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Mould and mycotoxins are terms that often appear together, especially in discussions about indoor air quality and health. While they are related, they are distinct in terms of their biological makeup and their impact on health. This post will break down the science of mould and mycotoxins, the methods of testing for mycotoxin exposure, the controversies surrounding certain testing methods, and the relationship between mycotoxins and chronic illness.
Mould vs. Mycotoxins: Scientific Distinctions
Moulds are fungi that grow in damp or humid environments, thriving on various surfaces such as walls, food, and soil. These organisms reproduce by releasing spores into the air, which can easily spread and land on surfaces to establish new colonies.
Mycotoxins, on the other hand, are toxic compounds that some moulds produce as secondary metabolites. Secondary metabolites are chemicals not essential for the mould's growth but may protect the mould from predators or competing organisms.
Mycotoxins are small, low-molecular-weight molecules that can be inhaled, ingested, or absorbed through the skin, potentially causing health issues in humans and animals.
Here’s a breakdown of the key differences:
Mould: A type of fungus that reproduces by spores. Visible as green, black, or white growth on surfaces.
Mycotoxins: Toxic chemicals produced by certain mould species. These toxins can affect the immune, respiratory, and nervous systems when present in sufficient concentrations.
A single mould spore can release multiple types of mycotoxins. For instance, Aspergillus mould species can produce aflatoxins, ochratoxins, and gliotoxins, among others. Thus, inhaling mould spores potentially exposes individuals to a cocktail of toxins, each with unique effects on the body.
How Mould and Mycotoxins Enter the Body
Mould spores and mycotoxins enter the body primarily through inhalation, though they may also be ingested if they settle on food or surfaces that are later consumed. Here’s a closer look at their pathways into the body:
Mould Spores: Measure between 2 and 4 microns, mould spores are small enough to be inhaled deeply into the respiratory tract, where they can initiate an immune response. Due to their size, these spores can reach the lower airways and even the alveoli, the tiny air sacs in the lungs where gas exchange occurs.
Mycotoxins: Are much smaller, typically around 0.1 microns, comparable in size to many viruses. Due to their size, mycotoxins can enter the bloodstream through the lungs or even pass directly through cellular membranes, exerting effects on respiratory, immune, and digestive systems. Once in the respiratory tract, mycotoxins can be absorbed into the bloodstream, affecting organs throughout the body.
These pathways show that both mould spores and mycotoxins have a similar mode of entry to viruses, primarily through inhalation, which is why they can lead to both respiratory symptoms and broader systemic effects.
Testing for Mould and Mycotoxin Exposure
There are several tests available in functional medicine practice that test for mycotoxin exposure in humans, primarily through urinary mycotoxin testing and serum IgG/IgE antibody tests.
Urinary Mycotoxin Testing
Urinary mycotoxin tests are designed to measure the levels of mycotoxins excreted in urine. The tests aim to provide a snapshot of an individual’s exposure to mycotoxins by measuring trace amounts of these toxins in urine. However, urinary testing is a controversial method and has some inherent flaws.
Lack of Standardisation: Urinary mycotoxin testing lacks standardised procedures and calibration, meaning different labs may yield inconsistent results.
Non-specificity of Results: Urine mycotoxins reflect recent diet or environmental exposures rather than long-term body burden. For instance, mycotoxins present in consumed food are excreted in the urine.
False Positives and False Negatives: Due to the lack of regulatory oversight, there’s a risk of false positives and negatives, which can lead to misdiagnosis.
One significant and more serious flaw with urinary mycotoxin testing is that it only provides a single snapshot of exposure at the time of testing. Given that we are constantly exposed to various environmental mycotoxins, the concentration of mycotoxins in urine can fluctuate throughout the day. If urinary mycotoxin testing were to be used, samples would ideally need to be collected multiple times throughout the day and repeated over several days for accuracy. Unfortunately, no current test on the market offers this level of thorough sampling.
Risks of Inappropriate Treatment
The use of urinary mycotoxin testing has led to cases of inappropriate treatment, such as unnecessary anti-fungal or binding therapies. These treatments are costly, and when improperly prescribed, they can cause unwanted side effects. For example, using anti-fungals without clear evidence of fungal infection may harm the microbiome or lead to other immune system complications.
Serum IgG and IgE Antibody Tests
When it comes to assessing mould-related illness, serum IgE and IgG antibody testing are the most reliable methods, offering very high sensitivity and specificity to mycotoxins.
The Immune Response: IgE and IgG Antibodies
The immune system produces IgE and IgG antibodies in response to foreign invaders like mould and its toxins, creating measurable biomarkers that can indicate exposure and sensitisation.
IgE Antibodies:
IgE antibodies are typically associated with allergic reactions and are produced when the immune system encounters substances like mould, mycotoxins, pollen, or dust. When exposed to mould spores, some individuals’ immune systems respond by producing IgE, which binds to the mould antigen, triggering an immediate allergic response. Over time this can lead to Mast Cell Activation Syndrome and ongoing symptoms of sneezing, itchy eyes, nasal congestion, or even asthma, reflecting an acute allergic reaction to mould. Serum IgE testing measures these antibodies and is highly specific, meaning it accurately identifies immune system activation to mycotoxins
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IgG Antibodies:
Unlike IgE, IgG antibodies indicate longer-term, chronic exposure. They are produced after ongoing or repeated exposure to mould spores or mycotoxins, reflecting a delayed or sub-acute immune response. High levels of IgG suggest past exposure and sensitisation to mould, which may indicate a person has been in an environment with mould contamination.
The high sensitivity and specificity of these tests make them reliable for distinguishing if the immune system is generating antibodies to mycotoxins
Serum vs. Urinary Testing: Why Serum Antibody Testing is Preferred
While no test is 100% accurate (even those you order though the GP), serum antibody testing offers a much more robust method for assessing mould-related illnesses by detecting immune system responses. Like mycotoxins, many viruses are too small to measure directly in bodily fluids. Therefore, diagnosis relies on antibody testing to detect the immune response.
Similarly, serum antibody testing for mould and mycotoxins reflects the body’s immune response rather than attempting to directly measure mycotoxins, which, due to their minuscule size and transient presence, may be hard to accurately quantify in body fluids.
Other considerations
Mycotoxins and Lyme Disease: The Challenge of Co-occurring Conditions
Immune responses to mycotoxins can complicate the treatment of other chronic infections, particularly Lyme disease and related Co-Infections. Mycotoxins have immunosuppressive properties, which can weaken the body’s ability to combat infections effectively. They can disrupt immune cell function, inhibit protein synthesis, and even promote inflammatory responses that make it difficult to clear infections like Borrelia burgdorferi, the bacterium responsible for Lyme disease.
Some patients with Lyme disease who are also exposed to mycotoxins experience delayed or incomplete recovery, as their immune system is compromised by both the infection and the toxin burden. Effective Lyme disease treatment often requires addressing environmental toxin exposure alongside antimicrobial treatments or before antimicrobial treatment. However, many existing protocols lack a clear approach to managing these dual challenges.
Caution: Risks of Following Internet Treatment Protocols for Mould Exposure and Mycotoxin Detox
When faced with mould exposure and mycotoxin-related health issues, it can be tempting to look to the internet for guidance on treatment. However, treatment protocols found online often lack medical oversight, scientific validation, and personalised tailoring to an individual’s specific needs. In many cases, attempting these treatments without professional supervision can lead to unintended health complications. One example of a popular but potentially harmful remedy is the use of glutathione for mycotoxin detoxification, which can worsen symptoms rather than alleviate them.
The Risks of Glutathione in Mycotoxin Detoxification
Glutathione is an antioxidant produced by the body to combat oxidative stress and neutralise toxins. While glutathione is essential for cellular health, using it as a treatment to "detox" mycotoxins, particularly gliotoxin, can sometimes have adverse effects. Here’s why:
Increased Gliotoxin Toxicity:
Gliotoxin is a mycotoxin commonly produced by Aspergillus species, and it is known to be highly toxic to human cells, particularly immune cells. Glutathione can react with gliotoxin, inadvertently increasing its toxicity and enabling it to cause more damage to cells and tissues. This effect is due to a chemical process where glutathione forms a bond with gliotoxin, leading to a more reactive compound that can amplify oxidative stress rather than mitigate it.
For those with high gliotoxin levels, taking glutathione supplements or following a glutathione-boosting protocol can worsen symptoms, contributing to fatigue, brain fog, and inflammation rather than alleviating them.
Impact on Sulfur Metabolism Pathways:
Glutathione is a sulfur-containing compound, and its metabolism depends on well-regulated sulfur pathways. Overloading the body with glutathione through supplements can disrupt these pathways, especially in individuals with underlying sulfur metabolism issues. This disruption can lead to symptoms such as headaches, digestive discomfort, skin rashes, and fatigue.
Additionally, those with certain genetic mutations, such as MTHFR, may have compromised methylation and detoxification pathways, which can result in an accumulation of unmetabolised sulfur compounds. This overload can further stress the liver and kidneys and increase the body’s toxic burden.
Risk of Overburdening Detoxification Pathways:
Many online protocols encourage “pushing” detoxification by using detox supplements in high doses, which may overactivate the liver and kidneys. For individuals already struggling with detoxification challenges, these treatments can lead to a buildup of other metabolic byproducts, worsening symptoms rather than helping to clear toxins from the body.
Critique of the Shoemaker Protocol for Mycotoxin and Mould Exposure
When undertaking research into overcoming mycotoxin illness you may come across the Shoemaker's protocol, which is a specific treatment approach for chronic inflammatory response syndrome (CIRS) due to mould exposure involves multiple steps, including binding agents, anti-inflammatory treatments, and hormone regulation.
Although widely popular in certain circles, there are limitations and criticisms of this protocol:
Inconsistent Efficacy: The Shoemaker Protocol has shown mixed results. While some patients report symptom improvement, others experience little to no benefit. The variability suggests it may not address all underlying causes or may be unsuitable for certain patients.
Broad Claims: The protocol's effectiveness in treating various conditions has not been universally validated in clinical settings, and some claims about its efficacy remain unproven by peer-reviewed studies.
Potential for Over-treatment: The protocol’s intensive approach, which includes the use of multiple medications, may lead to over-treatment and unnecessary costs. Some argue that the treatment regimen may inadvertently add to the body’s toxin burden if not monitored carefully.
While it may be tempting to rely on generalised protocols found online, it's essential to work with a healthcare professional to tailor interventions specifically to your needs. This approach ensures that treatments are evidence-based and suited to your unique health profile, rather than relying on guesswork and incomplete information. Recovery will be much cheaper, more efficient and quicker in the long term.
The best course of action:
Appropriate case study taking and health history timeline
Appropriate and robust serum antibody testing
Appropriate and robust assessment of environmental exposure – home, vehicles and place of work
Appropriate anti-fungal treatment under medical assessment – Itraconazole is effective against all mycotoxins
Support redox before detox
Appropriate immune and gut support
Dietary intervention
Commence Lyme/Bartonella treatment if positive results are found
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