Is Mold Exposure The Cause of Your Symptoms?

Are you one of the many people unknowingly living or working in water damaged building? Did you know it may be dramatically affecting your health? It's estimated that indoor air pollutants, including mold and mycotoxins may be contributing to more than 50% of our patient's illnesses. Typically we think of smog, smoke, and outdoor pollution as detrimental to our health but indoor air quality may be an even bigger risk to your health. Many patients are unaware that a toxic home or workplace is contributing to their symptoms.

Exposure to water-damaged indoor environments is associated with exposure to molds. The most common types of mold that are found indoors include Cladosporium, Penicillium, Alternaria, and Aspergillus. Stachybotrys chartarum (sometimes referred to as "toxic black mold") is a greenish-black mold, which grows on household surfaces that have high cellulose content, such as wood, fiberboard, gypsum board, paper, dust, and lint and is usually an indicator that there has been elevated moisture present or previous water damage.

Some molds secrete mycotoxins, that can be measured in the urine, such as ochratoxin, aflatoxin, and trichothecenes. Exposure to mold and mold components is well known to trigger inflammation, allergies and asthma, oxidative stress, and immune dysfunction in both human and animal studies. Mold spores, fungal fragments, and mycotoxins can be measured in the indoor environments of moldy buildings and in humans who are exposed to these environments. Most of the time, we are exposed to molds, like stachybotrys, through the skin contact, through ingestion, and by inhalation. Most common are reports of exposure involve water-damaged homes, schools, office buildings, court houses, hospitals, and hotels. It's estimated that as many as 25% of buildings in the US have had some sort of water damage. Molds have the ability to produce various symptoms, such as skin rashes, respiratory distress, various types of inflammation, cognitive issues, neurological symptoms, and immune suppression. The most common symptoms associated with mold exposure are allergic rhinitis and new onset asthma.

How do you know if you've been exposed to mold or mycotoxins?

Top Symptoms Associated with Mycotoxin-Associated Illness:

• Fatigue and weakness
• Headache, light sensitivity
• Poor memory, difficult word finding
• Difficulty concentration
• Morning stiffness, joint pain
• Unusual skin sensations, tingling and numbness
• Shortness of breath, sinus congestion or chronic cough
• Appetite swings, body temperature regulation,
• Increased urinary frequency or increased thirst
• Red eyes, blurred vision, sweats, mood swings, sharp pains
• Abdominal pain, diarrhea, bloating
• Tearing, disorientation, metallic taste in mouth
• Static shocks
• Vertigo, feeling lightheaded

Checklist that might indicate mold exposure or mold sensitivity (from ECH website)

• Do musty odors bother you?
• Have you worked or lived in a building where the air vents or ceiling tiles were discolored?
• Have you noticed water damage or discoloration elsewhere?
• Has your home been flooded?
• Have you had leaks in the roof?
• Do you experience unusual shortness of breath?
• Do you experience recurring sinus infections?
• Do you experience recurring respiratory infections and coughing?
• Do you have frequent flu-like symptoms?
• Do your symptoms worsen on rainy days?
• Do you have frequent headaches?
• Are you fatigued and have a skin rashes?

How do I Treat Mold/mycotoxin Exposure?

1. Remove yourself from the contaminated environment (don't even think about going on to other treatments until you get out of the contaminated environment)
2. Avoid exposure to porous items (paper, clothing, etc) from the moldy environment.
3. Use clay, charcoal, cholestyramine or other binders to bind internal mycotoxins
4. While you are using binders, you must maintain normal bowel function and avoid constipation. You can add magnesium citrate, buffered C powder, or even gentle laxatives if needed but constipation is the enemy of detoxification!
5. Treat colonizing molds/fungal infections in the body
6. Common locations of colonization include sinuses, gut, bladder, vagina, lungs
7. Test and treat for candida overgrowth - living in an environment with mold leads to immune dysregulation that allows candida to overgrow in the body
8. Enhance detoxification support
1. Some common supplements used to aid detox are liposomal glutathione, milk thistle, n-acetylcysteine, alpha lipoid acid, glycine, glutamine, and taurine. Methylation support is also key and involves optimal levels of methylcobalamin (B12), methyl-folate, B6, riboflavin, and minerals
9. Invest in a high quality air filter and home and at work, like Austin Air or EL Faust
10. Avoid common mycotoxin containing foods:
1. Corn, wheat, barley, rye, peanuts, sorghum, cottonseed, some cheeses, and alcoholic beverages such as wine and beer. Others include oats, rice, tree nuts pistachios, brazil nuts, chiles, oil seeds, spices, black pepper, dried fruits, figs, coffee, cocoa, beans, bread.

Other Treatment Options

• Follow Dr. Jill's Low Mold Diet - many patients to well on a paleo, grain-free diet since grains are often contaminated with mycotoxins and molds
• Sublingual immunotherapy (SLIT)
• Anti-fungal herbs and medications
• Infared sauna
• Detoxification support - oral and IV
• Remediation procedures for environment and belongings
• Create a "safe" place, with little potential for mold/allergens and great filtration system - this could be a bedroom or other room that is mold and chemical free
• Some patients benefit from IV immunoglobulin therapy (IVIg)

Chart from article in Townsend Letter July 2014 that explains sources and binders for common mycotoxins:

More Helpful Resources:

1. Guidance for Clinicians on the Recognition and Management of Health Effects Related to Mold Exposure and Moisture Indoors
2. A Review of the Mechanism of Injury and Treatment Approaches for Illness Resulting from Exposure to Water-Damaged Buildings, Mold, and Mycotoxins
3. Chronic Inflammatory Response Syndrome - Dr. Berndtson
4. Slide Presentation on Mold Toxicity
5. Paradigm Change - information on role of mold toxins in Chronic Neuroimmune Disease
6. Real Time Labs - Urinary Mycotoxin Testing
7. Fungal spore DNA detectible in tissue and body fluids of patients exposed to moldy buildings
8. Stachybotrys chartarum: Review of Toxicology Literature

5 Tips to Safely Celebrate When You Have Food Allergies

Gathering with family is an important part of the holidays for most of us. If you suffer from food allergies or eat a restricted diet due to a health conditions, it can be especially tricky to navigate. I'm putting together a short list of tips and tricks to get through it safely and make sure you still have a wonderful family get-together!

Here's my top tips for celebrating with family if you have some dietary restrictions.

1. Talk to the host prior to the event - Ask ahead of time what is on the menu and if the host would like you to bring something. If possible you might ask them to prepare the main course in a way that fits your dietary needs. You should also figure out if there will be enough dishes that you can eat to fill you or if you will need to bring your own food. By all means, do offer to bring a dish or two that you know you can eat and then share the love with everyone! I'm always tickled if family raves over my grain-free paleo-style dishes.
2. Know what it's swimming in - I've found that most of the common food allergens come in the sauces, dressings or marinades. These culprits frequently contain gluten, dairy, egg, soy, or sugar. You may ask the host to hold aside a portion of undressed salad or fix your piece of chicken or fish with no marinade or sauce. I usually ask for olive oil, salt and garlic ...It's delicious every time and I know I'm not getting any hidden gluten or dairy in the sauce.
3. Send a package ahead of you - if you're traveling to an area where there is no Whole Foods or natural grocery nearby to accessorize your diet, you can often ship ahead a small box of essentials. You can either pack them yourself or you can use a service, like Amazon or Vitacost and have them ship the necessary items. I frequently do this with non-perishables, like coconut milk, sunflower nut butter, chia seed, and high quality coconut or olive oils. Plus you can leave any of the gourmet leftover items with your host to enjoy! Better yet, order enough to get free shipping and include a hostess gift of some special gourmet food item that he/she cannot purchase locally. Organic dark chocolate or specialty cooking oils are a wonderful gift idea!
4. Don't go hungry - When we are hungry our brains may bypass the filter of what we know to be a better choice. We'll often we end up eating too much and pick foods that we'd normally avoid. This is why I vow never take my husband grocery shopping on an empty stomach... you just never know what will make it's way into your shopping cart! ;-) Eat a small protein snack prior to heading out, like nuts/seeds, guacamole or jerky. If you know there will not be any safe options, it's ok to eat your entire meal before you go and just enjoy the company and not the food.
5. BYOBF (Bring your own back-up food) - whether traveling by plane or car or just driving across town for a holiday get-together, you can never go wrong by having a few nonperishable snacks or options with you. You never know when you'll get stranded in the car or in the airport for longer than expected. I carry things like packets of sunflower nut butter, coconut butter and shredded coconut, a piece of fruit, dried organic beef or bison jerky, Alter Eco 85% dark chocolate bar, and/or packets or tins of wild salmon or sardines. I can't tell you how many times I've been stranded somewhere longer than anticipated and hungry and so thankful for my little stash! As the true saying goes, "Fail to plan and plan to fail..."

Wishing you a most delightful and delicious holiday season making many memories with your loved ones!

Could These Seven Foods Be Causing Your Weight Gain?!

Food Allergy "Fat"
"Fat" that comes with food sensitivities is a characterized by bloating and fluid retention that many people experience when they ingest these top seven food allergens.  Eating foods that interfere with our body’s chemistry causes tissue swelling, abdominal bloating or even facial puffiness that may have the appearance of real fat. In fact, it’s not unusual for a person to look ten to fifteen pounds heavier due to these nasty reactions.

The foods that people react to most commonly are also the most prevalent in the Standard American Diet (SAD, for short)  They are dairy, wheat, corn, sugar, soy, eggs and peanuts.  Many patients assume they aren’t “allergic” to these foods because they don’t experience the immediate histamine reaction we associate with an allergy, like hives, throat swelling or vomiting.  Another complicating factor is that these type of reactions often cause delayed symptoms, meaning that you may not feel badly for 12-36 hours. This makes such sensitivities extremely difficult to identify, particularly if your sensitivity is to a food that you eat on a daily basis. If you are constantly consuming wheat or dairy, for example, and having a low-grade reaction, you may not recognize this as your body’s distress signals. Instead you might assume they are totally unrelated chronic problems, like a eczema, migraines, fatigue, joint pain, or heartburn.

Virtually any food can cause these reactions — even “healthy” foods like citrus or bell peppers. Typically an individual will develop sensitivities to the foods he or she eats most often. Unfortunately the top seven - dairy, wheat, corn, sugar, soy, eggs, and peanuts - are the basis for most processed foods so most Americans are frequently exposed to them.   If we eat such foods on a daily basis, we may experience a near-constant state of reaction — including bloating and fluid retention. More serious, it may cause inflammation to the lining of the gut, upset your metabolism, create nutritional deficiencies, and blood sugar imbalances.  This can lead to food cravings, low energy, depression and even PMS!

When you eat reactive foods, they enter your bloodstream incompletely digested... as bigger particles that your body doesn’t recognize as food. This not only causes indigestion and gas within the gut, but may trigger release of cytokines and chemicals like adrenaline and histamine that set off an inflammatory response. As fluids rush into afflicted cells and are held in your tissues, swelling and abdominal bloating occur. Due to the fluctuation in endophrins that occurs in this "flight or flight response, you may find that you crave the foods your are most sensitive to.  The only real way to heal the gut is to eliminate these food triggers from your diet.

Elimination Diet to the Rescue!

One of the best ways to determine if you are having food reactions is an elimination diet.  Plan for a minimum of 3 weeks off all of the most common seven food allergens:  dairy, wheat, corn, sugar, soy, eggs and peanuts.  You will not be cured by that time, but you can determine which of these seven you are reacting to by adding them back into your diet one-by-one and seeing which one(s) you have a reaction to.

Another way to find the food culprits is to have your physician test you for IgG food sensitivities.  The elimination diet is the "gold standard" to determine what foods you are sensitive to but some patients prefer to have the data on paper before they start.  I use laboratories like, Genova Diagnostics, Metametrix, and US Biotek for this type of testing. 

Be aware that avoiding staple ingredients like wheat, dairy and corn syrup may require you to limit restaurant and packaged foods and to prepare most of your meals yourself.  I also recommend drinking plenty of water and getting regular exercise. Exercise will stimulate your metabolism and boost your energy level. It will also help flush excess fluids, burn calories and suppress your appetite, allowing you to experience even faster results.  Finding you have hidden food sensitivities may require you to adjust your eating, but when the inches start coming off and you feel better than you have in ages it will be worth all the effort!

The Gut Immune System Connection - An Animated Video

The gut mucosa connects with the largest population of immune cells in the body!  Is it any wonder that in functional medicine we assess your gut function as one of the initial steps in cases of allergies, asthma, autoimmune disease, eczema, crohn's disease, ulcerative colitis, IBS, celiac disease, arthritis and more?  

It’s often the first point of exposure to pathogens.   Many microbes use it as a entry point into the rest of the body. The gut immune system therefore needs to be ready to respond to pathogens but at the same time it is constantly exposed to harmless environmental antigens, food particles and commensal microflora which need to be tolerated. Misdirected immune responses to harmless antigens are the underlying cause of food allergies and debilitating conditions such as inflammatory bowel disease. This animation introduces the key cells and molecular players involved in gut immune connection and disease.



By checking your gut's microbial environment and taking a functional medicine approach to health and wellness, we can actually modulate some of the underlying immune dysregulation and eliminate your symptoms!

Nature Immunology homepage: http://www.nature.com/ni/index.html

Constipation Trouble? Here's 5 Tips to Get You Going...

Photo courtesy of www.freedigitalphotos.net

Here's 5 Simple Tips to Keep You Going...

Constipation is one of those topics few like to talk about. If you've suffered from this problem, though, you know it can be both painful and frustrating.

Almost everyone gets constipated at some time during his or her life. It affects approximately 2% of the population.  Women and the elderly are more commonly affected.

You are considered constipated if you have two or more of the following for at least 3 months:

• Straining during a bowel movement more than one-quarter of the time
• Hard stools more than one-quarter of the time
• Incomplete evacuation more than one-quarter of the time
• Averaging less than one normal formed, but soft stool daily

Common causes of constipation include:

• Inadequate water intake
• Inadequate fiber in the diet
• Disruption of regular diet or routine
• Traveling
• Inadequate exercise or immobility
• Eating large amounts of dairy products
• Stress
• Resisting the urge to have a bowel movement too frequently
• Overuse of laxatives (stool softeners) 
• Low thyroid hormone
• Neurological conditions, like Parkinson's disease or multiple sclerosis
• Too much calcium in supplements or antacids
• Certain medications, anti-depressants, pain killers, and iron supplements
• Depression
• Eating disorders
• Irritable bowel syndrome
• Pregnancy
• Colon Cancer

If you simply treat the causes and the symptoms go away!

Here are five simple natural suggestions to "keep you going":

1. Probiotics - When the wrong bacteria or yeast gain control of the bowels, they slow things down to ferment foods just how they like them. A good quality probiotic like, lactobaccilus or bifidobacter can help change that. You'll want to take a dairy-free brand with at least 25 billion cfu's per capsule daily
2. Dehydration - Without enough fluids to move things through the intestinal tract, the feces becomes hard and your digestion slows way down. Drinking a large glass of water upon waking improves bowel movements in most cases. Drinking a large glass of water few hours of the day can also alleviate IBS symptoms.
3. Fiber - For both constipation and IBS, dietary fiber is the first line of intervention for symptom relief. I usually recommend patients add 2 TBSP of ground flax seed or chia to their breakfast or smoothie.  Another way is to use psyllium caps or powder. 
4. Vitamin C - One symptom of vitamin C deficiency is constipation. Taking vitamin C in amounts just below bowel tolerance (gas, bloating or diarrhea) can definitely improve bowel movements and regularity. Start slow with 3000 mg spread throughout the day and every 2-3 days add another 1,000 mg to the regimen. When you reach bowel tolerance and stools loosen up, back off a little and maintain the dose that works for you
5. Magnesium - if patients I see are complaining of difficulty with constipation, the first thing I usually recommend is adding magnesium citrate at bedtime.  Many patients sleep better, have less muscle pain and bowel function dramatically improves with a little magnesium.  Doses typically range from 300-600mg but may go upwards of 1000mg daily.  

Still no relief?!  If the five suggestions above don't relieve your constipation, then you might have food sensitivities...  A common symptom of food sensitivity is constipation. Studies show that milk can cause constipation and a more recent study also implicates gluten. Constipation is more likely to occur in children fed gluten at at less than six months of age with a 35% increased risk of constipation.  You might try doing a three week elimination diet avoiding the common culprits:  gluten, dairy, sugar, and soy. 

If you have slow moving bowels, bowel pain or both, find the cause and fix it! Treating the symptoms only hides the causes, allowing your problems to grow into bigger problems.

Is Leaky Gut Causing Your Eczema or Psoriasis?

How Leaky Gut is linked to Skin Conditions, like Eczema & Psoriasis...

First a little background ... When the body doesn’t tolerate a food or has created antibodies to that food, ingesting it creates a chronic, low-level irritation or inflammation in the gut. Over time, with regular exposure, the irritation worsens and creates spaces between the cells. (Picture the walls of the gut, once tightly knitted together, looking more like swiss cheese!)   This is what is commonly known as, Leaky Gut.  These holes allow bacteria and their toxins, as well as incompletely digested proteins and fats, to “leak” out of the gut and into the bloodstream. Leaky gut syndrome (or increased intestinal permeability), sets the stage for myriad health problems, including rashes and skin problems, like eczema and psoriasis.  The skin is the body’s largest elimination organ so it’s not surprising that it comes under assault when toxins careen through the bloodstream.   A skin rash or eczema is a sign that the body is trying to slough out these toxins.  Some people will also experience increase in acne or be told they have "rosacea".   The body is trying to eliminate the problem the best way it knows how, and unfortunately you may see the nasty effects of leaky gut manifest in skin problems.  In addition, you might also experience gas, bloating, fatigue, sinus congestion, or foggy thinking.  Many other autoimmune conditions are also linked to the underlying problem of leaky gut.

An Elimination Diet Can Heal Your Skin Conditions

An elimination diet is the best way to pinpoint the offending food.   Here's some practical tips and recipes on how to get started.

Don’t know where to start? Foods that are most likely to wreak havoc on the gut include wheat and gluten, dairy products, sugar, soy, eggs, corn and yeast. If you’re highly motivated go off “the big five” for at least 3 weeks: wheat, dairy, sugar, caffeine and alcohol.

Although this isn't easy, you're guaranteed to notice the foods you are reacting to and 90% of patients feel dramatically better after a 3 week elimination plan. You might also consider keeping a food journal. Spend a week or two writing down what you eat and how your body feels in the minutes, hours and days afterward (e.g., an hour after you eat dairy, you feel bloated). It’s about pattern and symptom recognition and connecting the dots which in turn helps you decide which foods to eliminate first.

If you are a "show-me the data" type of person, there are labs that will test the blood for levels of IgG4 against certain foods and may be a predictor of what foods you are the most sensitive to.  In addition, if you have many reactions to a variety of foods, this is almost diagnostic for leaky gut syndrome and you should consult with a functional medicine doctor to start the healing process.

Leaky Gut - The Syndrome Linked to Many Autoimmune Diseases...

"Leaky Gut" Syndrome

Hyperpermeability or "leaky gut" syndrome is the name given to a very common disorder in which the cells lining the intestines become "leaky" due to inflammation. The abnormally large spaces present between the cells of the gut wall allow the entry of toxic material into the bloodstream that would normally be eliminated.

The gut becomes leaky in the sense that bacteria, fungi, parasites, undigested protein, fat and toxic waste normally not absorbed into the bloodstream in the healthy state, pass through a damaged, hyperpermeable gut membrane. This can be verified by special gut permeability urine tests or microscopic examination of the lining of the intestinal wall.

Common Causes of Leaky Gut

• Infections - fungal overgrowth, parasitic infections
• Drugs like
• NSAIDS, chemotherapeutic agents
• Crohn's disease or Ulcerative Colitis
• Celiac disease
• Chronic alcoholism
• Strenuous exercise
• Food allergies

Leaky Gut and the Connection to Autoimmune Disease

Leaky gut syndrome is almost always associated with autoimmune disease. In fact, reversing symptoms of autoimmune disease depends on healing the lining of the gastrointestinal tract. Any other treatment is just symptom suppression. An autoimmune disease is defined as one in which the immune system makes antibodies against its own tissues. Diseases in this category include lupus, alopecia areata, rheumatoid arthritis, polymyalgia rheumatica, multiple sclerosis, fibromyalgia, chronic fatigue syndrome, Sjogren’s syndrome (dry eyes & dry mouth), vitiligo, thyroiditis, vasculitis, Crohn’s disease, ulcerative colitis, urticaria (hives), type 1 diabetes and Raynaud’s syndrome. Fortunately doctors are beginning to realize the essential role that the gut plays in these disease. Understanding the leaky gut phenomenon helps us see why allergies and autoimmune diseases develop and how to design therapies to restore intestinal integrity and reverse leaky gut.

Inflammation is a key trigger for leaky gut

Inflammation causes the spaces between the cells of the gut wall to become larger than usua. Then protein molecules are absorbed before they have a chance to be completely broken down. The immune system starts making antibodies against these larger molecules because it recognizes them as foreign, invading substances. Antibodies are made against these proteins derived from previously harmless foods. The immune system becomes hyperstimulated and over-reactive to substances that are not necessarily supposed to be dangerous.

Human tissues have proteins & antigens very similar to those on foods, bacteria, parasites, candida or fungi. The antibodies created by the leaky gut phenomenon against these antigens can get into various tissues and trigger an inflammatory reaction in that tissue when the corresponding food is consumed or the microbe is encountered. Autoantibodies are thus created and inflammation becomes chronic. If this inflammation occurs in a joint, autoimmune arthritis (rheumatoid arthritis) develops. If it occurs in the brain, myalgic encephalomyelitis (chronic fatigue syndrome) may be the result. If it occurs in the blood vessels, vasculitis (inflammation of the blood vessels) is the resulting autoimmune problem... and so on.

If the antibodies end up attacking the lining of the gut itself, the result may be colitis or Crohn’s disease. If it occurs in the lungs, asthma is triggered on a delayed basis every time the individual consumes the food which triggered the production of the antibodies in the first place. It is easy to see that practically any organ or body tissue can become affected by food allergies created by the leaky gut. Because the foods can trigger delayed reactions, it can often be very hard to pinpoint the triggering entity.

 
Leaky gut may cause increase risk of infection and sensitivity to environmental chemicals

This ongoing inflammation also damages the protective coating of antibodies normally present in a healthy gut called IgA. Since IgA helps us ward off infections we become less resistant to viruses, bacteria, parasites and candida. These microbes are then able to invade the bloodstream and colonize almost any body tissue or organ. In the clinic we often find patients with leaky gut or autoimmune disease also have microbial infections ongoing in the gut.

Not only can leaky gut create food allergies as the proteins we consume are activating antibodies, but the microbes in the gut can cross over into the blood stream creating a toxic burden that overwhelms the liver's ability to detoxify. Often in severe cases of leaky gut, patients will develop sensitivities to perfume, cigarette smoke or other environmental chemicals. Common complaints are also "brain fog", confusion, poor focus/concentration, or memory loss.

Leaky gut also causes malabsorption and nutritional deficiencies

Finally, leaky gut may contribute to a long list of mineral deficiencies because of the ongoing inflammation and damage to carrier proteins. The most common are iron deficiency, vitamin B12 deficiency, magnesium deficiency which can lead to fatigue, neuropathies or muscle pain. Zinc deficiency due to malabsorption can result in hair loss or baldness as occurs in alopecia areata. Copper deficiency can occur in an identical way leading to high blood cholesterol levels and osteoarthritis. Further, bone problems develop as a result of the malabsorption of calcium, boron, silicon and manganese.

Part II - Diagnosis and Treatment of Leaky Gut...

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