As a physician who treats patients with mold-related illness, as well as being someone who has a personal story of dealing with mold impacting my health, one of the things that I try NOT to do is to assume that every chronically ill patient is similarly affected. While mold is a contributor to illness and disease in many cases and should not be overlooked, it is not always the causative factor. It has been said that when you are a hammer, everything becomes a nail. I am very aware of this and have tried not to over-diagnose mold as the reason for every patient’s failing health. Recently, though, I was reminded of why mold is always a good and an important thing to rule out. With its uncanny ability to disrupt just about every body system, mold can be hard to spot and can be masked by many of the “bigger” more obvious symptoms that it ignites. Thus, the reminder to “think mold“, especially when nothing else is working, is my reason for this article.
What follows is a patient case in which I did not revisit the environmental piece straight away. Hopefully, this story will illustrate that the quality of air a person is breathing in their indoor environment must always, always be in the forefront of the mind.
Missing the Mold
The patient, in this case, was a 27-year-old woman, brilliant and beautiful, whom I know well on a personal level as her parents are my close friends. She works from home in another state and, as COVID began, isolation in her home became the “new” norm. As is sometimes the case with the intellectually gifted, there had been long-term anxiety with some elements of depression as well, but these issues had been successfully treated and she was receiving ongoing therapy. Over the course of several months, she began to feel so extremely fatigued that overall lethargy and complete loss of motivation was her day-to-day situation. To make matters worse, she developed a severe case of shingles that took months to resolve. Since shingles are usually found in the older population or in those in whom there is some compromise in the immune system, I immediately looked to her standard blood work but did not find evidence of any acute situation there. Continued efforts were made to have her psychiatrist work with her medications, but nothing seemed to make a difference in how she felt or to assuage her level of fatigue.
When she and her husband purchased their first home, I was asked to look at it to see if there were any overt issues. As they are friends, I gladly did but as I am NOT a mold inspector, was only able to look at a few important things and make very general recommendations. Humidity in their downstairs was a bit high so they purchased a dehumidifier. They also put in a very good quality HEPA air filtration and purification system. There was no moisture in the walls to indicate a leak, and mold plates did not show elevated spore counts in the indoor air.
When she failed to improve at all, I asked her to do an Organic Acids Test. Her results indicated severe deficiencies in her mitochondrial markers, which are the “energy pumps” of the entire body. Markers for oxidative stress were elevated and the process of methylation, a detoxification pathway often impaired by genetics, was considerably disordered. Aha! I thought. This is the reason she feels so bad. Let’s fix these pathways! At the time, I thought the culprit was the long-term shingles impact, as viruses can, indeed, affect all of these markers. As she began the treatment protocol, she did feel a little better, and a recheck on the organic acids test showed a modicum of improvement but not to the degree that it should have been.
Testing for Mold When All Else Fails
Quite fortuitously at that time in her treatment, I attended an Integrative Mental Health conference, and a topic of great interest was that of mold and mycotoxins and their impact on depression and anxiety. My mind began to revisit the mold piece; could it be? She did not have any obvious sinus symptoms, but could breathing mycotoxins be part of the problem? To start digging into the mold piece, I asked her to do a urine test for mycotoxins. When the report came back, I fell off my chair and had my answers. Her levels of Ochratoxin and Mycophenyllic Acid were several HUNDRED times the upper limit of normal. These are mycotoxins produced by aspergillus and penicillium molds.
A Building Biologist and indoor environmental professional was called out to her home and found that the coils and plenum of the HVAC were covered in mold. Additionally, there was a leak from a garden tub that had wet the floor beneath it and caused mold growth in the insulation below and into the area in which they slept. This leak had likely been going on for some time, but in the pre COVID times, she was not in the house all the time, so had not been as affected. By the way, her husband also did the mycotoxin test, and his levels of ochratoxin were even higher than hers, although he showed no mycophenolic acid, which demonstrates the individuality of response. Symptomatically, he mainly had lethargy but not overwhelming fatigue and no depression. Since his work had remained outside of the home, he had many hours less per day of exposure as well! Both had significant elevations in Transforming Growth Factor Beta-1 (TGF B-1), the inflammatory cytokine responsive to mycotoxin exposure, though.
We finally had an answer. My mistake was not delving into environmental causes sooner, especially when asking the question of why she would have gotten shingles! My mindset at the time was that it was stress-induced, and I did not immediately think of going back to the environment for answers. Some of these mold events likely happened AFTER they moved into the house and no one ever saw the overt need to check or to do mold plate testing again.
Additional interventions include shoring up immunity using IgG Gut Protect, enhancing liver detoxification for mycotoxin elimination with Myco Detox Liver Support and L-Glutathione. Both she and her husband are also on the prescription binder, cholestyramine. She currently reports improving in both energy and mood.
Taking Mold Off the Table
My point in writing about this is, again, that we must always remind ourselves that if the things we are doing are not helping, we should revisit the home environment. Things, like leaks or water intrusion, can happen that you are not aware of and may not be uncovered without professional help and investigation. Just because things look ok to the naked eye, and even when mold plates are not showing elevated counts, mycotoxin levels may need to be checked. This is an especially important step when you are doing everything you can think of, but are still not getting any better.
As an environmental physician, when it comes to mold, I have decided that I WILL be that hammer! I will be seeking any moldy nails that are there to pound before going down any other paths! Mold can be that much of an underlying illness factor. I am now at that point where if I have a patient with many difficulties, then I must think that mold is at the bottom of it until I prove otherwise!
Susan Tanner has practiced medicine for over 33 years, concentrating primarily on chronic illness and the impacts on the individual, the family and the community. Her driving curiosity into why people are made ill caused her to pursue education in Environmental Medicine, completing coursework, exams, and necessary practice years to earn board certification in this area in 2009. Her own struggles with mold-related illness drove her desire to teach those similarly affected. While in clinical practice, Dr. Tanner wrote and contributed to a number of publications on environmental health, prepared narratives for understanding in legal matters, and researched new techniques for modulating the body’s ability to clear toxins and infections. She now has a fitness and health website www.thebodynexus.com, where she writes articles and shares education on utilizing the various body systems into improve overall health.
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