Understanding and Treating Mould Toxicity, Mould Sensitivity and Bio-toxins
The symptoms of mould toxicity may be quite unusual, generally not well-recognised by healthcare professionals and may lead to a mistaken diagnosis of a psychological rather than a physically based problem
- Fatigue, weakness, muscle aches and cramps,
- Headaches, unusual pains (Dr Neil Nathan refers to these as “ice pick” or “lightning bolt” pains ),
- Sensitivity to bright light, tearing of the eyes, blurred vision, sensitivity to light touch
- Cough, chest pain, shortness of breath, chronic sinus congestion
- Abdominal pain, nausea and diarrhoea
- Cognitive impairment, appetite swings, weight gains, mood swings
- Joint pains, morning stiffness, frequent urination, excessive thirst
- Sensitivity to electrical shocks
- Menorrhagia (excessive vaginal bleeding)
- Temperature dysregulation, night sweats, metallic taste in the mouth
- Male impotency
- Numbness and tingling in unusual patterns which do not correspond to the usual nerve distribution pattern thus confusing neurologists
- Unusual ticks and spasms, balance issues and dizziness
- Sometimes there may be a diagnosis of ‘atypical’ MS, Parkinson’s, Alzheimer’s or “pseudo-seizures” (seizures which are diagnosed as not being epileptic in nature but instead being ‘psychological’ in their origin) but there is evidence to connect these pseudoseizures with mould toxicity in clinical cases
- Vibrating or pulsing sensations running up and down the spinal-cord
- Sometimes vision in dim light may be poor
- Many individuals who have mould toxicity are very chemically sensitive (i.e. sensitivity to perfumes, smells, deodorants, alcohol, petrol)
- Other more esoteric symptoms: one of my patients who is a most likeable gentleman tells me that if he drinks red wine becomes extremely bad-tempered and irritable; his wife corroborates this and, not unexpectedly, wholeheartedly approves of his decision to completely stop drinking red wine!
- Sometimes patient experience great difficulty /’mega-hangover’ on the next day after having consumed just three or four glasses of wine or beer (this isn’t reported in the American textbooks but then maybe patients with persistent illnesses in the US don’t have any interest in alcohol – but we like our alcohol in Ireland!)
- Some individuals report feeling quite unwell if they spend time in a damp building e.g. visiting a friend who has an older, damp house – their intuition tells them “stay away from damp, mouldy places”.
How does a patient end up becoming unwell with a mould issue?
- Frequently but by no means always there is a history of living in a damp or water damaged building. Or there just might be one damp room in the house, or sometimes I hear about damp bathrooms, damp wardrobes et cetera. Obviously Irish and British climate is pretty damp.
- I would also just like to draw your attention to the reference above and remind you that 75% of individuals have relatively good immune defences against mould but 25% of the population do not. Hence two individuals each of whom has been exposed to mould may react quite differently one may get sick and the other may feel quite well.
- Certain foods such as dried fruit, aged cheeses, mushrooms overripe fruit and vegetables, beer, wine, wine vinegar and some processed meats are known to contain minute amounts of mycotoxins but the expert consensus is that inhaled spores are the primary source of mould toxicity for the vast majority of patients
- Thus it is important that patients who have been identified as having mould toxicity should not touch or attempt to clean up visible mould as doing so may result in a significant worsening of their condition
- Mould has the capacity to colonise an individual’s body. So as well as outside mould sources of mould spores the individual may be manufacturing fungal toxins themselves. In ‘auto brewery syndrome’ an individual ferment sugars within their own body and may produce quite significant amounts of alcohol and so they get accused of secret and uncontrolled drinking whereas all the while it is the mould within their body which is manufacturing the alcohol
Mould toxicity and sensitivity is very important to understand and diagnose because
- Mould / Biotoxicity is one of the largest elephants in the room in the treatment of patients with persistent infections or who may have medically unexplained symptoms. I
- In my opinion many patients who fail to respond to treatment for a carefully diagnosed bacterial or viral infection probably also have mould sensitivity.
- Undiagnosed mould sensitivity may frequently be a significant cause of failure to respond to treatment.
- 25% of the population do not have the physiological ability to form antibodies against mould, 75% of the population are able to form antibodies
- Therefore two individuals each of whom has had the same degree of mould exposure may react totally differently. One individual may get sick while the other individual may get little or no symptoms at all – hence the individual who gets sick may really look as if they are ‘putting it on’.
- ‘Mould toxicity’ refers not only to the mould itself but also mould spore fragments, the volatile organic compounds (VOCs) i.e the toxins produced by the mould, the microorganisms Actinomycetes and Mycobacteria which are usually found along with toxic mould species as well as other substances called beta glucans, haemolysins, mannans and proteases – so there are lots of other irritants involved in “mould toxicity” as well as the mould itself.
- A significant number of patients who came to see me having failed to respond to antibiotic treatment for persistent bacterial or viral infections whom I then tested for urinary mycotoxins (fungal toxins) turned out to have significantly elevated levels of toxins thus implying that the failure to respond fully to anti-infective treatment or, in some cases not to respond at all, is quite possibly due to mould toxicity. I dearly wish that this information was in my hands 20 years ago
A very short history of mould toxicity and medicine
- The ground work on mould toxicity is Dr Richie Shoemaker a family physician in the Chesapeake Bay area of the US and Dr. Shoemaker published his first book on biotoxicity in 2005 .
- Other doctors who have done a lot of work on mould and by toxicity and how it affects patients are Dr Joseph Brewer (an infectious diseases doctor) and Dr Neil Nathan (a family physician who specialises in medically unexplained symptoms).
- A landmark paper published from the Mayo Clinic in 1999 for the first time suggested that the cause of persistent sinus infections might be fungal rather than bacterial and demonstrated improvement using antifungal agents intranasally
- In 2003 Dr Michael Gray and his group published several papers which clearly demonstrated both immune and nervous system dysfunction in over 200 patients with mould exposure in water-damaged buildings. The medical profession still does not seem to realise how commonly mould exposure can occur and how ill patients may become with mould exposure
By what mechanism does mould adversely affect the body? It is a complicated process but here are some pointers
- There are many mould toxins. The ones which are being tested for currently are Aflatoxin M1, Ochratoxin A, Gliotoxin, Sterigmatocystin, Mycophenolic Acid, Riordin E, Verrucarin A, Enniatin B, Zearalenone A, Chaetoglobosin A, Citrinin
- Mould toxins are small molecules called ionophores which have some unique physicochemical properties: one end of the toxin molecule can dissolve easily in fats (lipids) and the other end is hydrophilic which means that it dissolves readily in water.
- This quite unique molecular structure of mould toxins enables them to pass easily through any body tissue at will as well as through all membranes (membranes can usually regulate which molecules pass through them and which can not pass through them but mould toxins are able to evade surveillance) thus mould toxins are able to get pretty well ‘everywhere’ within the body.
- In the unlucky 25% a cascade of inflammatory compounds called cytokines is set off which then may proceed to cause regulatory havoc within the body affecting multiple systems and that is where the problem for the patient arises when they are giving their history to their doctor – their symptoms tend to be all over the place and hence there is a high chance of the “eyebrows getting raised” maybe even getting raised quite high! This inflammatory response is referred to as the Biotoxin Pathway
- This flood of cytokines blocks the body’s leptin receptors. One of the jobs of the fat cell is to manufacture leptins – the fat cells make more and more leptin in a vain effort to override the blockade. This creates leptin resistance (analogous to insulin resistance where individuals lose their sensitivity to normal amounts of insulin). Leptins regulate satiety and in normal circumstances you get the signal: “you are full: stop eating”. This is one of the reasons people with this kind of illness frequently tell me: “Three years ago I was a size 8 to 10 now I am a size 16!” And this provides an explanation for the weight gain frequently associated with biotoxin illness.
- This flood of cytokines also renders the hypothalamus unable to make adequate amounts of MSH(alpha-Melanocyte-stimulating hormone) and VIP (vasoactive intestinal peptide). Both are critical regulators of neurological, immunological, and endocrine function and more leading to a confusing array of symptoms.
- The hypothalamus which is the “master gland” becomes dysfunctional. Because of the leptin resistance and not enough MSH being produced the production of adrenal hormones, sex hormones (oestrogen and progesterone), thyroid hormones and antidiuretic hormone (ADH) is adversely affected. There is decreased endorphin production (hence more pain), decreased melatonin causes reduced sleep which may create a leaky gut which in turn increases the risk of autoimmune disease and weakening the immune system’s ability to respond to underlying infections.
- The dysregulation of endorphins predisposes people to illnesses such as fibromyalgia and irritable bowel syndrome and the decrease in endorphin production sensitises nerves to incoming pain stimuli. In women vulvar pain and interstitial cystitis are common. ADH dysregulation means that people become more easily dehydrated and this also contributes to balance issues/low blood pressure /POTS and frequently these individuals walk around with a bottle of water with them – you may even carry one yourself!
Diagnosis of mould toxicity
- The first thing is for the doctor to be aware of the possibility of mould toxicity
- Urinary mycotoxin / urinary mould toxin testing has only been available in the last few years. I find this the most useful test. This testing is available through Great Plains Laboratory in the US. I think it also is worthwhile to use glutathione for about a week before the test is taken and to sweat for 10 to 30 minutes with a sauna or hot bath 30 minutes before collecting your specimen
- There also is a visual contrast screening test on Dr. Richie Shoemaker’s site which can be carried out online. Supposedly there is a 70% sensitivity for individuals with mould issues i.e. it will pick up a problem in 70% of cases. The basis of this test is the ability to see contrasting shades of white grey and black. Some individuals with mould will notice that their dim light vision is quite poor
The treatment of the patient with mould toxicity : let’s presume that we have a patient with a urinary mycotoxin test which confirms the presence of abnormally high levels of fungal toxins in their body.
- It is important to have a mouldy environment cleaned by experts to avoid further exposure to the mouldy environment.
- Be judicious rather than aggressive with treatment or you may drive your patients health backwards. The first priority : avoid making the patient even more sick. Individuals suffering from mould sensitivity are usually chemically sensitive and very prone to die off/Herxheimer type reactions – so first of all don’t go too fast by the patient may get quite sick and may take months to recover.
- It is usually worthwhile spending some time first of all improving the patient’s detoxification chemistry – then if this is done carefully and thoughtfully the patient will hopefully be able to comply with the treatment without becoming sicker.
- The next stage then is to use agents to bind mould toxins.
- After mould toxins binders have been used for a while and reasonably well tolerated then the next step is to use oral/nasal antifungals