screen right now.

Thanks again for tuning in and I'll see you in the next episode.