The Mold Wars Controversies: What you need to know

The mold wars. What are the mold wars? What's the controversy and what are we talking about right now? There's a lot of controversy and debate even in the functional medicine world about mold. How you diagnose it, how you treat it, what do you do about it. So this series we're talking about right now is going to take a deep, deep dive into the controversies in the mold world. Diagnosis, treatment, what it is and how you can deal with it. But I need to start with a few caveats. The first caveat is this is a little bit higher level. So. So for those of you who aren't familiar with mold Biotoxin Related Illness series, if this is your first introduction to it, I'd recommend you reading our blog series on our website first to take a dive into what actually is chronic inflammatory response syndrome and learn more about it. We've also done multiple other blogs on the website as well that talk about this topic of mold. And so you need to have a basic understanding first. So as you listen to this, read this, digest this, if you don't quite understand where it's being talked about, I recommend those first. This is actually meant a little deeper level for those who want to take a deep dive into the controversies in mold. So let's begin. The first controversy is how do you actually test for mold? And there's two major camps. One camp looks at urine mycotoxin testing, looking for signs of mold in your urine. The other camp doesn't look at the urine. The other camp looks at blood testing to look for biomarkers for marks of your immune system being upregulated, dysregulated and abnormal. Which is the right way. Is, is it urine testing for mold toxins or is it blood testing? Let's talk about this first battleground, because this is crucial because depending on where your practitioner falls, they may fall in one camp or the other camp as much as possible. I'm going to avoid using names when I describe these camps and just talk about the information and the facts. So the urine mycotoxin testing. There's a couple of issues with looking for urine mold toxins. The first one has to do with the source of the urine mold toxins. So most urine mold toxins actually come from food, not the environment. Most things that you actually inhale or breathe through, you actually end up detoxifying in the mold world actually through your liver and bile, which is one of the reasons why I use lots of binders. The urine is actually looking more for food digestion of mold and there's several research articles that actually talk about this. The other thing that is an issue with urine mold toxin looking at that is how do people detoxify? Some people are great detoxifiers. If they get exposed to a little bit of mold, they eat it in corn, they're outside the environment, they will kick it out in the urine. And so seeing lots of mold toxins could just mean they're a really great detoxifier. Then you have people that are horrible detoxifiers, which tend to be those I see with mold illness issues. And the urine testing would be normal. And so you have to chelate it or bump it, or boost the detoxification some way with a nutrient, a sauna or brushing or something like that. There's too many variables in the urine, mycotoxin, urine, mold toxin testing to make it super accurate. Now, as far as blood testing, what are some nuances of that? When you look at the blood testing, you're not actually looking for mold toxins proper. You're looking for the effect on the immune system. The reality is mold is everywhere. We're all exposed to mold every moment, every time, everywhere. When you look at. So it's not an issue of it's being exposed or not in corn and bread and walking outside in leaves in our house, et cetera. The question is, what does your immune system do with it? And that's what the blood testing does. Blood testing looks for markers that show dysregulation and the part of your regulatory brain where your hypothalamus and pituitary sit. It also looks for dysregulation in your immune system, more like your innate immune system, which is the most immature part of your nervous system. So there's actually a case definition for Sears Chronic Inflammatory Response Syndrome based on your immune system's response. So in actuality, looking at blood inflammatory markers, dysregulation markers, is a better way to actually diagnose mold related biotoxic illness, referred to as sers. Then you're in mycotoxin testing. One just reflects exposure, primarily food. One reflects your immune system response and your brain's response to that. So that's the first battleground. What's the testing? How is it? How's it impacted? Is it accurate and inaccurate? So let's go on to the next battleground. The next battleground in Chronic Inflammatory Response syndrome and mold in the mold wars is, is what actually is chronic inflammatory response or mold. People focus on the mold itself, but the reality is actually most of it is not mold. This is the next battleground. 80% of chronic inflammatory response syndrome is water damaged buildings, which I'm going to put to the side real quickly. So what that means is 20% is not water damaged buildings. That could be Pfiesteria ciguateria. It could be related to recluse spider bite. It could according to some other research related things like vaccine related illnesses, silica exposure like in breast implants, a whole host of other things. We're learning more and more things. Traumatic brain injuries can also fall into this world as well and even overuse. Some people will over exercise to the extent they cause leaky gut and actually will cause a chronic inflammatory response. For repetitive over over training. That's 20% of this, 100%. The next thing about the 80% is actually water damaged buildings. So let's take a dive in there within water damaged buildings. 80% of that 80% is actually not mold toxins. It's like tenomices and endotoxins. So endotoxins are a gram negative coating. They coat bacteria, particularly gram negative bacteria, and they contain a toxin called endotoxin or referred to as lipopolysaccharide. So this can actually grow in furniture, carpet, a whole host of things in the environment. If there's water, you need humidity for these endotoxins to actually be made or formed. Actinomyces on the other hand is a soil based organism, typically comes from crawl spaces or places where you have dirt. So basically crawl spaces. So within that 80% of the 80% that's not even mold. So the reality is mold toxins proper are a small part of actually the mold related chronic inflammatory response syndrome. To take it to the next level within water damage building, a lot of it actually has to do with particulates, especially micro particulates. So if you do a test looking for mold spores for example, for every one mold spore you have 500 particulates. And these particulates proper actually can cause a lot of lung inflammation, which is how they're exposed, how exposed to it. And your lung lining, almost like your gut lining is extensive. It's huge, it's humongous. And getting exposed to micro particulates in your lungs can cause a whole bunch of inflammation. So as you can see if you're doing urine mycotoxin testing for example, looking for just that, realizing that there's all these other things, you're missing the boat. And so that's the reason one, doing immune system regulation testing is important and two, knowing that there's more to the mold world than mold proper. So these are one of the two big battlegrounds that most, even many experts and people to blog about don't really quite understand these nuances. So I want to go into the next level, to level three of this battleground, dealing with how you test if your environment has mold in your environment. So now we're going to talk about the third level of this battleground, actually testing proper. So some people will take spore plates, they take these little spore things and they actually put them out and plate them to collect spores in the air. The problem with that is it only finds the worst of the worst of the worst. What do I mean by that? I mentioned before that for every one spore in the air, there's over 500 particulates. So what that means is if you have a spore plate and there's nothing there, you can still have particulates. And again, don't forget, most of mold is not mold. So we're already in the different world. But when you go testing, that's what I'm talking about. So the other thing is when you also plate these things and grow things on there, it's not taking into account the other things associated what water damage, buildings. Like the particulates. There's a bunch of VOCs, MVOCs, which are microbact, you're basically fungal related toxins. These plates don't actually test for those. So really the spore plates, when people say they tested normal, it's really very, very, very inaccurate. You only pick up the worst of the worst of the worst. On the other side of that, there's an ERMI test which is actually environment, which looks at DNA, PCR particles, the particulates I was talking about, and gives you a view of those. This is super, super sensitive, meaning if it's normal, your environment's safe. However, the problem with this one is that it's almost too sensitive. So you could have had a water damage event three, four or five years ago. You cleaned it, you remediated, everything was fine. But you still have the particles in your carpet and your furniture, all over the place, on the walls. And if you don't throw your furniture away, you don't tear your carpet up, you don't repaint the walls, you can come back and retest a year later and still test positive. With the army testing, the more accurate testing for your environment is actually a thing called a Hertz Me too. Which looks at certain particles related to actinomyces, stachybopter Walimia, some of the more dangerous mold things, and that's actually directly related with health. But even then, you still have to realize this testing is still super sensitive. And again, you're only looking at mold proper. You're not looking at endotoxins, actinomyces. There is testing for endotoxins and actinomyces. So a good test would be doing Hertzme 2 with an actinomyces and endotoxin to give you a full view in the mold chronic inflammatory response world whether you have a water damage, building issue, which includes all these things. But again, you have to realize chemicals, formaldehyde, detox and other things, fire retardants. There's a whole bunch of things in the environment that can also cause issues with water damage, buildings that make people sick, that aren't being tested up, pissing off in the testing. So what's my response? How do I respond to this difficulty, this war, this battleground where people disagree vehemently? You really need an indoor environmental professional IEP to come in your house and look at your house. They can actually pull off and look inside your air handler, at the corals in there to see if there's mold in there. They can look at your ductwork, they can look at your crawl space. I've actually had patients who had seemingly nice houses, but the envelope, the Tyvek wrapping you see around houses when being built wasn't even done. And so what happened? The patient had humidity issues in their entire wall, everywhere. Micro particles, endotoxins, all this stuff going everywhere. You couldn't see mold, but it was a humidity issue related to how their house doesn't have the envelope. It took a environmental, an indoor environmental professional to actually discover that. I've had other patients who have issues with chemicals in their garage, for example, the paints and solvents and all kinds of stuff. And every time you open your garage door, that stuff comes in your house because of this thing called the Bernoulli effect, which is like a vacuum effect. So every time you open a door, air comes from the outside in from your garage, in from your crawl space in, which is one of the reasons why you don't want a vent in your floor in your crawl. But that's another battle to fight. And so what happens every time you open the door up, you have stuff coming from the garage in big, big issue. So it really helps to have a professional come look at your house to figure out what's going on with your environment, crawl space, humidity, moisture. I even had one patient have Their house. I didn't realize that. I learned from my IEP that for one point in time, they actually put Masonite outside of houses. This person had Masonite installed inappropriately. So what happened is the outside shingle kind of stuff on their house actually got moldy wet on the entire outside of their house. And so literally their house was encased in mold. Unless they had an indoor environmental professional come look at their house, they would never figure that out. So it's really over. My career, I've changed from doing lots of testing to actually just going right to having an indoor environmental professional come check the house and look at it for workspaces. It gets a little different. Sometimes it's better to have to do testing like it hurts me to at work, because can you get your work to pay for that or do that? Probably not. So these are three big battleground issues in the mold wars. Let's dive into the next level. Next battleground issue in the mold wars, let's talk about binders. Binders are an important part of treating patients with mold related illnesses. But one of the big battlegrounds of binders is what's the best binder? Which ones do you use and how do you use them? The one with the most evidence that's traditionally being used according to Dr. Shoemaker's protocol, is actually cholestyramine. The next best is Wellcol. These are two medications that are actually made to bind bile. Initially made to treat high cholesterol. I used them in my career for patients with C. Diffic colitis. Bunch of gut related diarrhea issues. People with diarrhea from having their gallbladders removed, a lot of other things. But they've been using the mold world for since the late 90s, early 2000s. They're the best binders. However, however, however, most pharmaceuticals have lots of other chemicals. Some of the cold styrene has artificial sweeteners in it, dextrose, a bunch of stuff. And so a lot of my more sick patients don't tolerate them. The other thing is these can be incredibly constipating. And if you're trying to detoxify, you want the bowels to move. Something that constipates is absolutely positively horrible. And many people just don't tolerate them. So if you can't tolerate cold styrene and you can't tolerate roll call, what's the next best thing to do? This is where the mold wars really take off and their controversy abounds. A lot of people in the integrative world start using Things like activate charcoal, clay, bentonite clay, alginate, silica, and a bunch of other binders that are good for environmental toxins, that are good for overall binding, that are good for heavy metals, but aren't specifically designed or made or studied for mold related toxins. So that's where okra and beet fiber come into play. There's actually been research looking at them and they actually bind. If you look outside of cold stem and roll call, the next best binder for mold related toxins is actually okra and beet extract. So finding a supplement that has those extracts in it is a better way to go if you're specifically focusing on mold related things. Now, in my world, the trick is many of my patients don't just have mold issues. They've got sibo gut gut issues, they've had heavy metal problems, they have other autoimmune issues. And sometimes those patients using a different kind of binder is more appropriate. But this is a very big controversy that depending on the specialist you work with, their experience and their thoughts, you might get conflicting information and not know what to do. So hopefully that helps you clear out that battleground. There's many other battlegrounds in the mold related world. Some people question if it even exists, some people question how you make the diagnosis appropriately, even what supplements to use. One of the things that's really important from an evidence based standpoint is actually using lipids or lipid therapy. With these patients, one of the big things is the mold toxins actually get stuck in your fat tissue, which is the reason why making bile or working on your liver is a super important way to treat that. So lipids that can actually help you detoxify become a big battleground and a huge intervention to help people get better. Many of the mold experts who are in the urine mycotoxin world don't actually use lipids as much because they're not as familiar with the importance of lipids for lowering the detox reactions, lipids for lowering inflammation, and lipids primarily as detoxifying or flushing the liver out, making more bile and actually acting like a soap, and cell wall membranes to actually pull the toxins out. That's where things like phosphylcholine, balanced omega 3s, omega 6s, things like torso deoxycholic acid, even butyrate can actually help detoxify the cells. And these are part of lipid therapy. On top of that, things like polycosanols are another group of anti inflammatory detoxifying agents used in lipid therapy. So as you can see dealing with mold issue in the mold wars is not just identifying and seeing the mold. It's more than that. It's not just knowing which binders to use. It's not just how do you make the diagnosis, it's all these other things. The last part of the mold wars I want to talk about is the controversy behind different things associated with mold related illness and how you can actually learn how to look for those. So I see patients who have mold related illness, it tends not just to be mold. They tend to have things like dysautonomia in pots, they tend to have sibo, they tend to be hypermobile, they tend to have autoimmune issues, and all these things tend to go together. So what's really important in dealing with these individuals in the battleground is what's the next thing, what's the biggest intervention, the biggest thing to deal with? Of course, moving yourself from the mold environment is huge, but it's not also always possible. The next big intervention is using lipid therapy and binders, which again, you have to have access to them and know which ones to use. After that is figuring is anything else going on. For example, if the person has dysautonomia, which is a dysregulation in their neurological system and their arterial system and their immune system, so they don't get enough blood to the brain, then getting their blood pressure up, using things like fluids, electrolytes, can be really important just to get enough blood to go to the person's brain, guts and other body parts. If the person is dealing with hypermobility, for example, that makes it harder to detoxify, also makes the person more likely to have sleep apnea. The person has sleep apnea and this is something I have not heard a lot of people talk about, which is a huge, huge factor with a lot of my patients that are hypermobile with pots, dysautonomia, autoimmune issues and mold. So they have undiagnosed sleep apnea. This is super, super critical. If you don't diagnose their sleep apnea, guess what? It's really hard to get them better. If you don't sleep, don't control your stress, it's really, really difficult to get better. The last battleground I want to talk about, which is probably one of the biggest and most difficult to overcome in patients with mold related illness, is the battleground of the mind. What do I mean like that mean about that? I don't just mean the difficulty of understanding these topics, difficulty family. I mean the difficulty of getting trauma brain from your mold related illness. There's literature looking at specialized brain scans, called neurquant scans, looking and seeing changes related to traumatic brain injury in patients with mold related illness. If you've had a concussion, a tick bite, other things can actually contribute to this brain related trauma response. But what happens is the brain proper gets inflamed and the brain proper, which is where all the regulation of your immune system, hormonal system, blood pressure, mood, gut sleep, pain, it gets inflamed all of a sudden. Now your brain, after you've remediated your house, after you've treated your gut, after you've got your lipid therapy, it stays inflamed. And so what happens is people get 60% better but get stuck because they're not dealing with this trauma brain response. So one of the biggest and last battlegrounds I deal with with my patients is the battleground of the mind doing trauma therapy, limbic kindling, EMDR tapping, there's a whole host of other trauma therapies that can be done to help these patients get their brain out of the spiral. And that by itself can lower patients inflammation and help the body to start to heal and repair. So hopefully this was helpful. The mold, the battleground, the battle, the issues. And hopefully this helps you understand some of the deeper concepts and issues that we deal with on a daily basis when we deal with our patients have mold related chronic inflammatory response syndrome. Take care. Let me know how this, if this was helpful, we'll talk to you soon.