About CIRS and the Shoemaker Protocol

The Science Behind the Shoemaker Protocol

CIRS is a term first applied to the response to exposure to Pfiesteria in the Pocomoke river. It now specifies the following environmental exposures as being key considerations for triggering a chronic inflammatory response:

• Post Lyme syndrome (CIRS-PLS), which occurs beyond the acute phase of Lyme disease in around 20% of Lyme patients.
• Ciguatera poisoning (CIRS-Ciguatera) is a fish borne dinoflagellate that can trigger neurologic and gastrointestinal symptoms when consumed. Around 5% of cases are thought to become chronic.
• Cyanobacteria (CIRS-Cyanobacteria) is a blue-green algae that can produce toxic substances, and that can have hepato and neuro-toxic effects.
• A bite from a brown recluse spider is also known to be a trigger of the same chronic immune response.

Whilst mould and exposure to water-damaged buildings (CIRS-WDB) are probably the most well-known in Europe, it is important to understand that the toxic soup found in a water damaged building may not be the only trigger.

In 2008, the US Government Accountability Office (GAO) delivered a case definition with four criteria for a CIRS diagnosis. Firstly, demonstration of exposure to water damaged building(s). Secondly, signs and symptoms consistent with exposure. Thirdly, laboratory testing consistent with results seen in published studies and lastly, improvement with appropriate therapy. The Protocol is split out into 12 steps. The first being remove from exposure.

To check an environment for key moulds, the most common tests that can be easily undertaken by self-testing of an environment are the Environmental Relative Moldiness Index (ERMI) and Health Effects Roster of Type Specific Formers of Mycotoxins and Inflammagens (HERTSMI 2), utilising dust sample collection. Eradicating MARCoNs comes next and re-balancing all other out of normal range markers from laboratory testing follows until all re-tests are normal. Colab Services Ltd. offer all these tests.

With volumetric MRI testing and NeuroQuant reporting we can now see changes consistent with exposure to CIRS-PLS and CIRS-WDB reflected in the brain. Different parts of the brain can show oedema or atrophy consistent with lab work. Improvements can also therefore be tracked with repeat scans. The work that Dr Shoemaker has published on brain changes ties in with the work of Dale Bredesen on cognitive decline, such that he has defined CIRS as being part of the pathology of type 3 Alzheimer’s.

Both Doctors also agree that resulting inflammation and eventual hypo-metabolism are the net result of inflammatory exposures, contributing to changes in brain function. CIRS can, therefore, be seen as very much part of the cognitive decline jigsaw. Once CIRS has been identified, the Shoemaker protocol can be undertaken in a pyramid fashion. Starting from the bottom, the steps are followed until the top is reached. The first step and most important is the removal of exposure to the biotoxin. Whether the exposure is school, home, work, a frequently visited service or gym, it is important to prevent exposure to inhaled contaminants. If this is not achieved, the inflammatory cycle may not be arrested.

Training in CIRS and the Shoemaker Protocol

For practitioners wishing to find out more about becoming a Proficiency Partner of CIRSX please contact [email protected]

Colab Services Ltd cover all aspects of the CIRS:

• We host an annual Foundation Training course in CIRS, called the Biotoxins in Clinical Practice Course (Training delivered by CIRS Academy)
• Relevant blood tests that are from laboratories used in CIRS related studies so the results can be contextualised with correct laboratory reference values.
• Technical support for laboratory results.
• Support with accessing MRI volumetric brain scans.
• Direct access to the GENIE transcriptomics test.