Unknown Cause of Nausea and Fatigue: A Medical Investigative Journey, Part I

David is a pleasant 35-year-old IT professional whom I see occasionally for neck and lower back pain due to sitting at work. He is busy with family life as he and his wife Audrey have young kids. Cupping, high-velocity adjustments and stretching help him keep the tension and pain at bay.

During one visit, he mentioned that he sometimes felt nauseated for durations lasting a couple of minutes. The nausea occurred irregularly and the onset began  three years ago when he started working from home in his basement. He recalled that it was a stressful period marked by the start of  a new job as well as  experiencing fatherhood for the first time. His family doctor ordered a blood test and the results were within reference range. H. Pylori infection was ruled out. He was then referred to GI specialist for endoscopy which came back nothing remarkable. Triggers for nausea primarily centered on strong odours yet symptoms also appeared with no causal factors. Since the nausea did not happen on a regular basis, it was challenging to find the root cause. David tried acupuncture which unfortunately did not help. Over the years, he did not pay much attention to the problem until the nausea came back more frequently. In the past few months, David mentioned that he had even less energy than a few years back but was not so concerned because he felt that fatigue was a typical symptom of having small children and therefore, sleepless nights. 

Audrey, David’s wife is also a patient of mine. She has been experiencing fatigue for more than 10 years. Other symptoms are poor short-term memory and short concentration span. Onset was moving to a new country and starting an intense master program. Energy is 3/10 and she feels better for a few hours after naps. We have been able to improve her energy and concentration from lasting 3 -4 hours a day, to 7 hours a day without naps. We have worked on her adrenals, optimized thyroids and iron levels, tested for heavy metals and food sensitivities and was treated with acupuncture over the years. She had 2 pregnancies that were uneventful and she went back to work part time after only a couple months of maternity leave. She is working almost full time in the healthcare field while juggling two young children. Sleep has been an issue since pregnancy. Her labs look great but she would feel better for a short period of time followed by fatigue. Both David and Audrey lead clean and healthy lifestyles however, one thing they both can incorporate is regular exercise.  

David and Audrey were hit by an episode of URTI last winter. David recovered after a couple of nutritional IV and some herbs to support adrenals, high dose vitamin A, D, and C. In Audrey’s case, her body aches and fever went away but the fatigue, sinus congestion, and coughing upon waking lasted for more than 2 months. She went to see a medical doctor and was diagnosed with bacterial sinusitis. She was given 1 week of antibiotics. After taking the antibiotics, she felt better 80%. Unfortunately, the coughing in the morning from post nasal drip is still severe and her fatigue and brain fog got worse.  

Even though Audrey feels tired all the time, surprisingly she has a healthy immune system and she seldom gets sick. On the other hand, David’s nausea symptoms recently returned. Their lingering symptoms prompted me to dig deeper as I felt that there must be some chronic infection or inflammation that we did not discover. I was curious to investigate their living environment for possible toxin exposure.  

Upon questioning, David and Audrey revealed that their basement was flooded by a storm last summer which required them to remove dry walls and flooring. Years of water leaking from cracks in the foundation led to large areas of mold growth on the wood studs behind the dry walls. Even though there was no visible mold growth on the interior side of dry walls, lightweight spores of mold could still travel through the air. Exposure to mold could explain David’s nausea and Audrey’s sinusitis. I ran Organic Acid Test and Mycotox test on both of them.

David’s OAT test report showed high Arabinose which is a yeast and fungal marker. This indicates a yeast/fungal overgrowth in GI tract. Other markers that are high are bacterial markers also in GI tract: hippuric, 4-hydroxybenzoic, 4-hydroxyhippuric, DHPPA. Mycotox report showed high markers for ochratoxin A (a metabolite from Aspergillus), mycophenolic acid (a metabolite from Penicillum), chaetoglobosin A (a metabolite from Chaetomium), and citrinin (a metabolite from multiple mold species). The markers are produced by different molds and are commonly found in homes that have experienced water damage.  

Audrey’s OAT test report showed high arabinose as well, but no elevated GI bacterial markers. Her mitochondria markers were high (2-Oxoglutaric and citric, 3-hydroxyglutaric) which could mean mitochondria dysfunction and impaired citric acid cycle. On her Mycotox report, markers from mold species Aspergillus, Penicillum, Fusarium, and multiple mold species were high.

The elevated bacterial, fungal and mold markers could help to explain the nausea and fatigue David is experiencing. Audrey has some fungal, and mold exposure which could result in chronic inflammation, suppressed immune system, and impaired mitochondria function, and chronic fatigue. In addition to this information, Audrey added that the townhouse she lived in after she moved for her study 10 years ago had visible black bold growth in her bathroom. She lived in that place for 8 years, then got married and moved in with David to another mold growing place! She did not link the long-term mold exposure to her chronic fatigue! After reviewing the reports with David and Audrey, they are in the process of restoring their basement and permanently removing all the mold. Treatments for them will include antimicrobials and antifungals for the fungal and mold infections, binders to help clear mycotoxins, antioxidants and liver support. This is an on-going case, so please stay tuned for the treatment detail and their outcomes in one of the future issues.