[INTERVIEW]
Ronda Nelson: You know the patient. This is the one that gets better with every single protocol you try. Her digestion improves, her sleep improves, her brain fog gets better, and then wham, two weeks later and it all comes back, all the beginning symptoms are back. These types of patients are so frustrating to work with, but today I’m gonna show you what to watch for and how you might start thinking about possible mold illness.
Let’s talk about it.
Well, hello and welcome back. We’re gonna be talking today about the elusive mold illness and why it slips under the radar so often. I know for a long time, I actually was kind of a little hesitant to treat it because I felt like it was maybe being over-diagnosed, or if I wasn’t 100% sure that that’s what it was, I really didn’t want to do anything about it because I didn’t want to give the patient like the wrong thing, right? I didn’t wanna make them, uh, how do I say? Like I, I d- I didn’t wanna give the wrong supplements, I guess is what I’m talking about. So I just kind of avoided it for a really long time.
But what I’ve realized over time is that when you have patients that show up, you know, we think that mold illness needs to look like chronic sinus issues or respiratory problems, or they live in a musty house and they can smell it, or there’s black mold crawling up the wall. But there may be none of those things. In fact, the patient might just come in as a gut case. They just got a really messed up gut, or you think, “Oh, this is histamine sensitivity for sure.” And then you treat it that way, or it’s just an unrelenting fatigue and nothing that you try helps. So we just keep going, different herbs, different things for the HPA axis, but nothing happens. Or again, as I mentioned earlier, they get better for a couple weeks and then the symptoms come back. So these are the ones that, like, their nervous systems are offline, their sleep is all screwed up, their digestion is all messed up.
And then we try things, it doesn’t work. We think, “Okay, well, we just need to try more of the same thing.” I’m not saying that in every single one of those cases it’s a mold case, because they may have, it may really truly be another underlying issue. But I don’t think with these complex cases that we really can rule this out, especially when the symptoms are crossing systems, okay? I’ve talked about that recently. But when the symptoms start to cross systems, you’ve got the gut system involved, you have the endocrine system involved, you’ve got the sleep system involved, you’ve got the inflammatory system involved, you’ve got the liver system involved, whatever it is, sometimes those are the patients that look…
They’re tricky, because we tend to think, whether we want to admit it or not, we tend to kind of put things in boxes. “Oh, that’s an adrenal issue. That’s a gut issue. That’s a thyroid issue.” And it’s so easy to do. I do it, too. But we have to be aware that that’s going to be our tendency, and back the truck up a little bit so we can think about it in a more holistic, from a 5,000-foot perspective. So it may or may not be that they had a damp, moldy building or they lived in that. They may or may not have respiratory symptoms, and the patient could be loaded with mold. So this is why it’s like the big masquerader, you know? It can be fatigue, it can be non-obvious complaints. So let’s talk about the pattern, okay?
The pattern that most of you will recognize, this is the patient that’s already tried gut support and it didn’t work. They’ve already tried adrenal support, it didn’t work. They’ve already tried the antimicrobials or elimination diets or reducing histamine foods. They’ve done sleep work. You’ve tried all the sleep things. Nothing works. You’ve done liver cleanse. Nothing works. You’ve done nervous system reset. You’ve worked on their hormones and nothing works. Or it works for a short time, and you’re like, “Okay, great, I found it,” and then it all comes back. So we have to think about, could mold be considered in this scenario?
The mold case that you’re gonna miss is not the patient who necessarily doesn’t even respond, because this patient that I’m talking about, they often do respond. They just respond and then bounce back, right? It might be the patient who responds to some part of it longer term and other parts not so long term, because there still could be other underlying causes, like truly maybe the thyroid is off with a fatigue case. Really truly there may be dysbiosis or SIBO or something like that going on with the gut patient. So I wanna reiterate that in the beginning: I’m not saying that every time you have a patient that doesn’t respond, that it’s always going to be mold. But I’m also not saying that if you have a patient that doesn’t respond, it doesn’t mean that your protocol needs to be adjusted.
I know, so what am I saying? Well, I don’t really know. I do know, but I don’t know, because this can get tricky, and that’s why we often either miss these patients or we treat them incorrectly, because we’re assuming… You know, you may ask all the right questions. You know, do you have a history of mold? Have you been in moldy buildings? Have you been in a moldy work environment? Do you smell moisture when you go into a building? You might be asking all those questions, and you should, for sure. However, what if the symptoms are a result of medication side effects? Or what if it is a result of a crappy diet over a long period of time? I mean, what if that’s the case as well? It could be that there’s a cardiopulmonary issue. Could be that there’s really truly honestly some hormone changes that are going on. So we still have to look at all of that, but when the symptoms span systems, I think that’s the thing I want you to take away here: when the symptoms are across multiple systems and they get better and they worsen, don’t rule out mold. It doesn’t prove that there’s mold illness, but it does tell you that a single system treatment is not going to work.
So now, how are we gonna figure this out? Well, build a timeline. Just build out your timeline. When did you stop feeling like yourself? When was the last time you felt better? When was the last time you felt like yourself? Start to build a timeline. Was it around a move? Was it around when they got a new job, a new car? Was there plumbing damage, or was there a renovation, or did they live in a storm? Or did they grow up in Florida, where there’s always going to be mold? Start building your timeline. Just because you don’t always see mold, doesn’t mean it isn’t there. We don’t see it. It could be behind the wall. It could be sheetrock that’s wet and damp.
I lived in an apartment for about two years that had massive mold damage, massive mold damage. And at this point, that was 10, 12 years ago, probably 12 years ago. At this point, I mean, I’ve tested, I have no symptoms of that. I feel fine, everything’s fine. So how can I live… I literally was sleeping next to a window that had a mushroom growing in the windowsill. I didn’t even know it ’cause the shades were down, and there was mold on the wall and in the closet. So my clothes had mold, and I was wearing them. Why? Why is it that I, at least right now, as far as I know, I don’t have any effect of that? Because my immune system, my body was able to deal with it. But then you have somebody else who has a completely different scenario, a health situation, their health status, we’ll call it, and then they don’t do well. They get in one moldy environment and boom, like the whole house of cards falls all over.
I knew where my exposure was. I grew up in Northern California, which is mold central. I grew up in a home where there was literally pink mold in the shower always, and we had black mold up the wall, and we would just do what you’re not supposed to do, which is use Clorox and spray it down. We didn’t know any better. But at this point, I’m fine. Maybe it won’t be in the future, but right now I’m fine. So asking, “Did you have mold in your house?” Oh, well, for sure, if you had a moldy house, then you’re definitely have mold. I don’t, at least not that I know about, and I’m fine. I feel fine. My health is fine. I’m good. So that isn’t the only criteria.
And remember, too, ask them questions like, “Do you feel better when you’re away from home, or at home? Do you improve when you’re on a trip, like a prolonged trip? Or maybe do you get worse when you’re in a certain room or a building?” I just had this happen with one of my kids, actually, said, “Every time I come inside, my nose starts to run.” And I said, “Ooh, what’s happening? Something’s in the house. Something’s causing you to react,” and that’s a sign. That’s just something to be paying attention to.
You also could ask, “Did you get ill after you moved?” That kind of relates to what we were talking about earlier. Did they work somewhere where other people were sick in the environment? That’s another question to ask. Did other people have respiratory issues, or were they ill? Did you notice that there was the same kind of sickness going around? So building that timeline will help you identify at least maybe the point in time, or close to the point in time, when the patient stopped feeling their best.
So just because no one else in the house is sick doesn’t mean that your patient may not have mold illness. Rick, my husband, he’s fine too. I don’t think there’s a problem. I’ve tested both of us, and we’re gonna talk about testing in a second, but I’ve tested us. I don’t think there’s a problem. Maybe it will be in the future, but individual responses will vary. So they may or may not have asthma, may or may not have allergies, may or may not have respiratory problems, may or may not have chronic lung issues. You just don’t know. You have to build that timeline.
So let’s talk about what this exposure really looks like. It’s a little bit more complicated than just one mold releasing one type of toxin. The exposure points are numerous. So yes, they can be exposed to whole mold spores, hard to say. They’re also, they can get exposed to just microscopic fungal fragments. There’s also fungal allergens. There’s fungal components. There’s bacteria and bacterial components. There’s VOCs that are produced by the microbes, volatile compounds, I should say more specifically, by these microbes. And then there’s other biological material.
And don’t forget about food, because sometimes they could be eating foods that have mold on them. Peanuts are a good one that come to mind. Any of those types of foods that are gonna increase their exposure. So grains are a big one. Dried fruits, so if they eat a lot of dried fruits, especially if they’re not organic. Some spices have mold on them. Coffee can be moldy. Apples, sometimes those have toxin-producing fungi on them, and the dietary route becomes the ongoing source of exposure.
People are spending money remodeling a house, and if there’s mold in the house, for sure, you’d wanna take care of it anyway. But what if the exposure is coming from somewhere else? So we wanna rule out all of that. So being exposed is not the same thing as having a mold sensitivity or an allergy, or having issues. It’s not the same. It’s when it colonizes in the body, that’s the problem. But even then, it can colonize, and the immune system can tackle it. Doesn’t mean that it’s a very invasive infection.
So you can see why mold is a little bit, it’s tricky. It’s just tricky. So the reason that I’m recording this today is because I want you to think, I wanna help you think outside the box. That’s what I want you to do, is don’t box in symptoms within systems. I tell you, I do know what I’m talking about. I don’t want you to box in symptoms within systems, but what I want you to do is to think about when the symptoms cross the… oh gosh, this is getting crazy. When the symptoms cross system lanes. Think of systems like lanes on a freeway. When the symptoms are crossing over, and you have one symptom that could be related to several systems, and there’s multiple systems involved, and the symptoms and the systems are all getting all confusing, this is often, not always, but often can be, an infectious, like a mold type case.
Now let’s talk about testing. This was really interesting to me because I’ve just always used the same lab to do testing. They do an air test, and then there’s a urine test, and I’ve been real happy with it. I have not had very many people that have been positive. A few had a little bit of positivity, but not a lot. But they were all people that I thought, “Hmm, this sounds like it could be a mold situation.” So when I started digging a little bit deeper into these tests, I found out that there are limitations with all of them, and I suppose there’s really no test that’s 100%, you know, the gold standard. I mean, blood test is pretty good, but even then you can have anomalies in the blood test.
So let’s talk about this testing. First, there’s air sampling testing. So this is only asking, when we’re sampling the air, it’s only asking, was there an airborne particle present at the time of the test, yes or no? So absolutely, the air sampling can give you useful information in certain circumstances, but there are no health standards defining safe, quote, “indoor mold count,” because where is it coming from? It could just be floating through the air and floating right back out the other side. It might be a windy day. It might be, who knows? So short-term sampling is only just a snapshot of that day. So a negative sample doesn’t necessarily mean that the patient is not exposed, doesn’t have a risk issue.
So think of it like this. If you were standing by a freeway at 3:00 a.m. and there were no cars, would it be safe to make the assessment or the determination that cars never use that road? Well, of course not, because you know that cars always use the highway. So just because you get a negative air sample test just might mean that there just wasn’t mold in the house on that day.
Some of them will test air vents, some of them will test the roller on your vacuum cleaner for carpet debris, that kind of thing. Some of them will do that. Sometimes the professionals will come out and they’ll test all the things, probably more likely, but what if those are old? What if there’s just a lot of instability with some of these tests. There’s a test called the ERMI, and basically that’s a DNA test that tests settled dust to estimate the amount and type of mold. And it might capture a little bit more, it has a longer window because it’s in the carpet or on the floor than an air sample. However, the EPA said that this test, this ERMI test, was developed and peer-reviewed as a research tool, but has not been validated or recommended for non-research use. So it may or may not be effective, but I had to kind of put that qualifier in there. There are some CIRS practitioners, chronic mold practitioners, that use the ERMI and related kind of scoring type systems within a framework, but that doesn’t necessarily mean that the EPA has ever validated them. But it could be a very useful test.
Then there’s urine mycotoxin testing. This is the one that I am the most familiar with, and it’s really looking at whether the lab detected those compounds and metabolites in the urine on that day. It doesn’t establish where the mold came from, whether the exposure was dietary or environmental. It doesn’t tell you when it occurred. It doesn’t tell you whether there’s fungi, if the patient has CIRS. You don’t know. So the CDC says that there is basically no FDA approval for urine mycotoxin testing. Well, they say that about a lot of the tests that we use, so you can take that or leave it. But I just have to be clear about that.
So there also can be false positives. So the lab may have detected a compound, but the result may be just misattributed, it just may be an anomaly. Or even on our side as practitioners, we could assume that the exposure in the sample was from the patient’s house when the diet might have been it, or they may have recently traveled and then got home and took the urine sample the day after they got home from their travel, and it was in their travel but not in their home. So it might be that there is a false positive, but we may have the wrong story around it.
So there could also be false negatives, and the false negatives measure, again, one point in time. So if it’s negative, does that mean that the patient doesn’t have it, or they just aren’t metabolizing, nothing’s coming out that day? So just be careful with how you explain and interpret the test. If you are gonna test, just be careful, because there can be false positives and false negatives. Again, you have to take the whole history into context and then build your timeline to see if this makes sense. Don’t rule out dietary. So don’t ever say, “Oh, your urine test is positive, so you’re for sure moldy.” For sure, may not be. Or negative.
And then another one that I hear, and I think I kind of fall into this sometimes too, is I think, “Oh, well, we’re doing mold work, and so if you feel worse, it’s okay.” I can sometimes… I think I just default there because that was my default for so many years. But I recently had, it was about six months ago or so, I had a young female that came to me. She was 12, and she lived in the South, and her parents said she just was tired all the time. Her digestion was all upset. She couldn’t eat anything. Food bothered her. She felt full all the time. She really couldn’t eat. She just wanted to sleep.
So what would you do? Of course, you’re gonna say, “Oh, well, it must be stress.” Well, what kind of stress? And tell me about her diet. And I might say, “Well, you know, you live in the South, maybe mold, maybe.” But to me, what jumps out is her stomach hurts, so I’m gonna automatically think upper digestion. Automatically, because that’s one of the first places that I always go clinically. If you can’t break down your food, you can’t digest your food, how are you gonna repair the body? So I’m gonna go there first, and then I’m probably gonna give her something that’s gonna give her a little bit of energy, like maybe rhodiola, ginseng, or maybe I’ll give her some ashwagandha, and I might even do a test ’cause she’s so young. I’m like, “Why are you tired all the time?” So you see how it’s so easy to default to that when that might not be it. It might be mold. And in her case, it absolutely was.
I put her on the CellCore mold protocol, and within three or four weeks she felt dramatically better, and she just continued to improve, and now she’s fine. She’s completely fine. We’ve been able to get rid of all of it. I think that CellCore mold protocol, for me, clinically, you might have a different protocol that you use, and that’s fine, but I absolutely love that. I’ve had the best results with it. I don’t get paid from them. They don’t even know I exist, other than I go to their seminar or their conference every year. But the CellCore protocol has worked really, really well.
So if they feel worse, it might be that you just need to adjust the protocol, because feeling worse doesn’t mean that you’re getting better results. They may just be getting, it might just be too high. They may be constipated because the binder dose that you’re giving is too high, or they’re dehydrated, they’re not drinking enough water. So just know that there’s probably some other things that are going on.
So the first thing, wrapping it up here, is principle number one: make sure that you are not expecting the supplement protocol to compensate for ongoing environmental exposure. You have to rule that out if there is exposure. I have another patient right now who is a practitioner, and he is in the middle of a full house renovation because he was so sick, he was really unable to work. It was very difficult for him. And he, when he came to me, he’s like, “I know something’s wrong.” And he said, “I have a suspicion it’s mold. I don’t have any signs of mold. I don’t think it’s in my building. I don’t think it’s in my home. Like, I don’t think so, but everything that I think… And I just need an outside opinion.” I said, “Okay, let’s do it.”
So sure enough, I just kinda put the timeline together. I’m like, “Hmm, I kinda think this might be what it is.” So we cleaned up any moldy foods out of his diet, no dried fruit, no apples, no things that are moldy. We got all that out of his diet, and then I had him come in and do a professional mold test. He did that, and I’m telling you, it came back just wickedly high, like screamingly high. You almost, I don’t know how you’d have a false positive. Every single marker was super high. So he just went about and did the whole, just said, “We gotta fix everything.” So they ended up refi-ing their house, got some money out, redid the whole thing, and now so much better. He feels so much better. He’s not out of the woods yet, they’re just finishing up, but he feels so much better. So you can’t fix them if they’re still in the environment, but as you’re fixing the environment, you can start to add in the supplements that you choose to use.
So I would be remiss if I didn’t at least acknowledge the work of Dr. Ritchie Shoemaker. He was one of the first and most early and influential developers of the modern CIRS framework, or protocol, which is chronic mold exposure. So his model, the way that he proposed it, was one that was multi-system, which we’ve talked about, right? It’s an inflammatory response related to mold exposure in a water-damaged building, and his approach uses a very test-heavy, intense, expensive, intense approach, and it involves environmental assessment and visual contrast testing and biomarkers and all the tests. It’s rugged. It’s very rugged. But kudos to him. He definitely was a pioneer in this world, in this work. I think that there are now better ways that we can do it, or easier ways that we can do it. I’ve had great success with this, and I haven’t had to put someone through that kind of extensive protocol, but I don’t wanna be disrespectful or dishonoring of the people that do know that protocol and know it well. So his work has really influenced functional medicine, environmental medicine, as how we look at mold exposure. So again, I’m just a big fan of CellCore. I really, really like it. It works really well.
So all right, here are my last five things to think about.
First of all, the patient whose environment might be contributing to their environmental illness, mold in this case, may not have obvious symptoms. They may not have respiratory symptoms. They may not have allergy symptoms. There may be nothing. But they’re really struggling with mold in their environment.
Number two, the patient who improves and then relapses, and improves and then relapses, that patient, although they may have mold, they may also have unresolved other systems or other drivers involved. Mold is just one possibility or one part of the picture, so don’t pigeonhole them into being a mold patient, because they may be a mold patient and a thyroid patient, right? Do you get that? Mold patient and a gut patient. Mold patient and a chronic sinus infection patient. So just don’t pigeonhole them.
Number three, when the symptoms span systems, you want to build a timeline. Build a timeline. When did X symptom start? In other words, what is a system? What is a symptom? When did that start? When did you start feeling, having gut issues? When you were in college, or when you were 35, or when you worked at this building, or when you lived in this house. Tie it to a location if you can. So when did you start getting X symptom? And then when did your runny nose start, chronic drainage? When did the fatigue start? When did the headaches start? Build yourself a timeline that’s going to help you contextualize this, to see if these multiple symptoms that are in multiple systems are connected and related.
And then number four, obviously, you’re gonna ask about water damage. You’d be remiss if you didn’t. Visible mold, leaks, flooding, working in an old building, you can almost guarantee these old buildings are gonna have mold in them. The new ones don’t, not as likely, unless there’s a construction error. But you wanna ask about water exposure for sure.
And then number five is don’t rely on just a single test. Some people, I’ve worked with patients before and they’re like, “I can’t afford to move out of my home, and I rent, and I can’t afford to go anywhere else,” or, “I can’t leave because of my job or my kids or whatever.” In which case you think, “Well, what are we gonna do?” Well, I just use binders and try and clear what I can. But I know that it’s like we’re never, I’m never gonna clear it, but at least I can maybe see if I can help keep it from getting worse. Because if you’re living in toxic fish water, right, we have a fish tank, and the fish are in toxic, cloudy water, if the water that keeps getting poured into the tank is dirty, all I can do is keep making the filter work better, right? But the water’s still gonna stay dirty. So ask about that. Make sure that you’re finding out, are they able to get out? And if it’s environmental exposure, not food. But don’t rely on just a test. Just because it’s a positive, use your timeline. Look at the symptoms and the systems. Don’t assume that it’s a false positive, a false negative. Don’t assume that it’s right or wrong. Use it in context with everything else if you’re gonna test.
So before you act on a patient and keep changing your protocol, that patient that comes in and then they regress, and no matter what you try, they’re not getting better, before you start chasing those symptoms, revising your protocols, “Oh, well, let’s try this, and let’s try this,” we’ve all done it. We’ve all done it. I do it, too. “Let’s try this. Oh, well, let’s not do that, let’s do this.” Before you do all that, just stop, build a timeline, look at whether you’ve got, you know, all these symptoms crossing all these different system lanes. Just build yourself a timeline, because sometimes the clue isn’t hiding inside another test. It might be hiding in their environment, or in their timeline, and you just didn’t know it.
So this is what I really love talking about, is how to think critically about clinical things. We are so quick, so often, to make a judgment call and say, “Oh, for sure, that’s the problem,” when that may not be the problem at all. More information isn’t necessarily the answer. You don’t need to go get another training. You don’t need another certification. Sometimes it just comes because you just ask enough questions, and you build yourself out a timeline with these really tough patients, and that helps you be able to start to tie up some loose ends, and you go, “Oh, yeah, okay, I think that’s exactly what I need to be doing.”
[CLOSING]
Ronda Nelson: If you want to think more like that, come and join me in Clinical Academy. This is what I teach. This is my philosophy. You’re getting the real deal right here. This is exactly what I’ll teach you how to do, is to think logically and critically. Don’t just try and modify the protocol. Yes, we need to know what to do, and I’ll teach you that, too. But I wanna teach you how to think about it so that you then become the practitioner that gets the results that no one else can get, ’cause there’s a lot of bad practitioners between you and me. Oof, if I had a dollar for every bad practitioner, I don’t know, I could’ve retired by now, because so many of them are just so quick to just do just that. Like, “Here’s a supplement for that. Here’s a supplement for this. Here’s a supplement for this,” and I don’t want you to be that way. I want you to be the thinker in the room. I want you to be the thinker. You’re the one that’s gonna put the timeline together, and you’re gonna come to the patient and say, “This is what I think we need to do, and here’s the order in which I think we need to do it.”
All right, friends, that’s all I’ve got for you this week. Thanks for being here. Be sure you like and… or subscribe to… I s- yeah, like, I sound like I’m social media. Subscribe to the YouTube channel so that you get the notifications when we do release a new podcast. Thanks for being here. Appreciate you so much. See you next week.
[END]