Mold Related Illness (CIRS)

Step #1 – Remove from Exposure

The single most important factor in your fight to survive mold is AVOIDING mold. If you do not succeed in this step, you will be wasting much time, effort, money and other valuable resources. Your health and quality of life will get worse and worse as you experience one setback after another with ever recurring symptoms that “come out of nowhere”.

You must have your home, work, school and other environments checked for mold and inflammagens from WDBs. Many tests and techniques exist to measure environmental safety. However, one testing method that has been clinically shown to correlate with environmental safety is called ERMI – Environmental Relative Moldiness Index. ERMI measures the DNA within dust that has accumulated in your carpets and floors. Since each fungal species has its own unique DNA, the ERMI test can actually measure the relative number of pathogenic (“bad”) fungus verses the relative number of benign (“not harmful”) fungus.

Clinical studies and experience has shown that how “clean” your environment needs to be depends on a few factors. If your MSH is less than 35 (evidence of hypothalamic dysfunction) and your C4a is less than 20,000 (evidence of cytokine activation), then you will most likely tolerate and environment with an ERMI less than 2. However, if your MSH is less than 35 and you have a C4a greater than 20,000 (evidence of much worse cytokine activation), then you need an ERMI <-1. In other words, the sicker you are, the more dysregulated your hypothalamus, the bigger the “cytokine storm”, the more sensitive you are to subsequent exposures and the cleaner your environment needs to be to be nonreactive (well).

We must also consider Biotoxin exposures other than from WDB. For example, you may be suffering from Borrelia spirochetes (from tick bites), poisoned fish, and exposure to dinoflagellate and toxic blue-green algae infested water.

Your remediation and avoidance plan:

This is such an extremely important and complex subject that goes way beyond the scope of this brief article. Briefly, you must remove (very carefully) all of the inflammagens in your environments. This may include discarding papers, cardboard, rugs, or other objects. You may need to remove walls, ceilings and floors. You must also remediate the reason (moisture) that created the environmental problem in the first place. This may require HVAC professionals, plumbers, and contractors. You must also become very vigilant about walking into any building. Up to 50% of all buildings, have unhealthy environments. Be especially careful in libraries, antique stores, and if you think you see or smell something, get away ASAP. Please find reliable, knowledgeable, compassionate and experienced professionals and mentors to guide you.

As you are achieving your mold avoidance strategy, your health should start to improve. In fact, you may be one of those people that merely need to do the first step of the Surviving Mold Protocol in order to get much better. However, you may need to go to the next step of biotoxin removal by using Cholestyramine or Welchol.

Step #2 – CSM/Welchol

Use a bile resin binder to reduce enterohepatic recirculation of Biotoxins – CSM and Welchol are bile-binding resins, which remove biotoxins because they contain side chains (binding sites) that are positively charged. These life-changing medicines bind the negatively charged biotoxins in your bile. CSM is the most powerful drug to use as it has about five times as many binding sites as does Welchol. However, CSM is often troublesome to use because it can cause you to become very constipated. Welchol is better tolerated but much less effective. The adult dose of CSM is 4 grams four times each day and must be taken either one-hour before eating or two hours after eating. Welchol is 625mg tablets, two tablets, three times each day with food.

You may experience worsening symptoms (intensification reaction) after taking several doses of bile resin binders. Dr Shoemaker recommends high dose fish oil for ten days (starting the binder on day six) to decrease this unpleasant reaction. If you suffer from Lyme disease, intensification symptoms are more common and often more severe and may indicate a need for antibiotic therapy against Lyme before treatment with binders.

Step #3 – Eradicating MARCoNS

Identify and treat multiply antibiotic resistant coagulase negative Staph Aureus MARCoNS – Treat using Bactroban, ethylene diamine tetra-acetic acid (EDTA) and gentamicin (BEG spray). The EDTA helps break down the biofilm and the two antibiotics will be able to eradicate your infection. BEG is dosed two sprays to each nostril three times each day for one month.

Step #4 – Correct antigliadins

You must adhere to dietary interventions – avoiding glutens for at least three months if have antigliadin antibodies. You may react adversely to these foods even if you do not make antibodies, and therefore they should be avoided.

The first four steps of the Surviving Mold Protocol are necessary to remove toxic substances from your system and your diet. You will only improve if you successfully remove toxins, otherwise, the toxins will continue to stress your immune, neuro and endocrine systems. This continued stress would keep you from regaining your homeostatic control.

The subsequent eight steps of the Surviving Mold Protocol help you to re-regulate your immune, nervous and endocrine systems. This re-regulation requires that all of your systems are working together in harmony. Consequently, there is quite a bit of overlap in steps five through twelve. In other words, correcting any one step will also help correct your other seven steps. Importantly, Dr Shoemaker has documented that vasoactive intestinal peptide (VIP) has profound positive effects on your immune, nervous and endocrine systems and therefore improves your homeostatic control.

Step #5 Correct Androgens

Improve production of testosterone and decrease conversion of testosterone into estrogen. You must consume adequate levels of cholesterol and saturated fat and not overeat carbohydrates. You must keep your insulin levels low because insulin enhances the detrimental effects of aromatase enzyme. Aromatase enzymatically converts your testosterone into estrogen. You may also benefit from appropriately administered bio-identical hormone replacement therapy (BHRT)

Step #6 Correct ADH/Osmolarity

Improve your water/electrolyte balance- Use DDAVP (as needed) to help normalize your levels. Take 0.2mg DDAVP every other night. You must have your sodium levels checked after five doses (10 days) of treatment, then again five days later.

Step #7 Correct MMP-9

You must be on a low amylose diet for at least thirty days. Dr Shoemaker also recommends high dose fish oil at this step, 2.4 grams of EPA and 1.8 grams of DHA each day for at least one month.

Step #8 Correct VEGF

Same recommendations as step #7

Step #9 Correct C3a

Persistent elevation of C3a indicates that you may have bacterial membranes (Lyme) activating your immune system. You will need antibiotic therapy if you have Lyme disease. In Addition, Dr Shoemaker recommends high dose statin drugs to lower C3a, Atorvostatin (Lipitor) 80mg or Rosuvastatin 40mg each day. You should take Co-Q-10 before and during any use of statin drugs.

Step #10 Correct C4a

This proinflammatory cytokine may self – correct. VIP can be very helpful. Low dose erythropoietin (EPO) has been shown to lower C4a.

Step #11 TGF beta-1

Elevated levels of this growth factor can cause much tissue damage (remodeling) and cognitive dysfunction (brain fog). This may self-correct; you can also reduce TGF beta-1 by taking Losartan (an angiotensin receptor blocker blood pressure drug) 25mg twice each day.

Step #12 VIP

Vasoactive Intestinal Peptide is a key player in the Surviving Mold Protocol – this hypothalamic neurological peptide confers a multitude of positive effects in properly selected and prepared patients:

1. Helps normalize ADH/Osmolarity (electrolyte/water balance) via effects on your ADH levels
2. Helps normalize your androgen/estrogen balance via effects on aromatase enzyme
3. Helps normalize your cortisol/ACTH balance via effects on hypothalamic function
4. Helps normalize your immune system balance as evidenced by CD4+/CD25++ levels /Treg levels
5. Helps reduce your inflammatory response as evidenced by decreasing C3a, C4a, MMP-9, TGF beta-1
6. Helps to reduce “remodeling” of your tissue (Endothelial-Mesenchymal-Transformation) as evidenced by normalization of TGF beta-1 and reduction of MMP-9
7. Helps improve your capillary function as evidenced by reduction in post workout pulmonary artery pressure, increase in your anaerobic threshold, reduction of lactic acid, improvement of your glutamate/glutamine balance as measured in your brain by magnetic resonance spectroscopy
8. Helps reduce your pulmonary artery hypertension as measured by echocardiography with assessment of tricuspid regurgitation and pulmonary artery pressure

Appropriate Use of VIP

You must meet the following criteria before using VIP:

1. Normal Visual Contrast Sensitivity
2. ERMI less than 2 in any environment you are in contact with
3. A recent negative MARCoNS test
4. Normal serum lipase

Test Dose of VIP

You need to have a blood draw (TGF beta-1 and C4a) just before your first dose of VIP.  You will repeat the same two tests 15 minutes after your dose of VIP. Your symptoms will improve and your TGF beta-1 and C4a will be reduced if you are successful. Lack of efficacy symptomatically and worsening of your TGF beta-1 and C4a indicate an unsuccessful test dose.