Week of January 2, 2023

1. Starting an exercise program with CIRS

Q: I would like to begin an exercise program to help me get stronger more quickly. Is this a good idea?

A: Starting an exercise program will not benefit CIRS patients and can often make things worse—unless they have reached a point during recovery where there system is ready. Even when a patient is recovering, too much strenuous activity can make recovery more difficult. Here is why:

In the chronic inflammatory response syndrome, invariably there is an excess of inflammatory compounds that will reduce blood flow in the smallest blood vessels.

This so-called capillary hypo-perfusion reduces delivery of oxygen in the capillary bed. If there is reduced oxygen delivery, muscles being asked to exercise quickly run out of oxygen, thereby exceeding the anaerobic threshold. When the anaerobic threshold is exceeded, there is invariably a breakdown of protein into amino acids to be used for fuel as the glycogen reserves are wasted with a 95% inefficiency converting sugar into ATP (energy) molecules. When there is reduced oxygen delivery, muscles quickly starve. Glycogen stores in the muscles, normally used as a secondary source for long-term energy, are also used inefficiently.

This leads to fatigue, muscle cramps, and shortness of breath. For some patients, walking up a small flight of stairs can leave them completely out of breath. Others may notice a more gradual decline in their endurance and ability to exercise over time.

For the CIRS patient this means avoiding exercise that exceeds the anaerobic threshold.  Exercise must be gradually introduced at the proper time during recovery, and slowly and methodically. Those who attempt to do too much, too quickly, will experience the “Push and Crash” effect. Feeling good one day and trying to exert yourself beyond your capacity will result in exhaustion and muscle soreness often for several days.

Your CIRS Practitioner can guide you in an exercise prescription to meet your individual needs, and determine your anaerobic threshold, when the time is appropriate.

The General Exercise Guidelines include:

• Exercise is to be done daily, no exceptions.

• Start with 5 minutes of walking or exercise bike with no incline or resistance.

• If tolerated well, add 2 minutes to the exercise time daily until you can tolerate 15 minutes.

• At this point, gradual muscle training can be started, usually beginning with abdominal exercises. Begin at no more than 5 minutes, and gradually increase, then add more muscle groups as tolerated, and as guided by your practitioner.

• After a full muscle and cardio exercise program is tolerated in a 45 minute time period, then resistance can be added to each individual exercise, one at a time and gradually.

Daily incremental increases are the key, which will increase a substance known adiponectin, a hormone that regulates fat metabolism and helps you burn fatty acids much more effectively. This dramatically helps energy available to your muscles.

Within 2 or 3 months of daily progress you will see a dramatic improvement in exercise tolerance. Skipping a day of exercise will slow your progress significantly.

For best results, always do the program with the oversight of a Shoemaker Practitioner, who can tailor the program to your recovery and progress levels, and help you determine your anaerobic thresholds. They are also an accountability partner, helping you stay consistent and on track. 

2. The No-Amylose Diet, the Protocol, and weight loss.

Q: Do I need to be on the no amylose diet while taking cholestyramine?

A: No. The only people for whom I use the no amylose people are those using medications in attempt to lower leptin, MMP-9 and PAI-1.

However, if you feel better on this diet and want to stay on it, that is fine, too I have advocated its use to help in weight loss since 1977.

I am always interested to see a new diet come along that simply follows the concepts of no-amylose (South Beach, Paleo; the list is long).

The Forbidden Foods on the L.A. Diet are:

• Roots & tubers including white and sweet potatoes, beets, peanuts, carrots, and other vegetables which grow under ground. Onions and garlic are permitted
• Bananas (the only “forbidden fruit”)
• Wheat and wheat-based products, including bread, pasta cakes, crackers, cookies
• Rice
• Oats
• Barley
• Rye
• Foods with added sugar, sucrose, corn syrup, or maltodextrin

3. Worsening re-exposure symptoms

I know that symptoms from a “mold hit” appear in as little as ten minutes. My concern is that now I seem to be getting stronger symptoms with re-exposure then what I did before. Please help me with my concerns.

Here you must be very certain that ERMI or HERTSMI-2 in your residence is normal.

The most common reason for worsening after treatment is re-exposure in the home environment. ERMI testing costs $300. While I use Mycometrics more than any mycology lab (and there is no conflict of interest here), it is even less expensive to use HERTSMI-2 which only costs $125. Once you are assured that the home is safe, now is the time that you absolutely must have your labs done looking at treatable aspects of “sicker, quicker.” We see this phenomenon commonly, particularly in people with HLA haplotypes of 4-3-53 and 11-3-52B but can occur with any haplotype. What happens is that the enzyme that makes C4a (MASP2) is one of the few (some say the only) enzymes that auto-activates. Trivial exposure will cause an exponential rise of C4a, with TGF beta-1 following as a result that in turn makes people much worse.

VIP has shown spectacular benefit in reducing this “sicker, quicker” part of surviving mold. If you haven’t discussed VIP with your physician, please do so.