Under what conditions do you consider testing for mold toxicity? What test methods do you use to determine whether mold toxicity in the home or workplace is contributing to a patient’s pathology?

This is probably a more nuanced question, and we don’t really, during this course, get into mold testing. I think it’s probably a bigger topic. I would say I’m going to think about testing for mold toxicity generally after I’ve already treated the gut, optimized nutrients levels, thought about adrenals, [and] worked on adrenals. I’m probably going to test for heavy metals before I test for mold because, to me, heavy metal toxicity is a little bit more palpable. It’s a little bit, I want to say, easier to treat probably, and some of the heavy metal toxicity can actually influence some of the markers that I might use for mold toxicity. I want to get heavy metals out before I start moving toward mold toxicity. Not only that, but as you remove one toxin from the body, you’re going to improve your detoxification capacity for other toxins, as well, so clearing out heavy metals will help you clear out mycotoxins to some extent. Mold toxicity testing [should be done] later on down the path, if you have unresolved symptoms and certainly if you have neurological symptoms or brain fog, anxiety, depressed mood, things that are relatively new to the patient, especially if they have known mold exposure.

Testing methods, I would say right now, I think I’m testing a little bit differently from what Chris is doing right now. I still use the combination of LabCorp and Quest markers, and that’s going to be C4A, which is complement protein C4A. I’m going to use melanocyte-stimulating hormone, VEGF (vascular endothelial growth factor), TGF beta-1 (transforming growth factor beta-1), probably antidiuretic hormone and osmolality combination, anti-cardiolipin antibodies, and these have to be ordered through really specific labs, which [is], again, a little bit more detail than we’re going to go into today, but certainly, this information is available if you want to dig into it, so I am still using those markers.

I’m also using the Great Plains urine mycotoxin profile. I don’t think any of the tests are perfect, which is why I’m using a combination of all these panels, but mold toxicity, we’re also calling it environmentally acquired illness, and I think there’s some value to looking at the Great Plains mycotoxin profile to give you some ideas [about] which mycotoxins you might be exposed to and what’s the level that you’re seeing excreted in the urine. Again, not a perfect test, but helpful.

And then, you asked whether mold toxicity in the home or workplace, so I’m not sure if you’re thinking about the source of exposure, and one of the things you’re going to do in environmentally acquired illness is, of course, think about what are the sources of exposure, so you probably want to do ERMI testing. ERMI is the Environmental Relative Moldiness Index. You can do ERMI, or HERTSMI-2 is another way to calculate that and figure out what is the level of potential mold exposure that the person’s getting in their environment, home or workplace.

Again, this gets pretty nuanced, especially when you start thinking about remediation and that sort of thing, and if they rent versus own, this can be a really stressful diagnosis, I think, for people because it’s like, if there’s mold exposure in your home, and you’re renting and your landlord’s not going to do the remediation. These are things that [we] also think about and sometimes discuss with the patients even before we pursue some of the testing, and there’s a lot of different schools of thought in terms of mold exposure. Do you need to be a strict mold avoider? Can your body handle some? And again, there’s a camp that says, “No. Strict mold avoidance. You cannot be exposed to it.” I’m more in the camp of “No, we just need to get the body to have the resilience, to be able to withstand some mold exposure.” Certainly, you don’t want a heavy mycotoxin exposure at home, in your bedroom, in your office, nothing like that, but I’m not a strict mold avoider. But again, there’s a lot of different opinions about this, and I think it’s good to familiarize yourself with the spectrum of thinking out there. And then, also depending on where you live, maybe learn some from your local resources for IEPs, or indoor environmental professionals, so that you can actually get boots on the ground in terms of exploring the patient’s home environment if there is significant concern for ongoing mold exposure. And one of the things you might do there is ask the patient, “Do you feel better or worse when you’re at home and when you’re away from home?” And sometimes, the patients can take a “mold sabbatical” and go somewhere like a really dry climate where you feel, like, a pretty low probability of mold there, and if they go there for two weeks [and] feel significantly better, that’s another indication that there’s something in the home environment. But remember, [the] home environment is not limited to mold. There can be off-gassing of volatile organic compounds, so know that there are different things in the home that could be contributing, but these are just some ideas in terms of where to get you started. But definitely, Environmental Medicine is a huge topic in and of itself, and there’s a lot of great resources out there, as well.