How Mycotoxins Effect the Gut
Mycotoxins can effect the gut either directly from ingestion on food or indirectly as a response to general body inflammation caused by CIRS due to a water-damaged building.
Moldy food can cause gut irritation and inflammation. This leads to a leaky gut and a whole host of systemic symptoms. Sometimes we can see that fruit or grain has fungal growth on them. However, fungus is not always visible on food and mycotoxins are too small to see.
It is not just fruit, grains and vegetables that are an issue. Herbs can also have mycotoxins on them and meat and milk can contain mycotoxins. Animals will store mycotoxins in their muscles and organs that humans eat. Additionally, mycotoxins are found in the milk of animals. Animal feed is often moldy when tested. This means meat and milk on the market has mycotoxins in it at various times. People with sensitivity to mold need to be very careful about their food choices. Details on moldy food can be found here.
Additionally, mold sensitive people who are exposed to a water-damaged building will often have an inflammatory gut reaction causing a leaky gut. As a result they may have trouble digesting food and become "sensitive" to many foods. This leads them to erroneously think they have many food allergies, when the actual issue is that their gut is inflamed due to a mold response. Once that is remedied, they are able to eat many of the foods that had previously bothered them.
Some of the symptoms a person with a leaky gut may have are bloating, gas, abnormal bowel movements, undigested food in stools, fatigue, inflammation in other areas of the body and autoimmune conditions such as hashimotos or multiple sclerosis. Brain inflammation due to a leaky gut can cause symptoms such as brain fog, depression, and migraines.
Also realize there are other factors besides mycotoxin exposure that can lead to a leaky gut.
Some physiology relating to leaky gut and details on how it occurs.
The intestinal lining is the second fastest reproducing tissue in the body. The whole gut renegerates every 5-6 days.
This means the gut reacts to the environment very quickly. 20% of it is new each day and reflects that days happenings. Nutrition available and toxins assaulting it will cause an immediate change in 20% of the gut cells each day. The intestinal cells have high nutrient needs. They take nucleotides and amino acids and other nutrients directly from the gut as they can only get about 70% of their nutritional requirements from the blood. Without optimal nutrients, the gut cells including the tight junctions can not respond optimally.
A leaky gut is caused by damage to the space between the intestinal epithelial cells called tight junctions. Damage to these tight junctions can occur with any type of gastrointestinally caused inflammation or damage. Mycotoxins are just one factor that can cause damage.
Many of the mycotoxins and their metabolites inhibit protein synthesis. It has been demonstrated that rapidly dividing and activated cells with a high protein turnover (such as immune, intestinal, and hepatic cells) are predominantly affected by mycotoxins. Since the gastrointestinal tract has a high level of protein synthesis and cellular turnover it is especially susceptible to mycotoxin damage. The tight junctions themselves depend on the proteins occuldin and zonulin to function properly. Occludin contributes to the tight junction stabalization and is necessary for optimal barrier function. Zonulin has been shown to increase the permeability of the tight junctions which may allow molecules to get through the intestinal barrier that should remain in the lumen
When there is a breakdown in this tight junction barrier, things such as undigested food and toxic chemicals can now get through the gut barrier. They get into the circulation which can lead to the formation of autoantibodies. These autoantibodies then cause a variety of systemic inflammatory responses through-out the body and a variety of symptoms.
Research on animals has shown ingestion of mycotoxin contaminated feed effects the GI barrier. In vitro research revealed that mycotoxins increase the permeability of intestinal epithelial cells monolayers. The mycotoxins deoxynivalenol (DON), ochratoxin A (OTA), and patulin (PAT) have all been shown to compromise the intestinal tight junction comples. There is a reduced expression of tight junction proteins which leads to increased passage of bacteria such as Escherichia coli and leads to malabsorption of nutrients like glucose. (See research articles at bottom of page.)
Lets take a look at mechanisms that protect the gut and what happens when mycotoxins are ingested.
Intestinal health encompasses passive barriers and active immunological protection as well as neuroendocrine function. The passive barriers are composed of the protective coat of mucin (mucus coating), gastrointestinal flora, and the tight junction complexes between epithelial cells. The active immunological processes are composed of gut-associated lymphoid tissues, and intra-epithelial lymphocytes which are part of the immune system. It is important to note that 70-80% of the bodies immune system lies in the gut. The guts neuroendocrine system is composed of endocrine cells and nerve elements containing a variety of peptides. Remember, both the tight junctions, the neuroendocrine system peptides and immune system depend on protein synthesis that is affected by mycotoxins.
It appears from research that several mycotoxins, when ingested, can lead to similar changes that we see in inflammatory bowel diseases in humans. This inflammation leads to a leaky gut.
Interestingly, animal research on some mycotoxins has shown a different reaction to low dose mycotoxins and high dose mycotoxins. When low or moderate doses of mycotoxins are introduced into the environment of the gut epithelium there is an upregulation of inflammatory cytokines. With high doses of toxins, there is often down-regulation except for IL-6 which was upregulated with high doses of the toxins. With deoxynivalenol (DON) there was almost always upregulation of the cytokines no matter low or high dose of mycotoxins.
The point here is that mycotoxins, especially low to moderate doses promote a rapid mucousal inflammatory response, and compromise Th1 and Treg responses over time. It is important to understand that low doses will upregulate the intestinal expression of pro-inflammatory cytokines, especially following DON ingestion. This disturbance in cytokine balance could cause intestinal disorders. For instance, cytokines have a key function in the regulation of tight junction (TJ) proteins [Capaldo CT, Nusrat,A, 2009]. These TJ proteins seal the space between two neighboring cells . However, upregulation of inflammatory cytokines has been related to increased permeability (leaky gut) that could allow the entry of luminal antigens and bacteria normally restricted to the gastrointestinal lumen (gut tube).
Research [Maresca and others, 2008], provided evidence that several mycotoxins induce intestinal alterations that are similar to those observed at the onset and during the progression of inflammatory bowel diseases in humans (among them upregulation of cytokines, increased permeability, and bacteria translocation).
For information on the most common mycotoxins found in the food supply go to the Moldy Food Link.
There is this additional thought by some Docs, but I have not yet had time to track down research or this. However, I will share it here with you:
Additionally, in people with CIRS due to water-damaged buildings, they usually have a reduced melanocyte stimulating hormone (MSH). This appears to promote edema in the tight junctions of the gut producing "leaky gut". There is an increase in bile salt production acutely. As excessive bile salts move down in gut they can add to the loosening of tight junctions in jejunum and ileum. However, over time bile flow is slowed in the chronic inflammatory response, and there is a sludging of bile and reflux of bile into stomach and the person can get belching, abdominal pain, and bloating.
I would also add that when the gut is inflammed the brain is inflammed and vice versa. You usually do not have one without the otehr.
So, what can be done to help the person with an inflammed gut from mycotoxin irritation and damge. First the person needs to follow the general protocol for treating CIRS. However, there are some additional things to address.
I mentioned that some people are so senstive that they are unable to eat hardly anything. These folks usuallly end up needing to be on a roatation diet where they do not eat the same thing more than once every 4 days or they react to the food. What is happening is that their gut is so inflammed that everything irritates the digestive tract and the tight junctions are allowing bits of food through them into the body that should not be allowed through. This causes the body to react to the food as an invader and when the food is eaten the body sees it as something to attack. So, the most important thing after removing ones self from the mycotoxins is to address the intestinal inflammation. Diets that are helpful are diets that use rotation of foods and food that is easy on the gut. For folks who have trouble eating everything, they have to go on a roational diet and need to start with eating tiny amounts of things and building up. Bone/meat broths mentioned below are a good thing for most people to start with as well as fermented foods unless they have SIBO. Many people end up drawn to eating cabbage which is no surprise since it contains a high amount of glutamine that the gut cells need. There are many different diets used by practitioners and what a person should eat will depend on their situation, and sensitivities. However, I would mention that the GAPS diet is a good place for many folks to start. There are those who will not do as well with it as we are all different. However, many seem to do good as a starting point. Practitioners should help their patients come up with diets that are specific to their individual needs.
Here are some general things to consider in the beginning.
Bone/meat broth is a good thing to consume to provide nutrients to heal the gut. In this broth include things like bones with meat and a little fat on them, pig feet, chicken feet. Whole chickens, fish heads are ideas. Not just a bone broth, but includes some meat too. some organ meats are also good. Meat that is muscle meat is the least helpful. Meat close to the bone is great. Add lots of vegetables such as carrots, zucchini, squash, onion, broccoli, cauliflower. Do not use any potatoes or parsnips or other starchy items. Cook long and slow until you have a gelatinous soup.
Use the bone broth along with fermented veggies (Unless you get gas and bloating from fermented veg due to SIBO in which case this needs to be addressed.) For some of these people who react to fermented vegetables negatively, it is a matter of slowly adding tiny amounts of them into the diet and building up slowly.
Use only meat sources that are from organic or grass fed (The grass and hay the animals eat can not be sprayed with chemicals or they will end up in your food and ultimately in your body.)
Use only organic vegetables.
The person needs to get adequate healthy fats. If the person has issues with digestion of fat (pain, loose stools), light colored stools but the liver and gall bladder are in good condition, I will add and glycine to the diet for amino acid conjugation. Usually, the first thing I think of with light colored stools and indigestion from fat is to look at liver enzymes and make sure there is no blockage of bile. However, I find many of these CIRS folks actually need taurine/glycine which is necessary for bile conjugation. They do much better with fat and their stools take on a normal color giving it. I find the taurine especially helpful.
Fresh, raw food is imortant in the diet, but may be iriritating to some individuals with an inflammed gut. So, introduce when able to.
The gut microbiome should be attended to. How this is done varies from person to person. Consider fermented foods, prebiotics, probiotics, supply necessary nutrients.c Communicate with your microbiome about your intentions to bring harmony to the whole system.
Use of antiinflammatory and gut healing herbs in tea form is useful.
Yarrow, ginger, chamomile, peppermint and other wonderful antiiflammatory, healing herbs could be used, but I would caution that these may be to much for these sensitive folks. I am listing the herbs that are less likely to cause a reaction in these folks. People may still react to the list below but there generally they are easier on the gut. Realize these folks are reacting to almost everything so all food and herb is a possible irritant. Even those herbs that would usually be healing to other folks may cause a reaction, so the person should be given very tiny amounts to start with and build up. I am talking about a teaspoon at a time. For some folks, perhaps even drops the first time. As a pracitioner you have to make a decision as to what your paitent can tolerate.
Licorice is one that I find is very helpful. Although, there is an issue with contraindications for some people as well as concerns about mycotoxins on licorice root. Besides acting as an exceptional antiinflammatory to the gut and supporting the liver, it will also help preserve fluid in the body of CIRS folks that have trouble with constant loss of body fluid and low blood pressure due to adrenal fatigue and/or low anti-diretic hormone.
Marshmallow is another useful herb that is the anti-inflammatory, antibacterial and is soothing to the gut. Generally, I have people use this in a slurry form, but for these folks I suggest a tea so their gut is not irritated by the fiber.
Aloe is another helpful herb which is generally consumed as organic aloe juice. It is healing to the gut. Do not eat the whole leaf unless you enjoy diarrhea. Only the inside gel should be used. The bitter tasting part inside the outer sheath is a laxative.
Calendula is antiinflammatory, antibacterial and healing to the gut while also acting on the liver.
Plantain is very healing to the gut.
Turmeric is an antiinflammatory that is used for CIRS in general and is specific for gut inflammation.
Fermented foods and or probiotics/prebiotics are helpful even if in minute amounts. "Real" fermented foods are necessary. This means they are raw and not cooked at all. Probiotics are usually given by mouth, but they are sometimes given as an enema. Additionally, for some individuals a fecal transplant is helpful.
L-Glutamine is a helpful supplement for some folks. It is a fuel source for the epithelial cells in the small intestine, is important for intestinal mucosal integrity, is needed for proper immune function, decreases gut inflammation, and is a precursor of glutathione. It has been demonstrated that glutamine can help improve blood flow in inflamed segments of the colon in patients who have ulcerative colitis, although its benefits did not extend to the most seriously affected portion of the colon. Research shows it increases the number of cells and the villi on these cells as well as reducing permeability of the gut lining. It can be found in grass fed meat, raw dairy products,and in cabbage juice.
Fermented cabbbage is a source of both glutamine and good gut microbes. It contains lactobacillus plantarum which is a very beneficial microbe.
Butyrate has been shown to decrease mucosal inflammation and improve gut oxidative states. Butyrate lowers various inflammatory markers and improves not just gut inflammation but also improves brain inflammation.
Zinc L-carnosine may also help decrease the leaky gut by supporting gut mucosal integrity. In animal studies it prevented inflammatory reactions and cellular damage in models of inflammatory bowel disease.
A 2007 study found it reduced small intestinal injury showing a 50% reduction in villus shortening at 40 mg/mml (p<0.01).1
You will find zinc carnosine being used for intestinal permeability (leaky gut) as well as treatment for stomach ulcers.
Essential Fatty Acids are important in maintaining the membrane of all cells in the body. They are therefore in high demand in the intestine where cells turn over quickly. Omega 3 and 6 essential fatty acids have been shown to be helpful in inflammatory gut disease. Omega 3s are the ones I would suggest for people usually. They also help decrease overall inflammation in the body. They can be found in cold-water fish such as salmon, halibut, sardines, trout, or herring.
Vitamin D mediates the tight junction barriers between the epithelial cells.
The tight junctions between the intestinal cells are mediated by vitamin D, and at the average wintertime levels of vitamin D in north america, these proteins decline, as they do in the entire connective tissue, to the point where for instance, tendon ruptures peak in march of each year.
The Gut Microbiome: Normally the barrier is protected by biofilms of friendly non-invasive bacteria. These are destroyed by broad spectrum antibiotics, research shows that there is no homeostatic mechanism, with no normal method to restore the previous species or balance. Simply taking some pills of the "friendly" bacteria may not be enough as the entire bacterial population in the gut, not just the friendly biofilms, is like an additional organ in the body, and it is from this biome that the chemical triggers for tight junctions and gut integrity occur, and these same triggers affect insulin metabolism and immunity throughout the body, as well as your brain and mood. In fact, be careful who you get a fecal implant from (If you consider that sort of thing.) Make sure you like their temperment first. The person getting a fecal transplant has been known to take on the mood of the person who donated it.
The biome also metabolizes otherwise indigestible fibers, including but not limited to cellulose, pectin, inulin, various polysaccharides, Selective bacterial populations can be increased by giving just one of these fibers which people call prebiotics. Giving a large percent of the diet and a wide array of them (such as may occur in 8-10 servings of fruits and vegetables a day) provides for a healthy volume and a healthy balance in the biome.
For more data on bowel inflammation you can check out this link from an old lecture of mine:
Research to support tight junction barrier disruption by mycotoxins:
Lambert, D.; Padfield, P.J.; McLaughlin, J.; Cannell, S.; O?Neill, C.A. Ochratoxin A displaces claudins from detergent resistant membrane microdomains. Biochem. Biophys. Res. Commun. 2007, 358, 632–636.
Mahfoud, R.; Maresca, M.; Garmy, N.; Fantini, J. The mycotoxin patulin alters the barrier function of the intestinal epithelium: Mechanism of action of the toxin and protective effects of glutathione. Toxicol. Appl. Pharmacol. 2002, 181, 209–218.
Maresca, M.; Mahfoud, R.; Pfohl-Leszkowicz, A.; Fantini, J. The mycotoxin ochratoxin A alters intestinal barrier and absorption functions but has no effect on chloride secretion. Toxicol. Appl. Pharmacol. 2001, 176, 54–63.
Maresca, M.; Mahfoud, R.; Garmy, N.; Fantini, J. The mycotoxin deoxynivalenol affects nutrient absorption in human intestinal epithelial cells. J. Nutr. 2002, 132, 2723–2731.
McLaughlin, J.; Padfield, P.J.; Burt, J.P.; O?Neill, C.A. Ochratoxin A increases permeability through tight junctions by removal of specific claudin isoforms. Am. J. Physiol. Cell Physiol. 2004, 287, C1412–C1417.
Sergent, T.; Parys, M.; Garsou, S.; Pussemier, L.; Schneider, Y.J.; Larondelle, Y. Deoxynivalenol transport across human intestinal Caco-2 cells and its effects on cellular metabolism at realistic intestinal concentrations. Toxicol. Lett. 2006, 164, 167–176.
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