Are you Moldy?

In Functional Medicine, the doctor’s job is not give you pills to feel better, but to help you identify imbalances in your body which could be making you sick. Usually there is too much of something in your body, and when we are able to lower the body’s burden, usually you feel better. Together we look at five major areas: food, gut health, hormones, mental, emotional, spiritual health, and toxins. While they can all be equally important in chronic disease, the one I am most passionate about is mental, emotional and spiritual health, but the one I want to focus on now is toxins. Given the mind-body connection, toxins are related to our body, mind and spirit—to detox the body is a subtle way to begin detoxing the mind as well.

Toxins come in all forms and sizes. We can create toxic burdens in our bodies through what we eat. High-sugar diets cause high insulin, which results in metabolic toxicity. Toxins can be chemical, such as heavy metals or mold mycotoxins, biological, such as bacterial, viral or fungal toxins, physical, such as radiation or trauma, or psychological, such as chronic stress or toxic relationships. Some of these toxins are evident. Others are not so evident and quietly tax our bodies. I have found over and over mold mycotoxins to be one of the most difficult to identify and treat. 

Mold seems to be a very controversial topic, in that the traditional medical community does not seem to accept it as an issue, unless it is black mold. Yet the most common mold when there is water damage to a building is Aspergillus. There are over 100,000 different types of mold; not all types of mold are a threat, but many are and end up being the major underlying imbalance we find in a patient’s body. Most people are familiar with spores created by mold. Spores are how mold reproduces, and once released spores can remain dormant for long periods of time, until the right growing conditions are available. The traditional mold testing of your environment typically compares the amount of mold spores outside versus inside your house, and if there is more inside you are told you have a mold problem. When someone has an allergy to mold, their immune system is creating a response against the spores. 

But mold also releases mycotoxins, which are secondary metabolites produced that are capable of causing disease. Mycotoxins are one of the major defense mechanisms of mold; they defend the mold and attack the body. Mycotoxins are small, as small as 0.1 microns, whereas mold spores are between 1 and 20 microns. This is why the spore testing of your home can give false negatives; mycotoxins are smaller and can be present when spores are not found. Another major difference is that mycotoxins are not alive so they are more difficult to get rid of than spores, which are alive. Yes they still create disease when they are dead. There are over 400 mycotoxins, most of which are toxic to living cells, but not all mold releases mycotoxins. When mycotoxins build up in our bodies, they create toxicity, which can present differently in each person who has high levels of mycotoxins.

Symptoms of mold exposure include: 

• Allergies
  Immune system toxicity

• Neurological symptoms

• Hormone disruption

• Cardiovascular symptoms

• Psychiatric symptoms
  Severe gastrointestinal distress

• POTS
  99% people with Sinusitis have mold

• 98% with Chronic Fatigue

Mold mycotoxins cause sympathetic nervous system overdrive, leading to anxiety, rapid heart rate, breathing, hunger, weight gain, and insulin resistance. They also cause vagal nerve dysfunction, leading to auditory and visual hypersensitivity, trouble swallowing, gut issues, dizziness, and low blood pressure. 

Mold Allergy vs. Mold Toxicity

An important distinction to make is that a mold allergy is different from mold toxicity. Just because you are allergic to mold does not mean that you have toxic levels of mold, and just because you have high levels of mycotoxins does not mean you are allergic to mold. 

Mycotoxins get inside of us in three different ways: ingestion (via our food; unfortunately many foods are moldy, including one of my favorite things; coffee), through the skin (common in contact with something moldy; this is the least common route), and inhalation (the most common route, through our mouth and sinuses). Clinically I have been helping patients detox from mold since 2016 and during this time I have found airborne exposure to be the most concerning. 

One reason that mold is difficult to identify is because people have frequently had a mold inspector in their home, who tested for spores and got false negative results. I have a very simple screening question for my patients for mold exposure: have you ever lived in a home which had water damage? Not mold but water damage, as in my experience water damage equals mold. 

Another reason mold is difficult to identify is because it is extremely rare that everyone living in a moldy house will be sick. I will frequently hear, “How can mold be the cause of my wife’s autoimmune disease? I live in the house and I feel fine.” Ninety-nine percent of the time in families I work with, only one person in the house is having symptoms from the mold. To explain this phenomenon, a metaphor I like to use is that we are all born with a bucket and all of our buckets are a different size. The size of your bucket is dependent on your genetics, which I call luck. Some of us are lucky and were given a huge bucket and some of us are unlucky and got a smaller one. Some of us with a huge bucket fill it up very quickly, and some of us with a small one never fill it to the top. Yet when this bucket overflows, it can present as “chronic” disease. Mycotoxins can fill your bucket very quickly. 

In many people, when the mold exposure stops, the body can detoxify it on its own. But I have seen countless patients over the years whose exposure was during childhood and they still have elevated levels of mycotoxins. The best way to test for mold by the way is urine mycotoxin testing. I use Great Plains Laboratory and highly recommend them. 

Mold detoxification treatment is different in everyone. There are two general steps, and one is consistent with anyone detoxing from mold. It is the first and most important step in detoxing: stop exposure. A related issue in my experience is that remediation of your home does not work out. When I first learned about mold at the environmental symposium a number of years ago, I was taught the only treatment for a moldy house is to knock it down. I have seen many people spend huge sums of money to remediate only for the mold to come back. This is not an easy conversation to have with a family to tell them to move, and I have seen a number of people choose not to test because moving was not an option. Since then, I have met some mold remediation specialists who seem more reliable but the cost can be very significant. 

Step two in detoxing in mold is sweating, best through infrared sauna, as toxins are fat soluble. Detoxification is a two-phase process that happens in the liver, is dependent on many nutrients, and converts the toxins to water-soluble molecules, which we then pee, poop, and sweat out. To further detox we use supplements and sometimes medications, ranging usually around six months or longer, once exposure has stopped. 

The first step for you is always testing, find a doctor is who familiar with mold mycotoxin testing, and get yourself tested if you are concerned you may have had exposure. 

An interesting note if there are any other dog lovers out there… Store bought dog food is full of mycotoxins. My family is a bulldog family, bulldogs besides being very stubborn have a history of allergies and dermatitis. We had been battling with skin issues for 8 years, then I learned about mycotoxins in dog food, so we threw it out and starting cooking for our dogs. Happy to report no skin issues in 2 years!

Mycotoxins

J. W. Bennett1,* and M. Klich2

Clin Microbiol Rev. 2003 Jul; 16(3): 497–516doi: 10.1128/CMR.16.3.497-516.2003

Toxins (Basel). 2021 Jan; 13(1): 65.

Published online 2021 Jan 15. doi: 10.3390/toxins13010065

PMCID: PMC7830565

Toxic Effect of Aflatoxins in Dogs Fed Contaminated Commercial Dry Feed: A Review

Lizbeth Martínez-Martínez,1 Arturo G. Valdivia-Flores,1,* Alma Lilian Guerrero-Barrera,2 Teódulo Quezada-Tristán,1 Erika Janet Rangel-Muñoz,1 and Raúl Ortiz-Martínez1

Mycotoxins in Pet Food:  A Review on Worldwide Prevalence and Preventative Strategies

Maxwell C. K. Leung, Gabriel Díaz-Llano, and Trevor K. Smith

Journal of Agricultural and Food Chemistry 2006 54 (26), 9623-9635

DOI: 10.1021/jf062363+

Intermittent Fasting for Weight Loss. Updates from IFM’s Annual Conference 2020.

Is intermittent fasting a good approach for weight loss? For many, there is nothing more difficult then taking off weight once it has accumulated. Partially because there is nothing more confusing than finding which diet is right for one for you. One problem is that every “expert" has a different opinion and they are usually very passionate about that opinion. Keto, Vegan, Paleo, Mediterranean, Carnivore, Atkins, Low Carb, High Protein, High Fat, Low Fat, Nutritarian, and the list goes on… The good news about intermittent fasting is that it doesn’t matter if you are keto, vegan, or anything else you can incorporate intermittent fasting in your lifestyle. 

Since I began my Functional Medicine training I have learned about Intermittent Fasting and its benefits, which include;

• Decrease in Insulin Levels (improving glucose control, improving Diabetes)

• Decreased Blood Pressure

• Decreased Heart Rate 

• Weight Loss

• Increase in Testosterone (Helps to turn fat into muscle, stronger bones, better memory, spatial, better libido, improves mood.)

• Increases Human Growth Hormone (Helps to regulate body composition, muscle and bone growth, sugar and fat metabolism, and possibly heart function)

• Increased efficacy of Endurance Training

• Improves Cellular Repair (Removes waste from cells)

• Improves Gene Expression (Just because you have a gene does not mean you are expressing it, but intermittent fasting can help you turn on your good genes and turn off your bad genes)

• Increases your Metabolic Rate (helping you burn even more calories)

• Less muscle loss than continuous calorie restriction

• Decrease Inflammation by Enhancing the Body’s Resistance to Oxidative Stress (When your body can react better to its stressors stemming from your food, gut, hormones, toxins, and mental, emotional, spiritual health your symptoms should decrease. The real key is to identify these underlying causes through the Functional Medicine process. But in the meantime fasting can make you more resilient)

• Increases in Brain Derived Neurotrophic Factor (BDNF) (Studies have shown, the higher you BDNF the lower your risk for Dementia)

• Memory Improvement 

Thats not bad right? So why isn’t everyone doing it? Well, it’s not easy to do. In my clinical experience, patients who came to me already on an intermittent fasting schedule or patients who I recommended to start an intermittent fasting protocol, I didn’t see many ground breaking results, the way I see when working with food sensitivities, gut health, hormones, or detox. I never met anyone who said intermittent fasting changed their life, it was too difficult without the benefits to show for it. Weight loss was minimal. The most common regimen I have recommended or seen is 16 hour fasts starting at 3 times per week. A 16 hour fast means that if dinner is at 6pm then your next meal should be at 10am the next day.

During our most recent Annual International Functional Medicine conference in June 2020, I saw a physician named Dr. Jason Fung M.D. present information about longer fasting periods. He presented studies where patients fast for 24-36 hours, 2-3x per week. That means if dinner is at 6pm, then your next meal is not until 6pm the next day or 6am 2 days later. 

Why have I not seen dramatic results from 16 hour fasts? Might 16 hours not be enough? 

In the “normal” metabolic process, after eating the body turns glucose into energy and stores whatever is excess as glycogen. (In the United States we tend to eat more than our body requires for energy production so we store quite a bit). Once your body has used the food you gave it and you don’t eat anything new, your body will turn to other sources to make energy, including a process called gluconeogensis, which is when your body uses excess sugar, protein, or fat as fuel.

Gluconeogenesis starts after about 8 hours of not eating, but it takes a little longer to ramp up. This is where I made my error in only recommending a 16 hour fast, the longer you wait before eating again the more effective intermittent fasting is. Estimates are that 54% of glucose (what we use to make energy) comes from gluconeogenesis after 14 hours of starvation, and this contribution raises to 64% after 22 hours and up to 84% after 42 hours. So we need to wait longer to eat.

One of the main reasons I was hesitant to recommend not eating for days at a time, is that it is not easy! Its not a common way of eating in our society and can present many challenges. However the science backs up the method and I believe it is something worth while to try.

If fasting is something you want to try here are some starting points, but always remember, listen to your body, go slow. 

• Start with 12 hours daily. Dinner 6pm, next meal at 6am the following day. 

• Then try adding in 16 hours a 3-7 times a week, while maintaining 12 hours on the other days. Dinner 6pm, breakfast 10am the following day. 

• Within a few weeks you can try 20 to 24 hours, and then 36 hours. Dinner at 6pm, next meal at 6pm the following day. 

• 36 hours mean dinner at 6pm, next meal 2 days later at 6am. 

• The end goal is 2-3 periods of 24-36 hours of fasting every week. 

The longer you practice these principles, the more your body will adapt to your new way of life and the easier it will become. And the best part is, you can stay on whichever diet you are already on. 

* Common side effects you may experience include hunger, irritable mood, and concentration difficulties while fasting. However, that these side effects usually disappear within a month. Drink lots of water and you can have appetite suppressants like green tea or black coffee while you are not eating.

References

https://www.nejm.org/doi/full/10.1056/NEJMra1905136

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050641/pdf/nihms-593309.pdf

https://www.ncbi.nlm.nih.gov/books/NBK544346/

https://pubmed.ncbi.nlm.nih.gov/3127426/

https://pubmed.ncbi.nlm.nih.gov/27569118/

https://pubmed.ncbi.nlm.nih.gov/27810402/

* The information in this article is not intended to replace any recommendations or relationship with your physician.  Please review references sited at end of article for scientific support of any claims made.