Why Lab Tests Are Only Part of the Picture for Making a Mold Illness Diagnosis
By Dr. Susan Tanner, MD
One of the most frequently-asked questions that I get from those seeking answers for mold-related illness is, “Is there a lab test we can do to confirm that I have mold illness?” Oh, how I wish it were that simple! Diagnosing and treating mold illness would be much easier for us all if there were a quick and easy positive/negative test that told us conclusively all we needed to know from the start! Unfortunately, that is not the case.
One of the biggest reasons for this is the concept of “biological individuality”: We are all naturally different, even though genetically, some of us are more predisposed to mold- and biotoxin-related illness. (Note: This is the HLA-DR gene that is often talked about with mold illness. Those that have it are less able to clear mold toxins from the body, so when exposed, these individuals become sick in a way that affects their whole bodies and compromises immune function.) The other factor, and this is huge, is that each of us has a different history of toxin exposure and “total body load”. In other words, the more illnesses, toxic exposures, and other stressors that one has already experienced can have a cumulative effect, increasing a person’s risk of becoming ill from mold. Our bodies act like buckets under the slowly dripping faucet of environmental toxins, viruses, stressors, manufactured foods, etc. that we are exposed to during our lifetimes. The “drips” add up and start to fill our “buckets”. Our natural detoxification processes usually manage the outflow of toxins and keep everything in check. But, if something like an ongoing exposure from living in a moldy home is added to the equation, the faucet is no longer just dripping, but is essentially turned on. Our bodies cannot keep up or detoxify fast enough to manage the toxin overload, or sometimes detoxification is genetically hindered, and our buckets overflow completely. This is when illness ensues, and the whole body can start going a bit haywire.
Testing for and Diagnosing Mold Illness in a Clinical Setting
A helpful technique that practitioners of environmental medicine, such as myself, are taught to do is to draw a timeline of each patient’s health history. By doing so, we are able to tie together the onset of symptoms with certain environmental exposures or illnesses. This exercise often provides the greatest clue in figuring out what is going on with the patient. However, it is also necessary to look at several objective tests to determine what is going on.
One of the first things with mold that we cannot lose sight of is the fact that testing the environment is just as important as running tests on the patient. A patient cannot be sick from mold if they are not being exposed. To that end, ordering mold plates and doing some simple DIY testing, or calling in a licensed and certified professional mold inspector to come in to look at the mold counts in the home, car, and workplace is extremely important. This information will also be important for getting the patient out of the exposure, so that treatment can work, and they can properly respond and heal.
As for testing of the patient, there are several things that I find very helpful and important, both for diagnosis and for convincing of family members, work place supervisors, and at times, proving in a court of law that a moldy environment was the cause of illness.
What follows are those tests that I find most helpful in looking at the problem:
1. A fungal culture of the nose and sinuses
As I am not an Ear, Nose, and Throat (ENT) doctor and cannot use a scope to do this, I insert a swab into the patient’s nostril as far as it can go and gently, swirl. I then wipe the swap on a mold plate for culture. We also obtain nasal mucous by having the patient blow air out of a nostril onto a mold plate directly. The nasal samples are incubated for 3 days minimum. Interestingly, we often find molds on the culture that match the mold in the patient’s environment.
2. IgG mold antibodies test
(Note: An immunoglobulin (Ig) test measures the level of certain immunoglobulins, or antibodies, in the blood. Antibodies are proteins made by the immune system to fight antigens, such as bacteria, viruses, and toxins.)
IgG is one of the body’s immune reactions and if positive, is indicative of exposure to mold. In other words, a person would have to have had or is currently having an exposure and immune reaction to mold to have a positive IgG mold test. This differs from an IgE mold test, which is more diagnostic of mold allergy, like when the immune system overreacts to environmental antigens such as pollen or pet dander. IgE is found in the lungs, skin, and mucous membranes. Remember, mold illness is NOT mold allergy, but both can exist in the same patient. Sometimes an IgE test is also done, but it is not as clinically significant for mold illness diagnosis as an IgG test.
3. Urine mycotoxins test
This is a urine test that shows the presence of mycotoxins secreted in a patient’s urine. In other words, if a patient is passing mycotoxins in their urine, their body has been exposed and is detoxing toxins produced by the molds in an effort to clear them. Repeating this test and looking for decreasing amounts of mycotoxins during treatment helps to determine a good response which often follows with improvements in the patient’s symptoms.
4. Transforming Growth Factor Beta-1 (TGF Beta-1)
(Note: TGF-b is a pro- and anti-inflammatory cytokine that affects the growth and proliferation of many cell types. It is produced in cells such as platelets, macrophages, B- and T-cells, fibroblasts, and microglial cells. The thymus, bone marrow and bone also produce TGF. There are different types of TGF, but TGF-b1 is the main one involved in immunity.)
This is blood test that reveals a particular immune factor that becomes quite elevated in patients with mold illness. It is also a very helpful monitoring test for patients in treatment as it quickly responds and decreases, along with symptoms, as patients are improving. It is very important that this test be done properly, and the specimen handled appropriately, or it has no value.
5. Complete Blood Count (CBC), Complete Metabolic Panel (CMP), and Gamma-Glutamyl Transpeptidase (GGT)
These are all fairly standard and inexpensive tests to do. While they are not in themselves diagnostics of mold illness, it is good to have this information when initiating treatment.
- The CBC is a test that measures the cells that make up your blood: red blood cells, white blood cells, and platelets. Abnormalities can point to anemia, and can help explain other health issues, like fatigue, fever, weakness, or excessive bruising.
- The CMP is a panel of 14 blood tests which provides a rough check of kidney function, liver function, diabetic and parathyroid status, and electrolyte and fluid balance.
- The GGT is a enzyme test that shows the liver’s reserve capacity to handle toxicity. A GGT test is currently the most sensitive enzymatic indicator of liver damage and disease. This damage is most often caused by heavy use of alcohol or other toxic substances, like drugs or poisons, but can also be caused by environmental toxins, like mold.
6. Thyroid and growth hormone blood testing
These tests don’t prove mold illness, but both are often greatly affected by mold toxins and must be addressed.
- A free or total triiodothyronine (free T3 or total T3) test is a good way assess thyroid function. Free T3 levels that are in the medium to high normal range are the most beneficial for an antifungal effect within the body. Free T3 levels in low-normal range indicate that sugar levels outside of your cells are too high. In simple terms, your body is not utilizing sugar effectively for energy, so fat stores and mold toxins are harbored more easily. Higher free T3 levels make you more antifungal. In addition, thyroid hormone controls the rate at which oxygen and iodine circulate through your cells, both of which are antifungal, antiviral, and antibacterial. You need to get your thyroid functioning properly and at optimum levels, so that your body can dispel the mold toxins and can heal.
- A test to measure the amount of insulin-like growth factor (IGF-1) in your blood can be helpful to determine whether or not you are producing growth hormone. This is a good test, because you are tested before and then after your body is provoked to release IGF-1. If your body is not producing growth hormone on its own, you may need HGH (human growth hormone) injections in order to fully heal.
Who Can Test Me for Mold Illness?
You may wonder how to get these tests done, and in this age of insurance-based medicine it can be a challenge. Apart from the nasal swab, the bloodwork may be handled by a cooperative primary care physician, or by going to a facility such as “Any Lab Test,” which will run them for you. The best route is to seek care from a knowledgeable ENT specialist, such as Dr. Dennis, or from a physician trained in Environmental Medicine. Go to American Academy of Environmental Medicine for a list of practitioners by state.
Other Diagnoses That Influence Labs & Symptoms
There are other illnesses that can cause similar symptoms, such as Lyme disease and chronic viruses, such as Epstein Barr. While at some point looking at these may be necessary, it is not typically the first-line thing to do. Even if a patient tests positive for Lyme or another virus, until the mold and mycotoxins are addressed, these other illnesses cannot respond to treatment as effectively. It can become one of those questions of “which came first”? A question that, in my clinical experience, is not one that really matters for us to answer before starting the needed interventions to treat the mold. While it is true that both chronic Lyme disease or viral infections may have weakened the system such that it succumbs to a mold exposure, I have learned that the treatment of other illnesses without addressing the mold first will get you nowhere and quickly. This is because, once mold has begun to affect the body, it actually turns on and heightens symptoms attached to other illnesses. For example, some patients never know they have Lyme until they move into a moldy home and become so sick that they are tested for the infection simply to rule it out. The Lyme has, out of nowhere, become a major player in their failing health, because mold causes so much inflammation and immune dysfunction that their bodies can no longer fight it off. On the other hand, if a patient is not responding in the way that we feel they should be, and we are all CERTAIN that mold in the environment has been addressed, then there are other specialized and individual tests that may be done. But, this is only after careful consideration and discussion with each patient. It is at this point that we may begin looking for and treating other things, like viruses and/or parasites to get them well again.
In conclusion, mold illness can be frustratingly difficult to diagnose, but is refreshingly responsive to treatment, especially when a patient is willing to do what it takes to remove themselves from the exposure. Unfortunately, finding a doctor or medical practitioner who knows about mold and who will look to a patient’s environment for the cause of their symptoms is still the exception, rather than the rule. Wanting to help you close that gap is the main impetus for me writing this article today. If nothing else, you can print out this list of tests and take it to your primary care physician and ask that they run the labs necessary to begin compiling information from which to make a diagnosis. The abovementioned labs and proper testing of your environment can lead you to some pretty conclusive evidence that mold is or is not the cause of your symptoms. Should you wish to work with me directly, I currently offer phone consults. You can contact me through my site www.thebodynexus.com and by going to the Medical Consults section on the Services page.
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