This post covers key considerations for testing for mycotoxins clinically as well as testing your environment.
If you missed Mold 101: Part One (Quick Facts), you can read it here.
Mold testing in humans
- The Visual Contrast Sensitivity Test (VCS) is a simple screening test that determines retinal function, which is often impaired in patients with suspected mold toxicity. VCStest.com offers an affordable ($10) test that takes about 15 minutes to perform with the use of a home computer, and the results generate a helpful PDF that contains information that you can take to your healthcare provider. These results are certainly not diagnostic on their own but provide a simple and affordable tool as an adjunct to the other tests.
- Blood tests are also not diagnostic in themselves but can indicate whether certain aspects of the Biotoxin Pathway are impaired or struggling. Low levels of MSH, VIP and VEGF and high levels of C4a, TGF-beta-1, leptins, and MMP-9 are suggestive of persistent inflammation noted with biotoxin issues, but other conditions such as Lyme disease and its co-infections will have a similar (abnormal) result with blood tests.
- URINE MYCOTOXIN TESTING
- At present, there are two main “gold standard” tests that evaluate levels of specific mycotoxins in the urine.
- Real Time Laboratories Mycotoxin Test
- This test evaluates for 15 of the more common mycotoxins that cause illness via ELISA technology.
- Con: cost (about $100 more than the other urine test), false positive results possible with this technology
- Great Plains Laboratory MycoTOX Profile
- Liquid chromatography and mass spectrometry are used to determine the presence of common 11 mycotoxins from 40 different species of mold.
- Con: turnaround to get test results can take longer (~2-3 weeks compared to the Real Time test of one week)
- Vibrant Wellness also offers a test that is becoming increasingly more popular, but not every expert recommends their test at this time.
- Unfortunately, the urine tests revolve around the ability to capture actively circulating mold toxins. The sickest patients often test negative with urine testing, because their body is unable to remove them via the urine. For this reason, some doctors advocate taking oral glutathione (500mg) twice a day in the week prior to the urine collection to aid the body in detoxifying bioaccumulated substances. However, it’s important to note that when it comes to the Great Plains Laboratory urine test, you should actually AVOID glutathione, NAC and toxin binders in the week prior to the test, as these substances can change the mass of the toxins and make them undetectable due to the mass spectrometry technology, which could result in false negative tests.
- The collection should be done first thing in the morning and fasting for 12 hours beforehand may increase the excretion of mycotoxins. It may also be helpful to sit in a sauna for 10-30 minutes prior to the urine collection.
- These strategies may improve the test accuracy, but they can also provide a big flare-up of symptoms because they are mobilizing toxins faster than the body can unload them. Patients whose symptoms are exacerbated while taking the glutathione should stop taking it and send out their urine sample immediately.
- Binders such as activated charcoal and bentonite clay need to be avoided for 72 hours-1 week prior to the urine sample, and the urine sample should be frozen before shipping to improve testing accuracy.
- Occasionally, providers will also look at serum IgE mold allergy testing to determine if a patient may be susceptible to allergic reactions from mold, which are different from mold toxicity that’s measured in urine.
- The tests are not perfect, and they can still be negative even with the above steps and a confirmed history of exposure to mold. The tests are more useful for confirming that mold toxins are present at baseline and are less useful to track progress or quantities over time. This is due to the fact that the values depend not just on the toxic burden, but on the patient’s ability to detoxify.
- Often, as patients’ health improves and their ability to detoxify is enhanced with a lower systemic inflammatory burden, more mycotoxins can be measured in the urine over time. Numbers going up may also indicate continued exposure to mold, or excess treatment with binders and antifungal therapy.
- The VCS Test is often repeated at regular intervals to determine whether biotoxin-associated systemic neurological inflammation is decreasing over time.
- Additional functional medicine testing such as the Organic Acid Test (OAT) can be useful. It’s common to find candida and/or clostridia infections, oxalate issues, neurotransmitter abnormalities and detoxification problems in patients who are sick from mycotoxins. Deficiencies in magnesium and glutathione are common. Specific markers on the OAT also increase the suspicion of mycotoxins.
Mold testing in buildings
Screening a testing company should be like screening a new healthcare provider. You will likely need to call several companies before you find one that has adequate testing procedures. Any company can put a “mold certification” on their website but the industry is full of corruption and people who cut corners. It’s up to you to find a company that won’t miss anything important. Below are some tips that may help ensure that you utilize a company that is familiar with testing at the level necessary for patients with CIRS from mold illness.
- Avoid conflict of interest by only looking at companies who test (not companies who do both testing and remediation).
- Use word of mouth and read reviews before calling a company.
- Devote at least 4-5 hours of time to calling different companies and speaking with them. You should be interviewing them for the job.
- Start out by asking if the company the following questions on the phone:
- Do they work with individuals who have CIRS? If they’ve never heard of CIRS you may want to keep looking.
- Do they use a moisture meter or infrared machine/thermal imaging? (This is a basic part of the process that all reputable companies use.)
- How long do you need to avoid opening windows, cleaning and vacuuming before they come in to test?
- Does the company perform swab sample testing of suspicious looking surfaces?
- Ask the company if they are willing to perform dust sample testing. If they only do air samples, find someone else.
- Do they investigate the attic and crawlspace if applicable? Do they walk around the exterior of the building? Do they investigate the HVAC system and do testing there? These are non-negotiable aspects of a thorough investigation.
- Ask the company if they are willing to do an ERMI test upon your request. (They will probably say that since it’s so expensive they don’t offer it, but some companies are willing to do it for extra fees.) If they are not familiar with the ERMI, keep looking. (You may opt to do the ERMI yourself anyways to save money, but it’s good to work with a company that has heard of the test.)
- Ask how long the inspection takes. Depending on the size of the property, if they are in and out in under an hour they are probably not being thorough enough.
- Will they put together a report following the inspection? What information is in the report? How long do test results take to come back?
- Do they have a senior mold analyst who helps you go over the report afterward?
- Does the company offer post-remediation re-testing? What does that look like?
- Who do they recommend for remediation? (Always good to start building a list of potential companies that are reputable, just in case.)
Summary: Components of a thorough mold inspection
- Examine outside of building and inside
- Examine/test crawlspace, attic, and HVAC system
- Use moisture meter/infrared technology to look for areas of current dampness
- Take pictures of every area they inspect
- Take air samples in different rooms, comparing it to the outdoor air (*this testing has very poor reliability and poor correlation with the gold standard dust testing and is fairly irrelevant, though most companies swear by it)
- Take swab samples of any suspicious area with visible mold growth
- Take dust samples on each floor at a minimum, ideally using an ERMI test kit
- Provide a thorough report (explained to you by their staff) and the option to re-test after remediation if needed
Bonus – If a company also does this type of testing, they are being extra thorough. Individuals with severe illness should have these tests done when able:
- ERMI (Environmental Relative Moldiness Index) – You can always do this one yourself and send it to the lab if they are charging a lot of money to do it for you. Visit mycometrics.com/ermi to order it. A less thorough version called the HERTSMI is also available but if often misses things in my experience. Typically, if cost is a concern, one ERMI is done on each floor of a building instead of in every room. The scoring system is an unusual scale (goes into negative numbers, with -10 being the best and +20 being the worst) and interpretation depends on the situation, though many experts recommend a score of -4 or less for individuals with CIRS. (~$285 per sample)
- Environmental Mold & Mycotoxin Assessment (EMMA) from Real Time Laboratory is a dust sample test evaluating for 16 mycotoxins including Ochratoxins, Trichothecenes, Aflatoxins, Gliotoxins, Zearalenones, and 10 toxigenic molds. Visit realtimelab.com and click on the “Test” tab à “Environmental” for more info. ($399)
- Actinomycetes Testing (EnviroBiomics Lab) dust samples with NextGen DNA sequencing. The most frequent bacterial species found in water damaged buildings are Actinomycetes, which are gram-positive bacteria that give off toxins in the environment. A score of 10 or less is recommend for patients with CIRS with this particular lab. You can order this test directly from envirobiomics.com/shop. ($245-260)
- Endotoxin testing – EnviroBiomics Lab dust samples show gram-negative bacteria that also tend to live in water damaged buildings. Scores of 100 or less are ideal for patients with CIRS with this particular lab. You can order this test directly from envirobiomics.com/shop. ($145-260)
*I am not affiliated with any of these companies. These are what mold experts/MDs recommend.
Interested in working with Amber? Learn more at www.originwellnesscolorado.com
