Is a Hidden Infection Causing Your Fatigue?

Are you suffering from unrelenting fatigue that doesn't seem to respond to any intervention?  Perhaps you've asked your doctor to check your thyroid function and it came back normal.  Perhaps you've been testing for iron-deficiency anemia this, too, was normal.  Or perhaps you've been told by an integrative medical doctor that your adrenal function is suboptimal.  Maybe what you haven't thought of is the fact that you could be harboring hidden pathogens in your body that are robbing your energy and stealing your steam!

If basic testing fails to reveal a cause of your fatigue, you may want to have your doctor test for occult infection. More sophisticated investigations can reveal the presence of all kinds of pathogens capable of colonizing the body and evading the immune system.  Some of them include: Parvoviruses, HHV6, Epstein-Barr, Cytomegalovirus, Mycoplasma, and Borrelia burgdorferi. Other patients have a history of chronic fungal infections or biotoxin exposure.  A history of chronic mold exposure is a feasible explanation for such symptoms, as is the presence of B. burgdorferi.

Chronic fatigue syndrome is a complicated disorder characterized by extreme fatigue that can't be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn't improve with rest.

Chronic fatigue syndrome has eight official signs and symptoms, plus the central symptom that gives the condition its name:

• Fatigue
• Loss of memory or concentration
• Sore throat
• Enlarged lymph nodes in your neck or armpits
• Unexplained muscle pain
• Pain that moves from one joint to another without swelling or redness
• Headache of a new type, pattern or severity
• Unrefreshing sleep
• Extreme exhaustion lasting more than 24 hours after physical or mental exercise

If you see a good medical detective, a physician trained in functional medicine, they can work with you to test for any of these underlying causes of the fatigue,

A study of 375 patients with apparently no cause for their disabling fatigue revealed pathological stimulation of white blood cells with abnormally elevated patterns of natural helper and natural killer cells, important infection fighting agents in the immune system in 53% of patients.  It showed depleted levels of IgG subclass three in 59% of the study population.  More than 50% had circulating immune complexes and many tested positive for ANA antibodies, usually seen in autoimmune diseases like lupus.

Why is it that some patients who get an infection recover and have no fatigue and others may be colonized with pathogens and suffer from intractable lack of energy?

It appears that part of the answer lies in the genetic polymorphisms or variances in our bodies response to infection and inflammation.  For those who develop severe fatigue in response to toxic exposure, like mold or infection, their immune systems respond more robustly to the threat with massive production of cytokines, like IL-ß1 or TNF-alpha.

Moreover, polymorphisms in TNF-alpha,IL-1β, interferons (IFNs), IL-6, and IL-10, acting together or separately can make the severity and response of immune system more profound in response to infection.  Why does this happen?  Well these pathogens can trigger TLR's (toll-like receptors) by either PAMPs (pathogen-associated molecular patterns) or DAMPs (damage associated molecular patterns).  Activation of the TLRs causes a massive cytokine surge that becomes like a domino-effect and keeps on going unrelenting in susceptible individuals, contributing to the inflammation, depression and fatigue.  This vicious cycle of pro-inflammatory cytokines that continue to trigger more inflammation and amplify the cycle, leading to more damage and inflammation.

The initial infection followed by chronic inflammation of the immune system could explain the cause of fatigue in these genetically susceptible individuals.  Some patients also suffer from cognitive dysfunction, memory loss, or brain fog as well.

What are some common hidden infections that may be causing your fatigue?

• Epstein Barr Virus (EBV)
• Cytomegalovirus (CMV)
• Human Herpes Virus (HHV-6)
• Parvovirus (Parvo B19)
• Mycoplasma sp.
• Borrelia Burgdorferi
• Chronic mold and mycotoxin exposure

Chronic fatigue syndrome is just a label.  It's useful to identify a group of symptoms that causes significant fatigue and may affect one's life dramatically causing inability to function or hold a job. It does not represent one clincial entity but the cause may be multi-factorial and different in each individual.  It may share a final common pathway of dysfunctional immune activation and inflammation that keeps on going in a self perpetuating manner (like the Energizer Bunny gone bad!)  From a functional medicine perspective it's important to get to the root cause of the chronic fatigue symptoms and cognitive impairment.   Most of these infections, including the inflammatory response (CIRS) to mold and mycotoxins can be measured by ordering conventional lab testing through a knowledgable practitioner.  Ask your doctor to see if he can help you determine the root cause of your fatigue.  Treating the root cause (or infection in this case) just might give you back your life!

References:

1. The Putative Role of Viruses, Bacteria, and Chronic Fungal Biotoxin Exposure in the Genesis of Intractable Fatigue Accompanied by Cognitive and Physical Disability
2. A narrative review on the similarities and dissimilarities between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and sickness behavior

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