Mold and Mycotoxins in Foods and Their Role in Mold Illness

by Dr. Susan Tanner, MD

Without a doubt, mycotoxins can be harmful to our health. As we have written in many previous articles, the importance of clean, mold-free air cannot be over-emphasized. The air you breathe indoors is important for you to test, purify, and safeguard because it is likely where you spend the majority of your time. With the average person taking between 17,280 and 23,040 breaths a day, it is clear that no nutritional or medical intervention could outdo the effects of ongoing exposure to moldy air. Thus, getting your air quality right should be first on your list for addressing mold-related health concerns.

We also have discussed many dietary recommendations in our articles on mold-triggered illness, most notably anti-candida diets as well as those aimed at reducing inflammation or histamine stimulation. When addressing diet, questions also arise as to whether or not certain foods should be eliminated to reduce exposure to mold and mycotoxins in foods. We actually hear a lot more in the news about the dangers of mycotoxins in foods like coffee, nuts, and grains than we do about exposure to them in the air, so this is a valid concern. But, what are the health implications of consuming foods with mycotoxins? Are symptoms and health issues as obvious, damaging, and wide-reaching as those I have previously described in articles about mold exposure from water-damaged, indoor environments?

Mold, Mycotoxins, and Dietary Restrictions

I want to begin by saying that dietary restrictions should not be implemented frivolously, especially for individuals who may already be overwhelmed with nutritional interventions and eliminations. Documentation within the literature and through clinical practice has shown that there can be deterioration of the overall health of patients with regard to their nutritional status, gut microbial function, and quality of life, due to restrictive diets. The decision to remove certain foods should be evidence-based, and a diet plan should present a clear benefit to each individual. Thus, the goal of this article is to provide substantiation for the idea that eliminating certain foods can reduce mycotoxin exposure in some situations. We begin by looking at the most common and relevant mycotoxins in our food supply, and then examining the data regarding mycotoxins frequently found in food, along with assessing the possible role of food mycotoxins in the development of mycotoxicosis.

Mycotoxins in Foods and Their Impact on Health

Before we delve into a literature review of mycotoxins in foods, let us briefly discuss why these mycotoxins are pertinent to our health. What follows are the most common mycotoxins, along with their potential impact on biological systems:

Aflatoxins

Toxicity and carcinogenicity have been found in both human and other animal populations. High acute exposure can lead to death, while chronic exposure can cause immune suppression and even cancer. The liver is the main organ affected in several animal classes (fish, birds, rodents, and primates). Aflatoxins are found in improperly stored corn, cassava, chili peppers, millet, peanuts, rice, sesame seeds, sorghum, sunflower seeds, tree nuts, wheat, and a variety of spices.

Ochratoxin A

Nephrotoxic (damaging or destructive to the kidneys) to all animal species, and, in most animals, hepatotoxic (damaging to the liver), an immune suppressant, a teratogen (causing birth defects), and a carcinogen. Primarily, its biggest impact seems to be inhibition of the enzyme involved in synthesizing the phenylalanine-tRNA complex, as well as, affecting ATP production (energy) in the mitochondria, and lipid stimulating peroxidation.  On a less scientific and morbid level, this may present as an overall loss of energy and vitality. Concerns regarding food exposure to ochratoxin have primarily centered on wine, beer, coffee, dried vine fruit, grape juices, pork, poultry, dairy, spices, and chocolate.

Trichothecenes

Trichothecenes cause various symptoms, from alimentary hemorrhaging and vomiting after high consumption, to dermatitis from smaller exposures. In several vertebrate organisms, studies have shown an impact on almost every major system, mostly associated with gastrointestinal, dermatological, and neurological symptoms. Trichothecenes are produced on many different grains like wheat, oats or maize.

Patulin

Patulin is very toxic in high concentrations, but evidence of poisoning in a natural environment is still inconclusive. Patulin is most commonly found in apples and apple products, and occasionally in other fruits like pears, apricots, and grapes.

Zearalenone

Effects mainly involve hormone disruption. This mycotoxin’s structure resembles 17Beta- estradiol, and, as expected, it impacts estrogen levels, and ultimately fertility. Zearalenone is found in corn, wheat, rice, oats, barley, sorghum, and rye as well as grain flours or processed food made from them. It may additionally be found in moldy hay as well as malt, soybeans, and beer.

Citrinin

Nephrotoxic to all animal species, but the threshold of acute toxicity is highly variable among species. Simultaneous exposure to both Citrinin and Ochratoxin A can depress RNA synthesis in kidneys. (Quick explanatory note: Though genetically unique from DNA, RNA acts as a disposable copy of genetic instructions that cells use for protein synthesis. Since proteins are necessary to build new cells, RNA synthesis is a continuous process. When RNA synthesis is depressed, damage and destruction can easily occur.) Citrinin has been isolated in cereal grains such as wheat, barley, oats, rice, and corn. Probably the major characteristic of its occurrence is that it often co-occurs with ochratoxin A.

Mycotoxins in Food

When we take a look back in history, we see some of the detrimental impacts that mold and mycotoxins have had on our food supply: ergot poisoning from contaminated rye (“St. Anthony’s fire”, 1100 BCE-1800 CE); cardiac beriberi associated with Penicillium molds in rice (“yellow rice toxins”, 2006 in Brazil; 1937, 1948, and 1951 in Japan); and alimentary toxic aleukia (a mycotoxin-induced condition characterized by nausea, vomiting, diarrhea, leukopenia, hemorrhaging, skin inflammation, and sometimes death) associated with Fusarium molds on overwintered wheat, millet, and barley (USSR, World War II-era). In 1974, acute Aflatoxin poisoning from moldy corn in Western India caused 100 deaths, and evidence suggests that the adults may have eaten 2-6 mg of aflatoxin in a single day. This event led to the calculation of 10-20 mg of aflatoxins as the acute lethal dose for adults. In 2004, Aflatoxin poisoning fatal to 125 people occurred in Kenya from contaminated corn (estimated contamination rate ranged from >20 to >1,000 µg/kg).

Continuing investigation of mycotoxin-contaminated food suggests that it is still quite common, but to a much lesser extent, at least in developed countries. The UN Food and Agriculture Organization (FAO) assessment indicates that 25% of global fodder crops are contaminated with mycotoxins. Shiratori N, et al. investigated penicillium contamination on rice in Thailand and found that only 1 of 10 samples contained Aflatoxin B mycotoxin (5.9 μg/kg), although 7 of 10 samples did have trace amounts of Penicillium species isolates. A study conducted on Green Coffee Beans from Brazil found that 91.7% of the 60 samples were contaminated with mold isolates (mainly aspergillus), but only 33% had Ochratoxin A (0.2- 7.3 μg/kg). Keep in mind, this is below the acceptable limit proposed by the European Union (<8 μg/kg), so we do see that some monitoring is taking place.

As a result of these historical events of sickness and death tied to contaminated foods, mold and mycotoxin contamination prevention have become part of the food and agricultural industry, which continues to work on monitoring and reducing it, in part by developing regulatory standards. Aspergillus, Penicillium, and Fusarium are the most common molds determined to be affecting our food supply. Guidelines for food production and storage have been put in place to protect consumers from the most prevalent mycotoxins in the most commonly contaminated foods in order to prevent exposure to toxic levels.

Diet Guidelines for Mold and Mycotoxin Protection

This brings us to what we can do from a dietary standpoint to be vigilant about potential exposure to molds and mycotoxins in foods. Organic foods deserve a special mention when considering mycotoxin avoidance. Quite a few studies support the claim that organic foods do tend to have more mycotoxin contamination, mainly due to the use of less-potent fungicides. In a 1995 study, conventional and alternatively grown rye and wheat were found to have a significant difference in DON levels (the most common trichothecene in food–deoxynivalenol or DON).  Conventional rye had an average of 160 µg/kg, while the organically grown rye had an average of 427 µg/kg. Zearalenone in wheat was also investigated and found to have an average of 6 µg/kg in conventional, compared to 24 µg/kg in the alternatively grown crops. A French study comparing organic and conventionally grown wheat generated similar findings: the organic version had an average of 106 µg/kg of DON, whereas conventional wheat had only 55 µg/kg. Apples have also been investigated, with similar results; conventionally grown apples had a median of 35.85 µg/kg of patulin mycotoxins, while the organic apples had a median of 211 µg/kg.

This finding of greater mycotoxin exposure with organic foods presents a significant barrier to reducing mycotoxins in the diet since organic foods are a large part of nutrition therapy in Integrative Medicine. Rather than eating conventional to avoid this, I have my patients avoid rye and wheat-containing foods and wash their produce using a soak method shown HERE or using a produce spray made by mixing about 8 ounces of distilled water with 12 drops of CitriDrops Dietary Supplement. The spray specifically removes mold, mycotoxins, and bacteria from the skin of fruits and vegetables to make them safer to eat.

Some people claim that mushrooms should be eliminated from the diet when trying to reduce mold and mycotoxins. However, mushrooms do not produce mycotoxins, nor are they known to have commonly high mycotoxin contamination. Mushrooms can produce mushroom poisons instead, and the main caution is to clearly identify mushrooms and avoid consuming poisonous species.

How Important is a Low-Mycotoxin/Low-Mold Diet?

It appears that some exposure to mycotoxins is almost inevitable, and a truly “low-mycotoxin” or a “low-mold” diet would leave one with very few food options. Before embarking on a project to eliminate mold exposure from food, it is imperative to take in the entire clinical picture as individual reactions vary widely. Ranges for potential exposure have been developed based on available data and clinical observation. However, it is necessary to consider a person’s; age, body composition, nutrient status, comorbidities, allergen sensitivities, genetics, current toxin burden, the effect of a combination of different mycotoxins, etc., etc., as all have shown to impact the severity of symptoms and their progression.

A look into the literature suggests that some diseases may be associated with food mycotoxins, but the evidence is incredibly difficult to assess over a lifetime. For example, epidemiological studies have shown correlations with an increased incidence of hepatic carcinoma in populations with higher dietary aflatoxin exposure in addition to a diagnosis of hepatitis B. An overall strategy, particularly for high-risk populations may involve reducing or removing foods likely to have fungal contamination with the clear understanding that individual response to mycotoxin exposure is not predictable. Thus, it is my experience that when we conduct mycotoxin tests on patients to look at body burden, I focus first on the air more so than foods. However, when I see elevated levels of mycotoxins and know that indoor air quality has been addressed, then specific food and dietary adjustments likely need to be made. I find Organic Acids Testing (OAT) helpful as a part of this determination as it can indicate mycotoxin, genetic, nutritional, and vitamin issues with one test.

In conclusion, dietary restrictions to avoid mold exposure should be decided between provider and patient, with the assumption that it is probably not possible to be completely free of mycotoxins in food.  The goal should be to reduce the total body load as much as is PRACTICAL for the individual.

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