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Wednesday, March 4, 2020

Mold toxins in perspective, a science based approach

Mycotoxins – the noxious chemical defense of these ancient and troublesome microorganisms.  Recently a  patient showed me a urine test. Mycotoxins were present in high concentrations. The patient was prescribed cholestyramine and the next test was almost clear. He said “his mold level” had improved. He fundamentally misunderstands the problem.

First, we want to know if he is right about his “mold level.” Are there a significant number of pathogenic mold organisms living in our body actively secretin caustic toxins?  Mold is not generally found in our bodies, at least at high or clinically significant levels.

Sure, we are all a waking zoo of microorganisms: bacteria, yeast viruses, perhaps some protozoa but no mold. Although yeasts and mold are cousins and frequently killed by the same drugs they act very differently.

I ask again: why are the toxins found in our urine at measurable concentrations.

Most readers likely believe that the primary source is largely aerosolized spores emanating from hiding places – wet basements and the like.

In actuality the biggest source of mold/mold toxin is food.  Many foods we eat all the time may have high levels of mold. We have all found moldy bread in the fridge at one time or another (I certainly have). Before the putrid green and blue areas appear mold long present. Just not in numbers easily observable to the naked eye. Our berries are covered in mold before the white exudate appears. Mold is present in many foods: cereals, grains, corn, fruit, peanuts and peanut butter, eggs, milk, meat, coffee beans, coffee – especially from our Keurig with its inaccessible wet, warm environs, a perfect culture media, etc.

The more serious, life threatening mold infections, for example aspergillosis of the lung or brain generally occur in those seriously immunosuppressed.  Ordinarily, aspergillus is a common food mold, a good source of aflatoxin and ochratoxins. Another common food mold, penicillin is a good source of ochratoxin. There are many other food molds and food toxins.

Black mold, Stachybotry lives in our homes. It eats cellulose, things like ceiling tiles, tiles and fiberboards. Its spores are aerosolized, along with very noxious trichothecene toxins.

Many mold toxins are xenobiotics recycled from liver produced bile to the intestines and back again endlessly (or perhaps 20 times). Enterohepatic recirculation may be beneficial in some circumstances. In this scenario the liver is assaulted by the same destructive toxins over and over again.

I have written about this system in a few posts. The bottom line is that this process explains why bile acid sequestrants (BAS) like cholestyramine and Wellchol work. Activated charcoal also works because at high concentrations it performs like a BAS. In fact, like the BASs, activated charcoal (24 gm daily) lowered cholesterol by 25%. These drugs grab bile acids and biliary toxins causing excretion through the colon – and the liver makes new bile acids, primarily from cholesterol.

The drugs  lower the overall level of toxins in the blood and therefore spare the liver and kidneys by a second mechanism.

 But we have not fixed or addressed the underlying problem.

Dietary sources of mold and mold toxins are significant.  We may need to seriously change our diets.

We may need to remediate our homes, especially wet basement areas if black mold spores are in the air.

But these molds do not really or should not really take up residence in our bodies.  They are not part of our normal microbiota.  But this in not always the case, especially with deep, chronic infection and immunosuppression.

 Where is the mold then hiding?  Sinuses, lungs and skin are possibilities. Specific antimicrobial therapy is indicated, either intranasally or with systemic agents.  The mold may be eliminated, or numbers significantly reduced. Retreatment may be par for the course.

A lot is made about epigenetics, especially MTHFR variants Genetic variations may interfere with “methylation.” DNA methylation is part of a switching -- turning genes on and off, with far reaching consequences. This is a real phenomenon. Complex and poorly understood.

Eliminating exposure to toxins is the most important part of therapy. You cannot get better if the fundamental problems is ignored.  BASs and vitamins for MTHFR can be given simultaneously- icing on the cake -- not the cake.  MTHFR for another day.