Hidden Effects of Mold Toxicity (And How to Deal With Them)

Episode Intro:

Welcome to Dr. Ruscio Radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now, let’s head to the show.

DrMichaelRuscio:

Hey everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Ruscio. Let’s chat about mold, and more specifically my personal mold experience, thoughts, questions, and observations. The backstory here (in case you hadn’t heard some of my discussions on the podcast in the past year or so) is when I moved to Austin, I highly suspected mold in the residence that I initially was in and ended up leaving there after a few months and going to a second residence. The reason why I see, I think, was my knowledge of assessment was still evolving. The assessments that were done I don’t have full confidence in, whereas the second spot in Austin did have fairly confident confirmation of mold. There’s definitely some nuance here that should be discussed, and I wanted to use my personal experience to help showcase some of that.

DrMR:

So the context and the timeline again because all this stuff matters quite a bit in how you interpret any given lab finding. And this is fully congruent with our philosophy of lab testing or other types of assessment… a home mold assessment… our 1/4th of the data needed to make a decision. So, I move to the first residence and notice that I’m sleeping terribly and notice a small amount of brain fog and/or difficulty focusing when the A/C is on. When it’s not on, there’s no problem at all. The second location I moved to, everything’s fine because it is November when I moved there of last year. Now, this place has mold. I don’t know at the time that this place has mold. I move into the new residence and because I’m able to open the windows and not be dependent upon the A/C, everything’s great. Back to normal, sleeping well, very good focus, exercising, all those things are where they should be.

DrMR:

Months and months go by. Everything’s fine. Summer’s coming around the corner so to be prudent, I say I should probably have this place assessed for mold. Part of what prompted that was as it was getting a little bit hotter, there were a few times where the A/C kicked on and I noticed I felt foggy. Now, I should clarify the directionality of that observation. I would be working. I would notice all of a sudden that I’d feel a little bit irritable and foggy, which is very rare for me. And it took me a little while to figure out this was because the A/C was turning on. So, it wasn’t an expected finding. It was a change in how I felt, which I (after a few days) was able to correlate to the A/C going on.

ERMI Testing

DrMR:

I would just turn the A/C off essentially, instead of leaving it with a certain parameter. The A/C turns on once it gets above 72, I’d just shut it off completely. And I noticed a complete resolution. So, that prompted the mold assessment at location two in Austin. And this is when I had a much better working knowledge and was also doing this (as we recommend) with the counsel of an EPI. And there was visual evidence of mold in multiple locations. And the specialist’s remark that you’ll see this sort of mold growth in about half of the homes in a climate, such as Austin. I also did an ERMI test and the ERMI test came back with some mild to moderate findings. So, there’s mold found and the summer is coming around the corner. I had learned from my last summer in Austin, which was just hellacious and terrible, that I did not want to roll the dice on dealing with this while having to live in the location that was being dealt.

DrMR:

So, I hightailed to California and spent the summer there. The remediation of the mold estimated cost clocked in at between $5,000 to $7,000, which I don’t think is terrible as far as mold remediation goes. Depending if you have infiltration into the duct work, it can be tens of thousands of dollars from what I’ve been told. However, I’m renting where I currently am. I’m new to Austin and I’m glad I decided to play it safe and not jump right into a buy, but because I am renting, it didn’t seem worthwhile to spend that much money. I had a discussion with the landlord and he felt that a few hundred dollars toward cleanup was reasonable. So, obviously there’s a big discrepancy between the cost and what he thought was reasonable. Now, sometimes people will say, “oh my gosh… the landlord… there’s mold… he’s obligated…” which is part of the emotional reactivity I went through. However, this is where the nuance comes in.

Contestable Mold & Relocation Concerns

DrMR:

It’s a little bit hard to say that there’s an infiltration of pathogenic mold throughout the entire condo. There is some pathogenic mold in one baseboard and there is some visual mold in some of the HVAC unit. The ERMI came back mildly elevated and ERMI tests are somewhat contestable. One of the challenges here is – if you have the extreme of black mold, highly pathogenic mold, that’s fairly infiltrated, then there’s more of an obligation. There’s some finding here, but it’s probably contestable in terms of, does this have to be dealt with? This is where it’s not necessarily a cut/dry assessment and or interpretation of an assessment, so you then end up in a situation of – How hard do I want to press on the landlord? Is it worth it?

DrMR:

Do I really like where I’m living? Is it worth potentially having them say, “Well, we’ll just terminate your lease then” and having to go through all the challenges of being upended in terms of having to relocate. For me, that was not a viable hypothesis because I do not want to have my work interfered with. My work output, as you can probably tell, is incredibly important to me – especially right now, as the clinic is growing and we’re pioneering various research initiatives. I need to have good output. I need to have good focus. I don’t want to have stuff get in my way. So, it just didn’t feel like a viable solution to either press a landlord and risk him saying, “okay, we will agree to disagree and we’ll just terminate your lease and you can do what you want” because that then requires me to have to look at a bunch of new places to live, set up the showings, and then go through all the labors of moving and resettling.

DrMR:

And remember, the context here matters. I love where I live other than when the A/C goes on, and you only have to use the A/C or the heating (really the A/C) and only in the summer. So, I decided while in California for the summer in navigating through some of these decisions, not to do anything and just stay in California for the summer and then return to Austin as soon as the hot summer broke in Austin. I did that as of October 1st.

Sponsored Resources:

Hey everyone. I’d like to thank Athletic Greens for making this podcast possible. If you’re like me, you may sometimes struggle with getting enough nutrient dense foods. One thing I’ve really appreciated about Athletic Greens – or AG1 – is not only are they the best tasting one I’ve had to date, they also help ensure I’m getting adequate nutrition and really hitting the mark regarding nutrient density. I’ve been using them pretty much every morning as part of my morning shake. Now, one scoop of AG1 contains seventy-five vitamins, minerals and whole food sourced ingredients, including a multi-vitamin, multi-mineral, a probiotic and a green superfood blend – all in one serving. The other thing I really like about the company is Athletic Greens continues to improve this one holistic formula based upon the latest research, and they’ve produced 53 improvements in their formula over the past decade. This is pretty remarkable – a hat tip to them for that commitment. I highly recommend Athletic Greens as part of your daily routine. And right now, if you visit athleticgreens.com/ruscio, you can get a free one year supply of vitamin D and five free athletic greens (or AG1) travel packs. Again, visit athleticgreens.com/ruscio to really cover your bases for well-rounded immune support vis-à-vis AG1, and that one year supply of vitamin D.

The “Psychology” of Mold

DrMR:

One of the things I wanted to point to upon making that move was the psychology of “there’s mold in this place I’m coming back to.” Is that going to be a problem? Now, what I think bode in my favor was the fact that I had lived in this spot in Austin for a number of months before the summer and felt great. So, that was a really helpful anchor to have, but it was really interesting to just audit my thoughts and my emotions as I moved back. Anytime there was a day that I didn’t sleep good or didn’t feel great, that fearful part of your psychology pops up – could it be mold? Maybe I’m colonized with mold? Maybe I’m hyper-sensitized? It was a valuable exercise for me to go through that — to just get a reminder of what patients are dealing with.

DrMR:

And it made me even more confident in the way that we discuss and frame issues at the clinic, which is not to be overzealous. If I had been working with someone who was a mold zealot, that would’ve poured fuel on that worry fire unquestionably. So I say to myself, “okay, you still have your spot in California you can go back to.” I decided to keep my lease there going for a few months just to make sure I had an out, should I need to exercise it. And it took about three weeks for me to finally realize – you feel fine here, there’s no issue, there’s no problem. So, even though there is mold here, that only seems to be an issue when the HVAC is on. And thankfully I was able to get through that period of doubt, worry, fear, and realize we all have some ups and downs, no matter how healthy you are.

DrMR:

And I shouldn’t be freaking out when there’s a down because that’s normal. And I shouldn’t let the fact that there’s been something found in the home freak me out. This maps onto many different things in healthcare. Let’s say someone had dysbiosis found on their stool test… or a better example would be SIBO. The worst thing that one could do is start worrying about that, and every time they have bloating or they have constipation or they have a food reaction of whatever sort it is, they start thinking, “oh, it’s SIBO.” It’s an incredibly unhealthy psychology and I’ve felt that flicker. And I’m so glad that I know what I know and I’ve learned what I’ve learned through working in the clinic and also participating in trying to be as healthy as I can be for years and years and years now. That parallel of not assigning the fact that you may be having a symptom total causality to a given lab finding is crucially important because that just tends to make you worried, and it actually isn’t productive.

Urine Mold Testing

DrMR:

Other thoughts, other context here that’s important. I did have, as I’ve mentioned before, multiple urine mold tests that were positive. Joe and I (at the clinic) are really going back and forth on this, trying to figure out the best way to use these tests and one of the studies that we want to do at some point. Keep your eyes out because we’ll probably do an announcement. I think the way we would do this would be – we’ll put out an announcement and we’ll do maybe 10 people who have no known or no suspected history of mold exposure, and don’t really have any symptoms will do a test. And then 10 people who have confirmed or suspected mold exposure, plus some symptoms, will also do a test. And we’ll look at the ability of these urine tests to discriminate healthy controls versus those with known or suspected exposure. I’m not sure if 10 and 10 will be enough so we’ll have to put our heads together with our biostatistician and see what that would be, and then come up with a budget to fund that. It wouldn’t really be a huge budget. But anyway, that’s something that we have on the list that we want to do in the near future. There are a few other priorities – papers that we’re working on that are taking precedent over that – I’m actually quite excited to have those published. More to follow on that, hopefully within three to six months.

Glutathione

DrMR:

My initial mold test was back in California a year and a half ago where I am almost positive there was 0, 0, 0 mold exposure, especially where I was living. It’s a dry, arid climate. I lived in a place where I always had the windows open. The probability of mold there was as close to zero as I think one could get. However, my urinary mycotoxins were positive. Now, there is one wrinkle here that I should loop into this, which is I was using glutathione. And the perspective on this – or the thinking in much of the mold community as I’ve been able to gather – is you should not take glutathione because that can liberate mold. However, my thinking was, I like glutathione, it’s an antioxidant, I may have seen some benefit from it. So, I wasn’t concerned about liberating mold because where would I be liberating it from? I had positive tests before being exposed and also while being exposed and also after months and months and months and months on binders.

DrMR:

And I did one more re-test recently off glutathione and I had zero mold. Joe and I went back and forth on this. Part of his thinking was, “Well, if you’re seeing mold when you’re taking glutathione on a urine test, that’s because you’re liberating these stores and there could be colonization.” However, that doesn’t really satisfy why pre-exposure (unless I was supremely healthy and colonized by mold about a year and a half ago) that when I was on glutathione, I would’ve had this store of mold that was being liberated by the glutathione. So, I don’t think that thesis satisfies and it does give me some pause with the urinary mold tests, although I am still open. Maybe there’s another mechanism through which the glutathione causes a false positive, but if you don’t use glutathione perhaps the urinary mold tests can still discriminate healthy controls from exposed individuals. I want to be careful in saying just because I’m questioning some of these things, I don’t think that question is strong enough to discredit the potential viability of the urinary mold tests.

DrMR:

So, now I am back in Austin – been back in Austin for a few months. The environmental issue, thankfully, is not a problem if I’m not using the HVAC. I had positive mold tests while on glutathione, did not have positive mold tests while off glutathione. The other thing I wanted to loop in here was — if you have mold in a home, it doesn’t necessarily mean that the mold is a problem. Look at my case and let’s pretend that I was someone who had symptoms. If I had symptoms and mold was found in this home and I had a positive urine test… let’s pretend that I wasn’t on glutathione. So, let’s paint this scenario. I’m having symptoms. I have a negative urine test for mold toxins. (Remember, when I did a test without being on glutathione, I did have a negative test.).

The Necessity of Discerning Analysis of Mold

DrMR:

So, I’m having symptoms. I’m in a home that has documented mold. I have a negative test. What do you do? This is a question, and this is again why I say (and we at the clinic embody) the philosophy of the lab testing is 1/4th of the data. What do you do in this situation? Well, I hope this is being done in the mold community more at large – I don’t know enough mold specialists to be able to comment – but I hope this really discerning analysis is occurring in the field. In my case, the symptoms are only a problem when using the HVAC. So, let’s continue building this hypothetical example.

DrMR:

So, current analogy – this person in a home with mold… having symptoms… negative urine test… it’s very possible that all the symptoms someone could attribute to mold are coming from what’s going on in their gut. So, that’s why it’s so important to start with the gut and then re-evaluate. And that would allow one to then see – okay, you’re in that home with mold… Do we have you spend $5,000 to $7,000 to remediate or do we have you move? This is a lot of money. It’s a lot of time. It’s a lot of fuss. Well, this is exactly what we do in the clinic – Let’s start with the diet, lifestyle, and gut foundations approach and then see how your symptoms evolve over time.

DrMR:

So when I had gut problems, I had many symptoms that one could attribute to mold – brain fog, insomnia, fatigue, and some joint pain. After addressing gut health, all of those symptoms for me went away. And the only thing I was left with was when the A/C comes on, I feel a little bit fatigued and brain foggy. What that allows you to do is better read someone’s situation and do what I’m doing right now, which is – okay, it seems that this is only a problem when the HVAC goes on so I don’t think that you’re colonized by mold… I don’t think mold is a big issue… I don’t think it’s causing this chronic inflammatory response syndrome. I’m not going to put all of that in your head, so to speak, and allow that worry train to just run unfettered. Now that we’ve cleared some of the symptomatic noise – meaning we’ve addressed your gut and your ongoing fatigue and brain fog and insomnia and joint pain are gone and you’re feeling pretty good overall – but you still have some reactive brain fog and fatigue when the HVAC goes on.

DrMR:

Now we have a really clear signal. We know what the problem is. We know how common that problem pops up. We have mitigation measures of ventilation, maybe an air filter, and now we can decide how we want to proceed and move forward. And essentially that’s what I’m doing. And my plan will probably be to move before the summer hits. That, in my mind, is the most reasonable calculation that I can make. I can’t bring myself to drop the money to fix a place that I don’t own. And while I do love where I am, I just don’t know if I’ll be able to swallow that pill, but I also don’t want to move right now. And this is where as a clinician you have to factor in the person, right? So, if I’m being my own doctor in this case – As a patient, I say I don’t want to move right now. I’ve got too much going on. The clinician could say one of two things – “Well, you’ve got to move! You’ve got mold! It can cause this chronic inflammatory response!” That’s the wrong way to handle this. Or “Okay. I get it. It seems like it’s only a problem when you have the A/C on. Thankfully, you’re in the winter so you’ve got maybe five months, six months until you have to worry about this. I think a reasonable plan would be for you to go through the process of looking for other places to live starting in maybe a few months. Give yourself plenty of runway, give yourself maybe a three month lead up, and then plan to move before the summer hits. I understand you’re busy with work or you just had a child.” Or whatever it is.

DrMR:

I hope this is landing in terms of how if we use just a lab testing – and God forbid, we use lab testing combined with an overzealous interpretation of lab results – someone like me could have been really spun out with fear and led to go through all of this rigmarole in their life and spend money that wasn’t necessary to be spent. Or the person could have a practical, pragmatic plan that wasn’t based in fear, but was based in data and then could make a really logical decision that was better for them from a financial, psychological, and clinical/healthcare perspective.

Dr Ruscio Resources:

Hi everyone. If you are in need of help, we have a number of resources for you. Healthy Gut, Healthy You – my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer, there is the clinic – The Ruscio Institute for Functional Medicine – and our growing clinical and supporting research team will be happy to help you. We do offer monthly support calls for our patients where I answer questions and help them along their path. Health coaching support calls every other week. We also offer health coaching independent of the clinic for those perhaps reading the book and/or looking for guidance with diet, supplementation, et cetera. There’s also the store that has our elemental diet line, our probiotics, and other gut health and health supportive supplements. And for clinicians, there is our FFMR – the Future of Functional Medicine Review database – which contains case studies from our clinic, research reviews, and practice guidelines. Visit drruscio.com/resources to learn more.

The Four Component Model

DrMR:

That’s some of what’s been going on in my life regarding mold. One or two other thoughts here, just to reiterate these in case they were a bit convoluted with all the context. I do think it’s important to try to establish that the environment seems to provocate someone’s symptoms. So in my case, pretty easy to see – even within a couple hour window. Hour one – I’m working, everything’s going fine. Hour two – I have brain fog and a little bit of fatigue because the A/C came on. That’s a really clear ability to attribute cause and effect. I don’t think we can say that for everyone it’s going to be that fast in terms of how the symptoms manifest, but you want to do the best job you can do to try to tie the environment to elicitation of the symptoms. And so that’s why at the clinic we ask things like – Did any of these symptoms start when you moved into a place? Or do you notice that they’re better or worse when you’re at a certain location? Or when you’re on vacation/out of your environment (traveling perhaps), do you notice your symptoms are any better or worse?

DrMR:

So, you look at that in juxtaposition to their lab work. That’s history + their lab work + their symptoms + how their symptoms respond to treatment. Those four pieces that we use – their history, their symptoms, their treatment response, and their labs – You look at all four of those and that helps you determine what to do. If their treatment response is “all of my symptoms are gone” then that tells us the environment probably isn’t an issue. Or maybe with the loose example analogy avatar I was creating, all of my symptoms are gone, except one or two of them come back when the A/C goes on. That really helps us hone in and quantify cause and effect. The couple principles here I’m trying to articulate are how crucially important it is to use that four component model – someone’s history, someone’s symptoms, someone’s response to treatment, and someone’s labs. All four of those have to be really woven together and analyzed collectively to help you make a decision.

Episode Wrap-Up

DrMR:

Someone could have a positive urinary mycotoxin test, but if all of their symptoms went away after gut care, then that nullifies the finding, right? Especially because many of these labs, we haven’t fully vetted (meaning the scientific community.) So, they’re helpful, but they really have to be interpreted with a grain of salt or against the context of the individual. So, just want to echo the importance of that framework of analysis helps you use the testing constructively and not interpret some causality from a test marker that’s not really there. And then it prevents you from over treatment, worry, fear, what have you. That’s a little bit of a stream of consciousness regarding mold, how it’s impacted my life, how our clinical model really seems to satisfy how to navigate this, (including how I’m navigating these things personally.)

DrMR:

I hope this helps you if you are struggling with symptoms and you’re thinking that mold might be the culprit, especially because mold seems to be something that’s progressively becoming more en vogue. I hope this helps you have a framework for – How can I maybe take the results of a urine test… or an inspector who came and looked at my residence – How can you use that information in this decision framework with those four components to make the best decisions possible? And if you’re in need of help, of course you can always reach out to the clinic, but if you don’t need to go to that level of calling on the clinic for help, I’m hoping that framework will allow you to make better decisions. Because really, if we make the right decisions, we get healthier. And if we make the wrong decisions, unfortunately, we don’t get healthier. Sometimes you become more concerned because we’re worrying about a fictitious diagnosis and we end up wasting financial resources. So, those are some thoughts on mold. I hope that is helpful, and I will talk to you guys next time. Bye-bye.

Outro:

Thank you for listening to Dr. Ruscio radio today. Check us out on iTunes and leave a review. Visit DrRuscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates.

 

• Athletic Greens
• Dr. Ruscio Resources