Mycotoxins, CIRS, and Thyroid Health
Published June 5 2017
Many people underestimate the negative impact that mold can have on their health. But the mycotoxins produced from mold can cause a lot of health issues, and can sometimes lead to debilitating symptoms. In this article I’m going to talk about the negative health consequences of mycotoxins, and I’ll also be discussing chronic inflammatory response syndrome, which is known as CIRS. I’ll also talk about how toxic mold can potentially lead to the development of an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis.
I’d like to start out by talking about the mycotoxins that are produced from mold. Mycotoxins are frequently classified by the organ they affect. So for example, they can be classified as hepatotoxins (affecting the liver), nephrotoxins (affecting the kidneys), neurotoxins (affecting the nervous system), immunotoxins (affecting the immune system), etc. Some mycotoxins affect multiple organs.
Not all molds produce mycotoxins, but over 300 types of mycotoxins are known to be produced by molds. And the concern isn’t just with humans, as molds can affect the livestock as well, which of course can indirectly affect humans. Aflatoxin, vomitoxin, zearalenone, fumonisin, and ochratoxin are the most significant mycotoxins affecting the livestock population. Grains such as corn, wheat, and barley may be easily contaminated with mold, which is how the livestock get these mycotoxins.
How Is Mold Toxic To Your Health?
First of all, it’s important to understand that not everyone has a negative reaction to mold. Genetics does play an important role with regards to how people will react to mold. HLA is part of the immune system involved in something called antigen presentation, and there are certain HLA genotypes that make people more susceptible to the mycotoxins, and thus cause numerous symptoms. The reason why people with these genes are more likely to react to mold is because having one of these HLA genotypes will reduce the person’s ability to clear the mycotoxins produced by the mold, which in turn is responsible for the symptoms people will experience.
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.
What Are The Symptoms of a Mold Toxicity?
Although there can be many symptoms associated with a mold toxicity, the following are some of the most common ones:
- Severe fatigue
- Memory loss
- Skin rashes
- Respiratory distress
- Sinus problems
- Neurological symptoms
Just about everyone who has a mold toxicity will experience many different symptoms. In fact, if the person is only experiencing a few symptoms, even if they are severe, then this probably isn’t related to a mold toxicity problem. On the other hand, if the person experiences a dozen or more symptoms, many which are extreme, then this very well could be due to a mold toxicity.
In addition to dealing with numerous symptoms you might want to ask the following questions:
- Is there a musty odor at home, at work, or in school?
- Are there any signs of water damage in these areas?
- Are there any leaks in the roof?
- Has your home (or place of work or school) ever been flooded?
How Are We Exposed To Mold?
Most of the time, we are exposed to mold through one of the following three mechanisms:
1. Eating contaminated foods. Mycotoxins usually get into food in the field, or during storage. This is why shipping, handling, and storage practices of foods needs to be considered. While most people get exposed to a lot of mycotoxins through eating grains, along with other foods such as nuts and seeds, we also need to keep in mind that animals consuming feeds which are contaminated with mycotoxins can produce meat and milk that contains these toxic residues.
2. Skin contact with mold. Sometimes there is unusual growth of commensal species that is normally present on human skin or in the gut.
3. Inhalation of mycotoxins. This typically is the problem when someone is living in a water-damaged home, or works or goes to school where there is toxic mold. As a result, if you feel worse while at home and feel better at work or school, then this is a good sign of a mold problem in your home. And of course the reverse is true as well. If you are a stay-at-home mom then you might notice that all of your symptoms improve when you go on a vacation. And while the positive feeling of going on vacation might play a role in you feeling better, if extreme symptoms resolve while away from your home then you really should consider hiring an indoor air inspector, which I’ll talk more about later.
Different Types of Mycotoxins:
I’m not going to talk about all of the different types of mycotoxins, but I would like to focus on a few of the more common ones:
Aflatoxins: the four major aflatoxins are called Aflatoxin B1, B2, G1, and G2. Aflatoxin B1 is the most potent natural carcinogen known, and is the best studied. However, there are over a dozen other aflatoxins that are known besides the four major ones. Aflatoxins are produced by many strains of Aspergillus flavus, Aspergillus parasiticus, and some other Aspergillus strains. Some of the common foods contaminated with aflatoxins include grains, figs, nuts, and even tobacco. And since aflatoxins can affect the livestock, eating meat and dairy can be indirect sources of aflatoxins. The liver is the primary organ affected by aflatoxins. But perhaps of greater concern is the evidence that shows a correlation between aflatoxins and certain types of cancers, including liver cancer (1) (2).
Citrinin: This mycotoxin acts as a nephrotoxin in all animal species tested. Wheat, oats, rye, corn, barley, and rice have all been reported to contain citrinin.
Ochratoxin: This is a potent nephrotoxin found as metabolites in many different species of Aspergillus. Ochratoxin A has been found in barley, oats, rye, wheat, coffee beans, and other foods. It might also be present in certain wines due to contamination of the grapes by certain aspergillus species. In addition to being a nephrotoxin ochratoxin A is also a liver toxin, an immune suppressant, a potent teratogen, and a carcinogen (3) (4). Ochratoxin has been detected in blood and other animal tissues and in milk, including human milk (5). It is frequently found in pork intended for human consumption (6).
Trichothecenes. These mycotoxins are found in numerous fungi, including Fusarium, Myrothecium, Phomopsis, Stachybotrys, Trichoderma, Trichothecium, and others (7). They are commonly found in food and feed contaminants. The trichothecenes are extremely potent inhibitors of eukaryotic protein synthesis.
Zearalenone. This mycotoxin is a secondary metabolite from Fusarium graminearum (7). It resembles 17B-estradiol, allowing it to bind to estrogen receptors (7). As a result, zearalenone is classified as a mycoestrogen, and is sometimes referred to as a phytoestrogen. The reduced form of zearalenone, which is zearalenol, has increased estrogenic activity. Zearalenone has actually been used to treat postmenopausal symptoms in women, and both zearelanol and zearalenone have been patented as oral contraceptives.
Mold Toxicity vs. Chronic Inflammatory Response Syndrome
Chronic Inflammatory Response Syndrome (CIRS) occurs when genetically susceptible people are exposed to certain biotoxins. Although the focus of this article is on mold, CIRS can also result due to biotoxins associated with Lyme disease and its coinfections, as well as certain cyanobacteria, and a marine dinoflagellate that produces Ciguatera toxin (8). So in addition to getting exposed to these biotoxins through mold, Lyme disease, and other pathogens, eating contaminated fish can also be a source.
So who is likely to develop CIRS? Well, not only does the person need to be exposed to biotoxins/mycotoxins from at least one of the sources I just mentioned, but they also need to have a genetic susceptibility. In other words, not everyone who is exposed to certain mycotoxins will develop CIRS. On the other hand, those who are exposed to certain mycotoxins (and other biotoxins) and are genetically susceptible will most likely develop CIRS. This in turn will lead to systemic inflammation, and also commonly causes vascular, neuroimmune, and endocrine imbalances.
Below I’ll talk in greater detail about the testing involved, but if someone is suspicious of CIRS then they probably will want to start with genetic testing, as well as Visual Contrast Sensitivity testing. If these are positive (especially the genetics) then the person will want to proceed with some of the tests I describe below, and will also want to hire an indoor air specialist, making sure that ERMI testing is conducted.
Testing Options To Consider For Mold Toxicity/CIRS
When talking about testing for CIRS that is associated with a mold toxicity, there are a few different things you want to consider doing:
1. Genetic Testing For Human Leukocyte Antigens (HLAs). HLAs are found on the surfaces of cells and play a role in something called antigen presentation. What’s important to understand is that having certain HLA markers can make people susceptible to different conditions. For example, certain HLA markers can make someone more susceptible to developing an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis.
Similarly, those who have certain HLA genetic markers will be unable to mount a proper immune response when exposed to mycotoxins, along with other types of biotoxins. As a result they will develop a chronic inflammatory response, which is known as CIRS. I’ll talk more about this shortly, but while the majority of people’s bodies are able to get rid of mycotoxins without any intervention, this isn’t the case with those who are genetically susceptible. And as I’ll discuss later in this article, this chronic inflammatory process will lead to imbalances of the hormones, along with other imbalances responsible for the symptoms associated with a mold toxicity.
The reason why testing for these markers is a good idea is because if a person has a lot of the symptoms listed earlier, yet tests negative for all of these HLA markers, then chances are they don’t have a mold toxicity. On the other hand, if the person tests positive for one or more of these genetic markers then there is a much greater chance of them having a mold toxicity. You want to test for the following HLA markers:
Fortunately most local labs, including Labcorp and Quest Diagnostics, will test for these HLAs.
2. Visual Contrast Sensitivity (VCS) Test. This test can be conducted either online or in an office setting. This test determines your ability to see details at low contrast levels by presenting a series of images of decreasing contrast. Many different factors can affect visual contrast, and failing the test is a sign of neurological dysfunction, which can be due the presence of neurotoxins. So while a positive finding of this test itself isn’t diagnostic of a mold toxicity, in combination with some of the other tests it can help to determine if someone has this condition. If you can’t get a VCS test done in person you can take an online VCS test, as there are a few different companies that offer this, including www.vcstest.com and survivingmold.com.
3. Test your home for mold. With regards to testing your home for mold, you want to hire a certified indoor air testing company, and preferably one that is open to ERMI testing. ERMI stands for Environmental Relative Moldiness Index. This involves DNA testing to identify the different species of molds, and it does this by analyzing the dust. And so this test can be very helpful in identifying toxic strains of mold in the home, workplace, or schools. Keep in mind that not all air testing companies offer ERMI testing, and so this is something you should ask when calling to schedule an appointment.
While you might not have control over testing an outside environment such as work or school, if you feel worse while working or attending school, and you don’t feel as bad when you are at home, then mold very well might be an issue in these locations. If this is the case then you probably won’t be able to hire an indoor air testing company to inspect the school or workplace, but you can contact the employer and/or principal about this.
4. Test the person for mycotoxins. With regards to testing for mycotoxins, I would recommend a specialty lab that focuses on this. An example is Realtime Laboratories, as they offer a urine test that measures 15 potentially harmful mycotoxins, along with 9 macrocyclic trichothecenes. Keep in mind that testing for mycotoxins isn’t the same as testing for mold. For example, Genova Diagnostics offers an IgE mold allergy test, which looks at the IgE antibodies to 15 different types of molds. I’m not suggesting that this test doesn’t have any value, but when someone is dealing with Chronic Inflammatory Response Syndrome, testing for mycotoxins is preferable. And the reason for this is because it is the mycotoxins that cause the inflammatory response in those who are genetically susceptible.
5. Other tests. If you are experiencing some of the symptoms described earlier, and if one or more of the HLA genetic markers come out positive then you probably will want to consider testing for the following markers. Fortunately most local labs have these available.
Leptin. Leptin is an important regulator of appetite and fat storage, and I spoke about this hormone in an article entitled “The Role of Leptin In Thyroid Health”. Sometimes this marker is elevated in those with CIRS, as what happens is that proinflammatory cytokines bind to the leptin receptor. This leads to leptin resistance, and this is the main reason why many people with CIRS will put on weight. In addition, having a blocked leptin receptor will also interfere with the production of melanocyte stimulating hormone (MSH), which I’ll describe next.
Melanocyte Stimulating Hormone (MSH). Because of the blocked leptin receptor this marker is low in most patients with a mold toxicity. Low levels of MSH can lead to a widening of the tight junctions of the small intestine, which is also known as a leaky gut. And having a leaky gut can make someone more susceptible to developing an autoimmune condition, which is one way in which having a mold toxicity can lead to the development of an autoimmune condition. Having low levels of MSH also can cause a type of bacteria to colonize the deep nasal passages, and is known as MARCoNS. The bacteria associated with MARCoNS can create certain toxins which help perpetuate the inflammatory process.
Transforming Growth Factor (TGF) Beta-1. TGF Beta-1 can help to suppress autoimmunity, but at the same time it is associated with decreased function of regulatory T cells. Worded a different way, an elevation of TGF Beta-1 can lead to a decrease in regulatory T cells, which play a role in suppressing autoimmunity. As a result of the low number of regulatory T cells, the person will be more susceptible to developing one or more autoimmune conditions. And so this is another mechanism where CIRS can lead to an autoimmune condition such as Graves’ Disease or Hashimoto’s Thyroiditis.
Vasoactive Intestinal Polypeptide (VIP). This marker will typically be low in those with a mold toxicity. When this is the case the patient will frequently have shortness of breath and air hunger, especially upon exertion. Low VIP levels can also cause an upregulation of aromatase, which is an enzyme that converts testosterone to estradiol. As a result, having low VIP levels can lead to low testosterone levels and elevated estrogen levels.
C4a. This marker is associated with the complement system, and it plays a role in activating inflammatory responses. It is usually elevated in those with a mold toxicity.
Antidiuretic hormone (ADH). This is also known as vasopressin, and it tells the kidneys to preserve water. In those with CIRS due to a mold toxicity, ADH is usually undetectable, which in turn means that the kidneys aren’t conserving water, and as a result the person usually experiences dehydration and excessive thirst. In addition, this can lead to frequent static electrical shocks.
Matrix metallopeptidase 9 (MMP-9). This is a marker associated with the innate immune system, and higher levels of MMP-9 have been associated with increased tumor invasiveness, and with increased permeability in the blood brain barrier.
Vascular endothelial growth factor (VEGF). This is a marker of capillary hypoperfusion, and low levels can result in a reduced oxygenation of tissues, which in turn will have a negative effect on the health of the mitochondria. This commonly causes symptoms such as fatigue and muscle pain. VEGF might be elevated early in CIRS, but in the later stages this marker is usually low. Treatment is usually accomplished by taking high dose fish oils, plus a low-amylose diet is usually followed as well.
NeuroQuant brain MRI. NeuroQuant is a software program that measures a few different MRI brain regions and measures the volume of each of these regions. So what does this have to do with mold toxicity? Well, mold toxicity can have a negative impact on brain volume. So while the NeuroQuant isn’t a specific test for a mold toxicity, this test can determine if someone with a suspected or confirmed case of mold toxicity has changes in brain volume, which can cause some of the symptoms associated with mold toxicity.
How can you have this test done? Well, the first thing you’ll need to do is have a brain MRI, and a special protocol is required. The results of this test can then be sent to another lab for further analysis.
Can Mycotoxins Trigger Graves’ Disease or Hashimoto’s Thyroiditis?
Having a mold toxicity/CIRS can make someone more susceptible to developing thyroid autoimmunity. I mentioned two different mechanisms earlier, as one involves low levels of melanocyte stimulating hormone causing a leaky gut, which is a factor in autoimmunity. I also discussed how increased levels of TGF Beta-1 can decrease the number of regulatory T cells, which also will make someone more susceptible to developing Graves’ Disease or Hashimoto’s Thyroiditis.
Treatment Options For Mold Toxicity/CIRS
If someone has CIRS associated with a mold toxicity, then what is the recommended treatment? Below I’m going to list what you need to do in the order of importance:
1. Eliminate the source of the mold. This is the most important thing that needs to be done in someone who has already been diagnosed with mold toxicity/CIRS, as if you skip this step then you will not get rid of the mold toxicity. This might sound like common sense, but some people will try to do some of the other things I’m about to mention, but they won’t do anything to remove the source. Of course before eliminating the source of the mold you need to confirm that there is a mold problem either at home, at work, or at school. And once this has been confirmed, then the next step is usually either 1) mold remediation, or 2) avoiding the source.
If remediation isn’t an option, or doesn’t help with the mold toxicity, then the next step is to avoid the source. This might seem like an extreme measure to take, as it might involve moving to a different home, quitting your job, or attending a different school. But if remediation doesn’t provide a solution to the mold toxicity problem then the best option is to do whatever is necessary to completely avoid the source.
2. Get rid of the mycotoxins from your body. I’m going to talk about both prescription medications and natural treatment methods. Let’s start with prescription drugs:
Cholestyramine. This is an FDA-approved medication used to lower elevated levels of cholesterol. Dr. Ritchie Shoemaker accidentally discovered how cholestyramine can bind to mycotoxins in the small intestine (along with cholesterol and bile salts). However, you don’t want to take it with food. The recommended dosage is 9 grams, taken four times per day on an empty stomach. Some forms of cholestyramine include asparatame, and as a result you might want to consider getting a compounded form. Constipation is a common side effect, and so you want to make sure to stay well hydrated and to consume plenty of fiber.
Let’s go ahead and discuss some natural treatment options for binding mycotoxins:
Bentonite clay, zeolite, and activated charcoal. These natural agents seem to be effective for binding to aflatoxins (9), which we’re commonly exposed to through the food. But according to Dr. Shoemaker these aren’t effective when binding to other mycotoxins. And so while you can always start by taking these natural binding agents, if you don’t notice a significant improvement in your symptoms then you will want to consider taking cholestyramine.
Glutathione. The CYP450 enzymes convert mycotoxins into reactive intermediates, and glutathione S-transferase catalyzes the conjugation of these intermediates with reduced glutathione, which in turn leads to the excretion of the mycotoxin. As a result, you want to make sure you have healthy glutathione levels. You can take a precursor to glutathione such as N-acetylcysteine, or an acetylated or liposomal form of glutathione.
Air purifier. Although some good quality HEPA air purification systems might be able to help reduce airborne mycotoxins, if someone is dealing with CIRS then getting an air purification system alone usually won’t be sufficient.
Ozone machine. There is some evidence that ozone can degrade certain mycotoxins (10) (11). Just as is the case with an air purification system, having an ozone machine probably won’t provide a permanent solution for someone with CIRS, as you need to remove the source of the mold.
3. Address MARCoNS. These are strains of staphyloccoci bacteria, and they colonize the nasopharynx. The problem with MARCoNS is that they can create biotoxins, and this in turn can further increase the inflammation associated with CIRS. As a result, if this is an issue then it needs to be addressed in order to overcome CIRS. Eradication of MARCoNS is typically done through the use of a compounded nasal spray.
4. Reduce Inflammation and Correct Hormone Imbalances. The final steps involve addressing the inflammatory process and hormone imbalances associated with CIRS. While removing the source of the mold exposure and using binders to eliminate mycotoxins can help greatly, this doesn’t always suppress the inflammatory response, and it also won’t address the hormone imbalances I spoke about earlier.
In summary, mycotoxins from mold can cause many symptoms in those who are genetically susceptible. Some of the symptoms someone with a mold toxicity can have include severe fatigue, anxiety, insomnia, memory loss, migraines, skin rashes, respiratory distress, sinus problems, and neurological symptoms. Three of the main ways we’re exposed to mold is through contaminated food, through the skin, and inhalation of mycotoxins. Although there are many different tests to consider, one of the more important tests in someone with a suspected mold toxicity involves testing for human leukocyte antigens (HLAs) in order to determine if someone has one or more of these markers. If someone has a mold toxicity, then the first step is to eliminate the source of the mold. Other treatments to consider include using binding agents to rid your body of mycotoxins, along with glutathione, address MARCoNS, and do things to reduce inflammation and correct hormone imbalances.