Demystifying mold toxicity treatment with Dr. Ami Kapadia.
Hi everyone. In today’s episode we discussed mold with Dr. Ami Kapadia. What I enjoyed about her perspective is she is a testing minimalist and someone who simplifies treatment. I think we’ve done a pretty good job bringing you guests and experts in this area who are of that same mindset and we’ve had our pinnacle today with Dr. Ami. Really simple narrative on testing and a straightforward protocol for treatment. It was reassuring to me personally to see that what she’s doing as someone who’s fairly focused on mold and environmental illness is very similar to what I’ve been leaning toward in the clinic. This tells me that I’m on the right track in terms of determining what’s working, what’s not working, what to focus on, and what falls along the line of frivolous testing and or treatment recommendations regarding mold and environmental toxins.
One thing I do want to mention (that I thought was exceptional) is that she recommends working with an environmental professional to evaluate mold in the home. Certain tests like auger plates or ERMI testing results are up for interpretation and I think this is really important for both patients and providers to be aware of. There may be a lot of gray areas in your interpretation of these tests for mold and mycotoxins in the home and a doctor really may not be well suited to do this. You may really need an environmental professional. She goes over what credentials to look for. I thought this was a very waste-saving recommendation because looking at some of these, it’s very hard to adjudicate what’s normal, what’s abnormal. Her recommendation to find an environmental specialist who reads these tasks on a daily basis, focuses on these, and can really help parse out what we recommend on certain GI tests was fantastic.
There are a number of markers that may be meaningless or may be positive and for most people that’s just kind of noise. Same thing holds here, focus on what really may be the signal. So a great podcast from A to Z with Dr. Ami. We really help demystify mold, mycotoxins, how to treat it, and how this does not need to be some esoteric challenging issue to navigate. Rather, it seems to follow the same common sense approach that we apply in the GI. I very much appreciate the conversation and look forward to this conversation with Dr. Ami. If you’re looking for a simple but effective guide for improving your gut health that parallels this conversation, I would refer you to Healthy Gut, Healthy You. If you haven’t yet read Healthy Gut, Healthy You, it is very much in the same spirit of how do we get you well at minimal cost with minimal intervention and really help you focus on the things that are needed to improve your health. So if you haven’t read Healthy Gut, Healthy You yet, I highly recommend you do. And now we will get into the simplified version of how to overcome mold, illness and mold exposure.
Episode Intro … 00:00:39 Dr. Ami’s Background … 00:04:51 Mold and MCAS Association … 00:7:25 Patient Evaluation & Treatment Plan Flow Chart … 00:09:16 Visual Contrast Sensitivity Test … 00:11:43 Urine Mycotoxin Test … 00:14:01 Home Testing … 00:17:18 Why You Want an Indoor Environmental Professional … 00:19:07 Best Uses for Agar Plate Testing … 00:25:38 Assessment Questionnaire … 00:32:09 Mold Symptoms … 00:35:21 How to Best Use Binders … 00:40:15 Treating for Gut & Sinus Colonization … 00:44:04 Order of Operations … 00:50:11 Dynamic Neural Retraining System (DNRS) … 00:54:29 Oral vs. Nasal Antimicrobials … 00:57:44 Length of Time to Recovery … 1:01:15 Episode Wrap Up … 01:04:45
Mold and Mast Cell Activation Syndrome (MCAS) Association
Dr. Kapadia said a study “showed that small amounts of mold and mycotoxins can trigger histamine release. And so I do think it’s one of the underlying triggers when we’re trying to sort through when someone has a potential MCAS issue and histamine intolerance issues…” She said that exposure to mold toxins from water damaged buildings is one thing to consider in addition to gut infections as a potential trigger.
Mold and Environmental Illness Assessment
Dr. Kapadia uses a flow chart to help her think about how to evaluate her patients for environmental illness and mold allergy. The three main evaluations are:
A history and questionnaire
A Visual Contrast Sensitivity (VCS) and urine mycotoxin test.
She said a thorough assessment questionnaire is important because many patients don’t realize what mold in their homes looks like. The questionnaire asks a series of relevant questions to help patients think about possible mold exposures. Though certain mold blood testing can be valuable, it’s often quite expensive and not instructive.
Home Testing for Water Damage and Mold
ERMI Test: Uses quantitative PCR analysis. This should be interpreted by a professional.
Agar Plate Testing: Dr. Kapadia doesn’t find very useful.
Tap Testing: Checks furniture or cars.
Why You Want an Indoor Environmental Professional
Dr. Kapadia highly recommends having an Indoor Environmental Professional (IEP) on your team for home assessment and ERMI test interpretation. She says that it’s important to have a trained professional reading household environmental mold tests, because there is a lot of nuance to interpreting results.
Here are some ways to find a mold assessment professional in the United States:
For a quick, one-hour assessment of a work or car environment.
To check furniture upholstery for mold contamination.
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Common Mold Illness Symptoms
Mold and environmental illness often present with neurological and respiratory health problems, but Dr. Kapadia says she often sees “a poly-symptomatic patient with symptoms in multiple organ systems”.
There can also be extra pulmonary symptoms like:
Nervous system symptoms
Significant gastrointestinal symptoms
Respiratory symptoms, such as persistent sinus trouble, runny nose, allergies and asthma
A 2018 review compiled symptoms, including cognitive changes that mimicked mild traumatic brain injury.
A 2020 study found multiple chemical sensitivity, arrhythmia, and chronic pain in people who worked in a water-damaged building.
Mold Illness Treatment
Many practitioners use very complex treatment protocols for mold illness patients. But the cost and complexity of these treatments often exhaust patients’ finances, or are too confusing or complicated to complete.
Dr. Kapadia uses a simple, three-pronged treatment approach for her mold patients:
Remediate and get rid of mold in their environment or encourage them to move.
Use mycotoxin binders.
Treat the patient for mold colonization in their body.
How to Best Use Binders
The best approach with binders is to find what works best for the patient that they tolerate.
Some binder options include:
Making sure the patient is detoxing what the binder is collecting is important. Key supports include:
Glutathione, Vitamin C, Magnesium, B vitamins
Treating for Gut & Sinus Mold Colonization
Treat both the sinuses and the gut with antimicrobials. Oral options work well for the gut, while nasal sprays may help both.
Some options include Neem, SF722, Berberine, and Olive Leaf.
Nutribiotic Citricidal nasal wash
Lactobacillus sakei probiotic for the sinuses, applied with a q-tip
Mold Illness Treatment Order of Operations
Deal with the environment that is causing the problem first. This isn’t usually a quick fix, but a process that can take time.
Begin binder treatment at the same time.
If minimal or no response, treat for colonization.
For Hyper-Sensitive Patients
Refer for Dynamic Neural Retraining System (DNRS). Dr. Kapadia has seen results with her most reactive patients.
MAST cell stabilization treatment.
Length of Time to Mold Illness Recovery
Dr. Kapadia says it’s important to think of recovery from environmental illness as a process, not a quick fix. There can be ups and downs along the way. But if the patient is no longer exposed to mold, she expects to see quality of life improvements within 2-3 months.
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