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Patients who present with severe intractable apparently idiopathic fatigue accompanied by profound physical and or cognitive disability present a significant therapeutic challenge and many such patients are afforded the exclusionary, non-specific diagnosis of chronic fatigue syndrome if rudimentary testing fails to discover the cause of their symptoms. However, more sophisticated investigations often reveal the presence of a range of pathogens capable of establishing life-long infections with sophisticated immune evasion strategies….Other patients have a history of exposure to mycotoxins or other biotoxins.

What are Mycotoxins?

There are estimated to be over 50,000 different species of mold, but only about 200 present serious health risks to humans or animals. These harmful species are referred to as toxic mold and are potentially hazardous because they can produce toxins known as mycotoxins.


Substances which are both toxic and have a biological origin. They come in many forms and can be produced by nearly every type of living organism. There are

  1. Mycotoxins (made by mold/fungi)
  2. Cytotoxins (made by viruses)
  3. Endo- and Exotoxins (made by bacteria)

Health Problems Associated With Molds and Mycotoxins

Mycotoxins are well documented for their toxic effects. Mycotoxins are associated with numerous neurologic abnormalities, endocrine abnormalities, immune dysregulation, oxidative stress, free radicals and impaired antioxidant function and mitochondrial dysfunction. As a result they are associated with a wide variety of clinical symptoms and diseases:

  • Kidney Toxicity
  • Immune Suppression
  • Autism
  • Neurotoxicity
  • Depression
  • Chronic Fatigue Syndrome
  • Cancer
  • Acute Pulmonary Haemorrhage
  • Aplastic Anaemia
  • Birth Defects

Most of what we know about this condition is the result of practice-based studies done by physician-researcher Ritchie Shoemaker. In a series of studies going back to 1998, Shoemaker developed an increasingly thorough description of an illness caused by poor clearance of biotoxins produced by certain algae and molds. He named it Chronic Inflammatory Response Syndrome (CIRS), and he successfully developed methods to diagnose and treat it.

Shoemaker speculates that the neuroimmune, vascular, and hormonal dynamics present in CIRS may play roles in other forms of chronic illness including chronic fatigue syndrome (CFS), fibromyalgia (FM), post-treatment Lyme syndrome (PTLS), and multiple sclerosis (MS).

CIRS occurs when genetically susceptible people are exposed to certain biotoxins 

Shoemaker subsequently mapped out the pathways involved in CIRS and developed a case definition for the condition. The biotoxin-driven multisystem, multisymptom pathway imbalance persists until the culprit biotoxins are effectively cleared from the body and the neuroimmune, vascular, and endocrine imbalances are corrected. Among the sources of biotoxins that can produce CIRS, biotoxins from molds known to grow in water-damaged buildings (WDB) account for some 80% of the CIRS-related illness burden. In the case of mold toxins, recovery depends on continual effort to avoid re-exposure.

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In a study (Brewer et al., 2013) the authors explained how water-damaged environments contain a complex mixture of biocontaminants produced by both mold, Gram-negative and Gram-positive bacteria. Secondary metabolites of molds and bacteria have been identified in the dust, carpeting, wallpaper, heating, ventilation and air-conditioning (HVAC) systems and respirable airborne particulates. The study was conducted to determine if selected mycotoxins could be identified in human urine from patients suffering from chronic fatigue syndrome (CFS).

Ninety-three percent of the cases demonstrated the presence of at least one of the mycotoxins in the urine. Over 90% of the patients gave a history of exposure to water-damaged environments (many with visible mold).

The conclusion from this study was:

Mycotoxins can be detected in the urine in a very high percentage of patients with CFS. This is in contrast to a prior study of a healthy, non-WDB exposed control population in which no mycotoxins were found at the levels of detection. The majority of the CFS patients had prior exposure to WDB. Environmental testing in a subset of these patients confirmed mold and mycotoxin exposure. We present the hypothesis that mitochondrial dysfunction is a possible cause of the health problems of these patients. The mitochondrial dysfunction may be triggered and accentuated by exposure to mycotoxins.

In another study (Brewer et al., 2014) the authors discussed the theory that some chronic illnesses (upper and lower respiratory disease, central and peripheral neurological deficits, chronic fatigue type illness, among others) may be associated with mold and mycotoxins. They went on to show that in some individuals who remain chronically ill despite leaving the moldy environment, and who still show mycotoxins in their urine several years later. The authors proposed that there may be an internal presence of toxin producing mold. They raised the question ‘where was the mold located in the body?‘ and concluded the presence of fungi/mold in the nose and sinuses.

The authors also discussed how the fungi that are present in the sinuses are in biofilm communities which allows for chronic persistence. This would explain the chronic nature of the fungi/mold in the sinuses and explain the difficulty in treatment.

Prior exposure to toxic mold and mycotoxins may represent an important feature of chronically ill patients such as CFS as well as those with CRS. An internal reservoir of toxin producing mold (e.g., sinuses) that persists in biofilms could produce and release mycotoxins. This model of fungal persistence may help explain these chronic illnesses and represent a potential new understanding of mechanisms of disease that can be treated and/or lessened.

In a review paper (Morris et al., 2015) they stated:

Exposure to mold antigens and toxins, frequently found in the air in water-damaged buildings, are a well-documented source of inflammation, oxidative stress, and subsequent inflammatory reactions

These are all frequently seen in chronic fatigue syndrome patients.

Mycotoxins can cause mitochondrial dysfunction

Mitochondrial dysfunction is frequently seen in chronic fatigue syndrome patients

Numerous studies also report the existence of mitochondrial damage and compromised bioenergetic function in people subjected to chronic mold exposure. Elevated levels of ROS/RNS are likely to be partly responsible for the existence of mitochondrial pathology, but various mycotoxins can compromise the function of these organelles directly by a range of mechanisms.

Chronic exposure to mycotoxins may cause injury to the gastrointestinal tract

As discussed in our article on digestive health and chronic fatigue syndrome (read it here) imbalances in digestive health are incredibly common.

Individuals who have developed symptoms stemming from chronic exposure to mycotoxins and mold particles may present with classical neurological abnormalities including movement disorders, pain syndromes, neurocognitive defects, and impaired coordination and balance


As is often the case there is challenge in interpreting results from tests. RealTime Laboratories that offer testing explain that “we see mycotoxins in urine when the body is working to detoxify and remove them (via urine). It is possible to be negative for mycotoxins in urine, but the mycotoxins are still present in the cells in the body where they are causing damage. Talk to your Health Care Provider and discuss the clinical history of exposure.”


There is no generally accepted ‘standard treatment’. Doctors who specialize in mold and mycotoxin associated illnesses have developed their own treatment protocols. These include saunas, glutathione supplementation, use of antioxidants, probiotics and intra-nasal anti-fungal treatments. It is important to note that avoidance is the most important criteria. Leave the dwelling where you are being exposed until it is inspected by an Environmental Inspector and remediated, if necessary.

Some practitioners recommend using an infared saunas. Others recommend ‘low mold diets’ which means avoiding foods that include ‘high sugar’ foods, cheese, alcohol, mushrooms and condiments such as vinegar. The importance of this is questionable though and I don’t feel is always necessary.


Considering whether you have had mold exposure may be an important aspect of understanding the cause, and treatment plan, if your suffer with chronic fatigue syndrome. Shoemaker estimates that 75% OF CIRS cases are caused by repeated exposure to water damaged buildings. Having an understanding of chronic inflammatory response syndrome is important with a history that includes exposure to water damaged buildings and Keith Berndston  has an excellent article that discusses the criteria that must be met to get diagnosed with CIRS.


Keith Berndston article on Chronic Inflammatory Response Syndrome

Dave Asprey’s DVD documentary

Podcast with Dr Jill Carnahan