A good portion of my clients have dealt with or are dealing with symptoms related to mold (mycotoxin) related illness. There has been alot that has been written about this by Richie Shoemaker (www.survivingmold.com) and others, and new information comes out every year, sometimes enhancing our understanding and sometimes dismissing prior conclusions. This whole area is fraught with humans, trying to make a buck, trying to prove they are right, trying to say they have the right protocol, and also fraught with supplement hocking pyramid marketing companies (hello CellCore / Microbe Formulas). Sigh.
With all this said, testing to see if you have mold should be easy right! Wrong! Here again we have polarized camps on which test technology is best, and what test methodology is best. I will try and share what i feel is an objective assessment here. First, there are two basic ways to assess what mycotoxins (what mold gives off) you have in your body that may be causing an immune reaction and potential sickness. First, are the more well known urine based excretion tests from Great Plains Laboratories, RealTime Laboratories, and Vibrant America. Each uses slightly different technologies, but important is the fact that these are excretion tests, not body burden tests, and they don't tell us if you are "sick" or having an immune reaction. In fact, some tests have been done to suggest that there isn't much difference from sick people who take these urine based excretion tests from those that have mold illness 'symptoms'. What!? Yep. Next, and importantly, is that the coverage of these tests varies widely. RealTime and GreatPlains have some overlap, but test different mycotoxins from each other - both about a dozen, with some overlap, but different technologies.
The Great Plains Mycotox plan tests for 11 mycotoxins, the list includes: Aflatoxin M1, Ochratoxin A, Gliotoxin, Sterigmatocystin, Mycophenolic Acid, Roridin E, Verrucarin A, Enniatin B, and Zearalenone.
The RealTime Labs test covers 15 mycotoxins, and includes: Ochratoxin A, Aflatoxin Group: (B1, B2, G1, G2), Trichothecene Group (Macrocyclic): Roridin A, Roridin E, Roridin H, Roridin L-2, Verrucarin A, Verrucarin J, Satratoxin G, Satratoxin H, Isosatratoxin F, Gliotoxin Derivative, and Zearalenone.
The Vibrant America MycoToxin Panel costs $375 and covers 31 mycotoxins. Aflatoxin A1, B1, B2, M1, M2; Ochratoxin A, Sterigmatocystin, Zearalenone, Enniatin B1, Fumonisins B1, Fumonisins B2, Fumonisins B3, Citrinin, Patulin, Gliotoxin, Mycophenolic Acid, Dihydrocitrinone, Chaetoglobosin, A, Roridin E, Verrucarin A, Deoxynivalenol Vomitotxin (DON), Nivalenol (NIV), diacetoxyscirpenol (DAS), T-2 toxin, Satratoxin G, Satratoxin H , Isosatratoxin F, Roridin A, Roridin H, Roridin L-2, and Verrucarin J S.
My favorite, for two reasons, Vibrant, because of coverage, and cost. If you bundle their Mycotoxin Panel with Heavy Metals, Chemicals/Environmental Toxins its $480 for all 3, or add on Organic Acids and its $600. There is alot of value there- versus $300+ for Great Plains and RealTime with far less coverage.
The other test methodology is a blood test that measures the levels of immune antibodies in your blood, from MyMycoLab. Its $380 + cost of a blood draw, so figure your at ~$425 in all. It measures 12 different mycotoxin anti-bodies, both for IgE and IgG. However, this is also not body burden to be clear. This will tell you if you are sick (having an immune reaction) from one of the 12 mycotoxins it covers. From the MyMycoLab.com website, "IgG antibodies to mycotoxins indicate that currently the immune system is reacting to mycotoxins. It is not an indicator of past exposure. IgG to a toxin such as mycotoxins, mercury, pesticides is current exposure; IgG to viruses, bacteria, molds, and parasite is an indication of past exposure. IgE is an indication that mycotoxins are stimulating mast cells, causing an inflammatory reaction and can result in Mast Cell Activation Syndrome (MCAS)." The list of mycotoxins MyMycoLab tests for includes: Penicillium (mycophenolic acid), Alternaria, Aspergillus (gliotoxin), Stachybotrys, Cladosporium, Aspergillus auto-toxin, Aspergillus/Penicillium neurotoxic mycotoxin, Ochratoxin, Satratoxin, T-2 Toxin, Vomitoxin, Verrucarin and verrucarol
How do you decide between blood and urine based testing ? If you are convinced that the person has all the symptoms of mold, and has known exposure, then the real question is - which mycotoxins do you have so you can design a detox protocol around them. I go for urine in this case, and always choose Vibrant given the value. If I am unsure if the person has had mold exposure, and symptomology is unclear, i go for the blood based antibody test.
Folks often ask me how I look at mold toxicity and differ from the 'shoemaker protocol'. I will offer the following observations and reflections to consider:
I don't require a $500 intake and $2,500 of testing at an initial appointment.
I don't look at primarily one gene (HLA) and a narrow set of biomarkers, and then determine that there is a one size fits all protocol (often costing $30K-100K) for everybody. All this with an approximate 10% success rate at completing the protocol with symptom resolution. I usually assess 900-1,000 genes.
Why wouldn't we look at the genes within the 7 phase 2 detox pathways (sulfation, acetylation, glucuronidation, methylation, glutathione, amino acids, and pon1), especially after we know which pathways will be primarily used if we know the mycotoxin present ? Why wouldn't we look at the phase 1 CYP450 detox pathway ? Why wouldn't we look at phase 2.5 (BSEP) ? Why wouldn't we look at sulfur sensitivity ? Why wouldn't we look at histamine, mast cell, and EMF related issues ? Why woldn't we look at critical antioxidant genes like : HMOX1, Keap1, NRF2, SOD1, SOD2, SOD3, the more than dozen GST genes, GPX1-7, GSR, SIRT1-3, and the list goes on......
I don't turn people away because they are still living in an environment with mold.
I offer a range of alternatives to consider based on financial constraints. As one example Cholystyramine and Chitosan as binders have essentially identify molecular structures. A months supply of the former is typically $300-$1,000; while Chitosan is around $40-100, depending on dosing.
When somebody is hell bent on having formal publications with their name on it, yet every two years re-writes the story of what is 'right', do we not begin to question that their polarized assertions may be more from a need to be right than actually a sound comprehensive understanding of what is really going on ? Each year or two, there is a change in direction, once again asserting that only they have the complete truth - after 3-4 of these changes in direction, don't we question what is going on here ?
The issue of whether to 'provoke'. Hmmm. In general i think this can be done, in a non-aggressive, non invasive way. No 500mg/day of glutathione and daily saunas for a week - that is pure non sense and will make the person more un well. Open some common phase 2 pathways (see other blog article on phase 2 pathways), along with phase 2.5, and support methylation just a bit for 5-10 days and that should be enough.
Happy Testing!
By RimmaKhaz - Own work, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=79132975
