Mold & Mycotoxins – What You Can’t Smell Could Be Harming You

Symptoms, testing, and treatment with Dr. Jill Crista

Hi, everyone. In today’s episode, I am joined by mold expert, Doctor Jill Crista. She puts out some fascinating theories regarding what happens in mycotoxicity, this syndrome where your body is inundated with not actually mold itself, but the toxins that are produced by mold or fungus. She delineates some of the finer points of this philosophy, which is pretty darn interesting if I’m being fully honest. She lays out some symptoms that help one to determine if there’s an increased likelihood that they may have been, or currently are, being exposed to mycotoxins.

She goes through some history findings, things that may have happened to you, places where you may have lived that could increase your risk. Both the symptom delineation and the history are important because, like many things in healthcare, one root cause can manifest as a litany of different overlapping symptoms with other causes, so it’s very difficult sometimes to determine what causative factor might be most indicated for you to pursue.

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She also outlines some helpful testing and some helpful treatment strategies. I was interested to hear that she feels most mold or mycotoxin patients have to go beyond just using binding agents to pull out these toxins. They also have to co-administer antifungal agents, which will actually stop the production of these mycotoxins.

I was also very happy that we were in agreement that starting with the gut is a very important aspect of successfully treating mold or mycotoxins. I will refer you to Healthy Gut, Healthy You, if you want a comprehensive plan for improving your gut health. Again, I’m so happy that Doctor Jill acknowledges that this pillar really needs to be in place to allow one to optimally respond to mold and mycotoxin therapy. Frustratingly, we got cut off at the end of our conversation before we could go even deeper into how to troubleshoot treatment, how to use testing to monitor your treatment, and how to try to resolve the issue of environmental exposure. So we will be following up in part two.

Again, this was a great conversation with Doctor Jill Crista regarding mold and mycotoxicity, and I really hope you will enjoy it as much as I did.

Episode Intro

Hi, everyone. Welcome back to another episode of Dr. Ruscio Radio. This is Dr. Ruscio. Today, I’m here with Dr. Jill Crista, and mold will be on the menu today. We’ll be dissecting what it can feel like, symptoms, available tests, how to treat it, and troubleshooting items are that you may want to consider. Jill, you came highly recommended. As the audience probably knows, I’m a bit wary of some of the mold treatment realms that want patients to do a God-awful amount of testing. The treatment protocols seem more like engineering equations than they do good clinical decision trees.

You came recommended in a camp that seems to be a bit more practical. I don’t want to create large shoes for you to fill here preemptively, but I’m really looking forward to continuing our prior conversations and supplying people with a more reasonable, patient-centered, simplified, but also effective, method for navigating mold. I’m really, really excited to dig into this conversation. Welcome to the show.

Dr. Jill Crista:  Thank you so much. It’s a real pleasure.

DrMR:  And you have written a book on this, so maybe we should start with that just so people know that you’ve gone through the laborious process of thinking through all these things and writing them down, fact-checking some of your claims, as we do when writing a book. Tell us a little bit about your background and a little bit about your book.

Background

DrJC:   Sure. I’m trained as a naturopathic doctor. I started my practice in Wisconsin, and right after graduation found myself in Lyme endemic areas. I started in the Lyme world, and pretty much when you apply the principles of naturopathic medicine, functional medicine, you identify and treat the cause, people get better with these tools. But I had this subset of patients that weren’t getting better. I just didn’t really understand what I was missing. There must be something there. Of course, now we know about things like genetic snips. I was treating the microbiome as a naturopathic doctor already, but I didn’t really realize the impact that mold had, how global it was, the far-reaching impacts that it has on a body until in one of those patients they found black mold in his home.

As I dug into the research, and thankfully as a naturopathic doctor, I came with a strong environmental medicine background because we’re trained in that, but previously I knew mold as this respiratory problem and asthma problem. As I dug into the research, I realized, “Oh my gosh, I think this is what’s going on with this guy, why he’s not getting better and progressing.” And it got me thinking, “I wonder about these other people.”

So I became like the mold Canary in my community. I would go to these people’s homes. I have an awesome indoor inspector, and she’s taught me a ton. We found mold in almost every single one of those patients’ homes. That was a jump-off point for me. I used things I found in the research, of course, there is almost no research on humans and I think that’s purposeful because there’s a lot of money to be lost if we can prove that that’s a real thing.

There are occupational situations where they don’t necessarily want to pay for the cleanup or to pay for people’s health or rental situations. There are insurance coverage situations, so there aren’t a lot of studies that we could go to on humans. I had to sort of translate, do translational medicine with all the animal research that I was finding. Thankfully, many of the things that they were using, they were using in feed, and nutrients are a lot cheaper than drugs. So they’re adding things to feed to protect these animals from mold and mycotoxins, which we can talk about what that means. I thought, “Wow, I wonder if this would help my patient get better.” I used those principles that I learned through environmental medicine and the research that I found and developed a protocol and saw very solid responses. Then I had mold happen in my own home.

That’s always the moment when you get the, “Okay, what’s going on? What’s the message here?” I realized that once we found out it was mold, I knew exactly what to do. I could protect myself, my family. I went to my protocol, and I thought, “This is really unfair that people don’t have this knowledge.” I felt very duty-bound to write a book and put it out there because so many of the things are things that people can do on their own and they can get started. Then if they’re not getting responses they can see a mold-literate doctor to take them to the full healing. That’s my background of how I got into the mold.

Narrowing Down Symptoms, Research Strategies

DrMR:  Great background story. I agree with you that there’s a lot people can do with a well-written book. That can be a huge cost savings for people. I encourage people to navigate this chasm between what you’ve read on a blog, on the one hand, and then going to a doctor’s office on the other, because the books will put a lot of these things together for you and give you a more overarching all-encompassing plan, which is oftentimes the difference between success and failure. One of the things I want to start with, and this is always a challenging question, is what are the symptoms of mold exposure? Like so many things, there’s a litany of symptoms from neurological, to joint, respiratory, but I’m assuming that there might be some symptoms that give you a bit more of an indication.

It seems that respiratory is kind of a giveaway, and neurological symptoms that are kind of paradoxical, at least.  I’m starting to have that hunch that those two, not an exhaustive list, but those two get me thinking, “There could be something with mold here.” Although there are violations to that, just trying to give people, “Okay, here’s the list”  Pretty much every podcast you listen to, you’re going to hear fatigue, depression, all these things. What are some that are more of a flag for you than others?

Symptoms of Mold

DrJC:   I think it’s important for us to really understand what part of the mold is making people sick. I’m on a mission to redefine the definition of mold illness. If you look at the CDC, they define mold illness as basically what I call spore illness. Things that spores or interaction with spores cause. We think of that as allergies, hay fever, respiratory problems, sinusitis, asthma and maybe things that … there’s something the CDC calls hypersensitivity pneumonitis. So basically: reactive lungs, itis of the lungs. So that’s spore illness, but most of the mold-sick people are sick from the mycotoxins. These are these toxins that are spit out by mold when it’s in a competitive environment, which is what happens in a water damaged building.

So if you have excess moisture in a building, many molds will want to come in because it looks like lakefront property to them, and they’ll start trying to gas bomb each other out to hold their turf, so to speak.

And humans get caught in that crossfire. These toxins don’t have a scent, they don’t smell. That’s what got me in my house. We had a relatively new house. If you looked at it from the outside and the inside, we kept a very clean house, clutter-free. You wouldn’t have said this is a moldy house because nothing stunk. All of the problem can be trapped behind building materials. Those toxins move through into the indoor air, but the spores don’t. You can have a toxin-based illness and not have any of the things that are associated with spore illness. That’s why.

DrMR:  Wow, that’s fantastic to know.

Effects of Mycotoxins on the Mind and Body

DrJC:   It’s important to know that because then you can understand, “What do these mycotoxins do to a body? And this we take from the animal research. Mycotoxins are nephrotoxic, so kidney toxic, hepatotoxic, so liver toxic, neurotoxin, so nervous system gets affected, including the brain. Some can cross the blood-brain barrier. They’re toxic to the digestive system. They can actually cause early death of the intestinal lining. So apoptosis of the enterocytes. They’re toxic to respiratory passages obviously in any mucous membrane. If you think from sinus all the way down to anus, basically it can cause toxicity to those systems.

In the GI, which I know is your focus, those neurotoxins then get absorbed in through the lacteals and into the myenteric plexus. So you can get nerve toxin and neurogenic bowel from mycotoxins and they can be genotoxic.

Some of these toxins actually go in and they rewire our genes to make our immune system less reactive to the mold, which is amazing if you think about it. Thereby, then being immunotoxic, not only by rewiring the genes of the immune system, but also having a direct effect on the immune system in the periphery and in the bone marrow.

There’s a crazy amount of things that it can do and that’s why it’s missed so often, and it’s so hard for me to give you a list and why it was so hard for me in practice to identify it because it’s just like Lyme disease where it can imitate any condition, it can affect any system in the body, but there are some key standouts. I would say in almost every patient that I worked with mold, there is some level of anxiousness. I’m really careful not to use the word anxiety because that conjures a panic disorder, somebody that has anxiety so bad they may need medication, but the anxiousness I’m talking about is an inner feeling of being unsettled. They just feel like something’s not quite right. They can’t settle, easy to overwhelm, can’t quite get it together.

Their inner experience can be an inner talk of, “God, get it together, get it together.” And the outer can be calm, cool, collected, but in the inside, they’ve got this vibe happening.

DrMR:  Does this also cause insomnia if this is happening at night time?

Specific Symptoms of Mycotoxicity

DrJC:   Absolutely, and especially if they’re trying to sleep in the moldy environment, the body wakes them up perpetually saying, “We’re not safe, we’re not safe, we’re not safe.” I feel like that’s the overarching inner thought is I’m not safe, but I don’t really know why and in what way. So they horde, they over earn money, they over save. Somebody who is financially fine and their key worry is that they don’t have enough, they’re not going to have enough. All these little things are little signs of what the anxiousness of mold toxicity looks like.

The other thing is fatigue, of course. There’s a lot of links between chronic fatigue syndrome and mold exposure. But fatigue can be many, many, many, many things. Food allergies, all kinds of stuff, adrenal fatigue. So, that isn’t necessarily diagnostic of mold. The neurotoxin thing is kind of interesting because I see two symptoms related to neurotoxicity that are really commonly seen with mold toxicity and difficult to figure out what’s going on otherwise. And that is tinnitus and pelvic pain. Those two areas get excessive exposure to the toxins.

In the tinnitus case, because your respiratory passages, your sinuses are the first experience or first absorption of those toxins, you can get a build-up in the sinuses of the toxin, which not only causes ‘itis of the mucous membranes but also gets absorbed and gets into that neurologic tissue.

So you can see tinnitus, and in pelvic pain it’s because we detox these through the bowel by bile or via the bile and we excrete them in the urine. If you are somebody who can’t leave your desk to go to the bathroom when you need to and you’ve had to hold your urine, you can actually get those toxins absorbed into the pelvic region of the body. So you see an increase in vulvodynia pelvic pain, prostatitis, that kind of thing with mold toxicity. Those are some quirky ones.

DrMR:  Yeah. I think it’s good to have those because I think people are going to be saying fatigue, insomnia, and anxiousness may be a cause, or be caused by so many things. The more we can get these subtle little tells, I think it’s fantastic. I love that description of this inner feeling of being unsettled. Then also, it’s a little bit of a foreshadow to something I want to ask you to expand upon later, but maybe I can get your quick 30-second comment on it right here. I would be inclined to think that for people who felt that inner feeling of being unsettled, especially if they feel it could be driven by something in their environment, they might become hyper-vigilant for how they monitor their environments everywhere that they go. This could lead to limbic imbalances that could really lend themselves to improving from limbic retraining therapy. I think this is becoming a more common recommendation in those with mold. Is that something kind of the short answer on that now, we can expand on it later, but is that something that you think ties in here?

DrJC:   Yes.

DrMR:  Okay.

Correlation to Food Sensitivities

DrJC:   Very well put. So often we’ll see somebody who, not only are they hyper-vigilant to their environment, but they start to drop out foods. Because they have that limbic overdrive, the last thing they ate, they’ll associate with the thing that made them sick. It’s common to see increased food sensitivities, not only because the mycotoxins are causing apoptosis and leaky gut and more propensity to food sensitivities, but because now if there is a reaction to that food, which may actually be because it was a high carbohydrate food that created fungal overburden, which created some histamine response and they got some symptoms and now they’ve cut that food out.

It’s very common to see new-onset food allergies, new-onset chemical sensitivities. Some of those are related to the limbic overdrive. It has really nothing to do with the fact that that food was necessarily bad for them. It now just became associated with, “I don’t feel good.” or it reinforced, “Ooh, I’m not safe. I’m not safe in the world.” Yeah.

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Look at Exposure History

Identifying the Presence of Mold and Mycotoxins

DrMR:  Regarding history, you kind of took a gash out of one of the things I’ve been leaning on from a historical perspective to suss this out, which is, have you ever lived in a home that you suspected mold and maybe smelled musty or mildewy? Certainly it’s something that can be a giveaway, but that’s going to miss some. I never thought it to be perfect, but I’m even less confident in that now. What are you looking at in terms of history? There are some obvious ones, “I was feeling great and then I moved into this house, I started feeling terrible.” But it’s so rare that we have a nice, neat little bow around the history like that. What are some things you’re looking for in someone’s history to get you suspicious mold might be the culprit?

DrJC:   That is a very good question, because like you said, it doesn’t necessarily have to have a musty smell or a mildewy smell to have the exposure, but it is common. I’ll flip that on its ear a little bit and say, if you have been exposed to musty or mildewy spaces, then we know there were mycotoxins, because the things that smell musty and mildewy are the general, I’ll call them “mold farts”, the chemicals and things of just normal daily living for a mold. Those, once they’re exposed to air, then you get the smell. But when it’s trapped, that’s when you get the sneaky hidden problem where you don’t get the musty smell because those chemicals haven’t made it through the building material, but the mycotoxins do. They’re incredibly small. They can go right through drywall, they can go right through tile, all kinds of things.

DrMR:  So the mold particles are not, but the mycotoxins are more able to permeate different things.

Prime Environments for Mycotoxins

DrJC:   Exactly. Mycotoxins are 50 times smaller than the smallest spore. If you think about that, then people wearing masks to keep spores out, they’re keeping the spore out, but they’re not keeping the mycotoxins out. I’m probably wandering away from your question, but the key things that I look for are obvious exposure to a water-damaged building, knowing that a structure has had a water damage event, even if it’s been cleaned up. In our area, one in three remediations needs to be redone because they didn’t take enough material out.

If the structure or the built structure has had water damage at any time in its life, which, think about it, do you know any building that hasn’t? My grocery store has water damage. My hair studio had water damage.

It’s par for the course, and normally that would be no problem if we weren’t building our buildings the way that we do. Our building practices make it a little more challenging. Buildings that maybe had a work exposure. Flat roofs are terrible for water damage, spending time in finished basements. Especially if somebody grew up in a finished basement or had their stuff stored in a finished basement and then move to a pre-water damaged apartment. Now you’ve just taken things that had spores and introduced them to a different biofilm, pathogenic biofilm and now those spores will act competitively.  Then anything where you are living in an apartment situation, where you have a shared wall and you know there was water damage on the other side, that obviously can also be coming through to your side in condo and apartment situations.

DrMR:  Okay. All right.

DrJC:   Does that help?

Where to Start with Diagnosis? On a Case by Case Basis

DrMR:  Yeah, it does. The way I look at this and the way I’d encourage any providers or patients who are trying to be their own health advocates to look at this is, we’re trying to build a case and what cropping of evidence has the most justification to move on. In some areas that’s the gut. I think that’s usually the best place to start. However, if someone comes in with a history of having been on paleo, having been on low-FODMAP, doing probiotics, they’ve done antimicrobials, they’ve done all these things and they are maybe reacting the whole time or just spinning their wheels with only a flicker of improvement, and you see some of these things in their history and or symptom inventory.

Now we’re building a case for, “Okay, maybe we depart from my normal, kind of start with the gut philosophy, or in this case, they kind of already have started with the gut and now we have to do a lateral move to something like mold.” So yeah, I look at this as it’s all a probability calculation. These things are super helpful to that endpoint.

DrJC:   Absolutely. Yeah, that used to be my clue that something might be Lyme disease before I understood that a lot of people with Lyme have mold, and vice versa. But it was okay, if I’ve done everything that I normally do with my typical patient and it’s not working, then it goes into my differential. You have to do the gut work. You have to do all that other stuff to set the foundation. It’s not like you weren’t doing the right thing. You gain ground with every positive change that you make, but all of these things are data points.

Careful and Targeted Patient Care

DrMR:  Yeah, and that’s a good thing and encouraging for patients where sometimes patients get frustrated, or even clinicians, that they’re doing all this stuff but the patients aren’t feeling better. Sometimes you just have to kind of keep going, building that foundation and you’ll eventually clear the bar of symptoms, but understand that that gut work, like you said, is definitely not done in vain. It’s setting the stage for what will hopefully be the treatment of mold if that’s the issue down the line.

DrJC:   Absolutely. That’s one of the things that I put in my book because I tried to think of what was a visual to describe my therapeutic order? I found by making people a lot worse by not doing the homework, sometimes they came to me with mold, “Oh, we have mold in the house. We just found it. I want to get better.” Then if I started right with the final step, which for me is antifungals, I made people way worse. In one case, a patient with Lyme and mold, I put her on a strong antifungal and she had an event of seizures.

So I learned to back up, do the foundations, practice like a naturopathic doctor. By using that therapeutic order, the gut is key to that. That’s the whole second step.

The first step is avoidance. Of course, you have to get out. But by doing the second step, which is all the fundamentals, the gut is absolutely key in making sure that somebody can move on to the next steps of treatment.

Creating a Solid Foundation for Treatments

DrMR:  Yep. Love it. I tried to layout something similar in Healthy Gut, Healthy You, which was a map or a hierarchy or a pyramid model of, “Where do we start? Then where do we go next and what do we do after that?” It’s amazing how important that is and for how so many patients, when they come in, just haven’t followed the simple order of operations.  We’ll do nothing more than just go through exactly what’s written out in the book. Patients will think you’re a miracle worker, which is great, don’t get me wrong, but in a lot of times it’s just having the confidence to start here, then move on to that and then do this next. I think there’s this pull from, “I have this symptom, I read a blog about this symptom being caused by this exotic thing. So now I do exotic test A, Y, Z and exotic treatment X, Y, Z also.” People flounder. But anyway, I’m on my soapbox is a little bit now.

DrJC:   No, it’s perfect. That’s what I liked about your book is that it is so organized and stepwise, and obviously, as a clinician, you have way more tools than you could possibly put in a book. You put the things in there that people can take charge of on their own and then they go see you, or they go see a mold literate doctor if it’s mold, and they get the fine-tuning of, “why is this food necessarily better for me when my friend’s miracle thing was that she gave up this other food?” Those are the nuances of having a doctor on board. I think offering stepwise things like you have in your book and things so that people really have actionable steps is so important because they can do so much of the homework ahead of time and then come to see you and they get much faster results.

DrMR:  That’s true. It’s another good rationale for starting with a book protocol, whether it be your book for mold, my book for gut, is that you can go see the doctor. Now you may have taken your needed treatment time from six months down to three months. I’m just using an arbitrary example, but you’ve laid some of that groundwork.

DrJC:   Absolutely. Yeah.

Testing for Mold

Mycotoxicity Testing

DrMR:  One of the things that seems to be challenging is testing. From what I’ve gathered, and it seems that Neil Nathan is one of the pioneers of maybe an alternate camp to Shoemaker, and he advocates for two tests. One is the mycotoxicity or the MycoTOX Profile by Great Plains. The other is one that’s on the tip of my tongue. There’s kind of two urine tests, I believe they’re both urine, that are the two tests to use are for the simple assessment, but then there’s also testing of the home environment. How do you start organizing testing in your head, and what tests do you think are worthwhile?

DrJC:   That is such a good question. That’s a moving target. I try to get multiple data points that help shape my treatment and/or help convince the patient that’s what’s going on or their family. That’s kind of hard, because often with mold, only one person will be sick in the house, recognizably sick, and the other ones have anxiety and they don’t think that they’re sick. So sometimes we’re in the game of convincing family. I want to make sure that I’m getting data points that also are not just testing for the sake of testing and having a mind to the cost of these things. Then also taking a look at the patient, and if there are certain supplements they have been put on and they can’t get off of that shapes which kind of testing I do as well.

I’ve had mixed results on the urine mycotoxin testing on whether a person is on glutathione or not or on binders or not, that that can actually change the results of those tests. I look at those different variables and try to make sure I’m keeping a mind on their checkbook, because it’s so unfair to bankrupt a patient just to basically confirm your hunch. If they’re on board with that too, I don’t test. If we know it’s mold and they’re displaying symptoms, then, if they’re game for just wanting to feel better and they don’t have to see it on paper, I don’t test. So I’ll start with, Dr. Shoemaker does have a very easy cheap online test, the VCS test, the Visual Contrast Sensitivity test. I found this very useful for patients that say, “Oh I don’t think it is.

It’s sort of like our little easy screen to have them start accepting that it might be mold. Of all the environmental sick patients that I’ve worked with from mercury lead, hexavalent chromium, from heavy metals to environmental exposures at work.

Mold sick people are the most resistant to the fact that mold is the problem. I think there is some sort of neuroinflammatory change that mold has evolved to do — I call it its Jedi mind trick — to keep you in the environment. When I take the 10,000-foot view above Lyme and mold and all these stealth infections, most of these stealth infections need you alive to survive, but mold would just as soon compost you. So it goes on my higher level of concern, and also realizing some of the neuroinflammatory and immune changes that it’s making are to help itself persist.

A little anthropomorphizing, but it kind of helps you organize the treatment. I found in practice that if you aren’t addressing the mold, either first or alongside Lyme treatment, then the Lyme patient doesn’t respond, or they’ll become like the harder patient to help get better. I start with the VCS test, sometimes for convincing, sometimes for myself, just to see how deep into the system has this gone. The more the eyes are affected, the deeper the problem, typically, in my experience. I also use mycotoxin testing. It’s urine mycotoxin testing. My favorite is the technique of mass spec, and there are two labs that do that. Great Plains does that and Vibrant Wellness. Mass spec is a more direct measure. It is an excretion test as Dr. McCann said when she was on, but it also is a direct measure.

We’re not doing an ELISA, we’re not asking anybody’s immune system to flag or tag anything, no proteins. We’re just basically looking at, “Is this mycotoxin in urine or isn’t it?” The problem with mycotoxin testing is it doesn’t tell you if this is a current or past exposure, and so we should talk about colonization a little bit so people understand that.

DrMR:  Yes. I was hoping you were going to touch on that.

Testing Trends, Common Tests Used

DrJC:   I would love to talk about that because I think my perspective on it is quite different. I think that that’s helped me organize why I treat the way that I do with antifungals. Another data point that I like to look at is just a regular CBC. We can see changes on the white count. We can see a relative eosinophilia. Somebody that you have old blood work on and the new blood work and you’re starting to see some of these changes. White counts drop, you can see iron-deficient anemia. If it’s someone you’ve been following for a while and you see these little subtle changes, it helps you paint the picture. CBC is super cheap. It’s something in which we’re not asking a lot of the patients. It’s covered by insurance if they have insurance coverage.

I’ll also do a liver panel, including GGT. One of my patients had a high GGT. He came to see me because his medical doctor wouldn’t stop referring him to AA, and his religion was that he couldn’t drink. He actually never drank alcohol. He was in the military, but then, according to his religion, he was not supposed to be drinking. He would say to his doctor, “I’m not drinking.” And the doctor would say, “I know, I know. A lot of alcoholics say that.” Here, it was that he was being made toxic by his room air conditioning unit in his office window, and it was raising his GGT. He actually was developing NASH.

He had fatty liver and then it was developing into NASH and GGT was on the rise. AST and ALT were on the rise, and it had nothing to do with alcohol intake. It had to do with mycotoxin toxicity.

It’s a simple, easy thing to look at. There’s a reason why a CBC and a metabolic panel are common, because we can tell a lot of things from those if you’re looking at it through a finer tooth comb, so to speak. Then a natural killer cell function test. This is different than a natural killer cell total. A total is useful in that you want to know if someone is high or low, but it’s quite common for the total count to be normal, but the function to be lowered, and this is actually a direct effect that the mycotoxins have on the natural killer cells.

You can actually see a reduction of the natural killer cell function. We see that also with cancer, but we see that with mold. Those are some of the data points that I like to look at to tell the story. In addition, I usually will run a glutathione with the mycotoxin test so that I can see if the person has the ability to show me if they have mycotoxins.

DrMR:  And the glutathione, you’re running that through LabCorp or Quest or one of the big box?

DrJC:   RBC, glutathione through doctor’s data. Then I also might run an OAT, if I want to know more about how their gut is functioning, if they have a lot of neurological or gut issues, I might look at that through organic acid tests.

DrMR:  Gotcha. What should we tackle next? Because there are two things I want to go to, kind of this Gordian knot here that we have to unravel slowly.

DrJC:   Yes.

DrMR:  Is there a way of assessing for colonization or do you want to go to how to test the environment?

Insurance Interference

DrJC:   Okay. I should back up on urine mycotoxin. One of the things that insurance companies are saying about this test is, oh, they just ate mycotoxins. That’s not actually telling us what’s in their body. They just ate it. In order to take away that argument, I have a one-pager, no-no foods that the person is supposed to avoid for the three days before taking the sample so that we know that we’ve taken that possible weakness out of the tests. I’m happy to share that with any clinician or patient. If you’re doing it on your own, I’m happy to share that. They can just email me through the website. I wanted to back up on that just to make sure that I talked about that limitation.

Colonization

Let’s talk about colonization because I think it helps people understand. My understanding of it is that by being exposed to a water-damaged building, it triggers something in the natural flora of that person’s body on the skin surface, which is why you can see rashes of undetermined cause, in the sinuses, any mucous membrane and in the immune system, especially secretory IgA and those that are surveilling the mucous membranes. If we were to test everybody’s sinuses, healthy people, sick people. So we have healthy controls and people who are displaying chronic fatigue syndrome, all the things that go with that, depression and fatigue and pain, that kind of thing. We would find fungus in everybody’s sinuses. We would find fungus in everybody’s colon. We know that.

Mental Symptoms of Mycotoxicity

The difference is the people who are sick, those fungi are now secreting mycotoxins, whereas in a healthy control they’re not. If you do a nasal wash, you will find mycotoxins in the sick people and not in the others. The way that I walk away with that, my understanding in that is that we have taken a healthy microbiome or a sinubiome, or whatever you call it when it’s in the sinuses and a healthy microbiome in the gut. And now by being exposed to these toxins, which can be endotoxins as well, water damaged buildings have endotoxins as much as mycotoxins.

It triggers a protective response in the body. Now you can, with enough exposure and enough mycotoxins seeping into the immune system changing the genetics of your immune system, your body can now actually feel perpetually unsafe, and that microbiome turns into pathogenic biofilm.

DrMR:  Is this, that you have your commensal, somewhat normal fungus in your nasal and respiratory tract and once they are exposed to a building’s mycotoxins, they get this sense that, “There are other guys who are trying to attack us and push us out, so let us fire back with our mycotoxins.” Is this like an arms race between these two distal colonies trying to kill each other off?

DrJC:   Wow. That is a great description.

DrMR:  Yeah, that’s fascinating. Wow.

DrJC:   Yeah, that’s the way I understand it and the way that I’ve been treating this for a couple of decades. The way I understand it is that you’re basically, the biofilm of that water damage building is moving into your body, first and foremost, by the toxin, and then of course, those guys can follow. We’ve been able to see things like aspergillus and penicillium in people’s fungus. We do see it in healthy people too. That was the confusion. It’s like, “What’s this idea of colonization? That’s a bunch of bunk because everybody has the microbes.” It’s not whether they’re there, it’s, “how are they behaving when they’re there”

DrMR:  Is there no way to really assess this other than just a clinical read?

Urine Mycotoxin Tests to Determine Colonization

DrJC:   Yeah, that’s one of the ways that mycotoxins, the urine mycotoxin, revolutionized our ability to test that. Adding that lab made us able to see, “Is this potentially happening in this person’s sinuses, respiratory passages, lungs, gut, vaginal tissue everywhere that has a mucus lining?” That is certainly what could be happening.

The way I’m using the urine mycotoxin test is as a marker for colonization. On the organic acids test, there are a few markers that Great Plains is saying is a sort of an indicator of having colonization.

We don’t have a lot of science to be able to define what colonization is, because we don’t have enough studies where they’ve done washes of different mucous membranes, where we take a healthy control who has the exact same microbes and a sick person who has the exact same microbes and do those washes and see what kind of chemicals they’re emitting.

We only have one right now on study. There are some possible debates about the adequacy of that study, but I’ve been treating that way based on what Dr. Crinnion taught us in environmental medicine in school. Understanding that biofilm is more the rule than the exception, and you’re either dealing with one that works really well together, which what we would call a happy microbiome. Or you’re dealing with a pathogenic biofilm. In that case, that’s why I use antifungals because it seems to knock back the fungal burden and make the internal milieu feel safer.

Colonization Trends Between Various Mycotoxins

DrMR:  Gotcha. Now, is it fair for me to say that there are maybe two things going on here at once? Your resident fungus are releasing mycotoxins to fight off the external mycotoxins that are trying to colonize it. Am I misunderstanding this, or is that happening?

DrJC:   I think you got it. It’s just a matter of what stage. How far along the trail are you when you come to your doctor? We see some people that just by getting out of the water damage environment, they get better because there weren’t enough endogenous mycotoxins, and we know with gut dysbiosis, there’s endogenous endotoxin. It’s the same sort of concept. There haven’t been enough endogenous mycotoxins to knock down the immune system of that sinus area, and therefore, other microbes, fungi, bacteria could move in.

DrMR:  So like an unsuccessful colonization, but there still a response by your native fungus that’s releasing the mycotoxins in a protective fashion. Gotcha.

DrJC:   Right.

DrMR:  Okay. That’s a fascinating theory. I have not heard that at all before.

Pragmatic Treatment Philosophy

DrJC:   I know. It’s the Jill Crista way of treating things. But, it’s been working, so I may be wrong in my theory, but I know that the treatments are working.

DrMR:  The treatment works. Okay.

DrJC:   I’m fully accepting of the fact if someone wants to come and straighten me up on that, but I hope that that were to happen with enough studies so that we could actually say, “Yes, for sure this is happening — or not,” but we’re just not there.

DrMR:  And you have my full support in the statement, which I love by the way, which is, “My theory might be wrong, the mechanism might be wrong, but the treatment works, and that’s really what we’re after.” If the treatment works, I will let the people who care about mechanism figure out the mechanism after, and we all have our time and our place. We just want to make sure that the clinical end point is what we hit first. That’s the most important target. So if the theory is off, okay, we can swap in another theory at a later date.

DrJC:   Yeah. This theory explains why someone can have had their water damage exposure 20 years prior and they have not been well since.

Long Term Mycotoxity Damage Likely Caused by Colonization

DrMR:  Yeah. That’s one of the questions that I’ve been discussing with some of my colleagues who specialize in mold, which is, “What are your thoughts on it, is it really possible for someone to be exposed years and years and years ago, but still have a problem?” You’re thinking, I’m assuming, it is primarily colonization? Is there also a degree of people who can’t clear the toxins? Is it both? What do you think is going on there?

Understanding the Effects of Lipophilic Chemicals

DrJC:   Oh, it’s both for sure. It’s definitely both. Even if you are able to clear it, if they’re lipophilic, it’s really important, for the practitioners listening, you understand what this means. Lipophilic means that this is now in our storage. We have it in our adipose tissue, in our glands, in our gut, in our brain, in the myelin sheathing of our nervous system. These are lipophilic. Let’s think about what that is. Anywhere where cholesterol can go, anywhere where phosphatidylcholine can go, mycotoxins can go. That’s cell membrane, that’s mitochondria. When you start to really think about the impacts of that, is it that they can’t clear it? Maybe, probably. It also just may be that they got such a total load — such a dose — that the body had to find a way to store it, so we see weight gain quite commonly.

Mycotoxin-Related Gut Issues

We can also see weight loss because of the gut destruction. Someone all of a sudden gets maybe nausea, cyclical vomiting syndrome, eosinophilic esophagitis, diarrhea, irritable bowel syndrome. Those are sort of the gut manifestations that we see with mold. But understanding that they’re lipophilic, someone may not necessarily be colonized from 20 years prior, but they still could be toxic. That’s our job as clinicians is to try to figure out, “To what degree do I need to reset the flora of this body? To what degree do I have to detox this person?”

That’s where, when you’re talking about the fundamentals. It’s so important to have those on board because you’re going to be asking the organs of detoxification, the circulatory system, nervous system. You’re going to be asking a lot of those systems, immune system. If they don’t have some base, you’re going to be making the person feel cruddier before they get better, and they won’t like you very much if you do that.

 Treating with Antifungals

DrMR:  That makes complete sense. No one wants to be a martyr, do they? You mentioned treating with antifungals. Tell us more about that. Are you using pharmaceutical agents, herbal agents? What are some of your go-to treatments for this fungus that we’re really now trying to get rid of?

Differentiating Mycotoxicity from Candida Overgrowth, Reducing Complications in Treatment, Pharmaceutical and Homeopathic Treatments

DrJC:   I think of it as a fungal overburden in the body. That can look different than candida. The treatment can look different than candida. If you have a body that is in fungal overburden from mold, not just a candida overgrowth because of poor diet choices, if you add certain things like Saccharomyces boulardii, you may actually be making that fungal overburden worse and you may be triggering the flora to fight harder. I’ve seen it happen. In those cases, I’m very careful to, in my understanding that what we’re trying to do is just reset the balance. I think that that’s what gives me more flexibility, is I have a naturopathic doctor bent, and tools, so I don’t have to go in with a Fluconazole or a Triazole family or a Nystatin or those kinds of things to reset that balance.

I can use plants that have a strong effect, and we actually see pau d’arco. The mold killing ability is of that is right on par with Amphotericin B, but it’s also addressing the bacterial overgrowth and it’s also addressing some detoxing factors. It’s a bitter so it can get bile moving. It’s also doing all of these other things. While it’s a big gun, it doesn’t feel like a big gun to the patient. They don’t get really sick. Some of those drugs that we use for antifungals, they have side effects that we have to be careful of.

We can’t just throw everybody on an antifungal, but you can put someone on an herb long-term. If the person has been sick a while, it can take a long time to be on antifungals before that balance is reset.

I use antifungals pretty judiciously once I’ve laid the foundation. I think that’s the difference of why the people that are the bad detoxifiers are the people that got a lot of mold toxin storage and their immune system is now affected. They’re getting better using this protocol is because they needed that extra lift to get the balance.

DrMR:  Pau d’arco is one of your favorites. Do you have a specific protocol for this in your book?

Homeopathic Treatment Plans

DrJC:   I do. I put doses and everything in the book, because I think that people … Again, these are plants, they’re relatively safe. I did put cautions in the book. One of the many things that use the Cytochromes P450 system, or if they have … another one that I love is old man’s beard, or usnea. That’s a bigger gun, and it can have some liver stressing properties. That’s one that I say in the book, “Only pulse in, don’t use it long-term, daily, but you can use it to kind of pulse in.” I have found that that’s the most successful treatment is if you do one or two things continuously and rotate those things, so I might have someone drink pau d’arco tea a couple of times a day, and then in a different season or a season change, do holy basil tea, because that also has antifungal properties and adrenal properties.

If their mind is struggling and they have a lot of adrenal fatigue and insomnia, they can use the holy basil tea, so something like that that’s safe to use every day. Thyme is another in that family. Then I pulse in the bigger guns, so oil of oregano, old man’s beard.

There are quite a few others that you can use that have strong antifungal effects that you wouldn’t necessarily want to start with. If somebody is more fragile but are fantastic, once they get that fungal burden, they’re starting to get on top of it, and then you can just plunk in, pulse in those stronger antifungals and they really get ahead. I’ve heard from so many people around the world, actually I have a client in the UK right now that’s a doctor. I work with doctors on behalf of their patients.

I do mentorship and consultation. He had a patient who had been following the protocol that’s out there, the Shoemaker protocol, and he was getting micro-improvements, but then the minute he would get an exposure, he would crash again. That’s what I found. By adding the antifungals, you don’t necessarily get that hyperreactive patient anymore. They can go to a moldy restaurant and not be in bed for two months afterwards. I learned this from Brian Carr, he is a certified mold inspector and he described it so well that if mold is the fire and the mycotoxins are the smoke. Just fanning out the smoke, so doing binders only, is still not going to take care of the fire.

If you do understand this idea of colonization the way that I do, and again, I may be wrong, by adding the antifungals, we’re now putting out the fires in the body and it helps them get so much more resilience to future exposures.

Episode Wrap-Up

DrMR:  That’s great. Gosh, I have to apologize to the audience. I have a meeting that I am 15 minutes late for already, but I have just been not wanting to end this conversation because it is so, so good. But I’m also doing the calculus in the back of my mind in terms of how much trouble I’m going to get with or into with our team. Yeah, I’ve got to pin this here even though this is killing me.

How about we do a part two because I want to go into MCAS, your thoughts on that, how to go into what’s going on in the environment, and then how do we use, let’s say the urine tests to help guide our treatment? Are you using those to quantify the levels are decreasing? Are you just using those like I use a SIBO breath test where you do it to tell us if you’re in the ballpark and then you treat someone’s symptoms from there? Those are all things that are very important obviously for us to unpack. Gosh darn it, I do not have the time to do that right now, even though this is a great convo.

DrJC:   Well, it’s a big topic.

DrMR:  Well, tell people before we wrap up, about your website, about your book and then we will definitely have you on for a part two.

DrJC:   Great. Okay. So my website is drcrista.com and my book is called ‘Break The Mold’. On my website there is a mold quiz. You can go to either moldquiz.com or the quiz on my website. If somebody is listening and you’re curious, “Oh, I wonder if I might have mold.” The quiz kind of takes you through some of the questions that are related to mold toxicity that aren’t on everybody’s radar. Then if clinicians are listening and they want my clinical questionnaire, I’m working to get it scientifically validated, and they’re welcome to go to my website on courses, which is where I have information about my practitioner training course so you can become mold literate. I hope you’ll take the course because I would love to send you all the people that are contacting me from all over the country. I’d love to send you patients. So if you go through the course, we put you on my website as a referral base.

DrMR:  Awesome. Love it. Great conversation. Sorry I have to cut it short. It really does kill me.

DrJC:   No problem. We all get it. We all get it.

DrMR:  Clearly, I did not budget enough time for this one today, but we’ll do a part two. Again, love what you’re doing, love your theories and your level-headed clinical approach. Thank you so much, and for our audience, more to follow. Sorry to cliff hang you on this one, but I did a bad job with my schedule today.

DrJC:   Thanks so much for the opportunity to share

DrMR:  Thank you, Jill. It’s been an absolute pleasure.