Toxic Mold Illness - 5 Important Things To Know | Chris Kresser
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5 Things You Should Know about Toxic Mold Illness

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The awareness of toxic mold’s effect on human health has increased dramatically over the past few years. But mold is only one of the many biotoxins found in water-damaged buildings, and the illness caused by exposure to these toxins is much more complex than most clinicians and patients assume.

mold illness
Mold illness is all too common and more serious than we realize. istock.com/enviromantic

Over the last several years, I’ve written extensively about the importance of nutrition, physical activity, stress management, sleep, social connection, pleasure, and spending time outdoors. There’s no doubt that these factors are vital for all of us.

But it’s also true that there are other factors that are just as important to our health, yet far less often considered. One of these is toxic burden.

Toxic burden is determined by two factors: the levels of toxic chemicals and microorganisms that we’re exposed to, and the function of our innate detoxification system. If our exposure to toxins is high and our detoxification system is compromised—due to genetic predisposition, environmental factors, or both—then our toxic burden will be high.

The toxins that adversely affect our health include chemicals (e.g., BPA, phthalates, pesticides), heavy metals (e.g., mercury, arsenic, lead, cadmium), and biotoxins (toxins produced by living organisms like mold, bacteria, dinoflagellates, and blue-green algae).

Toxic mold illness has received a lot of attention recently, including a recent documentary created by Dave Asprey of Bulletproof.

While this is surely a positive development, there are a number of misconceptions and misunderstandings about mold illness that I’d like to address in this article. So let’s get to it!

#1: Mold Illness Is Not Just Caused by Mold

Yes, I know this doesn’t make sense. Of course mold illness is caused by mold. That’s why it’s called mold illness!

However, what we often refer to as “mold illness” is actually a much more comprehensive and multi-faceted syndrome now known as chronic inflammatory response syndrome, or CIRS.

CIRS was originally defined by Dr. Ritchie Shoemaker, a former family physician in Maryland. (Dr. Shoemaker is now retired, but he is still actively involved in raising awareness and advancing the understanding of CIRS.

Is the air quality in your home or workplace making you sick?

In the late 1990s, Dr. Shoemaker discovered a connection between a mysterious illness that some of his patients were experiencing and a toxin produced by a fish-killing dinoflagellate called Pfiesteria. Since then, Dr. Shoemaker has linked a similar kind of illness to toxins from a wide variety of microorganisms and chemicals.

These agents—which are collectively referred to as “biotoxins” and are often (but not always) encountered in water-damaged buildings—include (1):

  • Fungi
  • Bacteria (possibly including Borrelia, Babesia, and other organisms transmitted by tick bites)
  • Actinomycetes (gram-positive bacteria from the order Actinomycetales)
  • Mycobacteria
  • Mold
  • Mold spores
  • 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”)

Nearly everyone will become ill when exposed to sufficient levels of these biotoxins, but most people recover once they are removed from exposure. Their detoxification system is able to recognize the biotoxins in their bodies as toxins and eliminate them via the normal mechanisms.

However, a minority of people have HLA (human leukocyte antigen) genes that prevent their bodies from being able to recognize and thus eliminate biotoxins. The biotoxins will remain in the body and trigger a chronic, systemic inflammatory response. These are the people that develop CIRS.

#2: CIRS Is Much More Common Than You Might Think

According to Dr. Shoemaker’s research, roughly 25 percent of the population is genetically prone to develop CIRS if two conditions are met:

  1. Sufficient exposure to biotoxins
  2. A “priming” inflammatory event (something that triggers and activates the immune system, such as a serious upper respiratory tract infection or a tick-borne illness like Lyme disease)

Dr. Shoemaker also estimates that 2 percent of the population has genes that render them highly susceptible to developing a multi-system, multi-symptom illness after prolonged or repeated exposure to biotoxins. (Side note: unfortunately, I am part of that 2 percent, which could explain a lot about my past history with chronic illness!)

This suggests that roughly 1 in 4 people have the potential of developing CIRS when exposed to biotoxins. But how common is exposure to biotoxins?

Unfortunately, the answer is: extremely common.

According to a report entitled Implementing Health-Protective Features and Practices in Buildings issued by the Federal Facilities Council, 43 percent of buildings they examined had current water damage and 85 percent had past water damage. When water damage occurs, mold can grow in as little as 24 to 48 hours.

As alarming as these numbers are, they don’t tell the whole story. Although water damage is probably the biggest concern, mold and other biotoxins can also develop in buildings that are not water-damaged but have indoor humidity levels above 50 to 60 percent. In fact, many experts recommend maintaining indoor humidity levels between 30 and 50 percent for preventing the growth of mold and other biotoxins.

Here’s a list of steps that you can take to minimize biotoxins in your home and improve indoor air quality (2, 3):

  • Fix plumbing leaks and other water problems as soon as possible. Dry all items completely.
  • Scrub mold off hard surfaces with detergent and water and dry completely.
  • Discard absorbent or porous materials, such as ceiling tiles and carpet, if they become moldy. Don’t paint or caulk moldy surfaces.
  • Clean and repair roof gutters regularly.
  • Keep air conditioning drip pans clean and the drain lines unobstructed and flowing properly.
  • Make sure the ground slopes away from the building foundation, so that water does not enter or collect around the foundation.
  • Keep indoor humidity between 30 and 50 percent. Relative humidity can be measured with a moisture or humidity meter, a small, inexpensive ($10 to $50) instrument available at many hardware stores. Venting bathrooms, dryers, and other moisture-generating sources to the outside; using air conditioners and de-humidifiers; increasing ventilation; and using exhaust fans when cooking, dishwashing, and cleaning can all help to reduce indoor humidity.
  • Do not install carpeting in areas where perpetual moisture problems may develop (i.e., in a bathroom).

Another helpful intervention is to use air filters and purifiers/sanitizers. I will write an article discussing them in more detail soon. For now, I will tell you what I use and recommend to my patients:

  1. A HEPA filter that is capable of removing ultrafine particles (<0.1 microns) like mold, dust, pet dander, VOCs, and even viruses from the air. These ultrafine particles represent 90 percent of all airborne pollution that you breathe.
  2. An air sanitizer that eliminates allergens, odors, mold, and germs.

The number and range of devices on the market in both of these categories is mind-boggling, and I’ve spent countless hours figuring out the best options for our home. My research is ongoing, but currently this is what we are using:

  • An IQAir HealthProPlus. IQAir makes HEPA filters that employ a four-stage filtration process (which includes activated carbon) to filter particles all the way down to 0.003 microns—the smallest particles that exist—with a guaranteed efficacy of more than 99.5 percent. We have one of these in the main living area of our home and one in the basement. Important note: Amazon.com is not an authorized reseller of IQAir, so if you purchase from there the warranty won’t be valid. I recommend purchasing directly from IQAir or from one of their authorized resellers.
  • Blueair Sense filters. Blueair filters use “HEPASilent Technology,” which combines electrostatic and mechanical filtration to capture 99.97% of airborne particles down to 0.1 microns in size. We use these in bedrooms and my home office because they are smaller, quieter, and more energy efficient than the IQAir HealthProPlus units.
  • AirOasis air sanitizers. These units work differently than HEPA filters. They use a technology developed by NASA called advanced hydration photocatalytic oxidation (AHPCO) to destroy mold, bacteria, and other microorganisms with ultraviolet light and a catalyst. We have a few of the Air Angel units in smaller rooms, as well as an AO3000 in the main living area. Important note: I currently recommend running the AO units only when you are not in the rooms, and turning them off when you enter. This is due to the small amounts of ozone that they release. Though these levels are well below the recommended limit according to AO’s website, I prefer to be cautious. I also recommend using a HEPA/charcoal filter along with the AO devices, rather than using them on their own.

These devices are not cheap, but given what I’ve come to understand about the importance of indoor air quality to health, and given that my wife, my daughter, and I are all genetically susceptible to CIRS, I think they’re worth the expense. As an added benefit, the air in your home will smell like it does outside! It’s an incredible difference.

#3: CIRS Is Frequently Missed or Misdiagnosed

As I mentioned in #2, up to 25 percent of the population is susceptible to CIRS and perhaps a majority of buildings are either water-damaged or have conditions that make mold growth possible. Combine these factors with the increase in inflammatory diseases (which can serve as priming events) that has occurred over the past few decades and you have an environment that is ripe for CIRS.

Unfortunately, the vast majority of patients with this condition have not been properly diagnosed or treated because conventional doctors—and even many functional and integrative medicine specialists—simply aren’t looking for it. The fact that CIRS patients also typically meet the criteria for other syndromes and diseases like fibromyalgia, ME/CFS, post-treatment Lyme syndrome (PTLS), and multiple sclerosis (MS) compounds the problem.

CIRS patients present with a wide range of symptoms, including:

  • Fatigue, weakness
  • Post-exertional malaise
  • Memory problems, difficulties with concentration and executive function
  • Disorientation and confusion
  • Headaches
  • Vertigo, lightheadedness
  • Muscle aches, cramping, joint pains without inflammatory arthritis
  • Hypersensitivity to bright light, blurred vision, burning or red eyes, tearing
  • Cough, asthma-like illness, shortness of breath, chronic sinus congestion
  • Air hunger or unusual shortness of breath at rest
  • Chronic abdominal problems including nausea, cramping, secretory diarrhea
  • A propensity to experience static shocks

As you can see, these symptoms are “non-specific,” which means that they don’t conclusively identify CIRS (or any other disease) by their mere presence.

Dr. Keith Berndston, a physician in Park Ridge, Illinois, has written a thorough summary of CIRS that I highly recommend reading. In it, he highlights the following criteria that a patient must meet to be diagnosed with CIRS (4):

  1. History, signs, and symptoms consistent with biotoxin exposure. In cases of mold toxicity, history should include exposure to toxin-producing molds as documented by the EPA-approved ERMI test (more on this in point #4 below). In other cases (microcystin, ciguatera, etc.), history should include likely exposure or laboratory evidence of exposure.
  2. A genetic predisposition to biotoxin-related illness based on identification of an HLA-susceptible haplotype.
  3. Abnormalities documented by visual contrast sensitivity (VCS) testing. VCS testing measures your ability to see details at low contrast levels. Dr. Shoemaker and Dr. Ken Hudnell—a principal investigator for the U.S. EPA’s National Health and Environmental Effects Research Lab and an expert on how neurotoxins affect the physiology of vision—discovered that the biotoxins affect the optical nerve and decrease the ability to detect visual contrast.
  4. Biomarkers consistent with the neuroimmune, vascular, and endocrine abnormalities that characterize CIRS. If you have a history consistent with biotoxin exposure, a susceptible genotype, and an abnormal VCS test, you are very likely to show the laboratory abnormalities seen in CIRS. Major and minor criteria are a work in progress.

The VCS test is best performed in the office of a CIRS-aware clinician. However, there are two online versions that can be used as a starting place.

The first VCS test is available at Dr. Shoemaker’s website, Surviving Mold, at a cost of $15. This is a Functional Visual Acuity Test (FACT) that uses a scoring algorithm developed by Drs. Shoemaker and Hudnell 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. As far as I know, this is the only FACT-based online VCS test that controls for display calibration.

In practice, I think both of these tests can be used successfully as screening tools, but the OCST offered by VCSTest.com has the advantage of full display calibration, which allows for accurate results across any device (helpful in re-testing and tracking progress if the patient is re-taking the test on an iPad, for example, if the original test was done on a laptop computer).

The VCS test is so accurate that, if it is positive, there is a 92 percent chance that the patient has CIRS. That said, it’s important to note that a positive VCS test cannot be used to rule CIRS in or out on its own, and I have definitely had patients that passed the VCS test who went on to be positive for CIRS, and vice versa.

A list of the biomarkers that constitute a CIRS diagnosis can be found on Dr. Shoemaker’s site. However, if you fail the VCS test, and/or suspect you may have CIRS, I strongly recommend finding a CIRS-aware clinician in your area. You can start with the list of clinicians that have been certified by Dr. Shoemaker on his website. There are other clinicians, like those of us at California Center for Functional Medicine, that are familiar with CIRS and are actively diagnosing and treating patients for it, but are not yet certified.

Diagnosing and treating CIRS is not a “DIY proposition,” as it involves a lot of nuance and complexity that isn’t always apparent to clinicians and patients that are new to the condition. For example, C4a has to be run through Quest Diagnostics and then sent out to a specialized lab called National Jewish Laboratories in order to get an accurate result. I can’t tell you how many times patients have come to me with a C4a result run through Labcorp or another lab. It’s painful to have to tell them that we need to run these (sometimes expensive) labs again because they weren’t done properly in the first place.

For much more on CIRS diagnosis and pathology, check out my recent interview of Dr. Shoemaker on my podcast, Revolution Health Radio.

#4: Removal from Exposure Is the First Step in Successful Treatment …

Dr. Shoemaker has developed a multi-step protocol for treating CIRS (it ranges from 11 to 14 steps, depending on how you count or combine the steps).

The first step in the protocol is removing the patient from exposure to the biotoxins. This involves testing all environments (home, workplace, recreational) that the patient spends significant amounts of time in throughout the course of his or her daily life. If mold or other biotoxins are identified, those environments must be successfully remediated (followed by taking adequate measures to prevent recurrence), or the patient must relocate to another home or workplace.

As both a clinician and someone dealing with CIRS myself, I have found step one to be by far the most difficult step in the protocol. Here’s why.

Many mold inspectors are not using comprehensive, accurate testing methods. If you call up a local mold inspector and ask him to come assess your property, chances are he will do a visual inspection and take some air samples. Both of these methods can yield useful information, but on their own, they are not enough.

Air sampling does not allow identification of particular species of Penicillium, Aspergillus, Wallemia, etc., which is important because different species have different health effects. In addition, air sampling devices only collect a small sample of air from directly around the device. This matters because mold spores have different molecular weights, and some do not remain airborne for long.

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.

The ERMI test was developed by the EPA as a means of determining the relative “moldiness” of a home compared to a group of reference homes that do not have mold. Thirty-six species were divided into 26 species/clusters of molds associated with water-damaged buildings (Group 1) and 10 common species not associated with water-damaged buildings (Group 2). The mold index is the sum of logs of Group 1 minus the sum of the logs of Group 2 in a building. The ERMI has been validated in several peer-reviewed studies (5, 6, 7, 8).

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 procedures exactly. Otherwise, whatever results the test returns will not be validated.

As Dr. Shoemaker explained in a recent article, one of the most prominent labs performing ERMI testing, ESML (also the lab behind MyERMI), is not following these procedures and is currently under investigation by the EPA. Several CIRS-aware physicians had noticed that levels of Wallemia, a particularly problematic species of mold, tended to be under-reported on the ESML test. These false negatives could lead to someone erroneously assuming their home or workplace is safe, when in fact it is not.

EMSL has apparently promised a refund to everyone who has had an ERMI test run through its lab in the past three months. If you fall into this group, I suggest you contact the company.

The lab that I recommend for ERMI testing is Mycometrics. It follows the procedures established in the EPA patent by the letter, and it has excellent quality-control procedures in place.

It’s worth noting that no single test—including ERMI—is reliable as a means of assessing whether biotoxins are present in a building. There is no substitute for an experienced mold inspector that is using evidence-based methodology. (I just wish they were easier to find!)

#5: … but Removal from Exposure Isn’t Enough for Most CIRS Patients

While removal from exposure is an important first step, as I mentioned above, there are at least 10 other steps in the protocol.

People with CIRS have genetic mutations that make them unable to remove the biotoxins that have accumulated in their bodies. This means that getting away from the biotoxins may stop them from building up further, but it will not remove them.

Removal of biotoxins in patients with CIRS usually begins with binders like cholestyramine or Welchol. Other steps include eradicating biofilm-forming staph colonizations that tend to develop in the nasal passages of CIRS patients and correcting high/low MMP9, ADH/osmolality, C4a, TGF-b1, VEGF, and VIP.

In an ideal world, we’d have CIRS-aware physicians in every city and town. Unfortunately, that is not the case. There are currently only a few Shoemaker-certified practitioners, and perhaps several others that are not certified but are actively treating CIRS. Please share this article with those you think may be interested so we can help to spread awareness of this debilitating yet under-recognized condition.

229 Comments

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  1. 1) Are you seeing a connection of the CIRS lab values and HLA mutations to other issues such as heavy metal toxicity? 2) If CIRS labs are out of range with HLA gene mutation and had a long-term past WDB exposure, can you recover without protocol over time? Will the labs remain out of range without treatment?

    • Virtually everyone we’ve tested in our practice has a susceptible HLA haplotype, which would mean most patients that test positive for heavy metal toxicity have susceptible haplotypes. But that association could be purely due to chance; more formal research would have to be done to establish a true correlation.

      Some people like Erik Johnson have recovered by doing extreme mold avoidance and not using binders or other interventions in Dr. Shoemaker’s protocol. But most people will need treatment.

  2. Thank you for this amazing article and the advice on how to get tested! I used hydrogen peroxide spray which is easy to make to kill the small amount of black mold in the bathroom ceiling and, after it dried and killed the spores, I could scrub it off without risking being exposed to it before it was dead. I’m extremely chemically sensitive and bleach which kills it really well is not an option for me because it’s too strong a chemical and hydrogen peroxide doesn’t smell very much. I repeat spraying often to keep it from reoccurring and that seems to work. I’ve been unable to move or I wouldn’t live in a place that has mold, but there’s a lot of it here in Seattle. I’ve been around mold before and I’ve been so sensitive to it that, even in small amounts, it overwhelms my senses and I develop symptoms. It’s really important to get away from it or kill it, one of the two. Thanks again for the article!

    • Kathryn — I have read and been told by a mold testing expert that I should never SPRAY any kind of product onto moldy areas…. the mold will release spores into the air immediately in reaction. Instead, I was told to use products directly on a cloth, then scrub…. it’s the spraying that splashes the spores into the air! So when I read yr comment, I got a little scared for you– pls be careful!! DO some research to find out if spraying is as bad as I’ve been told… and good luck!!

      • I learned from our Industrial Hygienist that dead spores are still allergenic and may still contain mycotoxins, so you don’t want to touch or breathe spores that are dispersed into the air when liquid hits them. Always wear gloves, goggles, respirator, and shower immediately if you’re susceptible or allergic. Or better to have someone else who’s not sensitive clean it up. Also I was told that hydrogen peroxide isn’t effective with mold.

  3. How do we find a certified specialist to come inspect for mold once we have done the HERMI test? I’ve spend hundreds of dollars on inspectors, but they don’t understand CIRS patients. I live in a small county in Missouri so I don’t have allot of options locally. Kansas City is the nearest big city to me. I hope you can help! Thanks

    • I wish I had an easy answer to that question. We’ve had a difficult time finding someone qualified even here in the SF Bay Area. It’s a major challenge.

      • So can you comment on what we should be looking for in terms of engaging a mold inspector? I have been told by my functional med doctor that chronic inflammation is contributing to my symptoms (elevated C4, MMP-9 and TGF Beta) and the tests showed that I have HLA Mold and multi-susceptibility type BUT so far I have not been able to find any significant areas of mold my home other than the usual – little bit on the bath grout, bit of black slime around the kitchen sink. Plus, my symptoms have been ongoing for four or five years now and we have only been in this house for three. Today I spoke to an independent mold inspector that said he would visually inspect our home (for several hundred dollars) and if there was mold or had been mold he would find it because it usually leaves some kind of indication. His website mentions the use of infrared thermography if necessary. Any advice on what else to ask/look for with mold inspections? Thanks

        • Often CIRS is part of the picture but not the whole picture, in our experience. Unfortunately mold is not always visible, so the fact that you can’t see it doesn’t mean it’s not there. Starting with an ERMI test from Mycometrics is typically what we recommend. It can’t rule in/out mold with 100% certainty, but it’s a good initial screen.

          • The advice I got from Dr. Ackerley is to buy the “swiffer cloth” HERTSMI test from http://www.mycometrics.com. She said not to trust anything else at this point. Use the cloth to wipe surfaces in all rooms – top of bookshelves, doors etc. Places that don’t get cleaned often. When the results come back you can decide if you want to pay extra to get full ERMI results. This is significantly cheaper than having an inspector come and gives you a good first indication of where you stand. I am waiting for our results at the moment.

      • Hi Chris,

        I also live in the SF Bay Area and have been searching for a knowledgable specialist to come check out my new apartment (just recently had to move as ERMI score was too high). Can you please share who you found in this area?

  4. Hi Chris,

    Do you think a BlueAir Sense filter would be enough for me Or is the heavy-duty IQAir HealthProPlus necessary?

    I used to live in a moldy house that made me sick. I’m better now and I live alone in a one-bedroom apartment. It’s standard size with a bedroom, living room, kitchen and bathroom.

    I noticed the BlueAir is cheaper, so I thought maybe I’d just go with that and have it in my bedroom/office (where I spend most of my time anyway).

    What do you think?

    • I’m still researching the difference between these filters, but one of the big advantages of the IQAir seems to be that it filters particles as small as 0.003 microns. This is 10 times smaller than a virus. Given that a lot of the most harmful particles are ultrafine, this may be a significant advantage over the Blueair, which only filters particles as small as 0.1 microns. But this is not my area of expertise and I am still learning more.

      • Are these considered better than the Austin air filter that I frequently hear recommended? Also, have you checked out how AllerAir compares to the others (one w/carbon filter)? Several yrs ago that was the one recommended yo me by an environmental health dr.

      • Call Mike Schrantz with Environmental Analytics. He is in Tucson however I have sent him all over the place for our customers. His number is 520.488.6639. I have been working with him for years and you will not find anyone more comprehensive.

        Thanks Dustin Anderson

  5. I recently had silicone breast implants and have been unwell since. I’ve been dx with Migraine Assoc Vertigo and present with light sensitivity, balance issues and chronic dizziness.

    There is a plastic surgeon that does implant removal and she contends that mold and other toxins poison us slowly. My symptoms started when I woke from surgery.

    Toxic overload? Surgical stress causing 5 month (so far) painless migraine? Mold?

    I found this article compelling.

    • Deanna

      I got exactly the same symptoms when I had silicone implants years ago. Bizarre and not sure why. I since had them removed. Good luck in your recovery.

    • Btw I should have qualified Deanna removing the implants didn’t have any positive effect on my health. Be gentle on yourself, work on your immune system, maybe try some decent colostrum powder and everything will be ok.

  6. Why did you use the word mutation along with HLA.
    I’m 11-3-52b with no mutations.

    Do you realize how many people are now going to look at their 23&me reports for an HLA mutation and be led to believe that they aren’t in the 24%.

    • That 24% is just a hypothesis by Shoemaker with no peer-reviewed studies to back it up.

      If 24% of the population is susceptible to mold illness, tens of millions would be severely ill, yet they’re not. Not like he describes anyway.

      Even in the case of Hurricane Katrina, we’d see thousands more chronically ill if his hypothesis is correct. It’s not.

  7. I certainly know that CIRS can be a difficult and problematic issue for some (since one of my family members tested positive for a mold mycotoxin that RealTime Labs tests for). However, I have a question that perhaps Dr. Kresser can answer. On other websites, I’ve read that Dr. Shoemaker compared haplotypes (i.e. one’s genetics) in this country to worldwide population frequencies. And, I’ve seen it written that via his method, that 90% of the United States population would end up with having genes that are of the mold susceptible type.

    So, if the above is not true, and one is in a minority of having mold susceptible genes, that is something that one really needs to be careful of and treat. If it turns out that nearly 90% of the folks in this country have the same genes, then you really have the same issues to treat, but that having unfortunate genetics isn’t one of them.

    Please note that I’ve read the above, but don’t know if the above is true, and therefore don’t know how much importance to place in the Shoemaker protocol in the overall grand scheme of things.

    Can anyone provide further guidance here?

  8. Such a great article! I’m so sorry you suffer/suffered from CIRS, but very happy to know what one of my primary care providers has been through it and can relate to how I’m feeling. I’m getting my blood work done tomorrow and a neuro quant MRI done on Saturday. Stay tuned!!

  9. I lived in an apartment for 21/2 years and right before moving out we discovered the air ducts were filled with mold. I had workd out of the apartment most of that time. 8 years ago I was diagnosed with MS after a bout of optic neuritis. I did have a VCS test which was found to be consistent with MS. I went gluten free, low dairy, low sugar and on LDN and have been stable ever since. However, I cannot be outside when the molds are high (this summer was awful-I literally have trouble finding words when speaking). The other day I tried to eat peanut butter for the 1st time in years and itched horribly for 2 days (I suspect the molds in the peanut butter). I have always suspected my illness was caused by my mold exposure. Thank you for this article-we are thinking about moving in a few years and my biggest fear is that I will end up in a moldy home. I will look into Dr. Shoemakers protocol but living in Louisville, KY we are always behind the times when it comes to integrative medicine.

    • Sara, I’m not to far from Louisville. You’re correct, Outside of conventional medicine, there are not many options in KY. There is an environmental Dr. In Louisville, not sure exactly how he treats though. There is a Dr. In southern Indiana that could help you detox. There is another Dr. Southeast Ohio, that treats mold illness. If you want a Shoemaker certified Dr., you would have to go further, like Chicago. Some of them will do phone appointments after your first visit in their office. I have contact info if you need any of it.

    • Hello, Sara. I’ve been sick for about a month and a half as has my mother. We also live in Louisville, KY. I was wondering if you have found a specialist close in this field so we could see them as well.

      • Robbie, there currently is no Dr.’s in Louisville that can competently treat for mold toxicity. I had to go to Chicago to see one. After the first visit, they can do appointments over the phone. However, lately there may be a few Dr.’s that are closer, that may possibly treat mold toxicity/CIRS. Send me your contact info and I can send their names/numbers to you. None of them likely take insurance, it’s usually an out of pocket expense.

  10. Desperate for a local Boston-based doctor to support me on this journey. I took have CIRS but have yet to find the right doctor to help me heal so I can focus on growing my family.
    With all of the amazing docs in the area – does anyone have a recommendation?

    • Danielle Shea Tan, Look up Peg DiTulio in NH. She is right across the border from Boston. She is my Shoemaker Certified Protocol doc and she was lovely.

  11. THANK YOU! THANK YOU! THANK YOU!!! I am so grateful you wrote this article and that you interviewed Dr. Shoemaker! I’m waiting for my CIRS tests to come back and I can’t wait to move forward toward healing! I’ve been very sick for 12 years and I am just feeling for the first time this may be a huge part of the illnesses I’ve been dealing with. Keep it up, Chris! Your work is so incredibly helpful!!!!

    • Mariah If you are on Facebook check out the group Shoemaker Protocol Toxic Mold and Lyme. It is a support group for people following Dr Shoemaker’s protocol. Lots of knowledgeable people there.

  12. I live in Puerto Vallarta, Mexico. It is currently very hot and very humid.

    I recently moved into a recently refurbished apartment. There is white mold on all 4 doors. The bathroom was always hot & humid even if I hadn’t taken a shower for hours.

    I have four 16″ floor fans going pretty much 24/7- 2 in living room area and one each in the 2 bedrooms. I put an 8″ fan on the floor just outside the bathroom door and it runs consistently. No more humidity there now.

    I also run another 8″ fan at night in my bedroom on a low setting to reduce fan noise. The ceiling fan works and is noisy so using the floor fan instead. Quieter.

    This whole city is moldy in varying degrees!!! Winter months are milder since it is usually pleasantly warm.

  13. THANK YOU for writing about this…this subject is so often not addressed and too often missed, yet affects more people and is underlying more illnesses than I think anyone realizes.

  14. Such a helpful and informative article! I have had several clients with mold-related health problems, and I will share with them all!! Thank you for all your hard work!!

  15. About thirty years ago, I was living in an apt on the top floor of a flat roofed building. The tar on the roof needed upgrading and it rained a lot one year and suddenly my bedroom ceiling was COVERED in black mold. The apt building was owned by an Insurance Company, and I called the manager to let them know that this problem had occurred. They didnt take my concerns seriously and I ended up moving, but not before I noticed that I didnt feel quite right, started going to doctors to get answers without success, and took days off work due to fatigue. I recovered, but a few years later, I had a BLACK fungal infection in one of my ears. Gross, I know, but Im sure that it was related to my exposure.

  16. The AirOsis intrigues me, but the Amazon reviews say there’s a lot of ozone or other byproduct smells. What’s your take on the danger of ozone producing machines?

    • The AO does produce a small amount of ozone, but it is below the recommended limit. That said, we have always had a HEPA/carbon filter like the IQAir or a BlueAir with a SmokeStop (carbon) filter added to it in the same room as the AO, and I do recommend that to my patients. http://www.airoasis.com/knowledgebase/ozone-air-quality-purifiers

      I mentioned that my research is ongoing: this is one area I’m continuing to look into, and I’ll report back if anything changes.

  17. Thanks for spreading the awareness of this condition, and all the good info. Your recent podcast with Dr. Shoemaker led to the CIRS diagnosis for my wife, after 10 years of battling chronic pain. It’s pretty incredible and sad that this is not better understood out there by regular physicians. Now we are having our kids tested.