The environmental movement has rightly focused our attention on smog, smoke, and outdoor pollution as disease drivers, but to some extent it has caused us to be a bit myopic to the fact that for many people, poor indoor air quality may be an even bigger threat to health.

Many patients are unaware that a toxic home or workplace—especially one contaminated by mold–is contributing to their symptoms.

Exposure to chronically water-damaged indoor environments is associated with exposure to molds. The most common types found indoors include Cladosporium, Penicillium, Alternaria, and Aspergillus. 

Stachybotrys chartarum (sometimes referred to as “toxic black mold”) is a greenish-black mold, which grows on household surfaces that have high cellulose content, such as wood, fiberboard, gypsum board, paper, dust, and lint. The unwelcome—and all-too-common—presence of Stachybotryx is usually an indicator that there has been elevated moisture present or previous water damage.

Some molds secrete mycotoxins that can be measured in the urine, such as ochratoxin, aflatoxin, and trichothecenes.

Inflammatory Triggers

Exposure to mold and mold components is well known to trigger inflammation, allergies and asthma, oxidative stress, and immune dysfunction in both human and animal studies.  

Mold spores, fungal fragments, and mycotoxins can be measured in the indoor environments of moldy buildings and in humans who are exposed to these environments.

Most of the time, we are exposed to molds like Stachybotrys via skin contact, through ingestion, and by inhalation.  Sites of exposure typically include water-damaged and poorly ventilated homes, schools, office buildings, court houses, hospitals, and hotels. It is estimated that as many as 25% of buildings in the US have had some sort of water damage.  

Molds have the ability to trigger a wide range of symptoms, such as skin rashes, respiratory distress, various types of inflammation, cognitive issues, neurological symptoms, and immune system suppression. In day-to-day clinical practice, the most common symptoms associated with mold exposure that we’re likely to see are allergic rhinitis and new onset asthma.

When in Doubt, Ask

I believe we need to raise our index of suspicion about mold exposure among our patients with chronic inflammatory conditions, especially when those conditions do not resolve with typically effective treatments.

I start to think about mold exposure whenever I see patients with the following:

1. Fatigue and weakness
2. Headache, light sensitivity
3. Poor memory, difficulty finding words
4. Difficulty concentration
5. Morning stiffness, joint pain
6. Unusual skin sensations, tingling and numbness
7. Shortness of breath, sinus congestion, or chronic cough
8. Appetite swings, body temperature dysregulation
9. Increased urinary frequency or increased thirst
10. Red eyes, blurred vision, sweats, mood swings, sharp pains
11. Abdominal pain, diarrhea, bloating
12. Tearing, disorientation, metallic taste in mouth
13. Static shocks
14. Vertigo, feeling lightheaded

To be sure, there are many conditions that can lead to each of these symptom patterns, and mycotoxin exposure may not be the sole explanation for any of them. Yet many clinicians do not even consider the possibility, though given the prevalence of water damaged homes in many parts of the country, we certainly should.

Whenever I suspect that mold exposure may play a role in the underlying causes of someone’s symptoms, I like to ask the following questions from a checklist developed by the Environmental Health Center-Dallas (EHCD).

• Do musty odors bother you?
• Have you worked or lived in a building where the air vents or ceiling tiles were discolored?
• Have you noticed water damage or discoloration elsewhere?
• Has your home been flooded?
• Have you had leaks in the roof?
• Do you experience unusual shortness of breath?
• Do you experience recurring sinus infections?
• Do you experience recurring respiratory infections and coughing?
• Do you have frequent flu-like symptoms?
• Do your symptoms worsen on rainy days?
• Do you have frequent headaches?
• Are you fatigued and have skin rashes?

A few “yes” answers to these questions, should prompt you and your patient to get serious about looking for—and eliminating—household or worksite molds, and doing whatever else is necessary to minimize exposure.

How to Treat Mycotoxin Exposure?

Dealing with the sources of exposure is obviously the first step. The patient needs to find the mold and to the best extent possible, eliminate it from their homes or worksites.

There are a number of companies across the country that specialize in household mold detection, elimination and remediation.

It is essential for patients to remove themselves from the contaminated environment—or remove the contamination from their midst. Don’t even think about going on to other treatment modalities until they’re able to minimize exposure by avoiding or cleaning up the contaminated environment.

Here are a few other steps for mitigating the physiological damage caused by chronic mold exposure:

• Use clay, charcoal, cholestyramine or other binders to bind internal mycotoxins. My favorites are Upgraded Coconut Charcoal or GI Detox and Glutathione Force!
• While using binders, the patient must maintain normal bowel function and avoid constipation.  If needed, magnesium citrate, buffered C powder, or even gentle laxatives can be a big help. Make sure your patients understand that constipation is the enemy of detoxification!
• Look for and treat colonizing molds/fungal infections in the body. Common locations of colonization include sinuses, gut, bladder, vagina, lungs.
• Test and treat for candida overgrowth – living in an environment with mold leads to immune system dysregulation that allows candida to overgrow in the body.
• Enhance detoxification support. Some common supplements used to aid detox are liposomal glutathione, milk thistle, n-acetylcysteine, alpha lipoid acid, glycine, glutamine, and taurine.  
• Methylation support is also key and involves optimal levels of methylcobalamin (B12), methyl-folate, B6, riboflavin, and minerals.
• Encourage patients to invest in a high quality air filter and home and at work. Some examples include Austin AirEL Faust

When detoxing from mold exposure, it’s a good idea to avoid common mycotoxin containing foods. These include: corn, wheat, barley, rye, peanuts, sorghum, cottonseed, some cheeses, and alcoholic beverages such as wine and beer.

Other foods to avoid include: oats, rice, tree nuts, pistachios, brazil nuts, chili peppers, oil seeds, spices, black pepper, dried fruits, figs, coffee, cocoa, beans, bread.

Other Treatment Options

• Follow Dr. Jill’s Low Mold Diet – Many of my patients do well on a paleo, grain-free diet, like the one I’ve developed. Grains are often contaminated with mycotoxins and molds, which can exacerbate the effects of airborne or cutaneous exposure to molds in the environment.
• Sublingual immunotherapy (SLIT)
• Anti-fungal herbs and medications
• Infared saunas
• Detoxification support – oral and intravenous
• Create a “safe” place, with little potential for mold/allergens and great filtration system – this could be a bedroom or other room that is mold and chemical free
• Some patients with severe symptoms may benefit from IV immunoglobulin therapy (IVIg).

END

Jill C. Carnahan, MD, ABFM, ABIHM, practices functional medicine with her medical practice partner Dr. Robert Rountree, at Boulder Wellcare and Flatiron Functional Medicine, in Boulder CO. Dr. Carnahan is board certified in both Family Medicine and Integrative Holistic Medicine. She founded the Methodist Center for Integrative Medicine in 2009 and worked there as Integrative Medical Director until October 2010. She completed her residency at the University of Illinois Program in Family Medicine at Methodist Medical Center and received her medical degree from Loyola University Stritch School of Medicine in Chicago.

Dr. Carnahan will be a featured presenter at the 2015 Heal Thy Practice conference, Oct 16-18, at the Coronado Island Marriott, San Diego, CA.