What is Mycotoxin Illness or Cirs? 


Mold or mycotoxin illness, which results in chronic inflammatory response syndrome or CIRS, does not just have to be caused by mold. Yes, I know this is confusing but hang with me here. Mold is often involved, but the cause of the continued inflammation is due to biotoxin illness, which can be caused by ANY pathogen with a biofilm. Biofilms, the sticky byproduct that many pathogens form to adhere to tissues in the body and HIDE, Many studies are now showing that mold jumps on board with other biofilm “frenemnies” and together these pathogens work in-step to overtake the hormonal and immune systems. Basically CIRS can be caused by mold itself, or it may be triggered by a multitude of pathogens capable of forming biofilms in the body to hide and fool the body’s defenses. This theory was formulated by Dr Shoemaker, who now has a successful protocol and guidelines for healing those with mycotoxin illness.

Here is a list of different pathogens/compounds thought to contribute to biofilm illness:

  • Yeast/fungi -unicellulared
  • Bacteria (possibly including Borrelia, Babesia, and other organisms transmitted by tick bites)
  • Actinomycetes (gram-positive bacteria from the order Actinomycetales)
  • Mycobacteria
  • Mold to include but not all inclusive of aspergillus, fusarium, and penicillum
  • Mold spores-behave like fungus or yeast, but are multicellulared
  • Endotoxins (aka lipopolysaccharides, or LPS; cell wall components of gram-negative bacteria)
  • Inflammagens (irritants that cause inflammation and edema)
  • Beta-glucans (diverse group of polysaccharides)
  • Hemolysins (exotoxins produced by bacteria capable of destroying cells)
  • Microbial volatile organic compounds (mVOCs; organic compounds released by microorganisms when there is adequate food supply for such “secondary metabolite production”)

Biofilm illness usually results from exposure to a water damaged building or leak at some point. This should be the first question addressed, as many patients can connect feeling poorly or worse to the initiation of the WDB exposure, Many of the triggers listed above are found in areas with water damage or leaks.


CIRS and mycotoxin illness is tricky, as you would assume that once the exposure is removed, the patient would improve. Unfortunately, that is NOT always the case as nearly 25% of the population contains a haplotype (certain immune genes) which makes them more susceptible to immune damage and continued inflammation as their bodies cannot recognize the mold trigger to rid itself of it. This has to do with our genes, but has A LOT to do with our environmental exposures, heavy metals and overall toxic burden which interferes with our bodies’ ability to detox down the correct pathways. This genotype does however require significant exposure as well as an already immunocompromised immune system or “trigger,” which sets the immune system off. This can be emotional, another infection or a perceived stressor that activates the biofilm illness and sets it into motion.

Once mold, yeast or another bug with a biofilm is thrown into the mix, the patient has an extremely difficult time healing since they already have a high toxic burden. Our livers, skin, kidneys, bile, and respiratory systems are amazing detoxifiers, but are not perfect and can become overwhelmed in the very toxic world we live in.

If you have any of the following symptoms, find a functional medical doc, naturopath, or osteopath who is literate in treating mold, biotoxin illness and its counterparts. Most importantly, YOU MUST REMOVE YOURSELF FROM THE EXPOSURE, even if that means selling your home. This is the hardest part of the treatment.


Biotoxin illness is missed by allopathic medicine because this section in medical school is breezed over in just 1-2 days. It is not a cornerstone to treatment, just as healthy food is not. Unfortunately, most MDs are not taught or trained in MOLD alone and never think that this could be the root cause of SO many symptoms they see daily, yet often do not know how to treat.

Symptoms of biotoxin illness coincide and overlap with symptoms that can be caused by a number of conditions, including autoimmune conditions, stress, fibromyalgia, Lyme disease or cancer. Often, Lyme and mold go hand in hand. Therefore, many practitioners are confused about what they are actually treating, how to test for it and ultimately, heal it.


Symptoms of mycotoxin or biotoxin/CIRS illness: 

  1. Chronic fatigue
  2. Brain fog/Memory problems
  3. Insomnia/waking multiple times at night
  4. Difficulty holding urine since antidiuretic hormone is inhibited
  5. Static shocks or bites at night
  6. Tinnitus
  7. Paresthesias/numbness/tingling in extremities due to mini episodes of the inflammatory cascade being set off in the body
  8. Headaches, sinusitis, upper respiratory problems
  9. Post exertional malaise
  10. Visual changes, blurry vision, difficulty focusing-TAKE THE VISUAL CONTRAST SENSITIVITY TEST ON survivingmold.com
  11. Joint pains, muscular soreness, cracking and feeling locked up
  12. Severe personality changes-frustration, anger, procrastination
  13. Insatiable sugar cravings
  14. Abdominal bloating or pains; difficulty with digestion
  15. Shortness of breath
  16. Worsening of symptoms when the person is placed back in the building with mold (i.e. home or work)

Unfortunately, biotoxin illness can spin the immune system out of control so it stays on top of the body and can use it as a host while staying hidden. Many patients experience lowered immunoglobulins, or soldier cells, due to these hidden infections. Eventually, the body becomes chronically fatigued since it is always fighting the hidden infection unsuccessfully. Both chronic stress and lowered immunity lead to further infections and then, lowered libido and skewed hormones. Eventually, this leads to autoimmune conditions and a body with much more pain and much less vitality. Serum biomarkers are consistent with the neuroimmune, vascular, and endocrine abnormalities that characterize CIRS.

Another way to screen for mold is by using the visual contrast test at http://www.survivingmold.com

OVER 90% OF PATIENTS WHO HAVE MOLD OR BIOTOXIN ILLNESS TEST POSITIVE WITH THE VISUAL CONTRAST TEST (VCS) The first VCS test is available at Dr. Shoemaker’s website, Surviving Mold, at a cost of $15. Dr Shoemaker is a pioneer in the field of biotoxin illness and continues to support this community with research. This is a Functional Visual Acuity Test (FACT) that uses a scoring algorithm developed by Drs. Shoemaker to determine the likelihood that a patient is being adversely affected by biotoxin exposure. The second VCS test is available at VCSTest.com. The raw (unconverted) scores and the contrast sensitivity curve are provided for free, and a $10 donation is requested (but not required) for the upgraded results with detailed analysis and interpretation and a PDF that can be downloaded and shared. VCSTest.com now offers what they call an Online Contrast Sensitivity Test, which addresses one of the primary shortcomings of online VCS testing: the variability in how different computer monitors and displays handle visual contrast. The OCST features full display calibration, which adapts the test images to each user by taking into account both their display size and individual display characteristics/properties, like their video card, video drivers, operating system and display settings, including contrast, brightness, gamma, etc.

Just because you test positive, does not CONFIRM that you have biotoxin illness. Other confirmatory tests are needed, as some patients can pass the test and still have mycotoxin illness.


Dr Shoemaker has come up with a panel of blood tests that can prove very useful to diagnosis. Although I do not always personally use these tests, they can still be handy. These include:

The visual contrast test

HLA DRB and DQ susceptible haplotypes (genes)

Elevated complement (c4a)

Elevated MMP-9

Reduced MSH

Elevated TGF-beta

Reduced Antidiuretic hormone (ADH) and inability to hold urine

Reduced VEGF and VIP which indicate decreased blood tissue flow

Decreased levels of IgG and IgA immunoglobulins or soldier cells, which deems it difficult to mount an immune response within the mucous membranes.

Positive multiple antibiotic resistant coagulase-negative staph (MRCoNS) (a marker of low MSH)-MRCoNS can be identified by nasopharyngeal culture. Biofilms produced by MRCoNS, mold, some bacteria, and/or yeast form a barrier to immune defenses and therapies. The MRCoNS nasal swab is more controversial. Researchers suspect that bacterial biofilms may account for many cases of chronic sinus congestion and inflammation.

I personally prefer http://www.greatplainslaboratory.com Mycotox urine test, which also has a successful track record of catching mold as well as a detailed history from the patient.


The short answer is PROBABLY. It is extremely difficult to properly test and rid a house of mold. Most home testing for mold uses air samples and the visual eye. These are not accurate.

A better method of initially screening a building for mold is the ERMI test. ERMI stands for Environmental Relative Moldiness Index. It utilizes quantitative polymerase chain reaction (MSQPCR) technology to identify mold in dust that has settled in buildings. Therefore, it is much more accurate as it uses DNA. If an ERMI test comes back positive, my advice is to move out of the house, which is often the most difficult thing to convince the patient to do for their health. Mold can hide behind walls or crawl spaces so it is very challenging to fully eradicate.

Dr. Shoemaker further refined the relevance of ERMI testing to CIRS patients by creating the HERTSMI-2 scoring system. This is a weighted score that takes the relative levels and danger of particular mold species into account.

The advantage to the ERMI is that it can identify the exact species of various molds present, and it will identify spores that are not airborne. However, it is crucial to understand that not all labs that perform the ERMI test are using the correct methodology.

In order to ensure reliable and accurate results, labs that perform ERMI testing must follow the EPA patent and laboratory procedure guidelines exactly. Otherwise, whatever results the test returns will not be confirmed


Once you have removed the offending agent, and tested for co-infections like Lyme if you decide to, prepare for the possibility of healing detox reactions. This is better known as Herxheimer reactions and they occur as toxic byproducts and biofilms are dislodged from tissues. This can cause a huge inflammatory reaction in the body which feels terrible for the patient. Herxheimer reactions usually include a generalized worsening of the symptoms-headaches, fatigue, nausea or even fever that lasts temporarily.

To prevent this:

  1. Load up with omega 3 fatty acids like fish oil or krill oil. CBD oil and other anti-inflammatories like curcumin or alpha lipoic acid may also be useful before starting the treatment. This will lesson healing detox reactions.
  2. Nattokinase or serrapeptadase, which are fibrinolytic enzymes, are useful to help temper the inflammatory cascade and prevent numbness or tingling in the extremities.
  3. I employ a KILL, BIND, SWEAT method which works beautifully for patients who do not suffer from POTS, postural orthostatic hypotension. Microbiome master or liquid liposomal Biocidin are used as biofilm disturbers or the KILL part of the treatment plan. An hour later, I utilize a binder like GI detox by Bio-botanical Research vs my own Heavy Metal Master. Binders include activated charcoal, zeolite clay, silica, gum arabic, fulvic/humic acid or citrus pectin. Do not take binders around other food or supplements as they bind most everything. I do not endorse cholestyramine, as it has caused detrimental micronutrient deficiencies occasionally in patients. Finally, if the patient can tolerate it, I ask them to sweat daily after the binder for 30 minutes each day. This kill, bind, sweat method not only gets biotoxin illness, but heavy metals and some environmental toxins as well. It is an excellent treatment plan to heal patients with multiple issues.
  4. silver nasal spray with a biofilm buster like ETDA is extremely useful as are nasal botanical washes. BEG spray, which includes EDTA and an antibiotic, is often used by is my second line of treatment.
  5. Secondary issues, specific to each individual patient, will also need to be addressed. For example if a patient has low secretory IgA, which is very common, they will heal much faster by replacing those immunoglobulins. Products like LD colostrum or SBI protect by Orthomolecular Products are very beneficial for low IgA. Mitochondrial damage or high TGF-beta may also need attention. I find that acetyl-L-carnitine, NAD, and nicatinomide useful for mitochondrial damage in some patients. The organic acids test (OAT) by Great Plains lab may also elicit some key findings in how the patient’s detox pathways are spun out of control and help to narrow treatment.
  6. The gut will likely need to be addressed as well, as it is definitely involved with the immune system. Avoid constipation as this will worsen healing detox reactions since toxins are not being moved out properly. Digestive enzymes, bitters, probiotics, or anti constipation aids should be employed. Colon Master, magnesium, colon hydrotherapy or coffee enemas are crucial during heavy detoxing. Diet should be free of processed sugars (fruit sugar is mostly tolerated but dependent on the person), gluten, dairy, or boxed/convenience foods. 
  7. I often employ proactive tasks for the patients such as castor oil packs on the liver or gut, coffee enemas and IV ozone. Ozone is extremely antipathogenic and has a successful tract record against CIRS and biotoxin illness in general.
  8. Most importantly, DO NOT GIVE UP! Indolent, chronic infections may take months to properly treat holistically and naturally but it can be done! Healing detox reactions should only last 2 weeks to a month at the longest, at which point, the patient breaks through and their body begins to positively react to treatment.

This graph is taken from www.survivingmold.com and the Shoemaker protocol. Please note the extensive inflammation and cascades that are activated in the body due to the presence of the biofilm.

Keep the faith. Find a physician you can trust. You can heal


  1. https://drjess.com/all-about-mold-and-beyond-is-biotoxin-illness-the-missing-link-in-your-chronic-health-puzzle-2/
  2. https://www.survivingmold.com/docs/Berndtson_essay_2_CIRS.pdf
  3. Chronic Illness Associated with Mold and Mycotoxins: Is Naso-Sinus Fungal Biofilm the Culprit? Joseph H. Brewer, Jack D. Thrasher, Dennis Hooper. Toxins (Basel) 2014 Jan; 6(1): 66–80. Published online 2013 Dec 24. doi: 10.3390/toxins6010066
  4. https://chriskresser.com/5-things-you-should-know-about-toxic-mold-illness/
  5. Rea W.J., Didriksen N., Simon T.R., Pan Y., Fenyves E.J., Griffiths G. Effects of toxic exposure to mold and mycotoxins in building-related illnesses. Arch. Environ. Health. 2003;58:399–405. [PubMed]
  6. Campbell A., Thrasher J.D., Gray M.R., Vojdani A. Mold and mycotoxins: Effects on the neurological and immune systems in humans. Adv. Appl. Microbiol. 2004;55:375–398. doi: 10.1016/S0065-2164(04)55015-3. [PubMed] [CrossRef]

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