Mold and Mycotoxin Illness/CIRS
This is a summary of the paper “Effects of Mycotoxins on Neuropsychiatric Symptoms and Immune Processes” by Aarane M. Ratnaseelan, MBS; Irene Tsilioni, PhD; and Theoharis C. Theoharides, MS, MPhil, PhD, MD ; Clinical Therapeutics/Volume 40, Number 6, 2018
Mold is a type of fungus grown on moist food and other surfaces. While generally thought to be an outdoor problem, mold contamination in buildings is quite common. One study from Harvard University (Cambridge, Massachusetts), reported that the prevalence of indoor mold growth was between 22%to 57%, affecting >50% of households in 5 communities. Another study in in Russia reported positive associations between water damage or the presence of molds in the home and asthma, wheezing, dry cough, bronchitis, and respiratory allergy. Many studies describe the adverse health consequences of mold-contaminated indoor environments, and especially mycotoxins, on the skin and respiratory systems. Some indoor molds, including Trichoderma, Fusarium, and Stachybotrys spp., produce mycotoxins, exposure to which occurs through skin contact, inhalation, and ingestion. Inhabitants of affected dwellings typically report headaches, respiratory and musculoskeletal symptoms. Some studies have also reported that mold-exposed groups had altered nervous system functioning, including changes in balance and vision. The exposed people also had significant depression and anxiety.
While a single mycotoxin may not produce any effect, a combination of mycotoxins could result in toxic reactions at very low levels. The major classes of mycotoxins include ochratoxin(A, B, and C), produced by Penicillium and Aspergillus spp., as well as the trichothecenes (T2).
- Ochratoxin A is the most common mycotoxin found in foods and water- damaged buildings ,and has been associated with serious health problems, including severe neurologic issues, in humans.
- The trichothecene mycotoxins (from so-called “toxic black mold”) are subclassified as non-macrocyclic, produced mostly by Fusarium spp, and macrocyclic, produced mostly by Myrothecium, Stachybotrys, and Trichothecium spp. Trichothecene mycotoxins can be released at 300-fold the concentration of spores. These are commonly detected in the air of contaminated buildings, and exposed persons have significantly more T2 mycotoxins in their blood as compared non-exposed people. These toxins can cause multi-systemic effects, including gastrointestinal, cardiovascular, and neuropsychiatric complications. One study reported neurotoxic effects on human cells exposed to satratoxin A at levels found in water-damaged buildings. Trichothecene mycotoxins released by Stachylobotrys spp, such as satratoxins G and H, have been shown to produce neurotoxicity in humans. The non-macrocyclic T2 fumonisin B1 has also been associated with neurotoxicity.
Findings in Adults
Individuals exposed to mold report a wide range of symptoms, including malaise, fatigue, and cognitive impairment, which appear to be related to the length of exposure. In one study, patients who had been exposed to mold were impaired on a variety of cognitive measures, including verbal learning, visuospatial learning and memory, psychomotor speed, and emotional functioning. Mold-exposed patients in other studies also displayed similar symptoms of neurologic dysfunction, including an inability to stand on one’s toes, inability to walk in a straight line with eyes closed, short-term memory loss, and visual changes. Another group of researchers assessed the psychological, neuropsychological, and electro-cortical effects of exposure to mixed colonies of toxigenic molds; the patients reported moderate to severe levels of cognitive, physical, and emotional symptoms, mostly depression, while quantitative electroencephalography results showed slowing in the frontal cortex of the brain. Neuropsychological testing also indicated impairments similar to those seen in mild to moderate traumatic brain injury, in which there were findings of impaired functioning on multiple cognitive tasks with memory and executive functions being the most commonly affected areas. One study conducted in patients with confirmed exposure to mixed-mold infestation in water-damaged buildings found that exposure to mycotoxins was associated with multi-system issues involving the nervous and immune systems.
Effects of Mold on Children
Correlations have been found between exposure to excessive moisture or mold in a home or school environment and the presence of respiratory issues, including infections, repeated wheezing, and prolonged cough. In children with long-term exposure to molds, there were significant neurologic findings on clinical neurologic and neurobehavioral tests, as well as abnormalities on a series of neurophysiological tests, including electroencephalography, brainstem evoked potential, visual evoked potential, and somatosensory evoked potential.
A study in Poland looked at cognitive functioning in infants exposed to mold in contaminated homes. In these children, the longer the exposure to indoor molds was associated with deficits in IQ. Another study in Spain revealed that persistent home dampness in a child’s bedroom during early life was associated with a significant decrease in the general cognitive score on 2 measures of intelligence.
Recent studies have reported a significant association between exposure to mycotoxins and autism spectrum disorder (ASD), which now affects an estimated 1 in 59 children. A significant association was found between levels of ochratoxin A in urine and serum found in children with ASD. In a subsequent cross-sectional study, levels of different mycotoxins (aflatoxin M1, ochratoxin A, and fumonisinB1) were shown to be significantly higher in serum and urine from children with ASD as compared to healthy children. Another study compared neurobehavioral and pulmonary functioning between mold-exposed boys with ASD, non–mold-exposed boys with ASD, terbutaline-exposed children, and unaffected children from a community with no known chemical exposures. The results showed that the mold-exposed boys with ASD averaged significantly more abnormalities than did the other groups, especially in balance, vision, and blink-reflex latency.
Immune Pathways of Mycotoxin Toxicity
Mycotoxins may produce their detrimental effects not only by affecting gene transcription and translation, but also through inflammatory responses such as the development of oxidative stress mediated by cytokines, and the depletion of reduced glutathione. Ochratoxin A exposure reduces mitochondrial function and could lead to apoptosis (cell death) in nerve cells as well as dysfunctional responses in cultured murine microglia and astrocytes in the brain. In studies in mice, satratoxin G was shown to produce apoptosis in sensory neurons in the olfactory bulb, as well as encephalitis associated with persistently high levels of pro-inflammatory cytokines in the frontal brain region. Mycotoxins can stimulate mast cells and microglia because mast cell–microglia interactions have been implicated in neuropsychiatric disorders, especially”brain fog.” Such triggers could increase the permeability of the gut–blood and blood–brain barriers through mast cell mediators, especially cytokines, allowing circulating and environmental toxins to pass into the brain, trigger microglia proliferation, and disrupt neuronal connectivity.
The above study demonstrates the importance of evaluating for the presence of mold and mycotoxin in practically everyone who is experiencing a wide variety of symptoms, including somatic (body), neurologic and psychiatric. Molds grow in damp places; this can include many different foods – such as grains (wheat, rye, barley, corn), peanuts and tree nuts, milk products and hard cheeses, grapes and grape products, coffee, dried fruits, fermented foods – as well as in water damaged buildings. Mold is not always visible as it can often be hidden behind walls, in crawl spaces and attics, under flooring, in the HVAC system, in washing machines and many other places. Mold can grow within 24-28 hours of a water leak or flood, and can be the result of excessive humidity and dampness, such as in basements and bathrooms. It can be found in homes, places of worship, businesses and schools – in fact a number of my patients have been exposed in schools and dormitories. Mycotoxins are toxic substances made by molds, and are not killed when mold is killed; more of them may be released if the mold is treated, for example with bleach. Mold and mycotoxins are often difficult to detect – and the most common ways of testing for mold (spore/air traps) frequently miss finding the mold. Having a trained, certified Indoor Environmental Professional/Mold Inspector evaluate the building is the best, most accurate way of detecting mold. Remediation is often a challenge, both in cost but also in effectiveness, and if choosing to move rather than remediate there is the risk of contaminating a new building by bringing items that have not been adequately decontaminated or that should have been disposed of.
A person who develops symptoms related to mold and mycotoxins CANNOT get fully well if they remain in an environment that is moldy. Mycotoxins can remain in the body for years in some people whose detoxification systems are not efficient.
Symptoms of Chronic Inflammatory Response Syndrome (CIRS) due to mold or other Biotoxins often affect many different body systems. This can include any variety of these (or other) symptoms:
- Respiratory – shortness of breath, sinus issues, wheezing;
- Circulatory – blood clotting abnormalities; elevated cholesterol
- Urinary – increased thirst and urinary frequency
- Endocrine – weight gain or loss; thyroid dysfunction, elevated blood sugar; low testosterone; adrenal dysfunction
- Immune – development of various autoimmune conditions; reactivation of dormant viruses and other infections
- Neurologic – numbness and tingling, word finding problems, visual changes; tremor; fatigue; malaise; “brain fog”, seizures
- Psychiatric – depression, anxiety, concentration and memory problems
- Gastrointestinal – diarrhea, abdominal pain; development of Celiac Disease
- Musculoskeletal – weakness, joint problems; muscle aches, “ice-pick” pains; static shocks
Assessment includes a thorough medical history and review of symptoms, including an environmental exposures history. I recommend doing extensive testing, including blood tests to rule out other conditions as well as to assess various systems that are commonly affected by mycotoxins by using specialized tests related to the immune and hormonal systems. I also recommend checking urine tests that look for the most common mycotoxins as well as organic acids that can indicate whether mold or Candida are colonizing the body, the function of the mitochondria, neurotransmitter balance, and whether the person has developed a problem with oxalates.
Treatment is primarily related to assisting the body to become better at detoxing the mycotoxins (as well as treating any mold colonization in the body). These treatments are not generally a “quick fix”, and depending on the person’s detoxification ability can take months or even years to complete. Although every treatment plan at Holistic Child/Adult Psychiatry is individualized, common treatment recommendations include:
- Binders – these can include prescription or non-prescription substances (or a combination) that “grab onto” the mycotoxins and help remove them from the body through the digestive system
- Liposomal Glutathione – helps reduce oxidative stress and helps “push” the mycotoxins from the cells where they are stored
- Additional detox modalities: Support for organs of detox – liver, kidneys, lymph; Infrared Sauna – uses sweat and the skin as a detox organ; Ionic Foot Baths – using ions to encourage the body to go into parasympathetic mode which is needed to detox through the lymph and kidneys
- Repair the Digestive System- which is often negatively affected by mold and mycotoxins
- Work on the Immune System using products such as Serum Bovine Immunoglobulins, Transfer Factors, Low Dose Naltrexone and others
- Address Endocrine abnormalities (adrenal, thyroid, sex hormones, etc) as needed
- Hyperbaric Oxygen Therapy – to reduce Oxidative Stress and help the brain and other organs function by increasing the amount of oxygen delivered to them
- Frequency Specific Microcurrent – using bio-compatible amounts of electrical current at frequencies that specifically target affected organs. This can address the mood component, brain fog, help support the liver and immune system and more.
- Address any infections or colonizations present using antifungals – this can be from mold, bacteria or viruses.