Is there any value in testing the body load of fungal/mold toxins by testing urinary mycotoxins?
Occasionally, I get a new patient who has had urinary mycotoxin testing showing elevated mycotoxins (mold toxins). When I see this type of testing, I know that I will now have to educate the patient about the proper testing for biotoxin illness. Further, I must carefully explain why urine mycotoxin testing is not worth doing. Often, this results in me being in a situation where I must be more convincing than the practitioner/blogger who recommended or ordered the test.
In the September 2024 issue of Health magazine, the article, Toxic Mold Can Turn Your Life Upside Down—And Climate Change Might Be Making It Worse, called more attention to illness triggered by exposure to mycotoxins.1 The downside was that the article talked about using urine mycotoxin testing to validate illness.
What is being measured with urine mycotoxins?
Urine mycotoxin tests measure the amount of mold particles excreted in the urine at one point in time. The problem is that the level reflects mold ingestion and not mold inhalation. Much of our food has some degree of mold growth. These foods are not toxic or spoiled but naturally have mold growth on them. Grains, berries, many fruits, apple cider/juice, cheeses, and canned foods also contain molds. Even if doing a urine mycotoxin test to assess the amount of mycotoxin in the diet, it is not possible to correlate the result with any food diary. Depending on the fungal element ingested, mycotoxins may remain in the body for up to 60 days after the point of ingestion.
There is no way to avoid eating molds, but should you? With the daily frequency of mold ingestion that all of us are taking in, you would think there would be more illnesses related to ingested mold than there are.
Does urine mycotoxin testing correlate with exposure to a water-damaged building?
In 2014, the CDC responded to a case of an employee who felt her workplace was contaminated with mold and who used the presence of two mycotoxins in her urine to bolster the claim. Urine tests showed elevated levels of ochratoxin and tricothecenes. With further evaluation, it was made clear that these are two of the three main mycotoxin families that grow on foods and that levels excreted by the kidneys reflect what was eaten. The CDC is firmly against the use of urine mycotoxin testing as it represents the diet burden of mycotoxins and results in unnecessary prescriptions of oral antifungal infections.2
To reiterate, there is no correlation between the level of measured mycotoxin in the body as done through urine mycotoxin testing with inhalation or indoor environmental exposure.
Urine ochratoxin levels reflect the direct consumption of cereals or grains and the consumption of animals (especially pork) fed contaminated feed. Any food that has a grain or seed in it may contain ocratoxin, including beer and wine. Other foods containing ochratoxin are foods that are aged or dried, such as cheese, dried/smoked fish, soybeans, garbanzo beans, nuts, dried fruits, and coffee. With the number of people in the world consuming these foods, we would expect to see an epidemic of ochratoxin-related illness, but we do not. The basic principle of toxicology, “the dose makes the poison,” holds.
To further illustrate the correlation of diet, we look to a Belgium study, BIOMYCO, which evaluated dietary mycotoxin exposure in 155 children and 139 adults through urine mycotoxin testing. One particular mycotoxin compound (a metabolite of DON, deoxynivalenol-15-glucuronide) was found in 100% of urine samples. Of the 33 mycotoxins tested, the presence of ochratoxin, the toxin mentioned in the above building case, was confirmed in 51% of children and 35% of adults. 3
Is there a better way to test for mycotoxin load?
The best way to test mycotoxin exposure is by testing the home and work environments and any other building in which the subject spends a considerable amount of time. Several tests are available, but it is most important to do the correct test to capture meaningful results. Air sampling and spore trapping and two such methods that should be avoided. One also does not need to pay an Indoor Environmental Professional to do a test for mold.
To learn more about screening for mold testing visit: https://www.savannahfunctionalmedicine.com/post/mold-testing-your-home-for-water-damage
References:
Women’sHealth: Toxic Mold Can Turn Your Life Upside Down—And Climate
Kawamoto M, Page E. Notes from the field: use of unvalidated urine mycotoxin tests for the clinical diagnosis of illness-US 2014. M MWR 2015; 64(6): 157-158.
Viegas S, Assuncao R, Nunes C, Osteresch B, Twaruzek M, Kosicki R, Grajewski J, Martins C, Alvito P, Almeida A, Viegas C. Exposure assessment to mycotoxins in a Portuguese fresh bread dough company by using a multi-biomarker approach. Toxins (Basel) 2018; 10: pii: E342. Doi: 10.3390/toxins10090342
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