The Prevalence of Subclinical Clostridial Infections in Mold-Injured Patients
You may have heard of Clostridium difficile, or “c. diff”, which is an antibiotic-resistant infection in the large intestine. In acute forms, c. diff can cause severe diarrhea and painful colitis symptoms. In my early practice years, c. diff infections were really quite rare and usually only occurred after a patient had been on particularly strong antibiotics or had been on repeated courses of antibiotics for an extended period of time. In more recent years, however, c. diff infections seem to be occurring more frequently and becoming more serious and virulent. Some of these difficult-to-treat occurrences even lead to death in severely debilitated patients. My thoughts are that the increased frequency likely correlates with increased antibiotic use, poorer diets, and other chronic illnesses such as Type 2 diabetes. But, there also seems to be an increased incidence of subclinical cases of clostridial bacterial overgrowth that cannot always be easily explained. These subclinical cases sometimes present as gastrointestinal distress, but in other instances, can be almost dormant yet cause significant health disruption in other seemingly unrelated functions.
First, Clostridia are a group of bacteria, and there are several species. Their common features are that they grow without oxygen and behave differently than other bacteria. For example, one type of clostridium is botulinum. When it infects improperly processed or canned food, then food poisoning known as botulism can occur. The impact of botulism is severe. It is neurotoxic and can lead to death if intervention is not administered promptly. Another manifestation is that in which a circulation-compromised and therefore oxygen-deprived organ or limb develops gas gangrene, which is caused by clostridium perfringens. Clostridium perfringens is an anaerobic Gram-positive, spore-forming bacillus associated with acute gastrointestinal infections.
Part of what makes these bacteria difficult to treat is that they grow without air, but more importantly, they create spores in their own reproduction which are hard to penetrate and kill. They are also resistant to environmental stress, so things like heat or normal cooking temperatures. It takes very specific treatments to effectively rid the gut of these bacteria once a person is infected.
In the case of clostridium difficile, the most severe presentations are usually seen in patients shortly after finishing antibiotics, but there are occasions when it appears seemingly out of nowhere. More commonly what I am seeing in urinary organic acids testing is an elevation in the acids produced by clostridia bacteria of multiple species in the small intestine. Small amounts of these clostridia are actually part of the normal flora of the gut, but when they grow out of proportion to other beneficial bacteria, then problems may ensue. Most times these may not be acute diarrhea leading to dehydration scenarios, but nonetheless are capable of causing anything from vague gastrointestinal symptoms to increases in food sensitivities, to psychological/psychiatric manifestations such as anxiety and obsessive-compulsive disorder.
What Does C. Diff Have to do With Mold Exposure/Injury?
Why I bring c. diff up on a website that focuses on mold-injured patients has to do with toxicity and impacts on the immune status of the small intestinal lining, the “gut”. Understand first that the lining of the gut is the source of Immunoglobulin A, the first line of immune defense. Through a cascade of toxicity, mycotoxins from molds can both lower the defenses of and stimulate immune reactions in the gut lining. This can render the gut immune process weaker or less protective and simultaneously more reactive, yielding the perfect storm. Poor immune protection can then allow opportunistic flora to grow, such as some clostridial species as well as yeast.
As mentioned, one of the most helpful tests that I do for looking at the internal works in my patients is the urinary organic acids test. Not only does part of the test reveal the likely presence of abnormally high levels of clostridia and other bacteria and yeast in the gut, but it also can demonstrate if these clostridia are producing particularly neurotoxic organic acids which disrupt dopamine processing in the brain and can clinically manifest as anxiety, depression, and OCD. It is important to point out again, that these overgrowths are different than acute clostridium difficile infections. Acute infections MUST be treated medically and thoroughly, often requiring very specific antibiotics and fluid support.
Effective Interventions for Subclinical C. Diff
Subacute overgrowth such as what we see on our testing may also require antibiotics such as Flagyl or Vancomycin, but often will respond to first-line interventions of gentler botanicals, such as Biocidin. For full success in treatment, however, the source of the mycotoxins MUST be eliminated if they are present. Thus, if you are breathing mold-laden air, you have to correct that to also effectively treat the infection. Then, many times these overgrowth problems will resolve by improving gut immunity to create an environment that does not foster clostridial growth. IgG Gut Protect by Micro Balance is excellent, well-tolerated, and should be continued for a minimum of 3 months. If simultaneously a probiotic is used, particularly one containing Saccharomyces boulardi, then these beneficial bacteria can help to displace clostridia. Microflora Balance, also by Micro Balance Health, contains all of these and works synergistically with the IgG Gut Protect.
Some of the interventions suggested for clostridia also help in decreasing candida yeast overgrowth, especially the IgG Gut Protect, as both yeast and clostridia flourish in an environment of lower immune status. However, if there is a robust number of clostridia then it is advised to treat this first, and then go on to specific anti-candida therapies. This treatment sequence seems to work best and yield the best and most long-lasting results. Candida Rid is a particularly helpful intervention here as it contains whole-body antifungals, biofilm busters, and recolonizing ingredients.
In my practice, I do have somewhat of a cut-off point for treating clostridial overgrowth with natural products vs. prescription medications. If levels are high and especially if the patient is struggling terribly and has done so for a period of time, I am much more likely to reach for prescriptions sooner than later. Once again, I want to drive home the point of improving gut immunity from the get-go, as no matter what therapy is selected, “killing” without restoring the essential immunity may not yield the best result.
With that, I would add that even in hospitalized patients with severe clostridial infections, I would like to see this added to their protocol. I see it only as beneficial and never a detriment!
I love all of your articles Dr Tanner, thank you for posting them! Do you have any thoughts on FMT? I know it is currently only approved for C Diff patients who don’t respond to antibiotics. But I am hoping that it is more widely used in the future as I feel like it could be very helpful for many people with gut dysbiosis.
Screening of the donor is, of course, of utmost importance, but truthfully this procedure is quite low risk and relatively inexpensive. It actually has been life-saving in some circumstances. Of course, the simultaneous use of probiotics and immune-supportive products for the gut is a very helpful and necessary adjunct to treatment.