Mycotoxins 101: Testing, Binders, & Detox
*This article is not medical advice. Before starting on any health related regimen, seek the advice of your Primary Care Physician or an M.D.
Mold / Mycotoxin Exposure
Mycotoxin exposure is synonymous with chronic illness, ME / CFS, and Long Haul Covid. Mycotoxins can cause organ damage, oxidative stress, and neurodegeneration. Some can cause blood glucose dysregulation and diabetes, while others can cause iron dysregulation and low ferritin.
“a formal study of 236 people diagnosed with ME/CFS revealed that 92% of them had elevated levels of at at least one mycotoxin”
A significant portion of my clients have dealt with, or are currently dealing with, mycotoxin exposure and mold-related illness. Approximately 50-75% of the folks that I work with test over the 95th percentile for at least one mycotoxin. Dr. Richie Shoemaker and others have written a lot about the fact that mycotoxin exposure is a common finding in those living with chronic illness. New information about mold-related illness comes out every year, sometimes dismissing prior conclusions and often enhancing our current understanding. The chronic illness arena is, unfortunately, fraught with people trying to make a buck, trying to prove they are right and saying they have the best protocol. It is also fraught with supplement-hocking companies and pyramid marketing schemes. I will do my best to offer objective information
Why Read This Article?
You may find this article valuable if you:
Want to learn about the different methods used in mycotoxin testing
Want to learn about other tests that can be beneficial for those with mold illness
Want to learn about what binders to choose
Want to learn about mycotoxin detoxing
Mycotoxin Testing - The Basics
Determining if you have mold-related illness caused by mycotoxin exposure is easy, right? Wrong! Here again, we have differing opinions as to which testing technology is best and which testing method is best. I will do my best to share what I feel is an objective assessment, here.
First, there are two basic testing methods used to determine the level of mycotoxins you may have in your body - urine testing and blood testing. The three most well-known urine mycotoxin testing companies are Mosaic Diagnostics (formerly known as Great Plains Lab), RealTime Laboratories, and Vibrant America. Each uses a slightly different testing technology, but the most important thing to understand about these tests is that these are “excretion tests”, not “body burden tests”. What this means is that they don't tell us if you are sick from or are having an immune reaction to mold. Additionally, the difference in mycotoxin coverage among these tests varies widely. Using different technology, both RealTime and Mosaic each test for about a dozen mycotoxins. Although there is some overlap between the two, different mycotoxins are tested for by each company (see below).
Urine Mycotoxin Testing
The Mosaic MycoTOX Profile
The Mosaic MycoTOX Profile (formerly known as Great Plains Laboratory’s MycoTOX Test) is a urine-based assay that tests for the presence of 11 different mycotoxins. The test includes: Aflatoxin M1, Ochratoxin A, Gliotoxin, Sterigmatocystin, Mycophenolic Acid, Roridin E, Verrucarin A, Enniatin B, and Zearalenone.
The test costs around $350 and can be ordered on line, direct to consumers from mymedlab.com or mylabsforlife.com.
RealTime Laboratories
The RealTime Laboratories urine-based mycotoxin test detects 16 different mycotoxins, and includes the following mycotoxins: Ochratoxin A, Aflatoxin (B1, B2, G1, G2), Trichothecenes (Satratoxin G and H; Isosatratoxin F; Roridin A, E, H, and L-2), Verracurin J and A; and Gliotoxin, and Zearalenone.
The test costs around $399, and it can only be ordered by a practitioner.
Vibrant America Mycotoxins Test
The Vibrant America Mycotoxins test detects 31 mycotoxins, including: Aflatoxin A1, B1, B2, G1, G2, M1; Ochratoxin A; Sterigmatocystin; Zearalenone; Enniatin B1; Fumonisins B1, B2, and B3; Citrinin; Patulin; Gliotoxin; Mycophenolic Acid; Dihydrocitrinone; Chaetoglobosin A; Verrucarin A; Deoxynivalenol (DON), Nivalenol (NIV), Diacetoxyscirpenol (DAS); T-2 toxin; Satratoxin G and H; Isosatratoxin F; Roridin A, E, and L-2; and Verrucarin J and A.
The test costs around $375 and it can only be ordered by a practitioner.
The Vibrant Mycotoxins test is my favorite for two reasons: mycotoxin coverage and cost. If you bundle theVibrant Mycotoxins test with Heavy Metals, Chemicals/Environmental Toxins, it costs $500 for all three tests. Or, if you add on an Organic Acids, it costs $620. There is a lot of value there, especially when you compare the $375+ price tag for both the Mosaic and RealTime tests, which offer far less mycotoxin coverage).
Blood Mycotoxin Testing - Antibodies
Blood-based mycotoxin testing measures the levels of mycotoxin antibodies in your blood serum. One laboratory that offers this test is MyMycoLab. Their test tests for 14 different mycotoxin antibodies, both IgE and IgG. However, to be clear, this is also not a “body burden” test. This test will tell you if you have a current exposure, or if you are having an immune reaction to any of the 12 mycotoxins it tests for. According to MyMycoLab.com:
“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 MyMycoLab blood test includes the following mycotoxins: Penicillium (mycophenolic acid), Alternaria, Aspergillus (gliotoxin), Stachybotrys, Cladosporium, Aspergillus auto-toxin, Aspergillus/Penicillium neurotoxic mycotoxin, Ochratoxin, Satratoxin, T-2 Toxin, Vomitoxin, Verrucarin and verrucarol, Fumonisin, and Zearalenone.
The test costs $380 plus the cost of a blood draw (around $425 in total).
Urine-based vs. Blood-based: How do you decide?
So, how do you decide between doing urine-based or blood-based mycotoxin testing? Here’s how I approach it. If I am convinced that a person has all the symptoms of mold illness and has known mold exposure, I want to know which mycotoxins do they have, because knowing which toxins they’re harboring helps me design a detox protocol specifically around those toxins. In cases like this, I choose urine-based testing, and I always use the Vibrant Mycotoxins test because of its value - it tests for the most mycotoxins at around the same price as others. However, if I am unsure if a person has had mold exposure and their symptomology is unclear, I go for the blood-based antibody test.
Provocation Testing - To Do or Not to Do?
The issue of whether to 'provoke' is commonly debated. Provocation testing refers to “provoking” the liver to “dump” toxins at a faster rate than would normally occur. This is usually accomplished using 500 mg of glutathione per day coupled with daily sauna therapy during the week leading up to the test. I do not agree with this approach. To me, this is approach is pure nonsense, and it may very well make a person even more unwell.
In general, I think provocation can be done in a non-aggressive, non-invasive way. My approach is to open some common Phase 2 and 2.5 detox pathways (see other blog article on Phase 2 detox pathways), and support methylation just a bit for 5-10 days; that should be enough.
Testing Your Living Environment
I often get questions regarding how to test your house for mold, and how to approach mold remediation. This topic is worthy of a whole book. The one resource I trust here is Carl Grimes (you can find him on Facebook). He experienced mold illness many years ago and has since recovered. He has become an expert, and he’s written a book on how to look for mold, how to test for mold, how to remediate mold.
When it comes to testing your environment, you can consider doing ERMI and/or HERTSMI testing, but these tests are flawed in that they only test for the presence of mold, not for the amount of mold present.
Likely one of the biggest challenges in regards to mold remediation is finding where in the heck the mold is located. A very simple, inexpensive way to do this is to use Immunolytics Gravity Plates. The plates are placed in different rooms of the house, and are left open for one hour, during which time the plates capture mold spores from the air that have settled onto the plates. The plates are then sent to the lab for analysis that includes identifying the types of mold present and the number of mold colonies grown. This is an indication of which room or rooms have the highest counts. The plates can be purchased at immunolytics.com for $3.00 each. People will argue with me, but spending less than $50 to see if you can find which room has the highest mold count (and thus has the highest likelihood of harboring mold) seems like a bargain to me. Once found, the mold needs to be properly removed and remediated. And since mold needs moisture to grow, any potential source of waterneeds to be eliminated as well.
Thoughts on Additional Testing:
When it comes to working with those with mold exposure and suspected mold illness, additional testing can be both informative and helpful. Here are some additional tests I consider:
Genetic testing - For the most comprehensive genetic information, I recommend combining two genetic testing kits. One is a kit I sell (for $319) and the other is from 23andMe (for $79-119). Together, these two kits give me access to 1,080 genes across more than 80,000 locations. This is a lot of genetic data to consider, and having this information can really be helpful for me, especially when dialing in a detox regimen.
Organic Acids testing (Genova, Mosaic, Vibrant) - Organic acids are products of the body’s metabolic pathways. This urine-based test is a functional snapshot that provides information about key metabolic markers for Candida, mold colonization in the gut, Clostridium bacteria (unavailable through stool testing), some nutritional status markers, methylation markers, fungal markers, phosphorous wasting, mitochondrial markers, krebs cycle markers, glutathione markers, and neurotransmitter markers. The Mosaic test is available direct to consumers for around $310. Vibrant’s is available through a practitioner for $325 to $400. Genova’s is availble for $294 plus a $15 physician fee.
Stool testing - My favorites are Thorne Gut Health Test (consumer direct for $199) and Vibrant’s Gut Zoomer (for $478). Both are best in their price ranges, but you will need to get the raw data from the Thorne test and have somebody skilled sort through it. I have found that once I see the stool bacterial profile, I dont really need to have a breathe test for SIBO: the bacteria tell the story. Note that almost everybody who has mold also has gut issues.
Iron/Iron Sat%/Ferritin - Testing these levels is super important. Both excess iron and low iron are seen in about 15%, and are a major cause for oxidative stress and fatigue, respectively.
Porphyrins Profile - Without a doubt, one of the most important tests for anybody with environmental exposures from mold, metals, or chemicals. Porphyrins are a by-product of heme synthesis, and if not properly cleared by the body, they can become toxic. This test can indicate how efficiently our body makes heme (the precursor to hemoglobin that carries oxygen). Most practitioners never use this, nor do they know how to interpret it. It’s critical, and it’s also why some folks really struggle with detox. I couple this with the genetics across a dozen genes in the heme pathway and get to the root cause. This test is available for practitioners through Doctors Data via mymedlab.com, or from RupaHealth via a practitioner.
COVID Long Haulers incellDx-14 Cytokine Panel - Dr. Bruce Patterson designed this panel while researching Long Haul Covid. The panel tests for 14 inflammatory cytokines (Il2, Il-4, Il-6, IL-8, IL-10, Il17, IL-33, TNFA, NFKB, Rantes, VEGF, SCD40L). The test costs $460, and it is available through the Radiance Diagnostics website (you may need a doctor’s prescription). It is a valuable test, BUT these markers are almost always consistent with the genetics, so I consider it to be optional if you have the genetic testing done.
MARConS - This tests for the presence of Multiple Antibiotic Resistant Coagulase Negative Staphylococci deep within the nasal cavity. It is available through several online labs (you will need a doctor’s prescription). This test is often positive in those who also have mold colonization in their sinuses ( a portion of mold folks do). It usually develops later and is pretty simple to treat using netti pots, herbal nasal rinses, and colloidal silver - all work well. In some cases, nasal peptide sprays can help with this, but they are expensive.
Micronutrient Panel - I consider this to be pretty fundamental. Almost everybody with mold has gut issues, and almost everybody with gut issues has nutritional deficiencies. Vibrant's Micronutrient Panel checks both serum and intracellular micronutrient levels, and includes vitamins A, B1, B2, B3, B5, B6, B9, and B12; inositol; vitamins C, D, D3, E, K1, K2; MMA; Zinc, Magnesium, Calcium, Potassium; antioxidants (Coq10, Glutathione); Selenium; Manganese; Iron; Copper; Chromium; the amino acids Leucine, IsoLeucine, Valine, Arginine, Citrulline, Serine, Asparagine, Glutamine, Cysteine; fatty acids DHA, DPA, EPA, Linoleic Acid, Arachadonic Acid. Vibrant offers this test for $358. Genova offers their NutrEval micronutrient panel for $525, and Spectracell’s Comprehensive Micronutrient Test is offered for $519. You will need a practitioner to order.
Hair MetalsTest - This test checks for 17 heavy metals and 22 other minerals. Note that hair is just one excretion pathway for metals (urine, skin, stool) are the others. Some of these levels may indicate nutritional status while others do not, sonyou will need a practitioner who knows how to interpret the patterns. Low hair levels do not mean your body burden is low. High levels are definitely a problem. There are some markers here that are super important for blood sugar (glucose) regulation - Chromium, Vanadium, and Rubidium. When it comes to mercury exposure, if you have a single specific genetic mutation, even minor exposure can cause major issues (think fish, mercury fillings, etc.). Also, keep in mind that the heme pathway is inhibited at certain points by lead. Doctors Data offers this test on Amazon for $125.
Other miscellaneous Tests: Comprehensive Metabolic Panel (CMP), CBC with Diff, Phospholipase A2 (PLA2), Myeloperoxidase (MPO), High Sensitivity C-Reactive Protein (HS-CRP), Homocysteine, Leukotriene E4, Propionylcarnitine, and BH4.
Binders - A Basic Overview
Everyone seems to have their favorite binders, but when choosing a binder, there are some important things to consider. First, there are two general categories of binders: single binders and binder blends.
Binder blends are just that - blends of different types of binders. Blends can be a good option, especially if you haven’t performed mycotoxin testing and are guessing what mycotoxins you may have. However, a potential downside to using a blend is that if you have a an unexpected reaction, you’re left guessing what caused the reaction. Another downside to binder blends is that, in using a blend, you are not optimizing your detoxification effort. Not all binders bind all mycotoxins, so blindly using a blend may result in you using the wrong binders. Knowing which binder binds which mycotoxin is super helpful. For example, if someone only has Ochratoxin A (OTA), why would I give them binders that do not bind OTA? Instead, I would choose to use a single binder that is best for binding to Ochratoxin A. Some binder blends on the market include GI Detox by Biocidin Botanicals (formerly Bio-Botanical Research) and Ultra Binder by Quicksilver Scientific.
Using single binders can be helpful for many reasons. First, it empowers you to select the specific binder(s) for your specific mycotoxin(s). Know that doing so will increase the rate of excretion of the mycotoxins DRAMATICALLY. This reinforces the fact that having mycotoxin testing done is always preferred over guessing.
Binder Considerations:
There are 3 main considerations:
Charge - Some mycotoxins are positively charged, and some are negatively charged. You will want to select a binder that has the opposite charge of the mycotoxin(s) in question.
Size of Binding Site - Each mycotoxin has a uniquely sized binding site, and so do binders. Like legos, the binding sites of the mycotoxin and the binder need to be the same size so that the binder is not only attracted through opposite charge, but can also 'grab' and lock onto the mycotoxin.
Number of Correctly Sized Binding Sites Per Molecule - This refers to density - how many molecules of mycotoxin can one molecule of the binder grab? For example, the difference between how much mercury chlorella can grab versus a very specific micronized silica binder is 300X! So, the potency of certain binders can be dramatically different.
pH - Some binders, like clay, can alter the pH of the gut which can have ancillary effects.
Probiotics - Some probiotics can be used to help facilitate the removal of mycotoxins. One way they do this is by acting like a binder. Another way is to biologically transform and process the mycotoxin (i.e. break it down).
Detoxification Pathways
General Considerations:
Each mycotoxin is excreted from the body using its own unique detox pathways. Knowing which mycotoxin uses which detoxification pathways allows us to optimize how to best support and facilitate its detoxification
Identifying if you are genetically compromised in certain detox pathways is important
Knowing which cofactors are needed for optimal function of each pathway is also helpful (and this is why micronutrient testing is important)
The phases of detoxification are:
Phase 1 - The Phase 1 detoxification pathway involves the Cytochrome P450 (CYP450) genes. Knowing which phase 1 genes are genetically compromised helps inform supplement selection. Some supplements use certain phase 1 genes, and if you are compromised, you may very well react to them. All Phase 1 enzymes require NAD (B3), some require vitamin B2, and all require Heme. Necessary cofactors for heme production include vitamins B2, B6, B7, and B12, and Zinc, Copper, Iron, Glycine, and Lipoic Acid. It is readily apparent that nutritional deficiencies can impede detox significantly.
Phase 2 - The Phase 2 detoxification pathway involves Sulfation, Glucuronidation, Methylation, Acetylation, Amino Acid Conjugation, Glutathione, Pon1). Knowing the genetic status for these pathways, as well as the status of the nutritional cofactors for each of these pathways, is super helpful.
Phase 2.5 - The Phase 2.5 detoxification pathway involves the Bile Salt Export Pump (BSEP). The BSEP is a protein pump in liver cells that moves bile salts from the liver to the bile ducts (this is the rate limiting step in bile formation). The bile salts are then transported to the small intestines, then back to the liver repeatedly throughout the day. When the Phase 3 protein MRP2 gets over whelmed (see below), it shuts BSEP transport down, resulting in a build up of bile and toxins in the blood. The toxins then hit the brain (causing neurological symptoms) and the kidneys (causing lower back pain), and the bile salts get excreted through the skin (causing rashes). Many refer to this a “Herxheimer” reaction, but technically what is happening is that your MRP2 proteins are overwhelmed and/or the BSEP is shut down. Knowing your genetic status, and thus how to support this phase, is critical so that the right herbs and compounds can be selected to support the healing process. BSEP is regulated by the Farsenoid X receptor, known as NR1H4.
Phase 3 - In the Phase 3 detoxification process, toxins are escorted through the liver by the MRP2 protein. Knowing if MRP2 is compromised, as well as knowing how to best support it, can be super helpful.
Mold and Myalgic Encephalitis/Chronic Fatigue Syndrome (ME / CFS)
In a formal study of 236 people diagnosed with ME/CF, 92% had at least one mycotoxin at a level considered “elevated” [1]. In fairness, these people in the study had known mold exposure, and most lived in Florida. In my practice, I see similar numbers, which is not everybody, but it is darn close. And COVID Long-Haulers are not far behind. However, in another study of 112 people diagnosed with ME/CFS, 93% were positive for at least one mycotoxin at elevated levels. From the study:
"This study was conducted to determine if selected mycotoxins could be identified in human urine from patients suffering from chronic fatigue syndrome (CFS). Patients (n = 112) with a prior diagnosis of CFS were evaluated for mold exposure and the presence of mycotoxins in their urine. Urine was tested for aflatoxins (AT), ochratoxin A (OTA) and macrocyclic trichothecenes (MT) using Enzyme Linked Immunosorbent Assays (ELISA). Urine specimens from 104 of 112 patients (93%) were positive for at least one mycotoxin (one in the equivocal range)."[2]
May the 2024 Holiday Season be one which brings you progress through recovery if you are suffering from mold exposure. If you would like to learn more or explore this topic in more detail with me, schedule an appointment online. There are many other issues commonly encountered in mold related illness - histamine and mast cell issues, EMF sensitivity, food sensitivity, sulfur sensitivity, etc., and each is worthy of their own exploration.
References:
[2] Detection of Mycotoxins in Patients with Chronic Fatigue Syndrome. Joseph H. Brewer,1,* Jack D. ThrasherToxins (Basel). 2013 Apr; 5(4): 605–617. Published online 2013 Apr 11. doi: 10.3390/toxins5040605. PMCID: PMC3705282. PMID: 23580077