Week of August 12, 2024

1/ Evaluating VIP benefits Q: Is there a lab that does blood test for VIP efficiency? A: Please follow the standard CIRS labs together with use of NeuroQuant indicated. The best test for looking at VIP is the mRNA of VIP receptor-2. This test is formed as part of a genomic assay and is available on a research basis now. The lab order sheet and many more free practitioner resources are available on this site. For an overview you may be interested in reading an article featuring FAQs about physicians’ resources here. 2/ Duration of therapy Q: I am from Finland and am sensitized to molds growing in a water-damaged laboratory. How long does it take to become symptom-free after therapy has started? Secondly, after re-exposure to prove causation, how soon can the person return to symptomless conditions? A: The answers to your questions are simply dependent on three elements: 1) What is wrong? 2) How bad is it? 3) Do you have the genetic make-up which is highly susceptible to CIRS? Are you familiar with the Shoemaker Protocol™ and the 11 steps? The first step is to understand that each step is strategically mapped out to optimally work through the numerous symptoms and affected systems. You may be interested in reading the Shoemaker Protocol™ Practitioner Essays, which thoroughly explain the Protocol in their words. For the first element of your questions, essentially each of the step-by-step sequential interventions takes approximately a month. CSM treatment will typically last a month before retesting Visual Contrast (VCS) available online and the required labs. After the CSM step, if you do not test positive in a certain step, you can skip that step and proceed to the next step. For example, if you have a positive nasal culture for MARCoNS, you can skip that step of treatment. If you do, however, have a positive culture that requires an additional month together with toxin-binding treatment. If you have gliadin antibody positivity that must be treated; similarly, for androgens, ADH/osmolality abnormalities and TGF beta-1, among others. A diagnostic re-exposure trial would not be performed until a patient had reached maximum medical benefit. So, the answer to your second question for re-exposure is a bit more straight-forward. Because you stated you will be initiating treatment within three days of exposure, reclaiming the status of health at the end of the initial therapy usually only requires a few days. If you have gone through all the necessary diagnostic testing and labs, you will have the information needed to assess the severity of your case, and will know if you indeed have “the dreaded gene” or not. Those with the genetic susceptibility may find post-treatment that they have strengthened their system to a degree, especially with VIP treatment and the use of VIP as needed, and may be less susceptible. However, most genetically susceptible CIRS patients need to stay vigilant in their efforts to prevent exposure. Remediating or even moving homes (or work, or removing yourself from whatever building or environment is making you sick) is the first step in the Shoemaker Protocol™. Post-Protocol, patients need to keep their environment “safe” through on-going rigorous cleaning, air filtration, and maintaining a water-intrusion-free home. They are also on guard when entering new buildings, checking for water-damage and leaving within 10 minutes if it appears to have water damage or leaving immediately if symptoms begin to arise. If symptoms do arise, beginning CSM or Welchol treatment ASAP is recommended. You will begin to know your initial symptoms and when this step is needed. Follow through with the Protocol steps and see your practitioner if symptoms do not subside within a week or two, or if they worsen. The 500 Answers to Frequently Asked Questions eBook will provide additional information for you. You may also be interested in a free volume of Member Q&As available for download. 3/ Ferritin Q: I have a patient who has CIRS and some additional unusual laboratory findings. Specifically, an elevated ferritin has been identified in the absence of hemochromatosis. von Willebrands profile is also abnormal. Is elevated ferritin found in other patients? What additional testing should be done? A: Ferritin is an iron storage protein which must unload its iron content to provide the iron required for bone marrow production of red blood cells. Very often under inflammatory stimuli there will be abnormalities in soluble transferrin receptors that is a possible confounder in this case. Because ferritin levels can be maintained at a high level in the presence of inflammation, treatment of the underlying problem of CIRS is mandatory. 4/ Treatment approach & diet considerations/CSM QUESTION: A patient from Iceland writes that he is ill following exposure to a water-damaged building. He has been removed from exposure but is still trying to regain his health. He is starting to take cholestyramine and wants to know what more he can do? He also wants to know about his diet. ANSWER: There is no special diet that I recommend for people taking cholestyramine with the exception that I do recommend increasing the amounts of soluble fiber as a reasonable mechanism to avoid constipation. Soluble fiber (not insoluble) is found in a variety of fruits and nuts with soluble oat bran fiber possibly being the best. Yes, good old fashioned dietary methods of regulation often do the trick such as eating just one or two prunes a day, or taking a small glass of prune juice. From Metamucil to Smooth Move type teas or over-the-counter remedies may be used if you need immediate relief of intensified symptoms. You will need to gauge what is best or necessary for your system. You do not need to avoid mushrooms, bread, cheeses, wine or beer. These mold-based food items do not have the moldy environment biotoxins and bacterias making you CIRS sick. They have different make-ups. However, there are some patients that are quite sensitive to those items (and more) when they have a CIRS. Read the following question for more information on the matter. 5/ Can CIRS patients eat nuts, or are they too “inflammatory”? QUESTION: I have been made ill by water-damaged buildings and I have an HLA of 4-3-53. This question might seem a bit off the wall at first. I have read a disagreement along the community of nutritionist talking about inflammatory states suggesting that eating nuts creates an inflammatory illness. I like nuts. I read in a recent paper in the New England Journal that eating nuts makes you live longer. ANSWER: For those who are avoiding sources of amylose, seeds and roots need to be recognized as being potent stimulators of a rapid rise of blood sugar solely following chewing. This rapid rise of blood sugar stimulates a rapid rise of insulin which in turns sets off inflammatory pathways. So foods with amylose are not a good idea for those who have (1) high insulin; (2) insulin resistance; (3) who are using either Actos or omega 3’s to reduce MMP-9, PAI-I or leptin. Over the years most people have been surprised that I suggest avoiding peanuts as they grow below the ground. Despite the fact that walnuts and cashews, for example, are seeds and theoretically could contain amylose, they have not been potent stimulators of a rapid rise of blood sugar. I do not restrict use of any nuts other than peanuts for those worried about insulin-driven inflammation. The inflammatory responses of CIRS are innate and are not driven by insulin for those who are not using the no amylose diet. Read the following questions for more information on the matter. You may also be interested in Dr. Shoemaker’s book, “Lose the Weight You Hate,” for more information on the No-Amylose Diet and the benefits for both CIRS patients, and those susceptible to the “slings and arrows” of insulin and inflammation. 6/ Mycotoxins and food QUESTION: Are mycotoxins in food a concern? ANSWER: There is a significant world of literature looking at aflatoxins found in food creating illness in animals. There are exposure limits set by the FDA (which are quite high) for presence of aflatoxins in food stuffs. Animal feeds are routinely protected from fungal growth to prevent toxin contamination. I have not yet seen a patient with CIRS symptoms worsening due to consumption of food. In one remarkable small study I found non-allergic volunteers willing to eat 4 giant jars of Skippy crunchy peanut butter in a two hour period (during this time they watched Young Frankenstein and danced to Putting on the Ritz). There was no change in inflammatory parameters before and after said consumption and no changes in blood results in the next two days. Fortunately, the patients did not suffer bowel perforation from this gross consumption of peanut butter. The basic understanding when dealing with CIRS is that the mold, bacteria and biotoxins found in buildings make you sick, but the typical types and levels of mold found in food, do not. Also, a distinction needs to be made between mold-related food allergies and CIRS. Mold on or in food does trigger allergic reactions in those with a mold allergy. CIRS conditions will not be made worse by consuming standard food from grocery stores or even food that’s started turning moldy, which may happen accidentally or when its not yet visible. It’s also helpful to understand that there are different types of molds, some naturally occurring in foods, and some are even considered good, healthy and highly edible (as in mushrooms, nuts, blue cheese and certain cheese processes). If you have CIRS, you can eat cheese if your digestive system is up to it – blue cheese included. While molds can develop during growing, harvest, or in warehouses, manufacturers have systems and standards in place to control the warehouse mold growth. In my treatment of patients, I have not come across anyone who has had an illness or CIRS symptoms develop from mold on or in food. Environmental mold such as from water-damaged buildings is, however, another story. 7/ Food intolerance from mycotoxins Q: I can’t tolerate any vegetables, fruits, nuts, seeds, legumes dairy or grain. I can’t tolerate fish oil among others. All I can eat are chicken and beef and possibly coffee and almonds. A: I do not agree that your case is reflective of intolerance simply due to fungal contamination or mycotoxin contamination of stored food. I would start by assessing the potentials of your case to be due to low levels of MSH providing inadequate regulation of inflammation in the gut. If you haven’t already, be sure to review the above questions on the matter. 8/ Krill oil Q: Is krill oil a good alternative to fish oil before starting cholestyramine? I am allergic to anchovies and sardines. A: We use omega-3 in substantial doses for patients who have had a history of confirmed Lyme disease; markedly elevated leptin; elevated MMP-9 and elevated PAI-1. Omega-3 can also assist in raising low VEGF. As there are many preparation of krill oil in addition to fish oil, I urge you to see manufacturer’s advice regarding the content of EPA and DHA. Those are the only two omega-3’s that make any difference. Omega-6 does not help in inflammatory response though I didn’t do extended clinical trials. Some people say it makes them feel better. Independent of endorsement from physicians/providers, especially anyone selling products widely, the real issue is that if you decide to use krill oil you need to look at before and after levels of the inflammatory markers you were trying to lower. For the rare patient who does not respond to omega-3 in high doses, especially with low VEGF, VIP is essentially the only other alternative.