Testing for mycotoxins
Mycotoxins are toxins secreted by molds. Urine testing for mycotoxins is a reliable method of diagnosing mold and mycotoxin exposure and possible illness.
We use several labs for urine mycotoxin testing. Great Plains Laboratory uses a technology called liquid chromatography / mass spectometry which is most accurate, reproducible and specific to what is being tested. Real Time Labs uses ELISA technology which measures toxins and their metabolites and is semi-quantitative. Vibrant Wellness is another lab we use. There are pros and cons to each test and if possible several should be performed.
With Real Time Labs it is recommended to take something to bind and pull mycotoxins from the tissues so that it will be excreted in the urine. Taking liposomal glutathione 500mg 1-2x/day for a week prior to testing helps increase the yield of the urine test. If the glutathione is too much and the first dose(s) cause a negative reaction right away, then proceed with the urine test right away. Also, it also helps by sweating via exercise, sauna or hot bath for about 10-20 minutes, roughly 30 minutes before the urine test. Stop all binders 3 days before urine testing. Great Plains Lab does not recommend provocation before testing.
Isn’t it normal to have mold exposure?
One criticism of urinary mycotoxin testing is that it is normal to be exposed to molds and mycotoxins, thus the mere presence of mycotoxins does not diagnose mold related illness. However, studies have shown while about 50% of healthy people tested have mycotoxins present, they are primarily ochratoxin and at very low levels. In contrast, patients with mold toxicity have much higher levels of ochratoxin as well as numerous other mycotoxins that are consistently associated with illness.
Not all molds are particularly toxic. These are the main toxic molds we deal with
- Stachybotrys chartarum (black mold)
- Aspergillus versicolor and A penicilloides
- Chaetomium globosum
- Wallemia sebi
Binders to remove mycotoxins
Binders are simple compounds that will connect with mycotoxins and help them stay in the gut for elimination instead of being reabsorbed and sent back to the liver.
Binders, with the exception of S boulardi and Colesevelam, should be taken on an empty stomach several hours before or after eating. Other supplements and medications should not be taken for about 90 minutes after taking binders.
Binders loosely hold mycotoxins and in some patients binders will cause a flare of symptoms by mobilizing mycotoxins faster than the patient can eliminate them. DOSING OF BINDERS IS CRITICAL. Start slowly with binders. If you have a negative reaction you are going to fast and it will backfire, so be patient. Increase the binders only as tolerated. Binders often cause constipation which is typically well managed with magnesium and/or vitamin C.
The binders with the most supportive data showing effectiveness for mycotoxins are
- Cholestyramine (CSM or brand Questran) 1/16 tsp every other day, increasing up to 1 scoop 4x/day
- Colesevelam (CSV or brand Welchol) 625mg 1/4 tab daily, increasing up to 2 tabs 3x/day – taken with food – has 1/4 the binding capacity as CSM
- Activated charcoal portion of 500mg capsule daily, increasing up to 1 cap 3x/day
- Bentonite clay 1/16 tsp liquid, increasing up to 1 cap 3x/day
- Chlorella 200mg, 1/8 tablet every other day, increasing up to 1 cap 3x/day
- Optifiber lean 1/4 scoop daily, increasing up to 1 scoop 3x/day
- Saccharomyces boulardi 1/4 capsule with food daily, increasing up 1 capsule 3x/day with meals
Mycotoxins bind best to certain binders
- Ochratoxins – cholestyramine, colesevelam, charcoal
- Trichothecenes / Aflotoxins – charcoal, bentonite clay, chlorella
- Gliotoxins – bentonite clay, saccharomyces boulardii, N-acetyl-cysteine
- Zearalanone / Enniatin B: bentonite clay, saccharomyces boulardii
Dietary and environmental considerations
Key is to avoid giving molds the sugars they need to survive. A low carbohydrate diet, even so far as going to a ketogenic diet, may be helpful. Avoid excess fruit and high starch foods such as potatoes, pasta, corn, root veggies, etc.
It does not appear necessary to avoid yeast/mold containing products such as cheese, mushrooms, dried fruit, processed meats, vinegar, coffee, beer, or wine.
Try to eat only organic foods and use non toxic or natural personal care products and household cleaners. Drink purified water. In general, reduce toxin loads.
Treatment for mold overgrowth
Inhaled or ingested mold spores tend to colonize in the body, particularly in the nasal/sinuses and in the gut. Treatment with antifungal medications to eradicate them is usually necessary.
Start with treating for mold in the sinuses. We generally use compounded Amphotericin B with a chelating agent (EDTA) to help dissolve biofilms. A gentler approach is using Agentyn 23 (silver), nystatin, ketoconazole 2%, or itraconazole 1% nasal sprays.
Finally, treat for mold overgrowth in the gut with oral antifungal supplements or medications. Taking something for biofilms is a good idea, e.g. Biocidin, MC BFM or Interfase Plus.
- Argentyn 23 1/2 – 1 tsp daily
- Nystatin tabs or liquid 500,000 units 1/4 to 1/2 tsp or tab daily, increasing to 1 tsp or tab 4x/day (if gliotoxin or candida present)
- Itraconazole (Sporanox) 100mg every week or two, increasing to daily or even 1-2 tabs 2x/day
- Fluconazole (Diflucan) 100mg every week or two, increasing to daily or even 2x/day
- N-acetyl-cysteine 500mg 1-2 caps 2x/day (especially with Gliotoxins from Aspergillus or Candida)
Very sensitive or toxic patients may need pretreatment prior to using the above measures. This may include repair and support of gut health and detox pathways. Various IV therapies may be helpful. They may also need repair of limbic system disturbances using programs such as the Dynamic Neural Retraining System by Annie Hopper. Her book “Wired for Healing” is a good intro to this topic.
About 25% of people have genetic mutations that predispose them to chronic illness even after treating for mold/mycotoxins. This is a condition known as Chronic Inflammatory Response Syndrome (CIRS).