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Toxic Black Mold: Ugly, Yes, But Really How Dangerous?

I think black mold makes us nervous because we can see it, clinging to the bottom of the shower curtain, lurking in the corners of the recently flooded basement. You almost expect it to throb or make a vaguely humming noise.

However, far more dangerous as a home hazard is the radioactive gas radon, but because it’s invisible and odorless it’s out of sight and out of mind, so we aren’t frozen in fear at the thought of it as we do with the black guck in our bathrooms.

If you read the internet’s top medical alarmists, Drs. Oz and Mercola, you wouldn’t be a bit surprised if they told you ISIS or Al Quaida was behind America’s black mold terror. Dr. M even alleges that toxic mold can be “FAR more damaging than pesticides and heavy metals” (caps his, not mine).

But Drs. Oz and Mercola are timid in comparison to the really serious black mold Cassandras, the most prominent of whom is Ritchie Shoemaker, MD, a primary care physician who proposes that mold toxins enter our bodies and produce a state of chronic inflammation that in turn may be responsible for many undiagnosed chronic symptoms, including fatigue, muscle aches, and brain fog. Worse yet, he posits, these toxins endlessly circulate inside us instead of getting cleared out, something our bodies have no problem accomplishing when it comes to Sauvignon Blanc or Little Debbies.

Dr Shoemaker suggests that when your doctor tells you she can’t find anything wrong with you and all your tests are normal you should think CIRS (chronic inflammatory response syndrome) and that your doctor is likely overlooking a toxic mold diagnosis.

Controversial diagnoses
This places toxic mold syndrome in league with other controversial diagnoses including candida (yeast), chronic Lyme, Epstein-Barr, Human Herpesvirus-6 (HHV-6), Mycoplasma, and the new XMRV virus, the latest cause of chronic fatigue syndrome.

So prevalent is the toxic mold problem that Dr. Shoemaker believes as many as one person in four may be affected. To determine if you’re among the 25%, he created an undeniably complex protocol of rarely used diagnostic tests along with a treatment program (or rather “treatment commitment”) that includes prescription drugs, nutritional supplements, dietary changes, weight reduction, saunas, and regular exercise.

I may sound skeptical, but I’m not disrespectful of his work. His patients report feeling better after years of chronic symptoms and I’ve learned never (ever!) to argue with a patient who has found something that returns her to health.

Other end of the spectrum
On the other end of the mold danger spectrum are reasonably respectable but undeniably conservative sources of information like the CDC (Centers for Disease Control), Mayo Clinic, and even the usually alarmist Andrew Weil, MD. These sources, like most conventional physicians, acknowledge that mold in your home can cause some annoying symptoms, but that once you get rid of it you’ll probably be just fine.

Nothing shakes your faith in the medical profession like two diametrically opposed points of view: Dr. Shoemaker with his chronic inflammatory response syndrome and the CDC with its not-to-worry approach.

Four diagnostic possibilities
For what it’s worth, I think when it comes to mold you’re dealing with four separate diagnostic possibilities. And by the way, even the word “toxic” is controversial. Certain species of mold do produce known toxins, but you need truly heavy exposure for it to be a problem. (For the record, Dr. Shoemaker would disagree with that statement.)

1          You see mold in your home and you think, “Yuck. Well, I’ll just get some Tilex Mold & Mildew Remover. You spray it on, the mold melts away, and you feel fine. In fact, you felt fine even before discovering the mold. Tilex is basically household bleach in water, so for a bigger job like a basement you can make it yourself (there are about as many recipes online as there are species of mold). But if you had no symptoms, it simply means you’re not allergic to mold.

2          This is by far the most common way mold manifests itself negatively in our lives, the notorious sick building syndrome you’ve read about or when you see a news story “School Closed by Mold.” You or family members have developed some irritating respiratory symptoms: cough, sore throat, sinus drainage, red eyes, maybe even some asthma-like symptoms with wheezing and shortness of breath. It dawns on you that you saw mold in the basement, your apartment has been smelling musty, or a well-meaning neighbor visits and wrinkles her nose like a deranged rabbit, suggesting “You’ve got a mold problem, honey.”

Your symptoms are all respiratory because you’re inhaling the mold spores and you’re having an allergic reaction, sort of like indoor hay fever, but instead of pollen it’s mold spores. Like hay fever or asthma, you’ll likely get relief with antihistamines or steroid nasal/lung inhalers, but your best bet is to verify mold as the culprit and get rid of it. You can buy a perfectly good mold home testing kit online or at a Menard’s or Home Depot. If your symptoms worsen in places where mold is heaviest, get the mold professionally removed. You’ll also learn ways to keep it from returning (such as using air cleaners and dehumidifiers).

3          Possibility #3 is very rare, but not at all controversial. Aspergillus is a common strain of mold that most of us breathe with no bad outcome. However, in certain susceptible individuals, aspergillus can literally set up house in the sinuses or lungs, producing constant severe allergy symptoms like cough and shortness of breath. If the situation worsens, the aspergillus moves on to the liver or brain into a fearful-looking “fungus ball” (see appetizing x-ray here). BTW, it’s curable with surgery and anti-fungal medications.

Usually people who develop aspergillosis have other longstanding medical conditions, such as chronic bronchitis or emphysema, or they’re immunocompromised due to conditions like HIV/AIDS. I’ve seen exactly one case of aspergillosis in my career—a chronically ill, malnourished homeless man brought into a VA emergency room.

4          Possibility #4 is the CIRS as postulated by Dr. Shoemaker, in which the toxins produced by mold trigger a state of chronic inflammation. The tests he’s selected to diagnose this condition are virtually unknown to most physicians and, unless your insurance picks them up, cost about $1,500.

Dr. Shoemaker was reprimanded by his state medical board in 2012 and no longer maintains a private practice. To some, being reprimanded by a conservative panel of physicians for out-of-the-box thinking is not in itself a bad thing. Many doctors practicing unconventional therapies have been reprimanded, only to be recognized as medical pioneers some years later. The problem you would face as a patient if you were interested in the Shoemaker Protocol is that doctors practicing unconventionally prefer not to wave red flags in front of state boards and you may find it difficult to locate a physician to supervise your care, order the tests, and prescribe the drugs.

If you read the proceedings against Dr. Shoemaker you’ll see the board was responding to a complaint from an unnamed person who was not a patient. My guess is that a local health insurance company filed the complaint because his tests were costing them money. You can read the details of his protocol at www.survivingmold.com.

Still curious?
If after reading about CRIS and mold illness you’re interested in pursuing this beyond a home mold test kit and a bottle of bleach, I believe you can replace some of Dr. Shoemaker’s tests with a selection that won’t shock your primary care doctor. (If you’re uncertain about your at-home test results, get your home professionally tested. We refer patients to Larry Schwartz at Safestart Environmental.)

I recommend these tests…

  • Immunocap IgE Mold Panel ordered through Quest or LabCorp (insurers usually have no problem with this—it’s a test widely used by allergists in their daily practice). It will diagnose a simple mold inhalant allergy. Make sure the panel includes both the black mold Stachybotrys and aspergillus.
  • ELISA/Act Basic Panel, which looks for antibody reactions (IgA, IgM, IgG) to 66 foods, 45 environmental chemicals/colors/preservatives, and 28 molds. This is not covered by insurance but is a real bargain at $265. If your mold levels are high, it does hint at CIRS.
  • C4a, an inflammatory marker in the blood that Dr. Shoemaker believes is a sign of possible mold-related illness.

In summary, most mold is unattractive but harmless. Some people are allergic to it and respond by sneezing and wheezing. Aspergillus, despite the scary x-rays, is rare. The verdict is still out on mold-induced CIRS.

Be well,
David Edelberg, MD

PS        Thanks to my friend Keith Berndtson, MD, medical director of Park Ridge MultiMed, for his lecture material and major article on CIRS.

PPS     If you’re interested in a spring detox, WHC nutritionist Marla Feingold will lead a workshop called “10-Day Detoxification Workshop” on April 14. Click here for more info.


Leave a Comment

  1. Tara Drolma says:

    Your articles are always so thoughtful, relevant and well written. This is very helpful. I was diagnosed with CFS (SEID), a number of years ago but no tests were ever done to exclude other possible causes for the fatigue. My problems began when I moved into my present home. The garage in this home used to flood periodically and there is often standing water under the house in winter. And, my neighbors 12 plus cats all urinate and deficate in my front yard. I have many allergies and am prone to respiratory infections. I have begun to think I should consider mold or toxoplasmosis as a possible culprit. I mentioned toxoplasmosis and my PA immediately dismissed it. But there is the possibility I fall into the #3 category. Thank you for this very practical and balanced information that I can now present to my PA.

  2. Deborah Zera says:

    I thought that the latest news in CFS was the 2015 research out of Columbia University about immune changes in CFS patients, and that XMRV was old news and it has been ruled out as a cause of CFS. Any comments Dr. E?

  3. Addie says:

    Last week’s blog documented comic/annoying affects of corporate sponsored nutrition research (without specifically blaming economic interests for the contradictions), and this week’s made me smile too. Drs. Oz and Mercola seem living testaments to the truth of Bernard Shaw’s send-up of the medical profession, “The Doctor’s Dilemma.” Please document more of their medical media madness. It’s so much fun.

  4. Dr E says:

    Hi Deborah
    You’re right–XMRV has been ruled out as a cause of CFS. Turned out the original researcher had fudged the data and was subsequently fired.

  5. Jo Peer-Haas says:

    I plan to sell my house in a year, and I always get some mold on my basement walls. Water comes in under them in certain places when it rains heavily. Is it enough to get the leaks repaired and wash the mold from the walls? Or do I need to go in and remove it from inside? I’m worried it will be a factor when the house goes up for sale. No one living here has symptoms from the mold.

  6. Dr E says:

    Hi Jo
    Most people do not react to black mold but the appearance can be off putting for a potential buyer. I think repairing the leaks and washing the mold is really all that’s needed

  7. Callie Marie says:

    Thanks for the great information about black mold. It is a relief to know that most forms of household mold are harmless. I’m curious to know how it could be affecting my pets though. I will be sure to have all the mold removed and the leaks causing it fixed.

  8. Mallory Ewer-Speck says:

    Is CIRS a controversial diagnosis? What lab tests are for diagnosing CIRS?

  9. Dr E says:

    CIRS is indeed a controversial diagnosis. Patients do feel “something” is wrong, that they’re chronically unwell, but the actual symptoms they feel are not specific for any one condition. CIRS advocates believe that toxic mold is the trigger but the tests they use to confirm the CIRS diagnosis are so little used in medicine (and as a result very expensive) that the majority of physicians see these tests (see the link) and don’t know what to do with them. The tests, they say, give vague answers and they’re relucant to start treatments.
    Chronic Lyme Disease triggers similar “positives.” So do you treat mold or Lyme? The jury is out.

  10. Anna Levis says:

    Mold is never a good thing. Spores reproducing on counters, walls, and wood trim can take flight and aggravate allergies and respiratory ailments, as well as ruin drywall, carpet, and woodwork. But in every life a little mold will form, and not every patch is a reason to panic.

  11. Sarah Aurich says:

    Mold is a natural element in our environment, living in air, in our homes and on the ground. It is everywhere. If you are allergic to it, it’s no different than being allergic to certain weeds, trees or other pollinators. Like mushrooms, some of them will make us sick. Before freaking out, get the information you need. I spent a fortune having black mold removed from my house before testing it to see if there was anything to worry about- maybe but probably not. Test first! Then decided what’s best.

  12. Robert Ross says:

    Hey, thank you for sharing this! Many people underestimate the danger of mold and live for years in a toxic environment, not even suspecting it, and also not realizing the reasons for their many ailments and poor general health. And the health of your entire family can be at stake!

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Just print this out, tape it on your refrigerator door, and stay calm.


• Runny nose
• Sneezing
• Red, swollen eyes
• Itchy eyes and nose
• Tickly throat
• No fever

• Runny nose
• Sneezing
• Sore throat
• Mild muscle aches
• Mild dry cough
• Rarely a low fever

• Painful sore throat
• Hurts to swallow
• Swollen glands in neck
• Fever

FLU (Standard seasonal flu)
• Fever
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• Sudden onset over few hours
• Headache
• Sore throat
• Fatigue, sometimes quite severe
• Muscle aches, sometimes quite severe
• Rarely, diarrhea

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• Slow onset (2-14 days)
• Mild muscle aches
• Mild fatigue
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