Series Intro (repeated from the last entry):
old is everywhere, so they say. “They” refers to mainstream medicine as they try to convince you that mold toxicity cannot be causing your symptoms. They challenge you to explain how a little chemical called a mycotoxin made by little molds that are all around us could somehow make you feel as horrible as you do. They would often rather blame your mental health and send you to a psychiatrist. You may begin to doubt yourself and doubt your functional medicine provider, like myself, who is urging you to detox and get mold out of your home. As my business coach would say, “Step back and gain some perspective”. In this case, look at the research evidence for mold toxicity and consider the fact that we have seen countless others with similar symptoms recover through mold detox. Over the coming weeks, I will share some of the research evidence so you can decide for yourself.
In today’s report, we will discuss aflatoxins, a nasty little set of mold toxins that contributes to considerable illness and death in third world countries as well as often unrecognized chronic illness in the United States. Aflatoxins first arise from various species of the mold known as Aspergillus and present as one of four toxin types: B1, B2, G1, and G2. While the source material for this review focuses solely on the agricultural sources of these mold species and their toxins, we know that water-damaged buildings also offer a considerable exposure risk with chronic inhalation exposure. The source article lists the variety of commodities where Aspergillus is known to grow: peanuts, spices, cotton, maize, pistachios, grains, cereals, corn, other tree nuts, and oil seeds (sunflower, soybean, sesame and others) (1). Besides those sources, a metabolite of aflatoxin B1, known as aflatoxin M1, may be found in milk and dairy products when the cows have eaten feed contaminated with B1. Interestingly, we still find this M1 type in patients who deny having had dairy in years.
In the functional medicine world of mold toxicity (known as a trigger for Chronic Inflammatory Response Syndrome (CIRS)) we are less likely to see patients with significant acute mycotoxin digestive poisonings given the monitoring of food supplies. Instead, we see patients who often become quite ill upon moving into a home or changing jobs or maybe after a water damage event in their home. The change in health status is usually gradual with an accumulating variety of symptoms and progressing severities. Tests on our patients indicate immune reactivity along with the presence of elevated urinary levels of the toxins. Tests on their homes demonstrate elevated counts of mold spores with a presumption that mold toxins are also present. With newer tests for the mycotoxins themselves, the ability to confirm exposure source will improve. Recovery for the patient requires leaving that location or remediating it and recovery very rarely happens unless the exposure is addressed adequately.
In our clinic patients, we see a variety of symptoms from these aflatoxin exposures. They are similar to the symptoms of other mold toxins for the most part, producing fatigue, chronic pain, brain fog, various GI symptoms, immune imbalances like autoimmune or immune suppression, insomnia and many other issues. Many of these symptoms arise through activation of the immune system of cytokines that regulate inflammation and the inability to de-escalate the immune reaction while toxins are still present. Chronic immune activation characteristic of CIRS then leads to mitochondrial dysfunction, leaky gut, hormone imbalances, gut dysbiosis, mast cell activation, and many other secondary processes.
Besides the immune activation that we see in clinic, the most studied mechanism of harm by aflatoxins is their ability to trigger cancer, particularly liver cancer. The B1 version appears to be the most dangerous in this response, as the other types display less propensity to cause cancer-inducing mutations. This characteristic appears to interact with hepatitis B in synergizing to cause liver cancer through a TP53 tumor suppressor gene mechanism. Various clinical pictures have been recorded for aflatoxin exposures besides this cancer potential. Vomiting, jaundice, fever, malaise, and abdominal discomfort were reported in some case studies. In 2004, Kenya reported not only symptoms but many deaths from contaminated corn (2,3). The toxic levels required for fatalities appeared to be somewhere above 1mg per day of ingestion in humans and other animals (4). These aflatoxin intoxications are a major concern in sub-Saharan Africa.
Immunomodulatory effects have also been studied for aflatoxins (5,6,7) more so in animals than humans (8). In Africa, children exposed to aflatoxins appear more susceptible to malaria infections (8). In another study, lower levels of B cell antigens (the immune cell that produces antibodies) was lower in number and activation status along with lower number of CD8+ cells (immune cells which actively kill infected or harmful cells) (9,10). In a study of HIV patients, higher levels of aflatoxin correlated with lower numbers of CD4+ T cells which support the immune system (10). In our clinic patients, we see many such mold toxic patients with lots of yeast infections and EBV (mono) recurrences. We cannot say for sure that aflatoxin is causing these as patients often have more than one mold toxin in them, but it does seem to match up.
Studies in Africa suggest that children exposed to aflatoxins suffer a variety of adverse consequences. One study linked the toxin to lower birth weights in female babies (11). Another study demonstrated higher levels of wasting when infants consumed more aflatoxins (12). In another cross-sectional study, children in Togo had slower growth with higher aflatoxin exposure (13,14). While studies of water damaged building exposure children in the US have not been performed, we are confident that many of the developmental delays we see in our patients are the direct or indirect results of mold toxicity.
Overall, we may not see the more obvious effects of acute aflatoxin exposures seen in the third world, but we do see adults and children who seem to have experienced significant health effects from exposures and recovered when the mold toxicity was treated. Between being too busy caring for these patients who are ignored by conventional medicine, the high costs of running studies to prove the connection, and the overly complex nature of the illness, currently we have to rely on clinical experience and extrapolations from studies like these. We don’t have the time or resources to run studies of proof ourselves. Helping patients restore healthier, more abundant lives means applying what we know to the unique patient before us and working with the tools we have.
Primary Article:
Awuchi, C. G., Ondari, E. N., Nwozo, S., Odongo, G. A., Eseoghene, I. J., Twinomuhwezi, H., Ogbonna, C. U., Upadhyay, A. K., Adeleye, A. O., & Okpala, C. O. R. (2022). Mycotoxins’ Toxicological Mechanisms Involving Humans, Livestock and Their Associated Health Concerns: A Review. Toxins, 14(3), 167. https://doi.org/10.3390/toxins14030167
Additional Citations:
1. Awuchi, C.G.; Amagwula, I.O.; Priya, P.; Kumar, R.; Yezdani, U.; Khan, M.G. Aflatoxins in Foods and Feeds: A Review On Health Implications, Detection, And Control. Bull. Environ. Pharmacol. Life Sci. 2020, 9, 149–155.
2. Lewis L., Mary O., Henry N., Helen S.R., George L., Stephanie K., Jack N., Lorraine B., Abdikher M.D., Ambrose M., et al. Aflatoxin contamination of commercial maize products during an outbreak of acute aflatoxicosis in eastern and central Kenya. Environ. Health Perspect. 2005;113:1763–1767. doi: 10.1289/ehp.7998.
3. Azziz-Baumgartner E., Lindblade K., Gieseker K., Rogers H.S., Kieszak S., Njapau H., Schleicher R., McCoy L.F., Misore A., DeCock K., et al. Case-control study of an acute aflatoxicosis outbreak, Kenya, 2004. Environ. Health Perspect. 2005;113:1779–1783. doi: 10.1289/ehp.8384.
4. Wild C.P., Gong Y.Y. Mycotoxins and human disease: A largely ignored global health issue. Carcinogenesis. 2010;31:71–82. doi: 10.1093/carcin/bgp264.
5. WHO Mycotoxins. 2018. [(accessed on 3 May 2021)]. Available online: https://www.who.int/news-room/fact-sheets/detail/mycotoxins
6. WHO . Evaluation of Certain Mycotoxins in Food: Fifty-Sixth Report of the Joint FAO/WHO Expert Committee on Food Additives. World Health Organization; Geneva, Switzerland: 2002.
7. Williams J.H., Phillips T.D., Jolly P.E., Stiles J.K., Jolly C.M., Aggarwal D. Human aflatoxicosis in developing countries: A review of toxicology, exposure, potential health consequences, and interventions. Am. J. Clin. Nutr. 2004;80:1106–1122. doi: 10.1093/ajcn/80.5.1106.
8. Turner P.C., Moore S.E., Hall A.J., Prentice A.M., Wild C.P. Modification of immune function through exposure to dietary aflatoxin in Gambian children. Environ. Health Perspect. 2003;111:217–220. doi: 10.1289/ehp.5753.
9. Jiang Y., Jolly P.E., Ellis W.O., Wang J.-S., Phillips T.D., Williams J.H. Aflatoxin Balbumin adduct levels and cellular immune status in Ghanaians. Int. Immunol. 2005;17:807–814. doi: 10.1093/intimm/dxh262.
10. Jiang Y., Jolly P.E., Preko P., Wang J.-S., Ellis W.O., Phillips T.D., Williams J.H. Aflatoxin-related immune dysfunction in health and in human immunodeficiency virus disease. Clin. Dev. Immunol. 2008;2008:790309. doi: 10.1155/2008/790309.
11. De Vries H.R., Maxwell S.M., Hendrickse R.G. Foetal and neonatal exposure to aflatoxins. Acta Paediatr. Scand. 1989;78:373–378. doi: 10.1111/j.1651-2227.1989.tb11095.x.
12. Okoth S.A., Ohingo M. Dietary aflatoxin exposure and impaired growth in young children from Kisumu District, Kenya: Cross sectional study. Afr. JHealth Sci. 2004;11:43–54. doi: 10.4314/ajhs.v11i1.30777.
13. Lombard M.J. Mycotoxins exposure and infant and young child growth in Africa: What do we know? Ann. Nutr. Metab. 2014;64((Suppl. S2)):42–52. doi: 10.1159/000365126.
14. Gong Y.Y., Hounsa A., Egal S., Turner P.C., Sutcliffe A.E., Hall A.J., Cardwell K., Wild C.P. Postweaning exposure to aflatoxin results in impaired child growth: A longitudinal study in Benin, West Africa. Environ. Health Perspect. 2004;112:1334–1338. doi: 10.1289/ehp.6954.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.
