Meet Your Mycotoxin: Ochratoxin A

Series Intro

Mold 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.

Meet Your Mycotoxin: Ochratoxin A

In today’s report, we will discuss ochratoxin A, another problematic mycotoxin faced by many living in water damaged buildings who then suffer from unexplained symptoms and are dismissed by conventional medical providers. Like aflatoxins discussed in prior articles, ochratoxin A is recognized as a major health detractor in the agricultural world of cattle and pig farming as well as the production of various grains. In third world countries, ingestions of these foods have been linked with cancer, kidney failure, and deaths. Ochratoxins come in a variety of forms- with ochratoxin A being most commonly associated with toxic effects. This form is produced by either Aspergillus species or Penicillium species, including A. niger, A. ochraeous, P. verruocsum, and A. carbonarius, though other Aspergillus and Penicillium can release other less toxic forms. Across the globe, agricultural commodities, including coffee beans, spices, cereals and their products, dry vine fruits, licorice, grape juice, roots, and wine may be affected. Most research comes from animal studies addressing the ingestion of these agricultural commodities showing carcinogenic effects and kidney damage.

Besides the oral ingestion route of exposure, some research does support the role of inhalation of ochratoxin A as a source of disease. These studies and case reports bolster the position that water damaged buildings with high levels of the mold species behind this toxin could impact on indiviudals health. Ochratoxin has been found in samples from air (1), dust (2), wallpaper (3), and from buildings, as well as in the agricultural dust in agricultural occupational settings (4). In a study comparing the urinary levels of ochratoxin in humans who had or hadn’t been exposed to water damaged building, the levels were statistically higher in those exposed (5). Some studies indicate that this mycotoxin may be absorbed efficiently through the lung (4,6). In a rat study, rapid appearance of ochratoxin in the blood occurred with inhalation (6). One case report highlights the possibility of inhalation causing significant health damage: a couple, exposed to A. ochraeous for 8 hours in a granary, both became acutely ill, particularly the wife who experienced prolonged symptoms across renal, immune, and respiratory systems.

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 ochratoxin exposures. For the most part, they have similar symptoms to other mold toxins: fatigue, chronic pain, brain fog, various GI symptoms, immune imbalances like autoimmune or immune suppression, insomnia and many other issues. Much 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.

Ochratoxin A has been studied for a variety of disease processes affecting the kidneys and bladder, the reproductive system, cancer, the nervous system, and the immune system. The most studied system would have to be the kidneys, so all can agree that ochratoxin damages the kidneys. This mycotoxin is considered the leading suspect for a disease called Balkan Endemic Nephroapthy (BEN) where those affected endure a severe and progressive decline to death after ingesting mycotoxin affected grains (7). This disease appears very similar to a similar condition in pigs that is clearly induced by ochratoxin (8).

Various cancers have been linked with ochratoxin including renal and testicular. Epidemiologic studies show that populations with higher ingestion of potentially contaminated foods like pork and coffee have higher rates of testicular cancer. In one study, animals exposed to this mycotoxin were found to have elevated levels of the toxin in the testes as well as higher DNA adducts (mutations) that could lead to cancer.

Beyond causing testicular cancer, ochratoxin has been found to be toxin to rat and mice embryos (9). In the study, the mycotoxin was found to cross the mother’s placenta (10) and has been isolated in breast milk (11,12). Various studies from the primary articles noted that infants were exposed to higher levels of this toxin when mothers had higher levels themselves. Besides these embryonic effects, a gerbil study demonstrated decreased testosterone secretion (13).

Moving to a completely different body system, the nervous system as a target of ochratoxin damage has come up in many studies. Various brain regions have been found to be affected including the cerebellar [14, 15] and hippocampus [16] and in one study six areas were affected: “the cerebellum, hippocampus, caudate putamen, pons medulla, substantia nigra, and cerebral cortex” (17). Dopamine levels were decreased in the striatum with one exposure (17). In another study, “in vitro experiments have shown decreased proliferation of neural progenitor stem cells in the hippocampal region of mice after exposure” (16). They suggest that this could account for deficits in memory experienced by those exposed to ochratoxin.

Ochratoxin A has also been found toxic to the immune system in various studies (18,19,20). In studies, immune organs including spleen, the thymus, and lymph nodes have been found to be smaller. Antibody production to fight infections has also been decreased with alterations in the number of immune cells and the levels of their messengers, cytokines (20). Another study demonstrated a complex relationship between T regulatory cells of our immune system with Aspergillus and candida (21). Clearly, ochratoxin affects the immune system in adverse ways.

While we do not see the acute effects of ochratoxin A to the same scale that affects in the third world, we see numerous patients here in the states who are experiencing significant health effects from exposures to water damaged buildings. As the conventional system tends to ignore and dismiss and even belittle these patients with their health complaints, we are glad we have been able to not only recognize this condition but understand and counteract these adverse effects in our patients. The studies above along with others in the literature support our approach to taking these mycotoxin illnesses seriously. 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.

 

 

 

 

Two primary articles reviewed:

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

Hope, J. H., & Hope, B. E. (2012). A review of the diagnosis and treatment of Ochratoxin A inhalational exposure associated with human illness and kidney disease including focal segmental glomerulosclerosis. Journal of environmental and public health, 2012, 835059. https://doi.org/10.1155/2012/835059.

 

Additional References:

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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.