It was great hearing Neal Nathan, MD speak in a talk titled Mold Toxicity As An Unrecognized Cause of Mental Health issues.
Living in the Pacific NW there are obviously many cases of mold exposure due to the unusually wet climate and high likelihood of building or auto water damage. There are two experts that I have studies in this arena Ritchie Shoemaker, MD and Neal Nathan, MD so it was a pleasure to sit down and hear Dr. Nathan speak. I have been reading Dr. Nathan’s book Toxic so the lecture was useful in solidifying some concepts. I want to preface this article by encouraging you to read this article objectively...don’t read this article and say “this is me; I have mold toxicity”. I am saying this because the chances you have this condition are not high odds. This is something that is more of a zebra and you should focus on more common things before focusing on a rare zebra like mold toxicity. We learned in medical school that “common things happen commonly”. Before diving into the deep waters of testing and treating mold toxicity make sure that the basics have been covered. That being said many people have gone through the common considerations and still feel unwell at that point diving into this level of investigation makes sense.
The talk put into perspective that not everybody is a risk for mold toxin issues as only 25% of people exposed to mold have the genetic inability to process mold toxins (biotoxins). I have heard that the genetic variant along the HLA genotypes and haplotypes makes someone most susceptible to mold toxicity issues. Mold is an issue that is quite extensive as susceptible people develop mold allergies, their immune system gets more vulnerable to infections, and their brain gets affected by the biotoxins.
Symptoms are vast but including cognitive impairment, panic attacks, anxiety, depression, depersonalization, derealization, and hallucinations. Mold toxicity may look like fibromyalgia, chronic fatigue syndrome, atypical multiple sclerosis, rheumatoid arthritis, Alzheimer’s Disease, Parkinson's Disease, asthma, chronic sinusitis, anxiety, depression, mood swings, cognitive impairments, and mood swings. No wonder it takes many months to years before someone will receive a proper diagnosis.
Many symptoms look like mold illness , however some stand out as more specific:
o Multiple chemical sensitivity
o Sensitivity to light, sound, touch, food, and, electromagnetic frequency
o Often joint and muscle pain
o I will also see chronic sinus issues, chronic allergy activation
o Air hunger
o Electrical shocks
o Ice pick pains
o Paresthesias that are non-dermatomal
o Internal vibration/tremor
Dr. Nathan spent a good deal of time talking about how to assess for mold. Interestingly, he looks for mold toxicity findings in the person before looking for mold exposure in a building . There are two basic tests he uses. One is Liquid chromatography/mass spectrometry (i.e. The Mycotoxin Panel by Great Plains Laboratory) and also ELISA testing by Elisa testing using Realtime (Measures gliotoxin) or Vibrant Health Labs.
These two tests screen patients for the widest variety of problematic mold species including:
o Stachybotrys (black mold)
Dr. Nathan will also use nasal washes with testing for the assessment of mold. He also uses a mold screening tool called Visual Contrast Testing .
Dr. Nathan talked specifically about the mold assessment and how testing for mold requires special preparation. As mold will often shut down detoxification pathways via suppressing glutathione levels. Then what happens is the mold toxins are not well-excreted making it difficult to pick up on a urine test.
For this reason, Dr. Nathan believes in provocation of mold toxins using a special procedure.
His provocation before testing protocol includes.
o First morning urine collection after not consuming liquids after the evening meal
o He gives a specific dose of glutathione twice daily for 7 days leading up to collecting urine on the 7th day.
o Also using sauna, or hot bath the night prior to the collection.
o He recommends stopping all binders 3 days before the collection
o Provocation may exasperate symptoms so precaution needs to be in place.
o When this is done, he sees the most accurate test results.
It was really helpful to hear that repeat testing of mold toxins often reveals worse results on the second test. This is because it is thought that as someone is going through treatment the liver starts clearing more toxins that were not being cleared on the first test. This should be weighed against someone’s response. Meaning if the urine lab results are worse on retesting but the patient feels better then this is likely due to improved detoxification.
But if the symptoms are worse and the patient is worse this may be due to:
· Re-exposure to mold
· Excessive toxin binding
· Excessive killing of mold-releasing toxin and stimulating mold to make mycotoxins.
Sometimes treatment stimulates molds to make toxins. Amphotericin B (an antifungal drug) stimulates the release of the immunosuppressive agent called gliotoxin.
Treatment specifics are beyond the scope of this article, however I will outline some of the strategies. It is important to note that people with mold exposure are usually very sensitive to everything. Jumping into a treatment right away is not always possible. Dr. Nathan points out that prior to treatment some people need support for their liver, gut, and lymphatic systems to help improve detoxification prior to getting rid of the mold.
He also likes some form of mind/body treatment on board like Dynamic Neural Retraining System (DNRS).
Once the mold is diagnosed, he recommends the following:
· Evaluate exposure at home and get the home and car tested for mold and remediate.
This can be done with independent testing, mold agar plates, and EMRI testing.
· The main treatment for mold exposure is mold binding agents. Choose binders specific for the type of mold. More on this later in a separate article.
· Use antifungals for colonized areas such as gut, sinuses, and lungs.
· Also start treating associated conditions like limbic system dysfunction/inflammation, vagal nerve dysfunction, mast cell activation, hormonal imbalance, andMethylation/Pyloria/Porphyria
I really enjoyed hearing Dr. Nathan speak. He is really down to earth and he says he owes his success to being patient. He encourages his patients to take a slow and steady approach to treating mold. It is a journey that may take even up to a year or more to successfully treat! Many people are gladly ok with this slow approach because they have been feeling unwell for so long that they feel at least encouraged they are on a path to stabilizing.