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REPLAY: Recognising Mould-related Illness with Dr. Michelle Woolhouse and Dr. Sandeep Gupta

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REPLAY: Recognising Mould-related Illness with Dr. Michelle Woolhouse and Dr. Sandeep Gupta

The World Health Organisation has suggested that between 10-50% of Australian buildings may be adversely impacted by the presence of mould. Consequently, mould-related illness or Chronic Inflammatory Respiratory Syndrome (CIRS) is something that practitioners are seeing an increase of in clinic – and we are aware of now more than ever on the back of last year's floods. 

In this week's podcast replay, Dr. Michelle Woolhouse talks with Dr. Sandeep Gupta, integrative GP and leading expert in Australia on mould and biotoxin illness to learn more about how to recognise and support our clients affected by water damaged buildings. 

Covered in this episode

[00:34] Welcoming Dr. Sandeep Gupta
[02:05] What is mould and when does it become a problem?
[05:11] Mould illness is multifactorial
[06:48] Strategic questions surrounding symptoms and water damage
[08:22] The complex symptoms of mould-related illness
[13:32] How infections prime susceptibility to mould illness
[15:04] Mould outside the home can also affect us
[16:52] Localised vs systematic responses to mould
[18:18] Additional risk factors 
[21:49] How to prevent mould-related illness
[25:09] The importance of simple and clear information on mould illness
[27:20] Obtaining a diagnosis: options for testing and  why case history is crucial
[35:41] Key treatment protocols
[43:17] Thanking Sandeep and final remarks

Key takeaways 

  • Mould is a multicellular fungal organism. Yeast is a single-celled organism - candida albicans is a common yeast. Mushrooms are also fungal organisms. 
  • When referring to a structure with a mould problem, there may be a number of biotoxins involved including bacterial volatile organic compounds (VOCs), microbial VOC (MVOCs), parasites, actinomyces and others. 
  • Mould is common within buildings but becomes a problem when it exceeds the tolerance of an individual’s immune system. 
  • Most people develop localised symptoms in response to biotoxins including a sore throat, runny nose, congested sinuses and sneezing. 
  • Those people who are more sensitive to mould are susceptible to a whole-body inflammatory response and may experience symptoms including fatigue, anxiety, insomnia, urticaria and digestive symptoms. 
  • While there has been a considerable body of evidence relating to mould-related illness, it has not reached conventional medicine, however, the NHMRC has provided a grant for further study into biotoxin-related illness. 
  • To identify mould-related illness, a comprehensive case history is essential. Time of onset, exposure to certain environments, reprieve from symptoms when on holiday, recent viral infection or cytokine-priming event may help to identify a patient with biotoxin-related illness. 
  • Microbes including mould will grow in a building that has been exposed to water for 48 hours or more – defining the building as a water damaged building. 
  • A cytokine-priming event such as viral infection may prompt susceptibility biotoxin-related illness upon exposure to a biotoxin. Emotional trauma, pregnancy and operations may also trigger inflammation increasing susceptibility. 
  • Exposure to a water damaged building for longer than 10 minutes a day can lead to biotoxin-related illness for susceptible patients. 
  • To limit mould in a building:  
    • Monitor building humidity. Humidity is ideal between 45-55%. Dehumidifiers may be required to maintain this. 
    • Carpet and fabric furnishings (curtains) are easily contaminated by mould. 
    • Ensure bathrooms have exhaust fans that exhaust external to the building. 
    • Kitchen rangehoods should exhaust to the external of the building and should be used. 
    • If there is a water intrusion event, remediation is required, generally through the use of high-powered dehumidifiers. 
  • It is essential to educate patients on mould-related illness (https://www.moldillnessmadesimple.com/)  
  • Diagnosis can be made based on case history and should be the focus of clinical identification. 
  • Testing for Mould-related illness:  
    • Urinary mycotoxin testing for mould-related illness is not well-supported in the literature. The test can identify whether someone is eliminating mould toxins, however the presence of mould (ochratoxin and mycophenolic acid) does not indicate illness as all people are exposed to mould. If no mould present, may suggest lack of elimination. High or low levels may be of interest. 
    • Visual contrast sensitivity is a screening test indicating neuroinflammation. Results should improve with treatment. 
    • VIP, leptin and copeptin testing are indirect markers for CIRS. 
    • VEGF (vascular endothelial growth factor) is often low in mould-illness patients. 
    • C4A, TGF-beta and MMP-9 generally increase with CIRS 
    • Organic Acids Testing can identify auxiliary problems associated with mould-related illness including bacterial or clostridium infection, elevated oxalates, mitochondrial function, nutrient sufficiency and markers of chemical toxicity. 
  • Treatment includes ensuring elimination through bowel movements and excretory pathways, sleep and digestive support. 
  • Binder supplements are used to bind to mycotoxins excreted via the bile to prevent enterohepatic recirculation and promote faecal excretion. Colestyramine works well, activated charcoal, bentonite clay, zeolite, chitosan etc. For more severe and acute illness, medicinal binders may be required. 
  • Reishi mushrooms have glucans to support the immune response and are antifungal. Pau d’arco and goldenseal may be of benefit also. 
  • Bile production support is important through the use of cholagogues including turmeric, globe artichoke and antioxidants such as resveratrol. 

Resources Discussed

Dr. Sandeep Gupta
Lotus Holistic Medicine
Lotus Institute of Holistic Health
Dr. Gupta's course: Mould Illness Made Simple
Australian Chronic Infectious and Inflammatory Diseases Society
International Society for Acquired Environmental Illness


Michelle: This is FX Medicine, bringing you the latest in evidence-based, integrative, functional, and complementary medicine. I'm Dr. Michelle Woolhouse. 

The recent floods in Northern New South Wales and Queensland have been devastating. The extensive water damage to both commercial and private property is not only associated with economic costs, but also mental, physical, and emotional costs as well, affecting the health of both the individual and the whole community. 

While the aftermath of natural disasters can sometimes be difficult to predict, we do know one major issue associated wherever water damage occurs, and that is rising damp and mould. There has been some great discussions happening in the community around this subject already to help people become aware of the potential issues, and most importantly, what can be done to help the situation. 

Joining us today is Dr. Sandeep Gupta, one of my dear friends and a fellow integrative GP, and he's one of Australia's leading experts on mould and biotoxin illness. In addition to his specialty in nutritional and environmental medicine, he holds certification in biotoxin illness and is a board member of both the Australian Chronic Infectious and Inflammatory Diseases Society and also the International Society for Acquired Environmental Illness

Welcome to FX Medicine, Sandeep. Thanks for being with us today.

Sandeep: You're welcome, Michelle. Excited to chat with you today.

Michelle: So, Sandeep, I wanted to start with the basics. Tell us what mould is, and when does mould become a problem?

Sandeep: Okay, so mould is a type of fungal organism that's multicellular. So single-celled fungus is what we call yeast, and yeasts include Candida albicans which is known quite commonly, but also a number of other organisms. They can also, by the way, grow in damp buildings but they're more known for causing infections in humans. 

So mould includes genuses, such as aspergillus, which is known to cause a variety of conditions referred to as aspergillosis, and also Penicillium, which is where the antibiotic penicillin came from. The fungal organisms mould are not so complex that they've actually become mushrooms, though. So mushrooms are the third type of fungal organisms. 

We talk about mould for shorthand, but really the problem is damp buildings, and it's actually not just mould, it's a whole toxic super organisms which include bacteria, VOCs, which stands for volatile organic compounds, microbial VOCs, or we MVOCs for short, parasites, actinomyces, etc., etc. Just to throw that one in, it's actually not just mould, but we do refer to it as mould in shorthand. 

So it is normal to have a certain amount of mould in an environment, particularly in outdoor environments, but it simply becomes a problem when it exceeds the threshold of any individual's capability to tolerate. And so that's individual, so I'm not going to give you a certain spore count or something like that because it doesn't exist. It's individual. And so...

Michelle: So some people are more sensitive to mould than other people. Yeah?

Sandeep: Yeah, that's right. That's what I was just going to say, is that you may tolerate a house that has a high level of mould for some reason. You may have very good genetics and very good gut health, and so on. While I, on the other hand, may only tolerate a mould counter one-quarter as much before I start getting some type of symptoms. I'll talk about the different types of symptoms and the different types of presentations, but it could be allergic, to start with, or it could be more like a mild infection that I start developing. 

You can hear I've got a little bit of a sinus infection going on at the moment, and that was actually from staying in a mouldy residence down in Byron Bay. So, that is the thing that I start to develop, but someone else may not develop that until a much, much higher level of mould is in a place. So, there's definitely a significant individual variability in the sensitivity to it.

Michelle: And so how does it cause illness? What's the actual mechanism of it, or is multifactorial?

Sandeep: Multifactorial. So there's different types. So if you have a property or a building that is damp enough, almost every person in there will develop some symptoms. However, the majority of people tend to get more localised symptoms, so that would be things like a sore throat, runny nose, congested sinuses, sneezing, etc. And generally, those symptoms are related to allergy or, in some cases, it can be related to a mild infection. 
Now, there's a small proportion of the population who are susceptible to getting a whole-body inflammatory process, where it doesn't just affect their nasal passages and throat and localised area, but it actually affects the whole body. And rather than just having those localised symptoms, they also get things like fatigue, anxiety, insomnia, skin rashes, digestive symptoms, etc. The list goes on and on. And that list of symptoms is probably enough to make most GPs go and hide under their chair and start pulling out the prescription book for antidepressants within seconds.

Michelle: Yeah, exactly.

Sandeep: But it's not depression. It's actually an inflammatory reaction to microbes in a water-damaged building. And it is a real condition that needs to be recognised.

Michelle: And so why is there so much controversy about it? Is it just because it's new on the radar? Is it because we've got issues with water damp buildings? Is it the building code? Why is it so controversial?

Sandeep: Well, it still hasn't made its way into conventional medicine. And even though there are quite a number of papers, what we haven't got at this point, is the classic lancet study or the classic BMJ or New England Journal of Medicine study that many of the specialists like to see before they declare something as being real. We still generally got articles which are in slightly lesser-known journals, and it's considered by many expert bodies to still be quite new and controversial. 

So, it takes a certain amount of time for something to break into the medical world, and some people say 20 years or so. And yeah, we're just still not there yet in terms of the worldwide literature. And we really are hoping that Australia is going to make a difference with this. We've recently been basically given a grant by NHMRC in a study run by Macquarie University and Professor Gilles Guillemin, including myself and Dr. Janet Kim as the main clinicians to run a study into biotoxin-related illness, particularly related to mould in Australia. And, yeah, we hope that the results of that may help the literature worldwide to be more solid and robust.

Michelle: That's fantastic, Sandeep. So tell us about what we need to look out for. You mentioned a couple of things like fatigue, anxiety, insomnia, skin rashes, digestive symptoms. That can be such across the board. Obviously, if somebody has been in the Northern Rivers or there's been flood effect, that gives us a clue. Is there something that really sticks out or is there some questions that we really need to ask everybody presenting with these things just to get us thinking about mould being a potential reason for why there's so much inflammation going on in that particular person's body?

Sandeep: Great question. The answer is not that simple but...

Michelle: That's okay. We can...Let's break it down.

Sandeep: Let's go to the flood part first. 

Michelle: Okay.

Sandeep: So, let's say there is a patient who you know has been in a flood situation. I think the first thing is to find out what was the extent of flood damage. So, if someone actually had water come into their home, like literally, they had water inside their house, then...

Michelle: Some people had meters of water.

Sandeep: Yeah, that's right. So, if you get that history, then the thing to know is they are in a water-damaged building. They're in a massively contaminated build by definition, okay?

Michelle: Yeah.

Sandeep: There's no way around that. So the first thing is just having that understanding. So, if you get water into the substance of a building for 48 hours or more, that is, by definition, a water-damaged building, and by definition, there is going to be microbes growing there, such as mould and bacteria, and so on. So, therefore, you can already add that bit of understanding into your assessment that that person is living in a water-damaged building. 

Now as to the symptoms, so then there's the timing of symptoms, of course. So, mapping out when the flood happened, and has there been new symptoms or has there been a change in symptoms that corresponds to the timing? And so, for instance, I have one friend in that Northern Rivers area and started developing regular respiratory tract infections, lower mood, more fatigue, all straight after the flood and the water came into the house. So, that's classic. That would be a classic example that they are in a water-damaged building and they're developing a reactivity because the symptoms are corresponding to the timing. So that's a really important way, is just to tease out. 

So when you start asking a patient about mould, one of the key things to know is just asking them straightly and plainly, do you have mould in your home? Generally, it doesn't give you a useful answer, the reason being that most people just don't have enough understanding of this problem and they see it as more of a cosmetic issue, and many people will almost interpret that as a statement of cleanliness that their cleanliness is being questioned and they will quite quickly say, "No, of course, I do not have mould in my home. I clean my home."

Michelle: Yeah. It's true.

Sandeep: And so there's just a gap of understanding there. And so you need to get a bit more sophisticated in asking, for instance, are there musty smells in the home? Have there been any episodes of flooding or leaking? So, for instance, leaking could be from the roof, it could be from white goods such as washing machines, fridges, etc. Has there been any occupant behaviour-related issues? So, for instance, running a bath or sink over, which is very common, actually, and various other... You can get into some other fine points, but they would be some things to ask about if it's not in the setting of a flood. And do they notice any difference when they go away from the home? Did they notice any difference when they moved into the home in terms of their symptoms? 

And sometimes when you have people who have been unwell for a long period of time and you start asking them this, there will actually be a light bulb moment where they go, "Oh, hang on. Okay. I developed chronic fatigue syndrome in 1984," let's say, "And hang on, that house I was living in at that time, that did have a leak," or, "That did have musty smells in it." So, just asking the questions is very powerful. Don't underrate that because sometimes you'll just put on a light bulb for a client. Sometimes you'll unearth that there has been a correlation to timing. 

Now, in some cases, the correlation to timing is not as clear for whatever reason. And I can go into that, but sometimes there's not a direct... Sometimes someone can be living in a building for years and they're not necessarily reacting to it until they get what we call a “cytokine priming event.” Now, that could be an infection. such as Epstein-Barr virus, Kawasaki, tick bite, etc., or even a big mould event itself could be worse.

Michelle: And what about COVID? What about a viral infection like COVID? Could that be...?

Sandeep: Yeah. Most likely yes. That hasn't been described in the literature from Richie Shoemaker because it wasn't around then.

Michelle: Of course.

Sandeep: But yeah, I'm quite sure that would be part of it, yeah, getting COVID. I haven't actually seen that yet, but I'm sure that is the case, actually. So Doctor Shoemaker was the doctor I studied with initially when I learned about mould-related illnesses is looking at transcriptomic testing, and he has found that people with long-COVID generally are reacting to mould.

Michelle: Right.

Sandeep: Yeah. So that's very interesting.

Michelle: What a triple whammy, double whammy.

Sandeep: Yeah. That's right. So sometimes they can be living in a home. They can be exposed for a long period of time and until that event happens. So that's also something to ask for in the history. Have they had a bad viral illness or tick bite or any big inflammatory illness along the way while they were living in that home or working in that particular workplace? So that's the history part.

Michelle: Yeah. So, they don't necessarily have to be living in a house. It could be their place of work. It could be a flooded shop and their home may have been immune from something, so they're not really thinking about that or they may not even know the history of that, which adds to the mystery in some ways.

Sandeep: Yes, exactly. It could even be, let's say they go into a room regularly for 20 to half an hour a day, they go into a meeting room or something. It could even be that. So anything more than about 5, 10 minutes a day could be significant in terms of turning on their inflammatory pathways.

Michelle: And I guess the other clue that I was taught about was to see whether their symptoms got better when they went away on holidays. For example, I remember a patient who went away to Central Australia, so in the desert, which is probably one of the most unmouldy places, and went camping, and found her symptoms were much better. And that was the clincher for us to go down that pathway. Is there other clues like that that you've heard? You've probably interviewed hundreds if not thousands of people with mould with clues like that that can sometimes prick your ears up.

Sandeep: Yes. Yeah, I do find that one is quite variable because, of course, the other side of that is generally when people go on holiday, they go and stay in a hotel or Airbnb or apartment or whatever, and guess what? The majority of buildings are water-damaged in Australia. So, therefore, they may not notice that type of pattern. And camping is definitely the best.

Michelle: One question that I've always had, a lot of people have that classic mould. You've got those kids that have got the runny nose and they constantly got that upper respiratory tract or even lower respiratory tract infection. Is that always the case, or do some people not get the respiratory type symptoms and come in with the more whole body anxiety, insomnia, aches and pains, fatigue, etc., what we discussed before? Can you have one without the other?

Sandeep: Yeah, yeah, you can. It doesn't necessarily...Yes. So you're not talking about a localised problem here. So the mould is coming in through the respiratory tract, but we are not talking so much about... Some people don't have a localised response. They have a systemic response. They may not have any respiratory symptoms whatsoever.

Michelle: Right. So that's important for all of us to know that it's not one and the same. It's not like a linear response. It can be completely different in different people.

Sandeep: Exactly, exactly. That's a really good point. It's not linear at all. It's individual. And some people could have only a mild amount of contamination in their building and they have a massive response because it's triggered a certain genetic pathway, and other people could have a massive exposure and only have a relatively mild response because of their individual genetics and bodily health.

Michelle: And along with things like the cytokine storm that you spoke about with the viral infections or other related infections, is there other causes of that? What about things like PTSD or other reasons for stressor, medications, for example? Is there any other risk factors that can trigger those events?

Sandeep: I suspect so based on my history taking through the years. Dr. Shoemaker hasn't described them, but the thing is there's only a limited amount of things you can actually study. And generally speaking, a lot of the time you take a history and you will notice that people's symptoms have really started after significant emotional trauma. And so we know there is an amateury aspect to that from various studies, including the one by Becker, which is a medical student from Harvard who published a really interesting paper a few years back where she also found that it activated or had an epigenetic effect on a whole bunch of genes. So I think trauma is highly likely. What was the other one you mentioned?

Michelle: Oh, just things like medications or...

Sandeep: Medications.

Michelle: Yeah, or operations, for example. Some other stressor...

Sandeep: Yeah, operations. Yes, definitely. I don't know. Yeah. I don't know about medications. It's possible. I think if someone had an inflammatory response to a medication, I think then, yes, that would be... Operations definitely are a stress. There's no doubt about it. Motherhood, going through pregnancy, is a stress, Oscar Serrallach says that's inflammatory in and of itself.

Michelle: Yeah, that's right.

Sandeep: So there's a whole series of life events that are potentially significant. And that's one big part of the history is teasing out the onset of different symptoms and how it relates to life events, but there appears to be a causal relationship to all those events and onset of illness.

Michelle: Sandeep, what don't we know about mould illness? I guess what concerns you the most about these recent events? Is it our lack of awareness? Is it the potential long-term effects? What don't we know and what do you feel like we need to know?

Sandeep: Yeah. I think potential long-term effects is very important because potentially if you look at the various genetic pathways that can get activated, there is concern about risk of triggering coronary artery disease. There is concern about triggering cancer in some people. However, this has not been documented at this point, and so it's only a possibility at this point. So that would definitely be an area of research, which is quite important to look at long-term effects and what risks there are. 

There's also quite possibly a risk of Alzheimer's that comes with long-term mould exposure, which has been documented by Professor Dale Bredesen from California. And so, there can be all types of long-term effects, I believe. I think autoimmune illness is another important one that needs to be looked at. I know Nicole Bijlsma, who's the head building biologist in Australia and educator believes that there is a very strong connection there with autoimmune conditions such as multiple sclerosis. Literature is starting to show a connection there.

Michelle: Wow, it's very multifactorial, isn't it? It's multilayered. So in many ways, we often talk about prevention as the ultimate treatment. Is there ways in which we can protect ourselves from potential issues with mould? Obviously, you've alluded to the issue that we've got some genetic susceptibility, but even if you were genetically susceptible, is there things that we can do to help protect ourselves from developing that inflammatory response apart from, obviously, not living and working in...?

Sandeep: Oh, absolutely.

Michelle: Yeah. So what are the things that we can look at to support the body in terms of prevention?

Sandeep: Well, I would go more to talking about the house, to be honest.

Michelle: Yeah, great. Let's talk about...

Sandeep: I would be thinking in terms of preventing mould-related illness, well, some of the key things are keeping an eye on the humidity in your home and make sure that that's generally staying in the 45% to 55% range. If not, you need to run dehumidifiers. Number two, generally choose a place that doesn't have carpet or that large fabric curtains because they're going to be materials which are very easily contaminated. Number three, exhaust fans in all the bathrooms that exhaust outside of the home, range hoods on the cooktop that exhaust outside the home. There's a whole range of things, but basically, awareness is the key. 

And then the other huge thing is if you have a water intrusion event, so let's say one of the kids runs the bath over, you need to know that there's an emergency protocol for that, which is you need to know of a remediator who can come in and run some very high-powered dehumidifiers for a couple of days and dry that out. And so, it's knowledge.

Michelle: Yeah, exactly. I mean, this is what this podcast is all about is to give people knowledge. I mean, obviously, people up in the Northern Rivers have been massively affected. One of the questions that I have had in the sense of like we know that mould is an extension and it extends beyond its boundaries, and sometimes you can't even see it and it could be in a wall that you don't even know that's there. So it has got this fear factor to it. If you are really aware of your household, could your neighbours' mould problem affect you?

Sandeep: If you are extremely sensitive and if your neighbour's contamination problem is massive, like literally, their whole place is just an absolute write-off, then that's possible. But I haven't actually encountered that in practice but there's a possibility that that could be an issue if someone had like... For instance, you lived in Mullumbimby and your neighbours basically had water all through your home and you've got your house totally remediated. Some people have to have the whole house rebuilt, and then your neighbours on both sides still got massively contaminated buildings, I could see that being an issue for some people.

Michelle: Yeah. So once we have established somebody that's got a mould-related issue, what do we do? What's our first port of call?

Sandeep: The first port of call is education, explaining the nature of the illness, explaining that there is a treatment. You can recover from this. This is not the end. So realising that your client is going to have a massive amount of overwhelm and fear. And so you need to explain to them that there is a well-documented treatment protocol. This can be overcome, and there is expertise in Australia that is going to be sufficient for them to overcome this problem. I do have an online course, and pardon me for plugging it, but I do...

Michelle: No, not at all.

Sandeep: I do believe that it's extremely helpful because what it does is go through everything very simply. So we call it Mould Illness Made Simple because a lot of the information out there on the internet is extremely complicated and overwhelming and actually incorrect, some of it. 

So, getting your client to get simple and clear information that guides them through the process of identifying whether they've got a mould-related illness, working out whether their building has a major problem or not, and thirdly, going through the treatment protocol themselves. And then lastly, recovering from the trauma of mould because it in and of itself is an emotional trauma having gone through a mould situation, and then finding a safe home for themselves, assuming the home is the problem, and being able to maintain that free of home for future. So we take them all the way through that.

Michelle: Fantastic. Sounds like a great initiative.

Sandeep: And I believe at the end of it, people feel a lot less overwhelmed and a lot more clear and confident, which is one of the keys. So that's to start off with, I would say.

Michelle: Yeah. Fantastic.

Sandeep: That's right.

Michelle: Well, that's a great initiative to simplify it and actually give people hope. This is the most important things and people can then go through a stepwise situation. But as practitioners, what's the best way to diagnose that or to confirm that? Can we diagnose it just on history and examination, or is there certain investigations that you like to do that can confirm you moving into the next treatment protocol?

Sandeep: Yeah. So after education, the next thing is discussing with them how clear they are about this or how confident they are on this diagnosis. And, yes, you can diagnose it on history in many cases. 
So let's say the case of patient X who's living in Mullumbimby or Lismore, and had a little bit of fatigue but then after the floods, they had water coming into their house and then they started developing much more severe fatigue and depression and joint pains. Well, there you go. Done. You actually don't need a test to diagnose that. 

So you can do tests. Now, there's a big fashion to just go and run a urinary mycotoxin test. I want to talk a little bit about that.

Michelle: Yes. Let’s do that.

Sandeep: The urinary mycotoxin test only tells you what the client is urinating at the time of the test. That is all it tells you. Now, if the person is urinating nothing, that does not mean they don't have a mould-related problem. If they are urinating out some small amount of mould toxins, let's say a little bit of ochratoxin, that does not necessarily mean they have a mould problem. So, we've got to put a stop to this nonsense about let's just run a urinary mycotoxin test and then you say to them, "Okay, there you go. You've got mould." That is nonsense and unscientific and we've got to stop doing that. We are doctors and we are clinicians. We take a history.

Michelle: Totally.

Sandeep: We don't... That's right. Urinary mycotoxin test is not well-validated in the literature. Now, I'm not also taking the other extreme that it tells you nothing. You can do it. But what I'm saying is that your history should be the key. You should be able to tell from your history once you become adept to this area that whether or whether not, and I guided you through how some of the questions that you'd ask, whether or whether not your client is likely to be suffering from a mould-related illness. Now that could be allergy-related, that could be infection-related, that could be a whole-body inflammatory process, which could be either what we call CIRS or mast cell activation syndrome, the two different flavours of it. 

So, based on the history, you then can do some tests to answer specific questions. They do not replace the history and they do not answer the question, “Is there mould?” Okay? So if you can't get that answer through your history, you need to go back and think about the questions you're asking, okay? So then doing a urinary mycotoxin test, in my opinion, is to answer the question, “How well is this patient excreting via the urinary route?”

Michelle: So does that mean if somebody is excreting large amounts, they're actually doing a good job, and the ones that are excreting small amounts could actually be holding onto their mould and actually having poor detoxification? Is that...?

Sandeep: Exactly. Exactly. You want to see a lot of moulds.

Michelle: Yeah.

Sandeep: Yes, exactly. You want to see...

Michelle: So it's actually the opposite.

Sandeep: That's right. So when people say, "Oh, there you go, you've got some mould on your urinary mycotoxin test," it's more like that's a good sign that you're able to detox. The one that shows.. Probably when people show up zero, that's also abnormal.

Michelle: A warning sign. Yeah.

Sandeep: And that's probably more the concern, that's more the concern. So, a small amount of ochratoxin and/or mycophenolic acid is probably within the range of normal. And yeah, so you should see a little bit coming through through normal exposure through food and just general day-to-day exposure.

Michelle: Yes, sure.

Sandeep: So if you see nothing, that's probably an important sign. And if you see high levels, particularly of trichothecenes in someone, well, that's significant as well. But a lot of results you'll see just show a little bit of ochratoxin and a little bit of mycophenolic acid. This is if you're using Great Plains Lab. Real-time laboratory is slightly different. And I'm not sure that's particularly predictive at all when you just see that small amount of ochratoxin, etc. I think that's probably normal.

Michelle: So is there a better test to do? Do you do visual contrasting sensitivity testing? Is there anything to guide you that gives you that “Right, yeah, definitely on the right path,” or do you do an ERMI at home?

Sandeep: Visual contrast sensitivity is more of a progress marker. It's also a screening test. It's not specific for mould. It's just a marker of neuroinflammation, in general, but you want to see that that's improving as you go along. You can do testing for VIP and leptin and something called copeptin, which are also indirect markers of CIRS, yeah, which are available in Australia through laboratories, and that appears to be useful. You can also now do VEGF or vascular endothelial growth factor which is also a useful marker, which generally will be low in mould patients. However, none of those markers individually if they're normal excluded.

Michelle: Yes.

Sandeep: But if you see, let's say, three out of four of those markers are abnormal, that's pretty much it.

Michelle: And are they all low or some high and some low?

Sandeep: So the VIP and VEGF generally go low, but they actually all can go both ways. You can get a high level in some clients. Then the leptin, which I mentioned, generally will go high, particularly in those with weight gain. And sorry, copeptin also generally will go low. We are also looking at just going back to having the U.S. labs available where we can run C4A and TGF-beta and MMP-9. Now, those three markers generally all go high in CIRS, chronic inflammatory response syndrome. So those are also useful. 

And the other thing that can be useful is the organic acid testing. Now, the reason for that is to ask about auxiliary problems. So, A, is there a mould-related infection? Now, that's the first page of the Great Plains organic acid test will help with answering that. It's not 100% specific, but it's pretty useful. 

Then secondly, is there also bacteria and clostridium associated with this? Is there elevated oxalates? Now, some people like Emily Givler, whose work I do recommend, is saying that oxalates are like a secondary mycotoxin. And so if someone has got high oxalates, you need to address that as well. 

And then mitochondrial function, is that being affected significantly? Because that is also an outcome of mould-related illness. And then nutrient sufficiency. So you often will see significant B vitamin deficiencies, particularly when you have hyperoxaluria, or high oxides. And then you'll also often see glutathione-related problems, abnormalities in mould-related illness. So that's quite a useful test just to pick up associated problems. And then there's also some markers of chemical toxicity.

Michelle: Yeah, that's right. So you're looking at... All right. So we've got a body that's under enormous amounts of stress. It's a chronic inflammatory cycle. What else is going on? How do we build the body up? How do we support all of the auxiliary systems so that we can work towards healing the body long-term? And so you're using some of these tests not only for diagnostic purposes but also to help shape your understanding of where this person needs to concentrate their attention to see them get better.

Sandeep: Yes, exactly. Yes.

Michelle: Perfect. And so, in terms of treatment protocol, and I love the sound of your online course, and thanks for sharing because that's really important information for people because I just love that educational awareness side of things because really, and let's face it, education just almost can be the relieving points better than an antidepressant in most cases I find. 

But what do we do in terms of treatment? I know eradication is really important and obviously, everybody is individualised, but is there some key features that you've found to be probably the most effective? How do we start off? Is there medications? Is there nutrition?

Sandeep: Yes. So one of the key things is firstly making sure that the client is passing bowel motions regularly and their excretory pathways are open and that they're getting reasonable amounts of sleep and that their digestion is working. That's the starting point because you don't want to give binders to anyone who is very constipated. 

So then the next step is if they're not constipated, etc., we will start some binder medications or supplements. And so, the idea with the binder or bile acid-binding resin is the technical name, is to bind onto any mycotoxins which have been excreted in the bile so that they don't undergo what we call enterohepatic recirculation, and they're actually excreted through the faecal route. 

So, the classic thing was colestyramine, which is a classic bile acid-binding resin which everyone knows binds onto the cholesterol and other aspects of the bile and pulls them out of the body. Well, it turns out that they actually... Sorry, colestyramine actually binds onto mycotoxins as well. Dr. Shoemaker discovered this by accident in a client who was suffering with a blue-green algae-related condition who came in with a whole-body inflammatory process, including diarrhoea. So he prescribed the colestyramine to help the diarrhoea but, in fact, it ended up helping with every symptom. So he found that out by accident. And we since know that there's a range of other compounds, colesevelam hydrochloride in the medical world, and then you've got activated charcoal, bentonite clay, zeolite, chitosan, etc., etc. 

So, natural binders also appear to have some effect, even though it does tend to be milder and slower, but that's... It just depends on how severe. The more severe and acute it is, the more you may consider using the medical or pharmaceutical binders. And yeah, if it's more mild and ongoing, I would tend to more use the... 

Natural binders also depends on the sensitivity of the client. If your client tends to react to a lot of pharmaceuticals, I wouldn't recommend using them then, and I would... If they're an extremely sensitive person, just start with a tiny amount of something like bentonite clay.

Michelle: So something gentle, what you'd...

Sandeep: Something gentle.

Michelle: More of a long-term view of getting rid of it over the long-term.

Sandeep: That's right. So if you've got infection or whatever it might be, you're almost always going to have mycotoxins involved. So that's the first part. Now, if there is mould infection present, you want to have some herbal treatment generally to start with. I actually use reishi mushroom quite a lot, which is paradoxical.

Michelle: Isn't it? That's the amazing thing about fungus. They are so paradoxical.

Sandeep: Yeah. There's a very good talk on the internet called How Mushrooms Can Save the World. So there is... I'm not saying that the whole other fungal kingdom is all harmful. There's actually very powerful and amazing properties. And so medicinal mushrooms, I'm a big fan of. They've got glucans and various other compounds, which greatly help the immune system. And so reishi mushroom, rather, in general, seems to be very anti-fungal. Can also use pau d'arco and goldenseal, etc. I generally recommend starting with the herbal route and only with someone who has very severe fungal infection. So, for instance, the aspergillus serology is positive. You may want to look at using one of the conazoles, if you like the azole fungals like Itraconazole. But generally speaking, yeah, I would start with fungals.

And then the next thing is you want to support the detoxification system of the body which is often affected, because if you are using a binder but the person is not actually creating any bile, well, there's nothing for the binder to bind onto. So, therefore, using what we call cholagogues or cholagogue herbs, which includes tumeric, and St. Mary’s thistle, and globe artichoke, etc., globe artichoke, rather, not bile artichoke, and will all be...That sounded like a good name for it. 

So, they're all things that can be useful as well. And then antioxidants are often needed as well. So we talk about turmeric. Curcumin extract is often very useful, also resveratrol. They can be extremely helpful. So you can see that already here we're creating a treatment protocol, which is pretty comprehensive.

Michelle: And holistic and looking at all the different factors of the body as well. So, well, it's just so much to it, but it comes back to that holistic principles of looking at the patient in front of you and really listening and taking an in-depth history, but also understanding how they feel.

Sandeep: Yes, absolutely, and understanding their tolerance level as well. So, you may get a big strong man, and not being sexist here, but there is a big difference in terms of how males and females seem to react is my observation. Some guys just have virtually zero sensitivity and so that person you might just start on a full dose of colestyramine, whereas on the other hand, you might find, particularly a female who's very, very sensitive, underweight and has mast cell activation. You may find that even just a sprinkle or a toothpick amount of zeolite or bentonite clay a day is all that can be tolerated. So there is a big difference there.

Michelle: Wow, Sandeep, there's so much to it, but just so much information and it's just wonderful to have you as one of our leading experts in Australia, really. Thank you so much for being with us today and discuss this incredibly timely subject of mould and all of the effects that it have on physical and mental health, as well as looking out for symptoms and really that key point of taking that incredibly detailed history and just having the time to ask those questions can be quite paramount. So thank you so much for joining us today.

Sandeep: You're welcome, Michelle. It's been nice chatting. And in closing, I'll just add that one of my textbooks that I had when I was a medical student, I think it was just called Clinical Medicine by Talley and O'Connor. You remember that book?

Michelle: Oh, yeah. Talley, of course. Yeah.

Sandeep: Yeah, yeah. So the statement right at the start of it said, "More is missed by not looking than not knowing." And I think that's a really key principle here in environmental medicine. If you take the time to ask the questions, you'll be surprised at what you can uncover sometimes.

Michelle: Yeah. Fantastic. And it's so great to have you as a resource that we can call upon, and we'll have all of your information and website and where people can access that information on the FX Medicine website.

Sandeep: Great. Good talking. And, yeah, well, I hope this has been a benefit to people.

Michelle: Thank you everyone for listening today. Don't forget that you can find all the show notes, transcripts, and other resources from today's episode on the FX Medicine website. I'm Dr Michelle Woolhouse. Thanks for joining us and we'll see you next time.

About Dr. Sandeep Gupta


Dr Gupta is a vocationally registered general practitioner who runs an integrative medicine clinic on the Sunshine Coast. His main passion relates to finding the underlying causes and innovated approaches to managing chronic illness. Dr Gupta graduated from medical school at the University of Queensland 1999. He has received specialized training in integrative medicine, and was awarded a Fellowship of the Australasian College of Nutritional and Environmental Medicine in 2008 and a Fellowship of the Australian College of General Practitioners in 2010. He also has a physician training certification with Dr Ritchie Shoemaker in biotoxin illness and Masters of Nutrition with Dr Gabriel Cousens in diabetes and living food nutrition. He is currently a board member of the Australian Chronic Infectious & Inflammatory Disease Society (ACIIDS) and also the International Society for Acquired Environmental Illness (ISEAI). He has a broad range of interests including environmental medicine, management of cardiology and cancer cases and mast cell activation syndrome, multiple chemical sensitivity and management of chronic infections.


The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.

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