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From the Townsend Letter
July 2018

Mold-Related Illness and Mycotoxins – A Unique Opportunity for Functional Medicine Practitioners
by Jill Carnahan, MD
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Mycotoxins of Concern
The Centers for Disease Control and Prevention (CDC) estimates there are over 500 species of hazardous molds; though, in the past decade or so a few have begun to stand out among the rest.16

  • Aflatoxins,
  • Aflatrem (a tremorgenic mycotoxin),
  • Aspergillosis,
  • Citreoviridin,
  • Ergot alkaloids,
  • Fumonisin B1,
  • Gliotoxin,
  • Macrocyclic trichothecenes,
  • Ochratoxin A,
  • Patulin,
  • Penitrem,
  • Rubratoxin,
  • T-2 Toxin,
  • Tremorgens,
  • Verruculogen, and
  • Zearalenone.

Of these mycotoxins, the most dangerous and best studied thus far include the following mycotoxins.
Aflatoxins (AT) – Aflatoxins are natural carcinogens and commonly contaminate foods, especially crops that are pre-harvested and stored, such as grains, corn, nuts, and seeds. Aflatoxins can also be found in water-damaged or damp buildings where Aspergillus mold is growing. Aflatoxins can cause many different forms of aspergillosis, which is a group of diseases caused by mycotoxins of the Aspergillus genus.
Aflatoxins are fat soluble and readily absorbed by the body. They are usually ingested through contaminated foods or inhaled through dust particles of food items. Once in the bloodstream they are distributed to tissues and the liver. From here (depending on the type of aflatoxin) they are metabolized into different proteins that can cause DNA damage and induce cancer or acute toxicity (aflatoxicosis).17
Aflatoxin exposure can result in leukemia, lymphoma, aplastic anemia, and renal failure. This mycotoxin gravely impacts the central nervous system through an invasion of blood vessels causing hemorrhagic infarction.18
Aflatrem – Aflatrem is a secondary metabolite of Aspergillus flavus that commonly occurs alongside aflatoxins. This fungus is commonly found in corn and therefore ends up in cattle feed. Aflatrem is able to infect both livestock and humans, where it has profound neurotoxic effects. Aflatrem decreases the capacity of glutamate and GABA uptake, which translates as degradation of nerve terminals, a decrease in corresponding neurotransmitters, and their release.19 This mycotoxin can result in seizures, tremors, and disorientation.
Fumonisin B1 – Another mycotoxin mostly found in corn and cereals, Fumonisin B1 induces neuronal degeneration in the cerebral cortex, disrupts sphingolipid synthesis, inhibits protein synthesis, promotes DNA fragmentation, increases lipid oxidation, causes cell death, and can eventually result in death.20,21
Macrocyclic trichothecenes (MT) – Macrocyclic trichothecenes of Stachybotrys chartarum, is one of the mycotoxins most often found in water-damaged buildings. MT is commonly found in ventilation systems, drywall, and ceiling tiles, but unlike many other mycotoxins, it's also found in airborne particles.22
MT causes neuronal cell apoptosis and inflammation in the olfactory epithelium and olfactory bulb.21 It inhibits protein synthesis through binding to proteins and other macromolecules. Chronic exposure to MT causes inflammation and cell death, which can lead to respiratory illness, immune system dysfunction, CIRS, and neurological impairment.23
Ochratoxin A (OTA) – OTA is caused by several species of mold and found both in food and water-damaged buildings. This mycotoxin is neurotoxic, teratogenic, immunotoxic, and genotoxic. OTA impacts the body by causing oxidative stress, which impairs the mitochondria, and inhibits protein synthesis. Chronic exposure to OTA has been associated with kidney diseases and enzymuria.24
In a 2013 study on CIRS, 93 percent of the 112 patients tested positive for one of three mycotoxins AT, MT, and OTA. Additionally, 30 percent tested positive for more than one mycotoxin. Of the three mycotoxins tested, OTA was by far the most common, accounting for 83 percent of all cases.25
T-2 Toxin – T-2 Toxin is not usually associated with chronic conditions but still worth mentioning because low level exposures to certain mycotoxins are proving to cause complex conditions, meaning, the T-2 toxin shouldn't be disregarded.
T-2 Toxin commonly causes an acute mycotoxicosis reaction and is usually found in contaminated foods. T-2 toxin causes neuronal cell apoptosis in fetal and adult brains.21 It inhibits protein synthesis through binding to peptidyl transferase, which triggers a ribotoxic stress response.26 T-2 toxin also interferes with membrane phospholipid metabolism, increases liver lipid peroxides, and suppresses glutathione S-transferases.

Psychological Effects of Mycotoxins
Perhaps the most startling findings surrounding the effects of mold on human health is the widespread and debilitating psychological, neurotoxic, and electrocortical impacts. Patients who are exposed to mold mycotoxins typically experience strong cognitive and emotional symptoms.
I often see depression, anxiety, and signs of strong PTSD-like reactions in my patients with mold exposure. Sometimes their symptoms appear similar to a mild brain injury. This is due to a hypoactivation of the frontal cortex, constant activation of inflammatory and apoptotic pathways at low levels of exposure in brain capillary endothelial cells, neuronal damage, and inflammation. Cognitive impairment, inability to multitask, and mood swings are also common.27,28 Studies even suggest that low level exposure to OTA increases oxidative DNA damage and decreases striatal dopamine levels, which could lead to symptoms of parkinsonism.29
One of the most fascinating developments unfolding in the realm of mold-related illness is the research under Dr. Dale Bredesen of the Buck Institute for Research on Aging. Dr. Bredesen has identified six subtypes of Alzheimer's disease, one of which is called Inhalational Alzheimer's Disease (IAD). He attributes the pathogenesis of this subtype to biotoxins, such as mycotoxins.
Inhalational Alzheimer's disease is a phenotypic manifestation of CIRS. The onset of IAD typically occurs at a younger age, the ApoE genotype is typically 3/3 instead of 4/4 or 3/4, there's usually a lack of family history of Alzheimer's, the symptoms are often set off by a period of stress, anesthesia, loss of sleep, menopause or andropause. Instead of memory loss, cognitive symptoms typically include depression, dyscalculia, executive dysfunction, aphasia, or other cortical deficits.30

Beyond Mold – This is Just the Beginning
Though there is still much to understand about mold and mycotoxins exposure, they are actually one of the best understood indoor air contaminants. Beyond mycotoxins, other exposures we know far less about include Gram negative and positive bacteria, endotoxins, microbial particulates, non-microbial volatile organic compounds, glucans, and microbial volatile organic compounds. All in all, we are just breaking ground in our understanding of environmentally acquired illness.22,31
There's a need and demand for more doctors on the front lines of environmentally acquired illnesses. I believe our understanding of mold-related illnesses is in its infancy. As we continue to research and understand the effects of mycotoxins (and other pathogens) on human health, we will be more effective in our diagnosis and treatment of mold-related illness. And I, for one, am committed to leading the way.

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Dr. Jill Carnahan completed her residency at the University of Illinois Program in Family Medicine at Methodist Medical Center. In 2006 she was voted by faculty to receive the Resident Teacher of the Year award and elected to Central Illinois 40 Leaders Under 40. She received her medical degree from Loyola University Stritch School of Medicine in Chicago and her Bachelor of Science degree in bio-engineering at the University of Illinois in Champaign-Urbana. She is dually board-certified in family medicine (ABFM) and integrative holistic medicine (ABIHM).

Dr. Jill was also part of the first 100+ health-care practitioners to be certified in functional medicine through the Institute of Functional Medicine (IFMCP). In 2008, Dr. Carnahan's vision for health and healing resulted in the creation of Methodist Center for Integrative Medicine in Peoria, IL, where she served as the medical director for two years. In 2010, she founded Flatiron Functional Medicine in Boulder, Colorado, where she partnered in functional medicine with medical partner, Dr. Robert Rountree. She recently opened a brand new medical clinic with a broad range of services in Louisville, Colorado.

Dr. Jill is also a 15-year survivor of breast cancer and Crohn's disease and passionate about teaching patients how to "live well" and thrive in the midst of complex and chronic illness. She is also committed to teaching other physicians how to address underlying cause of illness rather than just treating symptoms, through the principles of functional medicine. She is a prolific writer, speaker, and loves to infuse others with her passion for health and healing!

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