Functional Medicine MD’s like myself spend a lot of time tracking down evidence. We spend long periods of time working through complicated health stories with our patients. We also spend time tracking down helpful studies that guide us in caring for patients who have not received answers from conventional medicine. The field of mycotoxicity or mold toxicity stands out as one area where we uncover answers for patients who have been told that it is all in their heads.
While there exists good evidence both in research and clinical practice that mold toxins can underlie many chronic illnesses, we need more research to build our case before the watching and skeptical conventional medical world. Beyond more focused research on mold toxins themselves, we also depend on a growing understanding of our bodies’ detoxification and inflammation systems. In the two articles cited at the end, the glutathione detoxification system and the Nrf2 antioxidant pathway intersect with each other and with mold to potentially explain how a particular mold toxin called ochratoxin A (OTA) may lead to symptoms and illness.
On a side note, while tracking down evidence to guide my care of mold toxic patients, I always need to keep an eye open for conflict of interests. Our clinic works hard to limit financial conflicts when caring for patients and we don’t want to carelessly promote some new therapy that is only supported by those selling the product. The pharmaceutical industry is no more prone to self-promotion than a supplement company. Both can claim their product is amazing and “here is the research (by our researchers) to prove it”. In this case, the article by Guilford deserves the mention that he is a managing partner of You Energy Systems, LLC which manufactures ReadiSorb© glutathione, a brand of liposomal glutathione. This does not mean we should reject his article outright, but that we should discern whether he supports his claims with outside evidence. While I have not read every article he cites, he does appear to have justification for his statements. Regardless, I did search out and find the other article for my own peace of mind.
Between the two articles, the intersection of glutathione detoxification and Nrf2 does appear as a mechanism of Ochratoxin A’s toxicity. A number of experiments demonstrated that kidney cells incubated with OTA expressed less Nrf2. Nrf2 is responsible for upregulating the oxidative stress response system in cells, preventing further damage to the cell or its components. Less Nrf2 implies a weakened defense system against oxidative stress like free radicals. Taken together, OTA could lower the defense mechanisms of our cells allowing oxidative stress to cause more harm.
Other studies suggest that OTA lowers both the production of glutathione through two proteins, GCLC and GCLM, and also the utilization of existing glutathione by lowering levels of the class of enzymes called GST’s. Less glutathione is produced and less is conjugated to toxins such as OTA. To understand a little better, glutathione is an antioxidant molecule made by our cells which intercepts free radicals or reactive molecules and prevents damage to DNA, proteins, and cell membranes. Many mold toxins are inactivated and afterwards excreted thanks to this process. Countless other molecules we make or that enter our bodies need this as well.
With the Nrf2 system weakened and the glutathione pathway hindered, not only mold toxins, but many other harmful substances are allowed to continue in our cells and bodies. OTA therefore extends its affects far and wide, potentially leading to a multitude of symptoms. To a functional MD caring for numerous mold patients, this comes as no surprise. Mold seems to touch just about every body system and disrupt them all to some degree. To help patients live healthier more abundant lives we have to track down the footprints of our enemies like mold and understand their patterns of harm. Then we have to counterattack at the same weakened points with therapies to restore proper biological functioning. Nrf2 and glutathione are just two of the targets in Sanctuary’s counterattack.
Guilford, F. T., & Hope, J. (2014). Deficient Glutathione in the Pathophysiology of Mycotoxin-Related Illness. Toxins, 6(2), 608–623. http://doi.org/10.3390/toxins6020608
Limonciel, A., & Jennings, P. (2014). A Review of the Evidence that Ochratoxin A Is an Nrf2 Inhibitor: Implications for Nephrotoxicity and Renal Carcinogenicity. Toxins, 6(1), 371–379. http://doi.org/10.3390/toxins6010371