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COMING SOON: The Functional Medicine Collective...a mentorship and co-working space for clinicians who want more support!
The launch kicks off with a free 2-day workshop on May 8th and 9th...click the button below to get notified when registration opens!
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This week's topic: Mycotoxin-Induced Illness
Mold-illness or mycotoxin-induced-illness is another diagnosis that mainstream medicine is either unfamiliar with, or considers to be made up. An overview of today's email:
- What are mycotoxins?
- What tests can we use to assess mycotoxin involvement in a patient's health?
- My clinical experience
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1. What are Mycotoxins?
Mycotoxins are low molecular weight metabolites - aka toxins - produced by fungi. These are mostly associated with molds found in:
- Water-damaged buildings (with estimates that over 60% of buildings have water damage and mold, most of which is not visible)
- Food, with the most common foods being those that are stored in large containers during production (grains especially corn and wheat, nuts, coffee, peanuts) and beer/wine
Over 300 mycotoxins have been identified, but only a dozen or so are known to cause human health issues. These health issues are often neurological, endocrine, GI, or immunological, but because some mycotoxins damage DNA and increase oxidative stress, liver and kidney cancers are also tied to mycotoxin exposure.
Mold-Induced Illness and Mainstream Medicine
Mold spores - not toxins - are recognized in mainstream medicine as a trigger of illness in humans. Most allopathic clinicians, however, do not know about mycotoxins.
Most of the studies on mycotoxins are from contaminated food supplies or animal studies. It is unethical to do RCTs on humans which makes it difficult to study these toxins and efficacy of treatments.
Why Aren't More People Affected by Mycotoxins?
Mycotoxins do not produce overt illness in everyone. Dr. Richie Shoemaker, who is credited for bringing awareness of mycotoxins in human health and disease, estimates that 1 out of 4 people will experience overt illness from these.
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2. What tests can we use to assess mycotoxin involvement in a patient's health?
Blood testing: Blood is a newer way to assess for immune reactivity to mycotoxins. The company, MyMycoLab, looks for IgG and IgE reactivity to 14 different mycotoxins. I have only recently begun to use this in practice, but it is the go-to test by clinicians in my practice. This test can be ordered without a clinician's order, but interpreting it is a science and best done with someone who has had training. Note, clinicians can watch the free video series to learn more about the test.
Urine testing: Urine, which is the primary way these toxins are excreted, is the older and more common way to evaluate for whether the body is metabolizing and eliminating mycotoxins. There are 3 popular labs that run this testing: Real Time Labs (my go-to), Mosaic Mycotoxin testing (too many false positives in my experience especially for ochratoxin), and Vibrant Labs. I always remind patients that since urine is a waste product, we want to see toxins removed if there is known exposure...but this is why I also recommend avoiding high mold foods before running the test (since we want to know tissue burden as well as exposure).
Questionnaire: Dr. Jill Crista, one of my mentors, has been working with Dr. Neil Nathan on validating this 2-page questionnaire as a way to screen for mycotoxin-induced illness. I often recommend this along with a $10 VCS screening (non-specific for mold, but originally developed by the military to identify biotoxin exposure in soldiers) for patients who are on the fence about pursuing more expensive testing.
Clinical Pearl: For at least 1 week before running any blood or urine test, have a patient consume a Paleo diet (i.e. grain-free, sugar-free, legume-free) or low-mold diet to decrease the chance of false positive tests.
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3. My Clinical Experience
I have had training and mentoring from a number of sources, and have worked with hundreds if not over a thousand patients who had suspected mycotoxin-induced illness. This is one of the most difficult illnesses to treat, for both patients and clinicians! Why?
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COST: In most of my training, there is not a great methodical method for addressing mycotoxin-induced illness. Treatments often cost tens of thousands of dollars and are a mix of:
- A lot of supplements
- Specialty treatments (e.g. IVs, sauna, nasal prescriptions)
- Thorough testing of the home or workplace (ideally by reputable IEPs)
- Often a recommendation to move or completely remediate a home
- Many practitioners may recommend getting rid of most personal belongings to avoid continued illness from mold spores and toxins (which are thought to exist on porous materials, although there are very few good studies on this hypothesis)
- And the mental cost that leads to constant worry about re-exposure, safety concerns about where to move or live, often lack of support from loved ones who are not sick, and more
- PATIENT UNDERSTANDING AND FOLLOW THROUGH: Without mainstream medicine validation, as practitioners we often have to convince patients to follow through on treatments. Many understandably are attached to their home and personal belongings, or even their job (if mold is suspected to be at the workplace); it is difficult to give these up in hopes of seeing health improvements.
- TREATMENT: The most important step - getting out of mold exposure - is not something that medical clinicians should be in charge of verifying yet we often get involved in (again, certified IEPs are best). Lots of "negotiating" can occur, which is taxing on both the patients and the practitioners. And if someone is able to get out of exposure, the supplements and treatments used are often needed for at least a year and may not start "working" until at least 2 months of use.
There is so much more I could say about this, but I will touch more on the nuances of treating and addressing mycotoxin-induced illness in the mentorship, in addition to a methodical approach I use for patients who are cost-conscious.
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Thank you for being a part of this newsletter community. I hope these serve you in some way :)
Stay well, and enjoy the weekend!
Meg
Additional resources that may be helpful
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