10 Warning Signs of Mold Toxicity

A good proportion of my practice has been directed to helping patients who are sensitive to mold and mycotoxin related illness. While often we can get confirmation of an increased body burden of mycotoxins (toxins, or secondary metabolites from mold) through urine testing, there are some warning signs or hints in the history and exam that often lead us discuss such testing.

1. History of becoming ill after exposure to mold in household.

Usually, the patient will describe a relatively slow, gradual onset of symptoms, that had eventually snowballed into a more rapid descent. It may have started as simply becoming more fatigued over several weeks to months, leading into more cognitive impairments and then neurological symptoms alongside functional impairments.

When questioned while giving their history though, the patient might give an example of renovations having been done and noting that there had been water damage that had to be remediated.

If the symptoms seemed to start after exposure to mold and water damage, especially if the water intrusion was slow, consistent, and had not been noticed for some time, I discuss with the patient the possibility of looking into mycotoxin levels.

2. Feeling better while away, and then feeling worse when at home.

Some patients will describe a situation where their cognitive impairments ("brain fog"), fatigue, and flu-like symptoms improve when they are away from home, and return when they are back at home.

Usually, it takes at least several days, more usually a couple of weeks of being away from a water-damaged environment for a patient who is sensitive to mycotoxins to feel better. But on return, symptoms tend to recur much more quickly.

Often, the improvements are attributed to a reduction in stress with a location change, as the opportunity to be away from home is usually associated with a vacation. This may be the case in the majority of the time, but the possibility of a water-damage type exposure is still important especially if the residence is an older building or has a known past history of water intrusion.

When patients report being worse in their home immediately and then have an immediate improvement when they are outdoors, we think less about mycotoxins and more about allergens.

3. New onset of allergic reactions to a wide variety of things without strong past history

Some patients develop what looks like allergic reactions despite not having a strong history of this. They may find that they begin reacting to foods, but not always the same foods, with bloating, rashes, or stomach upset. They may get hives readily, or get dermatographism (where they become sensitive to pressure and scratches, developing welts).

In some cases, mycotoxin exposure can increase the activation and sensitivity of mast cells, leading to a condition similar to mast cell activation syndrome, in which a type of immune cell that usually causes allergic symptoms becomes triggered much too readily.

Note that this is different from the next point, in that we are not talking about allergic reactions to mold, but an increase in allergy in general.

4. Allergies to mold spores

Mold spore allergies are more typical for how patients can become ill from exposure. This differs from how the toxins from mold affect other patients, but if someone has known allergies to mold, and they are showing asthmatic or sinusitis type symptoms more frequently and more often indoors, then in addition to considering air quality improvement and allergen reduction we might look for evidence of mycotoxins, particularly if there are unusual symptoms on top of the allergies.

5. Visible mold in the home

Not all patients in the household may be ill, in fact, this is rarely the case. Thus, often small amounts of mold might be overlooked. There may be the usual mildew in the washroom, but cracks in grout that allow moisture behind tiles might go unnoticed. Or, since only one person might be ill in the house, patches of mold on drywall, or in the basement might have been ignored.

If a patient is presenting with unusual symptoms and especially severe fatigue with impaired cognition, and lives in a home with visible mold, then looking into the possibility of mycotoxins would typically be very worthwhile.

6. Describing an "internal vibration" or "internal buzzing"

This is one of the "keynote" symptoms that typically makes me think of the possibility of mycotoxin induced illness. Patients will often describe an internal vibration sense or say that they are "buzzing inside". Others will typically not be able to feel any tremor, or vibration.

This seems to be most likely associated with either an autonomic or possibly sensory neuropathy that is not following typical distribution patterns, or a problem with the brain and how it is filtering data (central sensitivity)). There may be an heightened reactivity or startle response, but this is not necessarily associated with anxiety.

7. Impairments in working memory

Working memory helps maintain attention and focus on tasks by holding relevant information temporarily. Impairments can lead to difficulties in maintaining attention, resulting in distractibility and decreased task performance. Impairments can make it harder to learn new information and retain it over time.

In occupational settings, individuals may struggle with tasks that require multitasking, prioritizing, and remembering instructions. Of note, the patient may have been at the same job for a decade, but suddenly finds it feeling like they are struggling with the same work.

While there are many causes for poor working memory, if it is new, consistent, and an unusual presentation (eg not associated with age, other psychiatric diagnoses such as ADD/ADHD), insomnia, advancing age) and associated with peripheral neurologic complaints (such as POTS, dizziness, or numbness/tingling) then mycotoxins might be a possibility worth investigating.

8. Dysautonomia

Dysautonomia refers to a dysfunction of the autonomic nervous system, which controls automatic bodily functions such as heart rate, blood pressure, digestion, and temperature regulation.

Most commonly, we might see orthostatic intolerance or POTS. The patient has a rapid heart-rate and dizziness when standing from a supine position, or if they have been standing for a period of time.

There is often an inability to sweat, even with exercise. Palpitations are the norm, as is a sensation of "air hunger" or shortness of breath.

Less commonly in this subset of patients, we might see autonomic function of the gut affected, and the patient describes constipation or diarrhea.

9. A new onset anxiety, occasionally depression, that is accompanied with a background of irritability

Similar to how infections might lead to some mental health symptoms mycotoxins might lead to an increase in inflammation that can lead to anxiety or depression. And similarly to the infection example, I have found that often there is a background of irritability that patients find unusual for their normal demeanor.

10. A patient has not been responding to chronic infection treatment, nor symptomatic management

In some cases of chronic lyme, lyme-like conditions, or post-treatment lyme disease syndrome, patients do not respond to either antibiotic treatment of infection, or symptomatic management of central sensitivity, or symptomatic management of alternate or secondary diagnoses (neuropathic pain, anxiety, depression).

There seems to be a higher likelihood within the patients with the chronic infections or post infection syndromes who have elevated body burdens of mycotoxins and problems with excreting them.

If a patient is not responding to treatment, and has any of the above 9 examples of hints related to mycotoxin illness, investigating the body burden may be helpful.