Science is all about observation and forming hypotheses to answer questions. For scientists like myself, I’m interested in how the environment affects health, and specifically, how water-damaged buildings and exposure to poor indoor air quality can affect quality of life. For this week on The Mould Show, we're going to be talking about fungal mycotoxins and myalgic encephalomyelitis termed ME for short and chronic fatigue syndrome (ME/CFS).
The reason I've chosen this topic is that I've met a family whom I've now done three separate mould inspections for. Why this is unusual is that the symptoms experienced by the female occupant and her daughter are classic ME/CFS symptoms. Across all 3 of the different properties hidden mould problems were discovered. That information in itself was useful for this family and helped them to break their lease due to the fact that there was verified mould present. However, that's not the point of this podcast and even the positive mould confirmation as an environmental trigger didn’t help the mother and daughter from understanding why they reacted so strongly when indoors. They thought they were going crazy, since how could 3 different properties cause them so much trouble? They couldn’t understand why some buildings caused no issues, and the 3 they’d chosen to rent all set them off?
This has bothered me all year. I know mould is a huge issue for some people – but what exactly might be going on for THIS family?
A very interesting article on Substack focuses on his experience with chronic pain and ME/CFS and how after 25 years of suffering, he discovered by chance, following a recommendation from a friend to read a book that talked about the connection between ME and chronic fatigue syndrome and mitochondrial dysfunction. So that is the true focus of the topic today.
• Could exposure to fungal mycotoxins be the reason why they were tired and experiencing pain?
• Could this be the reason you’re tired? Is this another aspect to environmental illness?
• And could this be classified as Myalgic Encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS)?
• Are there any patient-specific tests to verify ME/CFS or mould exposure and what can be done to alleviate the symptoms?
Firstly, let's define what ME/CFS is. There are three core symptoms + at least one or more other symptoms which include:
1. an inability to participate in routine activities that would have been possible before becoming ill and that lasts for greater than six months.
2. the fatigue which is also a primary symptom tends to worsen after physical, mental or emotional effort.
3. and does not resolve after sleep, termed ‘unrefreshing sleep’.
Other problems include:
a) an inability to concentrate or memory impairment and/or
b) something called orthostatic intolerance. This means that when people stand up, they feel lightheaded or dizzy and can even faint.
The family that moved into those three different properties all complained that after a few days of occupying the mould-contaminated building the wife especially experienced episodes of unexpected fainting and collapsing into her husband's arms.
Those 3 inspections coupled with reading the Substack article led me to investigate further whether there was any published literature, focusing on exposure to fungal cells or their mycotoxins in the ME/CFS literature.
Very recently a publication appeared in the International Journal of Environmental Research and Public Health that has looked at exactly this topic. These scientists looked at the levels of Aspergillus toxins like aflatoxin, ochratoxin, and gliotoxin in the urine of 236 ME/CFS patients who had a known exposure to mould from water-damaged buildings.
The evidence from two types of urine mycotoxin testing from Real-Time
Hello, and welcome to The Mould Show. My name's Dr. Cameron Jones. I'm an environmental microbiologist. And this week I have a fascinating topic, again, on the implications of living in a water damage building. And we're going to be going over some of the extreme symptoms, which are not that extreme.
Have you ever felt tired or lethargic after spending time indoors? What happens if that experience of tiredness and fatigue never lets up? Well for a range of people who are exposed to water damage building, that's exactly the types of symptoms that they tend to experience. And this is called ME or chronic fatigue syndrome and it has a specific name, and that's what we're going to be focusing on today. This concept of myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). What is the connection with fungal mycotoxins? And I know there has been a lot of research literature appearing that is focusing on the connection between experience of water damage building interiors and adverse health. Is it the spore? Is it the odour? Is it the mycotoxin?
The publication that we are going to be going over in depth today appeared just a few months ago, and it is almost proving the connection between exposure to water damage buildings and the ability to measure various different mycotoxin in the urine of these ME and chronic fatigue syndrome patients. So we're going to be diving into this.
But I want to explain to you how I actually decided to give this topic today and give it some air time. Really, like many of you, I've been enjoying Substack authors and Substack is a subscription service where a lot of diverse academics and thinkers and individuals post their experiences and what they want to talk about. And one of them most recently talked about chronic pain and this myalgia encephalomyelitis chronic fatigue syndrome. And he did a beautiful job, I urge you to download this and read this to yourself, talking about his problems with ME and the fact that this chronic pain condition and tiredness he had for 25 years. And he talks about the difficulty of getting his condition and syndrome taken seriously, and about the fact that he had to go and see many different types of healthcare providers spanning the gamut from infectious disease specialists right through to allied health professionals of all different types.
So we are focusing today really on the fact that this Substack article really pricked my interest about chronic fatigue syndrome. And then more interestingly, I had a client in the last couple of months that has gotten me out to inspect their rental property, not one, not two, but three different times. And you might think that's just bad luck but when I explained to you the types of symptoms that the woman, basically it was a family of husband and wife and their daughter, and the wife and the daughter were experiencing very specific symptoms. And these symptoms fall under the definition of ME and chronic fatigue syndrome. And certainly for the first inspection they got me in February 2022, the home looked pretty good, but it was very easy to quantify that there were in fact quite serious mould problems and subfloor drainage and water damage issues affecting the subfloor, which were essentially making this rental property a very serious health concern for the occupants.
So, I wrote up the report, gave it to them. They were able to successfully break their lease and they moved to another property. But during the discussion about her symptoms, especially affecting the wife, her husband was really brought to tears because he described the fact that when his wife spent any time indoors, she would appear to faint, lose her ability to remain upright. That, even notwithstanding the ability to smell any mould she seemed to be, after spending any time indoors, having all of these really serious problems. And she would complain about brain fog and inability to think. She resorted to sleeping in her car because every time she walked indoor, she had these horrible symptoms, and her husband couldn't work out what was wrong.
Fast forward a few months and in May 2022, the family rang me again. And the husband said, my wife is feeling dizzy, losing her balance, and fainting indoors. Can you come and assess the property? So of course, I did. And the outcome of that inspection was, yes, there was a severe rising damp problem, which again was affecting all the carpeting throughout the property and there was clear evidence of mould under the carpets. So, I presented that report to them. They also were able to use that to break their lease. Unfortunately, I then heard from the same family again, a short time afterwards in June 2022. This property also appeared okay, on first walkthrough, but soon there was mould discovered in the duct work. In fact, there were three different air handling systems, only one of which was operational and all the duct work at the subfloor level and also in the roof wood was not suspended, it didn't meet the code and there are all sorts of problems with this. As well as filthy insulation, many, many down lights. And again, it was quite easy to verify that this building also was severely mould compromised.
But why I'm telling you this is because in each inspection, the husband was explaining to me how his wife lost her balance, he couldn't understand it. She was okay when she was walking about when they were at their business, she was able to function perfectly normally, but soon time after going indoors to any of these three properties, she lost her balance, became extremely tired, and this was not rectified by even adequate sleep or a good meal. And really, she was terrified of going home. And so that is the topic of today because there is a wonderful publication, which has just come out in the research literature, which we are going to spend a lot of time talking about today.
So, what are the typical symptoms of myalgic encephalomyelitis, this ME/chronic fatigue syndrome. Now, the first symptom is not being able to participate in routine activities that before the exposure or before becoming ill the person was able to do. Now, these symptoms need to go on for at least six months and they're usually accompanied by fatigue and sometimes even pain, hence why the term myalgic. Now the second type of symptom is post exertional malaise. And you would be immediately thinking to yourself, that's like vigorous exercise, but even just walking around and even emotional or mental effort leads to this post exertional malaise type effect. The big issue here is these individuals that suffer from these three core symptoms, they don't have relief after what is called sleep. So the term is unrefreshing sleep in that it does not assist the individual suffering from ME/chronic fatigue syndrome to actually feel normal again and be able to participate in daily activity.
But there's two other symptoms that need to be met and added to the core three. And those are impaired memory or ability to concentrate. And if you look on this list, there's something called orthostatic intolerance. Now, what is orthostatic intolerance? Well, this means that people have an inability to remain upright and they feel faint or dizzy. Now, why this is so important is that this is exactly the symptoms that this man's wife complained about, and I met the wife several times, but she was absolutely terrified and was on her way back out to the car to remain in the car because it was after hours whenever I did these inspections. Because of course in a post COVID environment these individuals who were self-employed, they needed to spend as much time as possible on their business, which was already suffering. So each of these inspections was done after hours and she was rightly, frankly, terrified of losing her balance and fainting and potentially causing herself an injury. And so she couldn't work out what was causing this and this particular publication, very clearly articulates and defines why mould exposure can lead directly to ME and chronic fatigue syndrome. And we are going to dive into this now.
So, what is this publication all about? Well, it came out in the International Journal of Environmental Research and Public Health. And I've put the abstract up here because I just want to drive home the point that chronic fatigue syndrome ME occurs mainly in women of age 30 to 50 years of age. Now, the diagnostic criteria for ME/CFS is profound fatigue, post exertional malaise unrelieved by bedrest and persistent cognitive impairment or the inability to stand upright. Now we covered that in the previous slide, but the interesting point of this research publication is that this is what they term a prevalent study. So they get a cohort of individuals who have the diagnostic validation that they are suffering from ME/chronic fatigue syndrome. And they want to see whether or not there was a biomarker in this individual or this group of individuals, which could be connected to exposure to water damage buildings.
Now, each one of these individuals, the 236 patients had their urine analyzed, and each of them also had a exposure history to water damaged buildings. And the specific fungi that the scientists were looking at produce three types of mycotoxins and they are aflatoxin, gliotoxin, and ochratoxin. And for any of you who follow this channel and podcast and the live streams, or any of you who are suffering from exposure to water damage buildings, you probably already know about these mycotoxins. But I could tell you now that ochratoxin is the dominant mycotoxin that tends to cause problems for people. And we are going to drill directly into this research now. So, I'm going to go through the publication at this point in time.
So, aflatoxin is a common mycotoxin produced by Aspergillus flavus as well as a range of different Aspergilli fungi. And it is very common for crop contamination and in fact is a leading cause of crop loss throughout the world. But ochratoxin is another common mycotoxin. And this is commonly secreted by Aspergillus and penicillin. And again, it causes severe crop loss to grains and cereals. And again, it is well known to have an impact on organelles within our cells called mitochondria. And we're going to be talking about mitochondrial dysfunction because that original Substack article was talking about how that author experienced some relief when he started to look at ways of improving his mitochondrial cellular function, we're going to dive into what mitochondria do throughout this talk.
Gliotoxin is also the third important mycotoxin, and this is commonly secreted by Aspergillus Fumigatus and again, this has a significant impact on people's immune competency. And many people who are exposed to gliotoxin experience a range of complication ranging from mucosal disturbances to their eyes right through to respiratory illnesses and skin hypersensitivity changes to taste and smell is common as well.
Now, what did these scientists actually discover? And the most interesting thing, and I'm going to do a deep dive into this publication because it's really, really important. There has certainly been some emerging literature where people are discounting the impact of mould on health. And really this publication puts to rest that quite crazy concept that mould does not cause adverse health symptoms. If we look at the first table of research results for this group of people with chronic fatigue and myalgic encephalomyelitis, we immediately see in the top line, the three mycotoxin ochratoxin, aflatoxin and gliotoxin. And just looking at the differences that we can see here, you can see that there is a slight gender difference between the different groups. But the main thing is that ochratoxin is particularly dominant for both males and females. And if you look at the last column on this table, exposed to at least one of the three mycotoxin that they measured, you can see that anywhere from nearly 90% to nearly 94.4%, these people diagnosed with ME/chronic fatigue syndrome, all showed very high levels of at least one mycotoxin. This is really, important to recognize, because this is what we are looking at now.
Now, if we go into the next table here, these scientists have broken down the urinalysis results. And again, many of you who are already on a mould awareness journey would be aware of RealTime Laboratories in the United States and the Great Plains Laboratory, both of whom offer different types of urinalysis for the detection of mycotoxins. And these scientists in their publications sent the urine off to be assayed from one of the two labs, depending on what their medical cover or insurance coverage was like. And what they detected was that among the ME/chronic fatigue syndrome patients with chronic exposure to mould the percentage of patients that tested positive for mycotoxins, at least one mycotoxin, was 54.24%. Those exposed to at least two mycotoxin 18.22%. Those exposed or showing exposure to three mycotoxin was 19.92%. And out of this 236 patients, only 7.63% showed no mycotoxin activity.
If we then drill into a different way of reporting these results, we can see what of the three mycotoxin dominate. And it's quite clear for the mould types, the mould that produces ochratoxin, 80% of the damage is caused by that, or at least the concentration of ochratoxin in the urine is very high at 80%, followed by 40% for gliotoxin here, and then 30% for aflatoxin. This is really quite staggering research results, isn't it?
Now, let's now look at this issue of gender imbalance because the epidemiology and experience of adverse health symptoms is thought to impact on women more significantly than men, but let's have a look at what these specific graphs show. We can see in the top left-hand column that it looks like from the graph that females and males are equally impacted with ochratoxin in their urine. But if we look as well, there is a change in the right-hand column here for those individuals who are older, and you can see that there is a reduction in the prevalence of all three mycotoxin in older individuals, but those who are under the age of 65, again, show this dominant peak for ochratoxin. And this is really the take home key message that yes, there are three common mycotoxin that can be measured, and they do have slight differences between males and females, but they do show a clustering in the under 65 age group. Certainly, there's some interesting research evidence that can explain the over 65 reduction in mycotoxin levels in the urine, we'll get onto that in a little bit later. And again, the next graph, which is in histogram format is essentially showing the concentration in parts per billion of ochratoxin and that follows a normal decline curve that is quite consistent with toxicity curves that you would expect to see for a cellular response.
Now, the rest of the paper goes into obviously a discussion and conclusions. I urge you to download this publication again from either my website or from the links in this podcast or live stream or from YouTube. Something that I really want to go back to is talk about the discussion again. I've sort of extracted four bulleted points. Essentially, we need to understand that ME and chronic fatigue syndrome is obviously a burden to the patient. It impairs their physical functioning. It has an impact on their mental clarity and capacity. As well as interfering with daily family life. But it is a significant burden on the healthcare system. And certainly, in US dollar terms, it's been estimated that $17 to $24 billion is lost per a due to this ME/chronic fatigue syndrome. And imagine if this is connected with mould exposure. Because the ME/chronic fatigue syndrome literature is replete with induced reasons for people suffering this ranging from vaccine injury, exposure to bacteria, exposure to different viruses and exposure to toxic chemicals. But this publication is essentially validating that mould exposure can also lead to ME/chronic fatigue syndrome, and this really cannot be underestimated.
So, the second point I'd like to make is that mycotoxins are known to damage the immune system directly by disrupting CD4 and CD8 T-cell count ratios. And obviously if you have a reduction in your natural killer T-cells, you are going to be more immunocompromised, so this is something that we can't avoid recognizing that mould is more than just the exposure to the irritant mould spore or cell wall fragments, but it's the mycotoxin that impact so significantly on immune action. And thirdly, mycotoxicosis as a term, call it mycotoxicosis, call it chronic inflammatory response syndrome, just call it exposure to water damage building. This mycotoxicosis is defined as the accumulation of fungal toxins in the body and is associated with carcinogenic, teratogenic, neurotoxin, and immunotoxic effects.
Now, the fourth point I want to make is that once these toxins entered the body, they can, in fact, be easily measured using a urine test. And this is something that people who are grappling with the adverse impact effects to their health from mould exposure should definitely consider following up with their healthcare provider and downloading this article and really doing some of your own research to empowering yourself. So you can start measuring and quantifying these mycotoxin in your own body to determine whether or not there could be a connection with your exposure history and the accumulation of mycotoxin in the body.
And so the final point, which I've essentially just stated, is that this study demonstrates a high overall prevalence of mycotoxin in the urine of myalgic encephalomyelitis/chronic fatigue syndrome patients who have an exposure history to mycotoxins, this cannot be underestimated. And I think that this is really a very, very important publication.
So, what are you going to do if you think you might be also suffering from ME/chronic fatigue syndrome? Well, here in Australia there is an organization that is mecfs.org.au, and they run a very active Facebook page. You can, of course, go to the US Center for Disease Control and download quite a bit of information about this condition.
Now, it would be remiss of me if I didn't now look forward beyond this publication. And think back to that original Substack article, which was that first person discussion about living with ME/chronic fatigue syndrome. How are you going to fix it? Is there a way to treat mitochondrial dysfunction? Because this publication is essentially this prevalence study showing that for a group of individuals who have known exposure history to water damage, that they have very easily verified levels of mycotoxins and particularly ochratoxin in their urine. Well, that's all well and good, but what does the literature say about treating ME/CFS patients? And we are in luck because it turns out that this appears to be a mitochondrial dysfunction illness and therefore methods of helping your mitochondria maintain themselves optimally respire, optimally convert the energy they take from food and sequester as ATP inside their organelles, the organelles that are the mitochondria and are spread throughout our bodies, this may help attenuate or reduce the impact of these mycotoxins on the body. So the rest of this lecture is going to focus on three of the papers that are easily retrievable, that focus on how to treat mitochondria.
So, I'm going to jump into that now. Now the first publication is talking about something called functional phenolics, and again, functional phenolics when you plot out their chemical formula, they look quite complicated, but at the end of the day this publication. I've put the DOI here on the slide, but you can also retrieve this publication, it's free on PubMed. In this publication, there is a whole range of different nutraceuticals and supplements, essentially, that you could consider adding to your diet along with the publications that show whether or not there was a benefit to the cohort understudy when supplementation was introduced.
I wanted to list this as the first publication, because it is the most dense of the three, but also list some really interesting compounds. And what are these phenolic compounds? Well, many of you have instantly probably thought of tea and you'd be correct, that is a phenolic type compound. But there are a range of others as well, and inside this publication you'll be able to find a whole lot of options that you might want to consider along with why they influence mitochondria and why that would be beneficial not just for increasing the ability of these organelles to do what they're intended to do, but also for their ability to potentially extend lifespan or cellular lifespan. So, this dives in and keys into the anti-aging research literature, and therefore is very interesting in its own right.
The second publication is talking about dietary cocoa flavanols. And why I think that this is a really interesting publication because this is looking at whether or not short-term supplementation, even just for 15 days, has an impact on the mitochondrial mass and the ability of the mitochondria to do useful work. And they discovered that there was a key compound within dietary cocoa that was able to very quickly assist mitochondria to make use of the cellular energy supply and use this for use for work. This is important because ME/chronic fatigue syndrome is looking like a mitochondrial dysfunction illness. And therefore, if there is a way of improving mitochondrial action, then at the cell level, this hopefully will translate into a reduction in these adverse symptoms like inability to stand inability to concentrate or not feeling refreshed after long periods of rest. So, that is the second publication I wanted to draw your attention to.
And the last publication is again, looking at whether or not certain nutraceuticals like melatonin, glucosamine, astaxanthin, which we discussed last week for its connection with all sorts of neurodegenerative diseases. And that's important its own right and I'd refer you to last week's show if you are interested in the connection with nutraceuticals like astaxanthin and all sorts of issues to do with neuro cognition and myelin degeneration.
Now, what I want to talk about this particular publication is similar to last week with multiple sclerosis, which is the damage to the myelin sheath and the ability of those cells to actually transmit signals and how this is related also to potential exposure and mycotoxin for those with Multiple sclerosis (MS). These particular authors in this publication were looking at age related macular degeneration because this again is linked to mitochondrial dysfunction and they wanted to see whether there were some simple compounds that could be added to the diet or introduced into the area of interest that could show an ability to modify and change mitochondrial activity, which would show reduction in macular degeneration. Again, the scientists were in fact able to achieve this using a range of natural compounds.
Now, the last slide I want to bring to your attention again comes from... Let me just see, is that the last one? A very interesting publication, sorry, which is the impact of antibiotics on mitochondria. Why I've jumped to this particular part of the publication is that many people who are suffering bacterial infections are often prescribed antibiotics. We know that antibiotics are well matched in some situations to an underlying infection, but in many cases the introduction of antibiotics leads to really adapting those bacteria to be resistant to the antibiotic. And so, this is a whole worldwide problem with antibiotic resistance to bacteria. But bacteria, when a host an individual is prescribed a range of common antibiotics. This publication is showing that there is a massive impact on ATP production and mitochondria essentially use ATP, and this is how they operate.
So you can see that ampicillin has a 75% reduction in ATP production. When tetracycline, you'll note a 20% reduction in ATP. And you can also see in the second line, this ROS or reactive oxygen species, and reactive oxygen species for ampicillin you can see that this is going to lead to immediate inflammation at 200%. And kanamycin, another common antibiotic at 240%. But the bottom row, this 8-OHdG, this particular chemical moiety is linked to cancer, and you can see that ampicillin increases this by 720%. Look at kanamycin, 400%. So we can't escape the fact that common antibiotics' impact on mitochondrial activity and their ability to actually do useful work antibiotics can in many cases increase reactive oxygen species leading to localized inflammation.
So, what is the take home message of all of this? Absolutely read this publication, but strategies to improve mitochondrial function and I've highlighted four of them here. Optimize nutrient status to limit oxygen. So how are you going to do that? Well, you want to make sure that you don't do adverse lifestyle factors like drinking too much alcohol or smoking cigarettes, which all reduce the ability of your body to cope with these toxins. You optimize your nutrient status and that's up to the individual to optimize exactly what type of foods and nutraceuticals they might choose to consume.
The second point that I want to emphasize from this publication is that we all need to decrease toxin exposure, because this has a significant impact on mitochondrial activity. We want to utilize and take advantage of nutrients that are available and written up in the peer reviewed academic literature that facilitate mitochondrial ATP production. Perhaps the last take home point is that everyone needs to take advantage of physical exercise. Weight training is particularly beneficial, both aerobic and anaerobic weight training. So go to the gym, do some sort of resistance exercise workout, because this is overwhelmingly linked with ATP production and this is a really good thing for improving mitochondrial activity within you, the host.
In any case, I can't stress the value and the importance of this particular publication. You need to download it and read it. If anyone tells you that exposure to water damage buildings is just going to lead to irritation or sniffle or maybe some type of asthma type reaction, you can show them this publication, which proves that for a very specific illness definition, ME/chronic fatigue syndrome, the accumulation of mycotoxins and especially ochratoxin in the body is of such significance and is easily measurable that it essentially validates the connection between exposure to water damage, high accumulation of mycotoxins and the presentation of symptoms that are absolutely unwanted.
In any case, my name's Dr. Cameron Jones, I'll be back next week with another episode of The Mould Show. Stay safe and have a good week. Bye for now.
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