In Episode #39, Dr. Jill and Dr. Ben Weitz discuss mold toxicity, symptom diagnosis, mold exposure treatment and Chronic Inflammatory Response Syndrome (CIRS).
Dr. Jill Carnahan is Your Functional Medicine Expert® dually board certified in Family Medicine for ten years and in Integrative Holistic Medicine since 2015. She is the Medical Director of Flatiron Functional Medicine, a widely sought-after practice with a broad range of clinical services including functional medical protocols, nutritional consultations, chiropractic therapy, naturopathic medicine, acupuncture, and massage therapy. As a survivor of breast cancer, Crohn’s disease, and toxic mold illness she brings a unique perspective to treating patients in the midst of complex and chronic illness. Her clinic specializes in searching for the underlying triggers that contribute to illness through cutting-edge lab testing and tailoring the intervention to specific needs.
Featured in Shape Magazine, Parade, Forbes, MindBodyGreen, First for Women, Townsend Newsletter, and The Huffington Post as well as seen on NBC News and Health segments with Joan Lunden, Dr. Jill is a media must-have. Her YouTube channel and podcast features live interviews with the healthcare world’s most respected names.
A popular inspirational speaker and prolific writer, she shares her knowledge of hope, health, and healing live on stage and through newsletters, articles, books, and social media posts! People relate to Dr. Jill’s science-backed opinions delivered with authenticity, love and humor. She is known for inspiring her audience to thrive even in the midst of difficulties.
Dr. Jill 00:11
All right, we’re live, everyone, with Dr. Ben Weitz. I am so excited to actually be interviewed by him today on mold toxicity. Dr. Weitz is in Santa Monica, California. Hopefully, the weather is better than it is here—it’s 36 and snowy.
Dr. Ben Weitz 00:27
It’s about 75 degrees and sunny right now.
Dr. Jill 00:32
Oh, lovely, lovely. Well, I’m going to hand it right over to you. We’re going to switch roles a little for my Facebook Lives, kind of like you do for your podcast. This is going to go to both outlets. But I will just hand it right over to you.
Dr. Ben Weitz 00:45
Awesome. Thank you, Jill. Our topic for today is toxic mold—its effect on our bodies, how to get rid of it, and how to get rid of it with Dr. Jill Carnahan. Exposure to mold and mycotoxins affects many people and is often an undiagnosed underlying trigger for many other symptoms and conditions. Many people are unwittingly living or working in water-damaged buildings, and this exposure can be causing many negative effects on their health. Not only can mold and mycotoxin exposure cause a host of symptoms that we will go into, but it can also be an underlying trigger or root cause for many other serious health problems, including affecting our hormones, thyroid, adrenals, fibromyalgia, hypertension, heart disease, autoimmune diseases, Crohn’s disease, Alzheimer’s, and even cancer.
Dr. Ben Weitz 01:42
When looking at a patient from a functional medicine perspective, we usually focus on the likely underlying triggers and root causes of their health condition, and mold may be one that is frequently overlooked. Dr. Jill Carnahan is a medical doctor who runs the Flatiron Functional Medicine Clinic in Louisville, Colorado. Dr. Carnahan is one of the first 100 doctors certified by the Institute of Functional Medicine. Dr. Jill is a survivor of breast cancer, Crohn’s disease, and mold toxicity. That’s quite a lot to have gone through in your life, Jill.
Dr. Ben Weitz 02:20
Dr. Carnahan is a sought-after speaker at conferences—when we used to have conferences—and often teaches other healthcare practitioners the functional medicine approach. She’s one of the most recognized experts on mold and mold toxicity, which is our topic for today. Thank you, Jill, for joining me today, and thank you for letting me join you on your Facebook Live.
Dr. Jill 02:43
Yes, thank you, Dr. Weitz. I am delighted to be here. We had little snafus with scheduling, but I am so glad to finally be here and to talk to you about mold.
Dr. Ben Weitz 02:51
Sounds good. So why don’t we start? Maybe you could tell us a few things that are not commonly known about mold and mold toxins.
Dr. Jill 02:59
You got it. I’m going to go into just a two-second version, or quick version, of the story because [my] story always drives what I do. In 2015, after the huge flood in Boulder in 2013, I realized that my office had mold in it. It had been causing—which are some of the symptoms we’ll talk about for me—respiratory issues. I had shortness of breath, trouble running, and difficulty catching my breath when I’d walk upstairs. I had more brain fog and trouble with words and names—finding names and words for things. I’d say ‘cat’ instead of ‘dog’ or something like that. I noticed that when I was typing emails or letters, sometimes I would actually type the wrong word too.
Dr. Jill 03:37
Now, cognition and problem-solving weren’t so affected, but it’s weird how mold can kind of selectively affect portions of the brain. The other thing I noticed was focus and concentration. Where I could maybe write a blog in an hour before, it took me a little bit longer to really focus, concentrate, and be productive. So all of those things. And then mold can trigger a mast cell response—we’ll probably talk more about that—and cause histamine issues. So for me, I had rashes and hives, and I had swelling in my lower extremities. At the worst of it, I had 3-plus pitting edema. It was really severe. I had redness in my eyes, and I had congestion in my sinuses. I had more acne breakouts. I had skin lesions on my scalp. And I could go into more, but those are just a few of the things.
Dr. Jill 04:20
Some of the unique things that you asked about [are]: Some people have an electrostatic charge on the surface of their skin because they’re sweating out sodium. They’re losing sodium, so they kind of create a gradient or a battery on their skin. It’s not uncommon to have electrostatic shocks when you touch metal or doorknobs or to actually break watches or computers if you’ve had mold exposure. That’s one of those really unique things. Another thing is frequent urination, which is along the same lines because the antidiuretic hormone, which controls our hydration, is dysfunctional. It goes very low, so you don’t conserve water. So, you drink and you pee, and you drink and you pee. And a lot of these patients will get up during the night three, four, or five times to urinate [and go many times] during the day. They’re walking around and can drink loads of water, but they’re chronically dehydrated because they can’t maintain the volume in their vascular system.
Dr. Jill 05:09
Some of the other things that happen are that there’s an enzyme called aromatase, which upregulates and converts all of our hormones into estrogen, especially testosterone. So men will have man boobs, weight gain around the middle, and decreased libido and drive. Women will have excessively heavy or painful periods, or they’ll have fibroids, endometriosis, or all kinds of things to do with estrogen dominance.
Dr. Jill 05:32
It affects, like I said, mast cells, so [there are] histamine reactions and more sensitivity to foods. We didn’t even talk about the gut, but mold will directly affect the integrity of the gut lining, causing a leaky gut, more sensitivity to foods, and more issues with the gut as well.
Dr. Ben Weitz 05:50
So tell us a few things that we didn’t know about mold and mold toxins—things that aren’t commonly discussed.
Dr. Jill 05:56
Yes. Did you know mold can cause an increased risk of infertility in both men and women?
Dr. Ben Weitz 06:02
Dr. Jill 06:04
Yes. The livestock industry is a big one because a lot of the food can be contaminated with mold. For the farmers who raise cattle, pigs, sheep, and all these animals that could have contamination in their food, they see a loss in their bottom line dollar [figure] when there’s mold contamination in the food because their herds don’t reproduce as well. They have noticed fertility issues. They have rashes just like humans. They have gut issues just like humans and all kinds of things. So you’ve seen these. In the animal studies, they’ll show these. And then, of course, it’s very, very similar in humans. But there’s lots of research on mold-contaminated feed, cows, pigs, and all of these things, especially fertility.
Dr. Ben Weitz 06:47
That’s fascinating because, when working up a patient for fertility problems, I don’t think many people consider mold as one of the possibilities. We’re looking at the thyroid, and we’re looking at a whole lot of other things—maybe toxins in general—but we don’t really typically think about mold.
Dr. Jill 07:05
Yes. Some of the other unique things [include] Alzheimer’s disease. Dr. Dale Bredesen works a lot with Alzheimer’s patients, has written multiple books on the topic, and claims that one-third of the patients that he sees have mold-related Alzheimer’s. He wrote a paper about five years ago now called Inhalational Alzheimer’s, and it was basically related to inhaling mycotoxins from mold, going into the cribriform plate, right into the brain, and causing dementia-like symptoms. Especially in someone who’s in their 50s, which is so young for Alzheimer’s.
Dr. Jill 07:36
I’ve had a case, for example, of an attorney—55 years old—who all of a sudden can’t practice because of dementia-like symptoms, and it was all related to mold. A few other unique things would be, like I said, gut issues. It can present with Crohn’s or colitis—inflammatory bowel disease—because it has a massively inflammatory effect on the gut lining. Some people will present with autoimmunity of other types as well. Mold can raise TGF-beta, which is one of the drivers of autoimmunity. So if patients have that process going on, they might present with MS, Hashimoto’s, Lupus, Crohn’s, or Colitis, and it’d actually be mold as the underlying cause.
Dr. Ben Weitz 08:16
Interesting. A lot of the conventional medical profession has traditionally been very skeptical of this concept of mold toxicity. Are they starting to come around to accepting that this is a common problem for patients?
Dr. Jill 08:41
Yes. Now, just like mold, this is a sticky situation. And it’s interesting because I’ve had people almost angrily—
Dr. Ben Weitz 08:48
I get the double entendre there—sticky in terms of, possibly, legal issues.
Dr. Jill 08:55
Yes, exactly. It’s interesting because I’ve even had patients on Facebook groups and things [who are] kind of angry because they’re like: “Doctors, why don’t you do something about the way that we can’t talk to our landlords? And there are no regulations, and the insurance [companies] aren’t reimbursing.” Granted, what I like to do is stay in my lane. I’m a physician; I take care of patients. What I do is know the experts who deal with environmental issues, like environmental air quality specialists. And I know enough to help them navigate that world. I think that’s important. But I’m not a person who can remediate your home. I’m not a person who can do the politics of talking to your insurance company. Again, we stay in our lane, but I think we need people with more awareness.
Dr. Jill 09:34
I think it started way back. Mold is super common. Insurance companies know this. There are about a fourth of all homes and buildings in the U.S. that have some sort of water damage. And we could even expand it. We used to have homes that were built up, more like stone or brick, and that’s very impervious to mold. Nowadays, we have these niduses that are basically like cardboard, so our drywall and sheetrock—which is very, very commonly a source or a problem with mold—if they get wet, are the perfect growth substance for mold. Most houses are now more quickly constructed with these types of materials. Then the materials that are used are more prone to mold.
Dr. Jill 10:14
And then, during the construction process, they can bring in wet wood that may already have mold starting to grow on it. Or even during the construction process, depending on where it’s being constructed, it can actually rain in the house while it’s open, and all of these things. And then, as you build a house, you can have washers and dryers. You can have windows that leak. You can have poor construction. And more and more, there are quick construction methods that aren’t as detailed or done well. So, there’s more likelihood of problems, even in new homes.
Dr. Ben Weitz 10:44
Yes, I’ve actually heard of a similar problem. This is especially the case, for some reason, in California. They tend to build a home so airtight that there’s no ventilation. So in between the walls, if there was a little bit of moisture, that venting would decrease the likelihood of mold. But they make them so airtight that any moisture in there is more likely to cause mold. So you can have poorly constructed homes, or you can have homes that are maybe too tightly constructed.
Dr. Jill 11:17
Yes, that’s 100% true. In fact, I talked to a highly-paid investor in New York City who was part of the LEED certification. This is a certification that certifies the greenness of the buildings: Building materials that are recyclable, the airtightness, and the efficiency of the building. And what’s happened in some of these buildings—not all of them—is that they’re super efficient, and by nature, they are very sealed from the external environment, so the breathability of the building can be an issue. I’d rather be in a 100-year-old log cabin than in one of these super airtight, efficient buildings that have no airflow.
Dr. Jill 11:55
Sometimes, when you have a patient with mold in their environment, just opening the windows and getting a little airflow to dilute… We always hear this, and I’m not the original [source of this quote], but “Dilution is the solution to pollution,” which means that as soon as you get some outdoor air in there or you get a fan and bring some airflow in, that will automatically decrease the toxicity of your internal environment. So that can be part of the solution.
Dr. Ben Weitz 12:17
When you were going through some of the symptoms of mold that you had and a lot of the symptoms that other patients get, they’re common to many other conditions. When you have a patient who presents with some of these symptoms, what really alerts you to the thought that they might be dealing with mycotoxins?
Dr. Jill 12:36
Yes, I love this question, Dr. Weitz, because one of the things patients always say is, “Oh, it’s so expensive to see a functional doctor or functional chiropractor or to do all the testing.” I would say that just by taking a great history, I am usually 95%, maybe even 99%, accurate on where the direction needs to go if I think there’s mold involved. And that’s just a history; granted, the office visit is part of the expense, but it doesn’t take a lot of expensive testing. Before I do the test, I usually know the direction I’m headed. My office staff jokes with me because my batting average is like 100%. So far, there’s not one person that I’ve suspected of [having] mold that hasn’t had the lab results to back it up.
Dr. Jill 13:19
But the questions are important. So let’s go through a few of those. I’ll often ask: When did you first start feeling poorly?—because the timeline in my mind is so critical. Ten years ago, twenty years ago, or five years ago. “Oh, when we moved into that new house.” That’s a big one. And if the other family members also have some symptoms, they may present differently. The daughter may be perfectly fine. The son may have depression. The dad may have congestion, and the mom may have chronic fatigue and fibromyalgia. So it could present highly differently among the individuals, with some of them being less affected. That’s because there’s a genetic variance in our ability to get rid of these antigens and toxins from our bodies. So if the mother is extra symptomatic, she might have more difficulty tagging and getting rid of these toxins from her body. But all that to say, it can be variable, so history is key.
Dr. Jill 14:08
If I just ask someone, “Do you have mold in your home?” Everybody says, “No, I’m fine.” Or there might be a musty smell, “but it’s mildew.” And that’s just not true. First of all, the musty smell is [caused by] VOCs—volatile organic compounds—released from mold. So there’s an issue if there’s a musty smell somewhere. The second thing is that you have to ask the right questions. So is there condensation on your windows? Have you ever had a washer or dryer leak? Does the washer’s rubber gasket smell when you open it up? You see under the sinks, the faucets, and the pipes. Has the garbage disposal ever leaked? Do you have tile or grout that’s discolored? Do you have leakage around the shower pan? Is it properly sealed?
Dr. Jill 14:48
A lot of people don’t know that some of these really expensive types of tiles that go in beautiful multimillion-dollar homes and bathrooms are actually quite porous. So if your contractor has not put a vapor barrier or a sheet between the tiles and your wall… I just saw a beautiful multimillion-dollar home. It was loaded with mold in the master bath; nothing was visible. What happened was that they slapped up tiles right up against drywall with no barrier—these are permeable tiles—and after eight years, there was massive black mold all underneath there, and there was nothing visible. The bathroom looked beautiful. So all of these kinds of things.
Dr. Jill 15:22
And then basements. There are crawl spaces—earth crawl spaces—where there’s damp moisture that is venting into the home. If you have a sump pump that’s open and unclosed and there’s water standing anywhere in your home… If you have water that seeps in through the landing and there’s no barrier there where you get condensation or water into your basement… There are so many different ways this can leak in. Attics can be a big place. If the attic isn’t sealed and there’s lots of heat and condensation, those can be a big place too. So part of it is looking for the problem. Then, eventually, a good remediator will seal off your wall cavity from your home environment so that you’re not getting that air from the crawl space, the attic, or the in-between walls to exchange into your home.
Dr. Ben Weitz 16:08
Interesting. Have you ever had a patient, for example—as a way to test if they’re dealing with mold—just go out of their home for a while and take a mold vacation?
Dr. Jill 16:24
Yes, so often I’ll just ask the question… Nowadays no one’s going on vacation, but before I would ask: “Have you [inaudible] gone for ten days, seven days, or a period of time? And did you ever feel better?” Now, interestingly, I’ve had a couple of situations. One patient of mine—I always suspected mold. She had recurrent colitis and fatigue. And she had infertility and amenorrhea, so she stopped having a menstrual cycle—she’s in her 30s, so she should be normally cycling—infertility, and then the colitis and fatigue.
Dr. Jill 16:55
She had a condo in Winter Park, in the ski area, and then a home in Boulder. She always said, “Well, I feel poorly at both locations.” So then you’re like, “Well, maybe there’s no mold.” Well, she went camping for 10 days, and she said: “Dr. Jill, my colitis went away. My fatigue was amazing—I didn’t feel fatigued.” And of course, her cycles didn’t start back in those 10 days, but a lot of her symptoms improved. We found out that both her ski home and her home in Boulder had mold. So she was exposed at both places.
Dr. Ben Weitz 17:23
So what’s the best way to test your home for mold?
Dr. Jill 17:26
Yes. This is also a tricky one because there are a lot of inspectors and remediators who don’t really like ERMI testing. ERMI testing—what is it? You can get a dust sample of the dust in your home. If you do this, a couple of rules about it are that you want to get it from two feet above the floor so you’re not getting outdoor dirt and stuff tracked in. So, maybe it’s shelving, door handles, kitchen cabinets, or things like that, or shelving in your living room, like behind me here. But you wouldn’t want to get on the floor itself. Then you want to wait, like, seven to ten days after your cleaner so that you actually have some dust accumulation. You can collect the sample yourself and send it in. There’s environmental biotics [sic]—I’ll have to get the name for that for sure and post it—and then there’s Mycometrics. There are a couple of companies that do this.
Dr. Jill 18:15
Then you get a readback of the PCR—the DNA of the mold that’s in your dust. Even though that’s not perfect—I actually don’t use the ERMI score, I just look at the individual molds—I can often tell if there’s a big issue because if there’s [a reading of] 30 Chaetomium or Stachybotrys on that test, that’s a big problem. Even if there are five of those really toxic molds, it’s a big issue. So I will often look at that, and then that can tell us, “Do we need to get an inspector in or look further?” Ideally, everyone would have a complete inspection, but that can be costly. So I’m always kind of weighing the balance of the cost. I do still feel like ERMI is good. Then there are those little plates, the petri dishes, that you can buy at Home Depot, Lowe’s, or a store, and you can put those out in your house.
Dr. Jill 19:00
And here’s the cheap and easy way—you don’t even have to send them in if you just want to gestalt—you can set them out for 24 hours and then cover them. You can put them in different rooms, and then you let them grow. I think the kits are, like, seven to ten days. You can look at the colonies. If there are zero to four colonies growing of anything at all, that’s pretty normal. If there are five to eight colonies, that’s a moderate problem. And if there are nine or more, that’s a big issue. So even though that’s not perfect, these are very inexpensive ways to test and start the process.
Dr. Ben Weitz 19:30
Cool. So how do you test a patient for mold? What’s your work-up in terms of testing?
Dr. Jill 19:37
Yes. Like I said, I don’t want to forget history because it’s free, and a good clinician has to ask the right questions. And then [there are] two things that are also free in my office: I have a screening [called] cluster symptom analysis where I have them check off boxes. There’s a scoring system that tells me if there’s a higher likelihood of mold or not. The second thing is a visual contrast test, or VCS test. You can do these online for free. Or Dr. Shoemaker’s site, survivingmold.com, has another one. I think it’s $5 or $15. That’s the one I actually prefer, but they’re both excellent.
Dr. Jill 20:06
And in my office, I actually do this in person. We have an actual visual contrast board, and my staff knows how to do that. That will test visual acuity. What happens is that when we have biotoxins from mold, they affect our retina and our retina’s ability to differentiate black and white lines. These are little circles with black and white lines at different angles. So as you do it, you hold one eye closed and say, “Oh, it’s left, right, central, left, right.” If you miss those on some of the smaller lines and increments, there’s a more likely chance that you have had a biotoxin exposure.
Dr. Ben Weitz 20:41
Do you ever start treating a patient as a result of a history and maybe a questionnaire or the visual contrast test without doing lab testing?
Dr. Jill 20:53
Yes. And I didn’t get to lab tests, so I’ll get there next.
Dr. Ben Weitz 20:56
I know. We’re going to do that next, yes.
Dr. Jill 20:58
Yes. Say someone comes in, they have a positive visual contrast, and they’re highly symptomatic. It all started when they moved into this home. There’s a musty smell in the home. Then three people in their family are also sick. I’m like, “Okay, there’s a high likelihood.” What I know to be true is that they’re going to eventually need to get away from that exposure, remediate, or do something. But in the meantime, some sort of binder, which we can talk about, and some basic liver support—things like glutathione or the precursors like NAC, lipoic acid, vitamin C, glycine, and glutamine—can all be helpful. And they’re pretty safe for all of us, especially when we start with low doses and work up. So I’ll often start a detox protocol no matter what.
Dr. Jill 21:37
And you asked about other testing. I do use urinary mycotoxin testing. There’s a lot of controversy about that. But I do believe that after five years of doing this on many, many, many patients—thousands of cases—I see a very good clinical correlation. There are three labs that do that right now. There are RealTime labs, Great Plains labs, and Vibrant labs. They’re all excellent. There are different variances depending on them. I do have my favorites, but those are all good test companies to use.
Dr. Jill 21:37
There’s bloodwork, so there are things like TGF-beta, MSH, MMP-9, antidiuretic hormone, osmolality, and even C3 and C4A. Those are serum labs that can be done in any lab. Right now, I use Labcorp, but you can use typical hospital labs, which will sometimes do them. It’s a little tricky to get some of them on Quest, but it can be done as well. But those are options.
Dr. Ben Weitz 22:33
What do those labs actually tell us?
Dr. Jill 22:36
Yes, so there’s a term that Dr. Shoemaker came up with called CIRS, or chronic inflammatory response syndrome. It was his way of describing this inflammatory response from a water-damaged building and all the inflammagens. When I say inflammagens, I’m broadening it. There are molds, clearly, and mycotoxins. But bacteria can grow there. And other things like methyl brevi-, algae, and candida can all be in a water-damaged environment. So it’s not always just mold.
Dr. Jill 23:01
But all of those things can trigger an immunological response in the body. It’s not just the mold attacking the body; it’s actually the mold causing immune activation. It’s very similar to COVID and the virus with this IL-6 response in this immune activation that causes collateral damage and side effects. It’s very, very similar, both the virus and then things like lipopolysaccharide and gut toxicity. Leaky gut can cause this, as can mold. Many, many things cause this inflammatory response in the body. And when I mentioned those labs, it’s basically looking at all of these inflammatory cytokines and saying, “Are many of these that are common to mold active or abnormal?” And if most of them are abnormal, it paints a picture of a higher likelihood of mold being part of the picture.
Dr. Ben Weitz 23:53
Here’s a question for, say, a practitioner like myself who’s a chiropractor. When I send patients out for serum labs, I assume they’re not going to be covered by insurance. You might have different experiences as a medical doctor, but we’re assuming most of the time it’s not going to be covered. Let’s say I have a patient who’s a little bit cost-sensitive. If I were to choose between the urinary mycotoxin [test] and these blood biomarkers, what do you think is the best bang for your buck?
Dr. Jill 24:23
Yes. First of all, I do urinary mycotoxins [tests] on almost everybody. First of all, what you have to know is that it is excretion. So, number one, you could have a patient who is so toxic that they’re not excreting. And you can get a false negative with nothing in the urine because they’re so toxic, they’re holding on to it. And then you’re like, “Oh, they’re fine.” They’re not fine. So that’s one thing. Number two, if you start treating a patient, you’re actually pushing that detox pathway, and you want that to go into the urine and be excreted.
Dr. Jill 24:51
A lot of patients after two months will be like, “Dr. Jill, can we retest the mycotoxins?” Like I said, we can if you want, but guess what? It’s probably going to be higher. And we want it to be higher because you’re excreting. So as a physician or a patient, you have to know when you’re testing. As a rule, unless a patient absolutely begs or demands to be retested, I won’t test before six months after treatment. And even then, the levels might be higher. So, knowing what you’re doing [is important].
Dr. Jill 25:14
Mycotoxin testing ranges from $300-$400. So, while it’s not cheap, if you have to have one thing, it kind of guides. And now we have more data on the types of binders, treatments and pathways for each toxin. Say I have ochratoxin versus a T2 toxin or gliotoxin. I might use different binders and different pathways for that. So that actually guides my treatment. That’s my number one test. But again, you have to know what you’re doing because it’s not perfect. You have to now that you’re measuring excretion.
Dr. Ben Weitz 25:43
By the way, where’s the best source for that connection between specific binders and specific mycotoxins?
Dr. Jill 25:52
Dr. Neil Nathan has written about it a little bit, and he just posted some work on his blog. In his book, it’s also available, I think, in a chart with the binders. Beth O’Hara, who’s an expert on mast cells, has done some work with the pathway as well. So I think on her website she has it posted as well. And I think that’s mastcell360.com. If you just search ‘Beth O’Hara’ and ‘MCAS’, you’ll find her website. And of course, Neil Nathan as well. He’s an MD. Those are some good sources for that information.
Dr. Jill 26:24
Blood work for patients who can’t afford it: First of all, I do often get it covered. Not always. And if it’s not covered, these are thousands of dollars. The LabCorp [test] can be so expensive. So you’re right. But there’s a trick: Life Extension has navigated a discount with LabCorp for what’s called the Biotoxin Mold [Illness] Panel. You can go on it as a patient and order it yourself. It’s usually $300 or $400, depending on whether it’s on sale or not. Still, it’s hundreds of dollars, but way better than thousands of dollars. And a patient can actually order this themselves. So that’s a way that I’ll do it if I want. It’s only five of the markers, but it’s pretty helpful if that’s all I can get. It’s a way cheaper price for the patient to get it directly from Life Extension.
Dr. Ben Weitz 27:07
And that’s basically not measuring the mold but measuring whether you’re reacting to the mold, right?
Dr. Jill 27:13
Yes. If I had a million dollars for every question that I had, it would be: “What’s the one test for mold, right?” We get that all the time. “What’s the one treatment or the one test?” There is no one test.
Dr. Ben Weitz 27:26
How about the one pill?
Dr. Jill 27:27
Yes, the one pill, the one test. I wish we could give it to you.
Dr. Ben Weitz 27:29
Well, actually, there was just another study about the polypill. The medical profession has been wanting this one pill that everybody could take that would promote their long-term health.
Dr. Jill 27:41
Gosh, if we only had that, right? But you and I practice individualized medicine. There’s no one size fits all. I have a lot of colleagues who have protocols, and I have no disrespect for them, but I have resisted so hard. I really, truly don’t have protocols. I do some of the same things depending on the situation, but every patient is an individual, and I like to treat them that way. So we talked about testing and cost. And then in your last question, let’s see, you asked about the direction to go depending on… Oh, if there was one test. Yes, there really isn’t.
Dr. Ben Weitz 28:16
I know. I know. [laughs] So let’s get into treatment. Obviously, the first thing they have to do if they’re presently exposed to mold is somehow get out of that environment.
Dr. Jill 28:36
Yes, and let’s talk a little bit about this, because the confusing thing is if you have a remediator who is not aware of the sensitivity of the types of patients that we see—
Dr. Ben Weitz 28:44
So a remediator is somebody that you pay who comes to remove the mold, and they have a specialty in that.
Dr. Jill 28:51
Yes. There are a bunch of nuances in the industry. IEPs are indoor air professionals. For example, I’m on the board of ISEAI.org. This is nothing paid. But it’s a great resource; it’s all free. International Society for Environmentally Acquired Illness, ISEAI.org. [It provides] free resources and free professionals that have been trained in mold. If you’re looking for some resources, that’s a great place to start. There are blogs and things on there. It’s a nonprofit; they teach physicians. And I just love [the topic of] mold and teaching, so I’m part of them just for that sake. But that’s a good resource to start with. The same with survivingmold.com, which was Dr. Shoemaker’s website. He has a lot of free resources and literature there if you want to start on the journey.
Dr. Jill 29:38
But back to remediators. Indoor air quality professionals might be someone who, either virtually or in person, looks at the quality of your air. And they’re beyond the scope of just mold; they might look at radon, they may look at EMFs, and they may look at a broader spectrum of air quality. Remediators in the mold industry can be a varied batch. I kind of like to joke: It’s like used car salesmen; there are some wonderful ones and there are some not-so-wonderful ones. So you’ve got to know who you’re dealing with because you might get five different answers from five different remediators. The main thing is number one: They have to have containment and negative air pressure so that the rest of your home doesn’t get contaminated while they break down that wall and take out the mold. Number two: If they’re not wearing personal protective gear, that’s a problem. They don’t know what they’re doing because mold is super toxic, even to someone who doesn’t feel it over time or over the years.
Dr. Ben Weitz 30:24
And by the way, protective gear doesn’t mean one of those really inexpensive masks that they get from Home Depot. What’s it called, a ventilator?
Dr. Jill 30:39
Yes. And nowadays, because of COVID, we know [about] the N95s. That’s a minimum. I’m talking N95s with charcoal filters like the painters use. And ideally, they have a complete suit. Sometimes, in severe cases, they’ll have their own air supply. That’s a little less common, but I have known situations where they’re so bad that they’re almost like in an astronaut get-up with their own oxygen and air supply.
Dr. Jill 31:09
You might look at my study here, and there’s no visible mold; there isn’t mold in my condo. There’s no visible mold, and there’s no issue. But I might not smell it or see it. Patients are confused because they’re like: “There’s no mold in my house. I don’t see anything.” Most of the time, it’s not visible. It might be behind this wall because there’s a pipe that burst and leaked into my home or my basement and caused damage behind the wall that’s not visible. So you might not see it or smell it, but those toxins released from the mold could still go into your air supply. So say that’s the issue. The remediator would have to come in, put off plastic [inaudible], put off negative air pressure, come in and take out that piece of the wall, and replace it.
Dr. Jill 31:46
And that’s not the end of the story because, number one, they have to do that appropriately. Then, after that, you need to clean your vents and your house because that mold has been spewing toxins into your environment. And that dust left in your house—that’s what we check with an ERMI test—can still cause illness in someone even after the main mold source is gone. So typically, what I recommend is to get a remediator. Get the source out, get the crawl space fixed, get the attic fixed, get the sump pump fixed, seal the windows, and do the work. Then, number two: Clean your HVAC system if you have one because that’s been circulating toxins and dust. You clean that first. Then number three: A small particulate clean. There are instructions for this. You can get it from your IEP, you can do it yourself, or you can hire someone. They literally wipe down every surface of your place. Then you want to get rid of porous materials if you’ve been really affected.
Dr. Jill 32:37
That would be like the books behind me. I don’t really love to tell people to get rid of everything in their home. I don’t think that’s the right way to do it. But a lot of times, porous materials like paper or things that you can’t clean easily will continue to make you sick. So if in question—like say, these books behind me—you could store them in a plastic bin while you get well and then go back later and open it up and see. After the small particular clean, some people will do a fogging, or they might do the fogging with an enzyme, and then a small particular clean in that order.
Dr. Ben Weitz 33:08
Before we get into the rest of the treatment, I wanted to bring up a point of confusion that sometimes comes up when I discuss this topic with patients. There are some related conditions that are different. You can have exposure to mycotoxins, just like you were talking about. You can also have fungus growing inside your body. It can grow on your lungs. It could be on your skin. It could be under your fingernails. It could be in your vagina or other organs. You can have fungal overgrowth in the GI tract, like Candida. How related are these? How should we think about these?
Dr. Jill 33:52
Oh, I love this because this is one of those kind of secrets. I’ll see people who have been to 5, 10, or 20 other doctors and are still not well. And understanding that you can be colonized or infected with molds or fungus is really part of the puzzle. There are some doctors who teach that that doesn’t exist. Well, there’s tons of literature to support the fact that you can have Aspergillus in the sinuses, in the lungs, or in the gut. It is very well documented. This is not anything new. In fact, for some diseases like multiple sclerosis, they’re using antifungals and having great success because it’s so common to have fungal colonization. So let’s talk about the difference.
Dr. Ben Weitz 34:30
Dr. Jill 34:30
Yes, it is. And there are a lot of articles. My neurologist friend and I sometimes talk about this—how big the fungal burden is. The first thing I want to talk about is mycotoxin exposure. You can have exposure to mycotoxins where they don’t grow in your body, and they can cause immune damage and a cytokine storm. You can be very, very sick but not be colonized. Some of the ways to differentiate would be that you can do urinary organic acids, and there’s something called furans that come in the urine that shows Aspergillus or some other types of species. You can do the urinary mycotoxin [test], and if they’re coming out in your urine, you’ve probably had an exposure and been partially colonized as well. So there are these things.
Dr. Jill 35:12
And again, you have to figure out: Is it sinuses? Is it the gut? Systemic antifungals can treat both the sinuses and the gut, but for topical [use], you might use nystatin, which just treats locally—in the gut. It’s very effective. Or you might use something like grapefruit seed extract for the sinuses. Again, you’re treating locally, so you can do everything from sinus sprays to nebulized antifungals, which go to the lungs. Or you can do oral herbs and medications for the gut or for the entire system. Things like azole drugs—fluconazole, voriconazole, ketoconazole, and itraconazole—are all systemic antifungals. They can be toxic to the liver, so you absolutely want to work with a doctor who knows what they’re doing. But in some cases, they can be lifesaving because if someone’s colonized with fungus in the gut, that’s an issue.
Dr. Jill 35:56
Now, the other thing you mentioned is SIFO, or small intestinal fungal overgrowth. It’s super common and hard to detect. Often, it won’t show up in the stool, but it will show up in the urine, or it might show up with serum candida antibodies or saccharomyces antibodies. This is a big deal because both the mold toxins and the yeast metabolites, like acetaldehyde, will further weaken the immune system. So part of this balance is that mold tends to weaken the immune system, and yeast in general is opportunistic. What that means is that it takes advantage of a weakened system. If you have a really strong, robust immune system, you’re probably not going to have a fungal colonization issue. Nowadays, with EMFs, a poor diet, stress, isolation, and all these things, many of us have a weaker immune system. So it’s very common to see colonization with candida and other things because of our weakened systems.
Dr. Ben Weitz 36:51
Cool. So what if a patient does have, say, fungus under their nails? Is that at all related to systemic fungi or mycotoxins?
Dr. Jill 37:00
Yes. This is interesting on two fronts. The technical name is onychomycosis, which is a fungus. If you look and have really discolored toenails, thickening, or sloughing, it is often that fungus. Two things: Often, the periphery, like the extremities, if they’re a little cooler due to either dysfunctional thyroid or adrenals, then you can have more growth there because just that slight degree change in temperature in the periphery will enhance the ability of the fungus to grow. So there might be a thyroid or adrenal issue contributing. The second thing is that it can be a sign of systemic fungal overgrowth as well. Nystatin is supposed to be a drug that just treats the gut locally, not systemically. But in certain cases, I’ve seen that because of reservoirs in the gut, if we treat with nystatin, sometimes the nails will actually improve, which isn’t supposed to happen.
Dr. Ben Weitz 37:52
Interesting. What about if you use your mold and mycotoxin removal strategies?—which we’re going to talk about in a minute. Do those also help with fungus under the nails?
Dr. Jill 38:07
They can. Again, the gut is, a lot of times, the reservoir. If your gut is full of yeast and fungus and you remove that, sometimes you’ll see the nails improve. Again, the nails—there’s not a lot of blood flow there—are on the peripheries, so it’s cooler. They’re hard to treat, and typically, doctors who treat them are going to treat them with three months of a heavy-hitter antifungal. And even then, it might not clear it. So I always want to look at the terrain because, if it’s a weakened immune system, poor thyroid function, or poor adrenal function, you want to fix those first, or at least in conjunction with the nail fungus, because, to me, that’s just a symptom of something bigger.
Dr. Jill 38:41
The other thing that can correlate with it is blood sugar issues. If you’re an uncontrolled diabetic, those blood sugars will make fungus more happy and grow because they love sugar. So that’s another piece of the puzzle. If your blood sugar is not controlled, you want to work on that in addition to working on the nail fungus.
Dr. Ben Weitz 38:57
Yes. I know that you recommend a low-mold diet as part of the treatment plan. Maybe we should talk about that.
Dr. Jill 39:06
Yes. Again, there’s some controversy among other doctors; Do you really need a low-mold diet? I find that less exposure to mold, even in your diet while you’re getting well, will help. And maybe the bigger thing is histamine. So there’s also a low-histamine diet. A lot of patients who have had mold exposure have mast cell activation and more sensitivity to histamine. If that’s the case, they’re going to be very reactive to things like fermented foods, bone broth, aged meats and cheeses, and leftovers. Those are all high in histamine, so that can be an issue for patients as well.
Dr. Ben Weitz 39:39
Interesting. So what constitutes a low-mold diet?
Dr. Jill 39:43
Berries can have mold on them, [and], like I said, blue cheese [or] anything with visible mold or growth. In a similar way, leftovers or things that are left out. And then nuts, seeds, and grains can be contaminated. I have a suspicion that one of the reasons that paleo and grain-free diets are so popular is because grains are one of the most highly contaminated food sources for mold. In fact, a lot of our data on the gut comes from African children whose grain supply had been contaminated with mold and who were inadvertently fed moldy grains. They developed leaky gut and sometimes even villous atrophy, which is the same thing you see with celiac disease.
Dr. Ben Weitz 40:23
And is that because the grains are stored in these silos for periods of time?
Dr. Jill 40:28
Yes. I grew up on a farm in Illinois, so I know a little bit about grains and storage.
Dr. Ben Weitz 40:32
Yes. I’m a city boy, so I have no idea what really goes on on farms.
Dr. Jill 40:38
You’re right. It’s funny because I had horrible allergies as a child to corn and soybeans, which were the main crops. Now, looking back, I feel like I understand this so much more. I might still have been sensitive to the corn and soy, but what I believe, Dr. Weitz, is that it wasn’t just the corn and soy; it was the molds and fungus that were growing on the corn and soy. I would literally have my eyes almost swell shut from allergies, and I think I was really sensitive. And then you store them a little bit damp. Part of the purpose of the grain bins is to dry the grains out because they have to have a certain moisture content to be sold. So this is wet and damp grain sitting in a huge bin, and there is massive mold growth.
Dr. Jill 41:16
And again, there are levels. What’s sad about the United States is that our levels of tolerability for mold toxins on grains are actually quite high compared to Europe. For example, coffee and chocolate are things that often contain mold as well. There’s a European standard for coffee, and if it’s above a certain level, they won’t accept it into the country. Guess who gets those leftovers that aren’t accepted? We accept them in the US. So our coffee—our typical Starbucks coffee, I hate to say it for all those of you who love Starbucks—has mold in it. I know now. I drink a really clean brand called Purity. And I’m so clean in my diet that if I get a cup of Starbucks, I don’t feel well. I can tell immediately, like, “Ugh!” [from] that sense of headache or unwellness.
Dr. Ben Weitz 42:00
A lot of processed foods, like jellies, have mold in them. And there are so many foods that contain small amounts of mold that we’re not aware of.
Dr. Jill 42:13
Yes, children’s apple juice. You’ve seen those videos.
Dr. Ben Weitz 42:15
Oh yes, horrible. Basically, anything that comes in a squeezable, plastic kind of container, don’t eat it. So let’s talk about the rest of your mold protocol. I know Ritchie Shoemaker talks about using some of these prescription bile binders, like cholestyramine. Do you use those?
Dr. Jill 42:39
Yes. I’ll talk really quickly about treatment protocols and the gamut. I also want to mention that I have on my website—I’ll link it here, and then, for your podcast, we’ll give you a link—”The Low Mold Diet.” If you search my website, JillCarnahan.com, if you want to know exactly what’s on it, it’s there. I also have a free mold guide. I’ll make sure your listeners as well as mine have a link to that. Most of my listeners already have it. It’s all free. But for lots of this stuff, if you don’t remember the details or want more to read, it’s all on my website. So you can go find it there as well.
Dr. Jill 43:13
Treatment: First of all, [get] out of [the] source of exposure, which we just talked about. Then you’re working on getting your body rid of these toxic levels of mold through detoxification, so you’re focusing on liver support. We mentioned glutathione. Not everybody tolerates glutathione. And glutathione has to be recycled by NAD, so I’m a big fan of NAD as part of the protocol—sometimes not the initial part. If you can’t tolerate glutathione, you can use precursors [like] N-acetyl cysteine, vitamin C, glycine, glutamine, and lots of different things. I almost always put people on milk thistle or some other liver support, and sometimes bitters. Those will all help the liver and gallbladder. Then binders: Binders are key. There are many, many types of binders. Dr. Shoemaker is really heavy on prescription drugs and binders. I actually don’t use those as much because I find some of the natural binders work well and are a little more gentle.
Dr. Jill 44:05
I will say that with ochratoxin, cholestyramine tends to be very effective. So that’s the kind of toxin that, if they have a very high level of ochratoxin, I might consider cholestyramine. But in general, I like clay, charcoal, and chlorella. There are also glucomannans. There’s zeolite. There are silica-based binders, which are also great for heavy metals. But I get really good results with clay and charcoal—pretty simple stuff. So for supporting the liver: Clay and charcoal. Now, while you’re doing this, you’re doing a complete functional medicine approach. So if they need probiotics, gut support, brain support, adrenal support, or thyroid support, I’m doing all that as well.
Dr. Ben Weitz 44:40
I know some doctors say that before you even go into a detox protocol, if they have a leaky gut—and a lot of patients do—you should work on fixing that first because otherwise they’ll reabsorb the toxins.
Dr. Jill 44:53
Yes. And there is a point too that if someone has really bad mast cell activation and permeability issues, sometimes I found… I agree with you, and I’ve done 20 years. It started with the gut; I love the gut. But once in a while, if you don’t get that mold level down, the gut won’t heal, and you get stuck. So if you’re getting stuck with gut protocols, I would go to the mold and make sure you’re addressing that at the same time.
Dr. Ben Weitz 45:17
Yes. It’s always a question of [understanding]: This is the root cause. And that’s the root cause of that. And what’s the root cause of that? So let’s see, what else? I think we pretty much covered most of the points. What about air purifiers that remove mold? Is there a best one on the market?
Dr. Jill 45:40
Yes. There are some that are out there, and there is a specific name that is eluding me at the moment, but I’ll give you some examples: Air Oasis and Molekule. They can neutralize the toxins in the air, and they’ve been shown to improve air quality. It’s almost like it’s modifying the air quality. However, there is a caveat with that because, when mixing that type of device, it can produce some ozone when it reacts with the molecules in the air. So for someone like me with a history of lung sensitivity, those kinds of air filters would actually irritate my lungs. That’s not common with everybody, and those are really great air filters. So I’m not saying those are bad or wrong, but if you have any sensitivity to the lungs, you might be hypersensitive to the little bits of ozone they actually produce when they combine with the air molecules. I tend to use the ones that are just filtration, and they have HEPA filtration and a VOC filter. Those would be like Austin Air and IQAir. And Air Oasis and Molekule are the other types. They’re all good, and they’re all different. I have Austin Air—two here in the condo and five at the office—and I’ve just loved them.
Dr. Ben Weitz 46:48
On average, how long of a protocol does it take to remove mold? Is it reasonable to think that patients are going to get significant benefits in a month? Do they need three months? Does it take six months? Does it take a year?
Dr. Jill 47:04
Great question because people can be frustrated with the timeline. I usually say 6 to 18 months is kind of an average.
Dr. Ben Weitz 47:13
Of going through treatment that whole time.
Dr. Jill 47:14
Yes. And again, not that you can’t start to feel better in two months, but it’d be really unusual for someone to just turn around in a month or two. It takes some time, especially if you’ve been significantly impacted. Depending on the amount of time. I’ve seen that sometimes it takes two years. But not that you’re not making progress. It’s interesting; one of the things that I developed with Quicksilver is the Mold Detox Box. You can go on MoldDetoxBox.com to find out. Now, this is not for everybody. It’s an aggressive, great treatment. So if you are on the super, super sensitive side, you want to go really slow, [taking] products one by one, because it will detox.
Dr. Jill 47:51
It’s a 30-day kit. I didn’t do that because I thought that 30 days would cure everybody, but what we wanted to do was put everything you might need for the detox all in one package for 30 days. So I think about it that way, but I’ve had to clarify a lot because people are like, “Can I get well in 30 days?” And it’s like, ‘No.’ I mean, you might be able to get a significant handle on it, but it’s usually six months minimum and sometimes a lot longer.
Dr. Ben Weitz 48:16
A lot of times, when we’re using herbal protocols, we’ll rotate the herbs on a detox protocol for mold. If you have something after the first month that seems like it’s helping, do you just stay on the same protocol? How do you decide when to change things?
Dr. Jill 48:34
Again, history is so good because I’m always checking in. And I will tell them to start things individually. So start things one by one and see if there’s a reaction or a problem. And sometimes it’s a dose. Basically, with binders, you’re grabbing from the bile these toxins that are stored after they’re thrown from phase I to phase II into the bile from the liver, and you’re pulling them out through the stool. That’s a great way to detoxify. So if a patient is having trouble tolerating it, often we’ll have to go to a quarter teaspoon, an eighth of a teaspoon, or a pinch to get them to tolerate it. And what’s happening is that on the way out, as they’re pulling those toxins out of the body, they can kind of get re-exposed. So you have to factor that into how you dose. Sometimes you’re doing very small increments. It doesn’t mean the detox failed; it just means: Go slower. Herxheimer’s reactions are things that happen when you try to treat an infection. You have a massive die-off of an organism. I mean, you can also have a Herx reaction when you’re trying to detoxify.
Dr. Jill 49:30
I’m not a huge fan of pushing through those kinds of reactions. To me, there’s always this concept of mobilization of toxins and excretion. You’re mobilizing metals or toxins from mold or toxins from infection, and then you’re trying to get them out of the body through the urine, through the breath or lungs, through the sweat, through the stool—all these ways that we get them out of the body. And if you have a reaction, you’re probably mobilizing faster than you’re excreting. So then my job is to slow down the mobilization and increase the excretion. That can be done with things like infrared saunas, increased hydration or electrolytes, alkaline or mineral water, things like Epsom salt baths at night, dry brushing, castor oil packs, and even coffee enemas; those can all be helpful for excretion.
Dr. Ben Weitz 50:19
So a patient has a reaction, and they say, “Oh, I can’t take that.” The answer: It’s not necessarily that you can’t tolerate it; it’s just the dosage. So we need to dial way back on the dosage. Go with a very small amount and slowly bring it up.
Dr. Jill 50:36
Yes, there are three things. You could be allergic to something and not tolerate it, period. That will usually get worse over time instead of better. And some people just know. No matter how little curcumin I take, I don’t tolerate it. Number two, it could be dosage-dependent. So as you go very slow and very small and you’re mobilizing not too much for excretion, you’re tolerating, and then over time, you tolerate more. And number three, you could actually have a deficiency of NAD, so you’re not recycling glutathione. So every time you take it, it becomes oxidized and causes more toxicity. Or you could have a limit on B12 and be trying to take methylfolate, but it’s not working. So there really is an order of operations. And I find that even for myself, years ago, there were a lot of things I didn’t tolerate that I can tolerate now. That’s a sign that the toxic load is decreasing.
Dr. Ben Weitz 51:23
Cool. I think we really covered it. Do you have any final thoughts?
Dr. Jill 51:29
No, but thank you for coming on. Thank you for doing the interview. It was really fun to talk about mold. I think we really did cover a lot of the areas that people might have questions about with mold. If you have any questions, I’m going to be sure to link Dr. White’s site so you can know more about him and all the things I mentioned with the Mold Detox Box, my free blogs, and all that. We’ll make sure to link those as well, so you can stay tuned.
Dr. Ben Weitz 51:54
By the way, what is your website?
Dr. Jill 51:55
The website is just JillCarnahan.com, and then DrJillHealth.com is where you can find products, the Mold Detox Box, and that kind of thing.
Dr. Ben Weitz 52:05
Awesome. Thank you, Jill!
Dr. Jill 52:07
You’re so welcome! Thank you so much.
* These statements have not been evaluated by the Food and Drug Administration. The product mentioned in this article are not intended to diagnose, treat, cure, or prevent any disease. The information in this article is not intended to replace any recommendations or relationship with your physician. Please review references sited at end of article for scientific support of any claims made.