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This month’s featured Q&A Category: Food and Diet Considerations & The No Amylose Diet

1/ The No-Amylose Diet and the Protocol, and weight loss

QUESTION: Do I need to be on the no amylose diet while on the Shoemaker Protocol™, specifically while taking cholestyramine?

ANSWER: The no amylose diet is used in specific situations as noted below. I do not prescribe any diet during the course of the Protocol (or after).

The no amylose diet was initially developed to help people with CIRS who have high levels of MMP-9. Cutting back on amylose, a carbohydrate found mainly in starchy foods that mainly grow underground, works to lower MMP-9 levels, as well as inflammation and insulin levels.

The no amylose diet are used in the below situations during the Shoemaker Protocol™ as applicable:

1/ Eliminating gluten in those with anti-gliadin antibodies in order to help inflammation improve.

2/ The low-amylose diet is used in step 7 in conjunction with correcting MMP-9 as needed.

3/ It can be used to support lowering leptin and PAI-1, as applicable.

It is important to note, however, that it is not uncommon for CIRS patients to have food sensitivities and many have found they feel a lot better on this diet. If you do, I recommend staying on it. The added support in lowering inflammation can ease the effects of CIRS symptoms. Without high glycemic index foods, and bringing extra insulin into the bloodstream, patients avoid the slings and arrows of insulin, a hormone well known pro-inflammatory.

I have also 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).

With this in mind, the use of this diet is also particularly helpful for those with insulin resistance that is shown either by elevated levels of insulin, weight at least 40 pounds over desired or Type II diabetes.

The Forbidden Foods on the No Amylose Diet are:

Roots & tubers including white and sweet potatoes, beets, 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
Cereal grains
Rice
Oats
Barley
Rye
Foods with added sugar, sucrose, corn syrup, or maltodextrin
Peanuts (but not all nuts – see question #3 for more info)

The key to the no-amylose diet is to avoid foods that are high in the glycemic index. What this means is that because the enzyme, amylase, is present in saliva it will digest the complex plant starch called amylose (as opposed to amylopectin) causing a marked increase in blood sugar in a very short period of time. This enhanced rate of rise in blood sugar is the most important factor stimulating the release of insulin. Insulin in turn is a pro-inflammatory hormone that does so many bad things to patients with inflammatory illnesses. The no-amylose diet helps to regulate and balance insulin levels as well as reduce inflammation.

2/ Information on the No Amylose Diet

Q: Where do I find references to the no-amylose diet?

A: The book by Dr. Shoemaker, “Lose the Weight you Hate” is one place you can get more information. Most patients prefer to read the electronic version of the book which is available in the Surviving Mold book store where the diet is explained, including when the diet is useful during the Shoemaker Protocol™, as well as the benefits beyond CIRS recovery.

The no amylose diet was initially developed by Dr. Shoemaker to help people with CIRS who have high levels of MMP-9. Cutting back on amylose, a carbohydrate found mainly in starchy foods that mainly grow underground, works to lower MMP-9 levels, as well as inflammation and insulin levels.

RESOURCE NOTE: Dr. Shoemaker’s weight loss book, Lose the Weight You Hate provides more in-depth information on the above topics. Here is the website description:

“Finally, a weight loss book that not only is enjoyable to read, but is also jam packed with "how-to-do-it" based on 20 years of clinical practice and obesity research. The No-Amylose Diet (bet you haven't tried it yet) is a fresh approach to a tired subject that usually features some variation on the wrong-headed ideas that "the way to lose weight is to cut back on calories, avoid fat and get exercise regularly." Sorry, we have tried that approach for years and it just doesn't work. Just look at the maintenance rate for patients who use the "expert advice." Less than 10% of patients lose 30 pounds and less than 5% of that group keeps the weight off at 1 year follow-up. That advice is worthless, yet just look at the New Years' resolutions to push away from the table and go for a 30 minute jog. That's no way to lose weight! It won't work for very long. And it can't. Fat storage is a complex process that is based on genetically controlled insulin levels and the response of insulin to the rate of rise of blood sugar following a meal. The controlling factor on insulin release isn't the number of calories we eat, but the effect of those calories on blood sugar. Foods that turn to sugar (glucose) quickly, like all amylose starches, corn syrup (low-fat foods make us fat), maltodextrins and table sugar (sucrose) set off the insulin fat storage machinery like crazy.”

[See also questions #1 & #3 for more information]

Shoemaker Protocol™ practitioners can also help you assess if the no amylose diet is for you and many offer nutritional assistance.

3/ Diet, nuts, and inflammation due to insulin spikes

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.

4/ No Amylose diet, Welchol

QUESTION: Does a no-amylose diet need to be followed when taking Welchol?

ANSWER: No. The only time I use a no-amylose diet is when I am using either interventions with Actos (almost never anymore) or Omega 3 to either 1) lower leptin; 2) lower PAI-1; or 3) lower MMP-9. Once those tasks are completed there is no need to continue the no-amylose diet.

[See Question #1 for more information]

5/ Mycotoxins and food

QUESTION: Are mycotoxins in food a concern?

ANSWER: There is a significant world 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 a persistent illness 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. 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 molds on or in food are different than the mold, bacteria, and biotoxins found in water damaged buildings.

Furthermore, the “mold,” bacteria and biotoxins found in buildings cause CIRS/environmental biotoxin illness, but the types and levels of mold found in food, do not.

Also, a distinction can be made between mold-related food allergies and CIRS. Food related mold may be associated with a mold allergy giving rise to allergy symptoms. For those with CIRS, the CIRS symptoms are not made worse by consuming “moldy” foods.

Of course, that doesn’t mean it’s healthy to consume large amounts of moldy food, or over-consume foods that often have trace amounts or mold or aflatoxins (like peanut butter), or naturally occurring molds.

It’s also helpful to understand that there are different types of molds, some naturally occurring in foods, and some are even considered good (as in blue cheese and certain cheese processes or penicillin). And some fungi, such as edible mushrooms, are considered healthy for the vast majority, including CIRS patients.

In a pun-intended nutshell, if you have CIRS, you can eat cheese if your digestive system is up to it – blue cheese included.

Molds can also develop during growing, harvest, or in warehouses. Manufacturers have standards in place to control mold growth which must pass regulatory standards. Even so, trace amounts of molds and aflatoxins are typically present and near impossible to completely eliminate.

The bottom line: moldy building environments, which include strains of bacteria and biotoxins, are at the crux of biotoxin/mold illness (CIRS). The types and levels of mold found in or on your food – while not always ideal – do not trigger CIRS/mold illness.

6/ Food intolerance from mycotoxins

QUESTION: 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.

ANSWER: I do not believe your case is indicative of intolerance solely due to fungal contamination or mycotoxin contamination in stored food. I would recommend starting by evaluating the possibility that low levels of MSH (melanocyte-stimulating hormone) are leading to inadequate regulation of inflammation in the gut. Additionally, you might find it helpful to find medical answers and/or nutritional specialist support to help explore potential causes outside of CIRS.

Find a Shoemaker Protocol™ Practitioner to support you.

7/ Allergy versus innate response

QUESTION: I have CIRS but I wonder if I have a second problem of mold allergy?

ANSWER: The two conditions are mutually exclusive and have two entirely different testing and diagnosis systems. What we can surmise from the CIRS testing process is that innate immune responses are involved in CIRS with genetic susceptibility, and low IgE and high levels of C4a and/or TGF beta-1 are typically found. For those with allergy, high IgE and presence of excessive antibodies but without innate immune activation, is typically seen.

Testing for allergens to molds from blood test is problematic in that to my knowledge, none of the antigens used for mold allergy testing has ever been validated to be monoclonal. Any antigen detection system that is polyclonal will not be reliable in mold testing. Skin testing is the most commonly used approached diagnosis of allergy and high IgE levels. I have heard from multiple sources that IgE-based allergy therapies miss allergy from IgG-based illnesses routinely.

Also, a distinction can be made between mold-related food allergies and CIRS. Food related mold can be associated with a mold allergy. For those with CIRS, the CIRS symptoms and condition will not be made worse by consuming moldy foods. Treatment may or may not help food sensitivities diminish. Food sensitivities may need to be diagnosed and treated separate from CIRS.

8/ Does treatment ease food intolerances?

QUESTION: How long after starting CSM does it typically take before it affects food intolerance?

ANSWER: Cholestyramine use is simply the first step in a pathway that has been honed over the years. Food intolerance remains an enigma in the sense that people who have such intolerance know it and it can be quite profound to the point that people can only eat five or fewer foods. When we try to define the source of food intolerance we know that antibody testing and some alternative methods have limited applicability to groups of people. It’s possible that there may be an anecdotal correlation but there is nothing that can be stated with a broad brush.

If you have a chronic inflammatory response syndrome in which food intolerance is present, and this is not unusual, the approach to treatment is not to ask how long will it take but what abnormalities are yet to be corrected. Food sensitivities sometimes diminish during Protocol recovery, and sometimes do not. Looking into food sensitivities separate from CIRS is another course of action in which some have found answers.

9/ Treatment approach & diet considerations/CSM

QUESTION: A patient from Iceland writes that he is ill with beginning 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 192 mechanism to avoid constipation. Soluble fiber (not insoluble) is found in a variety of fruits and nuts with soluble oat brain fiber possibly being the best.

You do not need to avoid mushrooms, bread, cheeses, wine or beer in my opinion, also understanding that there are some patients that are quite sensitive to those items. Food sensitivities are a case by case basis and follow no broad stroke consistencies, nor have they proven to be a standard symptom of CIRS.

10/ Sluggish metabolism, weight loss with CIRS

QUESTION: I have been diagnosed with multiple autoimmune diseases. I have gained 30-40 pounds as a result of this illness. Now, following the Protocol, I am also currently following the no-amylose diet and have not seen any results in weight loss. Is there anything else I should be doing to help kickstart my metabolism?

ANSWER: Hypometabolism is well documented to be shown by GENIE. Insulin resistance will create difficulty losing weight as shown by GENIE. Leptin resistance, not shown by GENIE, but is shown by molecular hypometabolism.

Make sure you are not exposed and you have been following the Protocol, the 12-steps in sequential order, and thereby defeating molecular hypometabolism.

11/ GI Issues, low amylose diet

QUESTION: Is there somewhere on the site I can find more information about whether GI issues such as bloating prior to treatment are typical for CIRS? Is there somewhere that the mechanism of low amylose diet being helpful is explained?

ANSWER: Bloating can be typical of CIRS. This GI discomfort may be due to ingestion of binders such as cholestyramine take on an empty stomach or Welchol taken with food. This bloating is not necessarily due to intensification. The mechanism of low amylose diet is summarized in the weight loss book, Lose the Weight You Hate (by Dr. Shoemaker).

12/ Gluten Free Diet during the Protocol treatment:

QUESTION: Other than gluten free, is there a diet to follow?

ANSWER: There are 2 situations where diet is altered during the Protocol: 1/ eliminating gluten in those with anti-gliadin antibodies in order to help inflammation improve. 2/ The low-amylose diet is used in step 7 in conjunction with correcting MMP-9 as needed.

The No-Amylose diet was developed (by Dr. Shoemaker) to help people with CIRS who have high levels of MMP-9. Cutting back on amylose, a carbohydrate found mainly in starchy foods that mainly grow underground, works to lower MMP-9 levels.

Other than the above cases, the Shoemaker Protocol™ does not include a diet plan, and some patients tolerate gluten without any apparent problem.

Having said that, many patients feel better if they follow a gluten free or no amylose diet to support low inflammation, yet Dr. Shoemaker is fond of saying he follows a simple see food diet. That is to say, if you see food, you may eat it if it doesn’t bother you.

13/ Mycotoxins in food

QUESTION: What brands of chocolate, seeds and nuts have fewer mycotoxins than others? Are there any lists for my review?

ANSWER: To my knowledge, no stored foods can be assured to be safe from fungal growth. If the activity of water (AW) is over 0.85 there will be mycotoxin production from fungi growing on stored food. Food venders go to great lengths to prevent such contamination.

Rarely is this level reached in commercial storage. The good news is that extensive studies have shown that in normal patients, or control

patients if you will, eating standard diets in the U.S. and Europe do not have confirmed illness from ingestion, despite presence of mycotoxins from those foods being invariably found in urine using careful methods. The assumption that the problem is mycotoxins remains unproven in extensive research as that there are other elements that fungi and bacteria produce that can make people ill.

As well, the Shoemaker Protocol™ has been effective in tens of thousands of patients without altering the diet because of these factors. There are 2 situations where diet is altered during the Protocol: 1/ eliminating gluten in those with anti-gliadin antibodies in order to help inflammation improve. 2/ The low-amylose diet is used in step 7 in conjunction with correcting MMP-9 as needed.

The No-Amylose diet was developed by Dr. Shoemaker to help people with CIRS who have high levels of MMP-9. Cutting back on amylose, a carbohydrate found mainly in starchy foods that mainly grow underground, works to lower MMP-9 levels.