What is CIRS - Chronic Inflammatory Response Syndrome

How to Know if You Have Chronic Inflammatory Response Syndrome?

Illnesses caused by biotoxins are on the rise. Since I’ve begun testing my patients for Chronic Inflammatory Response Syndrome (CIRS) markers in my practice, I’m surprised at just how prevalent this condition is turning out to be.

Up to 25 percent of the population is thought to have the gene HLA, which makes them more susceptible to biotoxins. Though anyone can be impacted by biotoxins, these people are much more sensitive and therefore more likely to have symptoms strong enough to send them to the doctor.

Part of this apparent uptick in biotoxin illness is also due to the improvement in diagnostics. We are realizing the body’s reaction to mold, Lyme, and other biotoxins are unique in each person, which is partly why strategies for identifying and correcting these problems have remained largely underdeveloped until recently.

If you’ve been struggling with chronic health issues, you may want to consider getting yourself checked for Chronic Inflammatory Response Syndrome.

What is CIRS?

So what is CIRS? Chronic Inflammatory Response Syndrome or CIRS is a condition with a wide range of symptoms which are triggered by a biotoxin – usually mold. The term CIRS was coined by Dr. Ritchie Shoemaker to describe when a body’s immune system is out of whack. In some people this could mean the immune system is simply weakened, while in others it’s running rampant.

You can also get CIRS from common chronic sinus infections with MARCONS and tick borne illnesses like Lyme disease ticks, fish that’s been contaminated with ciguatera, and infections from a brown recluse spider bite. Essentially, CIRS is a dysfunctional reaction of the body’s immune system in response to a biotoxin. In my practice, I’ve seen the symptoms range from manageable to debilitating.

The different markers that we can test for, and the differences in how symptoms present, make CIRS a difficult condition to diagnose. Though diagnostics are improving, there still needs to be a cluster of symptoms and an improvement in treatment response for a CIRS diagnosis to be made.

Unfortunately, it’s not unusual for a person with CIRS to go years, even decades, without a proper diagnosis. However, if we can pool our knowledge and spread the word about the differences in this condition, I believe we can make a major difference in awareness and treatment of CIRS. This is part of the reason I’ve begun testing most of my patients for biotoxins and CIRS markers.

Waiting For A Diagnosis Might Not Be The Answer

There are numerous symptoms of CIRS, different biomarkers, and the toxins also differ. This complicates the diagnostic process and is part of the reason CIRS has gone largely ignored by conventional medicine. But just because an illness is complex and not fully understood, it doesn’t mean we should shy away from helping people heal – we just need to adjust our approach accordingly.

Testing and treatment often have to happen side by side when tackling CIRS. Sometimes the response to different treatments actually help in achieving a complete diagnosis. Symptoms, biomarkers, and testing must be used to correctly diagnose CIRS.

Some common symptoms of CIRS include:

  • Cognitive difficulties such as brain fog and trouble concentrating
  • Fatigue and weakness or chronic fatigue syndrome
  • Unexplained weight gain
  • Frequent urination, excessive thirst, dehydration
  • Fibromyalgia
  • Visual insensitivity
  • Post nasal drip and sore throat
  • Numbness and tingling
  • Digestive issues
  • Mood swings
  • Tinnitus
  • Static shocks
  • Vertigo
  • Metallic taste in mouth

If you have some of the symptoms associated with CIRS, you should make an appointment with a doctor who is experienced in dealing with this condition. If you’re in need of a New York certified functional medicine doctor, you can request a consultation here.

Testing for Chronic Inflammatory Response Syndrome Due to Mold

Some of the biomarkers for the different underlying causes of CIRS overlap, some are different. These are some of the biomarkers seen in mold patients which have been the most common forms of CIRS I’ve found in my practice.

CIRS due to mold exposure has a couple of characteristic markers, including high levels of

  • C4a – An activation protein that can cause inflammation, free radical production, and damage to tissues if too high.
  • TGF–beta1 – A cytokine in the immune system that has both anti– and proinflammatory effects.
  • MMP–9 – An enzyme that helps with tissue repair and is a significant marker of CIRS.
  • ACTH / Cortisol – A hormone that can be elevated and lead to weight gain in CIRS patients.
  • VEGF – A protein that causes blood vessel formation.

CIRS due to mold exposure is characterized by low levels of:

  • MSH – A hormone that is anti-inflammatory and typically low in CIRS patients.
  • ADH – This hormone regulates the amount of water your body removes and is associated with dehydration, frequent urination, and excessive thirst.
  • VIP – A neuroregulatory hormone that is associated with inflammation
  • Visual contrast ability – You can take the VCS test, which is simple and can be done at home.

There are several tests that can help you identify if mold is the cause of your inflammation, and therefore your symptoms. These tests are useful If you suspect you have CIRS, I recommend the following:

  • The Visual Contrast Sensitivity (VCS) test checks for neuroinflammation, which is often caused by mold exposure. The VCS test checks your ability to see differences in colors, a common symptom of CIRS. It’s also only $10 and can be done at home, so it’s a good place to start.
  • There is a Mold CIRS Panel laboratory markers that you can test in the conventional laboratory. This panel tests for MMP9, TGF-beta1, MSH, ADH, and osmolality.

If you believe your symptoms might be caused by chronic inflammatory response syndrome, it’s so important that you make an appointment with a doctor familiar with this condition. I can’t tell you the number of times I‘ve seen patients who have gone from doctor to doctor trying to find the cause of their symptoms.

When CIRS is the suspected culprit of your symptoms, there are a number of things that can be done right away to ease your struggles. Intervention and remedies like eating specialized diets, taking supplements that support natural detoxification, sauna therapy, and mold remediation can help those with CIRS.

If you are in need of a New York functional medicine doctor who is experienced in CIRS, you can request a consultation here. Don’t wait until this condition becomes worse, you can begin the path to relief today.




Diagnosing CIRS: Your Complete Guide to Testing

Diagnosing CIRS: Your Complete Guide to Testing

CIRS or Chronic Inflammatory Response Syndrome is really an umbrella term for symptoms with a few different causes. It can be caused by tick borne illnesses, mold exposure, and more. Characterized by extreme exhaustion, weakness, and cognitive difficulties, CIRS is a debilitating condition that’s inherently complex.

The nature of CIRS makes it difficult to diagnose. Sometimes patients go years, even decades before a full diagnosis is made. Fortunately, our understanding of this disease and its diagnostic testing has gotten much better.

I’ve found that because the functional medicine approach examines the body as a whole, it’s better at diagnosing complex conditions such as CIRS. In my article How to Know if You Have Chronic Inflammatory Response Syndrome, I explored:

  • What is Chronic Inflammatory Response Syndrome?
  • Why waiting for a diagnosis might not be the answer.
  • Testing for mold exposure.

If you need more of an introductory to CIRS, I recommend you start there. In this article, you will find a comprehensive approach to diagnostic testing for CIRS. This is a guide you can use before you see a doctor, to help you determine if you possibly have CIRS – and what testing you can ask your doctor for to achieve a proper diagnosis.

Do You Have CIRS? Testing Before The Doctor’s Office

Before you even make an appointment with your doctor there are a couple things you can do.

First, see how many symptoms you have in the CIRS symptoms clusters below. This system was developed by Dr. Ritchie Shoemaker through the analysis of thousands of patients. People with Chronic Inflammatory Response Syndrome will have symptoms in eight or more clusters.

For example, if you are experiencing night sweats that counts as a positive result for the entire cluster of symptoms in the red box on the right. Even if you don’t have red eyes, blurred vision, mood swings or ice pick pain, because you’re experiencing night sweats that counts as a positive result for the entire cluster. You only need one symptom in a cluster for it to count. You may have symptoms that aren’t on this chart, but if you have CIRS you’ll have at least eight symptom clusters. You can see how many clusters you have right now.

Diagnosing CIRS: Your Complete Guide to Testing

Next, you can take the Multiple Systemic Infectious Diseases Syndrome (MSIDS) Horowitz questionnaire. This questionnaire allows you to assign 0-3 in severity on a number of symptoms that are commonly associated with CIRS that’s been triggered by Lyme disease. At the end, you’ll have a total score which will tell you how likely it is you have a tick-borne illness.

Finally, you can take a Visual Contrast Sensitivity (VCS) test. This is a simple test that costs $10. It checks your ability to distinguish between very similar colors. Those with CIRS often are unable to differentiate between similar shades due to neuroinflammation.

If any of these tests result in a trip to the doctor’s office, be sure to bring your results with you to your appointment. These tools are excellent resources for beginning your CIRS diagnosis.

Testing for CIRS

Remember, because there are numerous underlying causes of CIRS, there are also various tactics in tackling these diagnostics. You’ll need to go through these with a doctor who’s experienced in chronic conditions. You might not need every single test listed here. Your symptoms will tell your doctor where to start.

Testing should include:

  • Mycotoxin testing – These tests can identify biotoxins in your blood created by mold.
  • Human Leukocyte Antigen (HLA) genetic test – An estimated 25 percent of the population have a genetic variation that makes their immune system bad at identifying and ridding the body of biotoxins. Sometimes when mold is an issue in a home,  the rest of the family only notices the problem after a person with the HLA gene becomes sick.
  • MARCoNS – Multiple Antibiotic Resistant Coagulase Negative Staphylococci (MARCoNS) live inside the nasal cavity. These can contribute to CIRS and need to be identified and treated.    
  • Mold CIRS Panel of laboratory markers. This panel tests for MMP9, TGF-beta1, MSH, ADH, and osmolality.

The following are biomarkers commonly associated with CIRS and should be tested:

  • Vasoactive Intestinal Polypeptide (VIP) – Normal range is 23-63 pg/mL. CIRS patients usually have lower levels.
  • Melanocyte Stimulating Hormone (MSH) – Normal range is 35-81 pg/mL. CIRS patients usually have lower levels.
  • Transforming Growth Factor Beta–1 (TGF Beta-1) – Normal range is <2380 pg/ml.
  • C4a – Normal range is 0-2830 ng/ml.
  • Antigliadin (AGA IgA/IgG) – Normal range is 0-19.
  • Adrenocorticotropic hormone (ACTH)/Cortisol – Normal range is ACTH 8-37 pg/mL. Cortisol in the a.m. 4.3-22.4 and p.m. 3.1-16.7 ug/dL. CIRS patients usually have higher levels.
  • Vascular Endothelial Growth Factor (VEGF) – Normal range is 31-86 pg/mL. CIRS patients usually have lower levels.
  • Antidiuretic hormone (ADH)/Osmolality – Normal range is ADH 1-13.3 pg/ml and Osmolality 280-300 mosmol.
  • Matrix Metallopeptidase 9 (MMP-9) – Normal range is 85-332 ng/mL.
  • Leptin – Normal range is 0.5-13.8 ng/mL for men and 1.1-27.5 ng/mL for women.

You should also have an Environmental Relative Moldiness Index (ERMI) test done. The ERMI test is a DNA-based test that’s used to identify specific species living in your home. This is beneficial because it helps identify potential mycotoxins that could be making you sick. Furthermore, it will help you know if you should have any mold remediation done in your home. Removing the cause of CIRS (in this case mold) from your life is the number one step in recovering your health.

Finding a Functional Medicine Doctor for CIRS

If you suspect you have Chronic Inflammatory Response Syndrome, it’s important you make an appointment with a functional medicine doctor who has experience in working with CIRS. If you don’t start with a doctor who’s knowledgeable in complex, chronic conditions it could end up costing you a lot more time, money, and energy down the road.

When potential CIRS patients come to me, not only do we begin diagnostics to completely identify the condition, we also start taking steps to alleviate the symptoms. Together we come up with a treatment plan that reduces any exposures, heals any outstanding infections, reduces inflammation, and supports natural detoxification.

As a certified New York functional medicine doctor with CIRS experience, I’ve helped thousands of patients get their life back from chronic, debilitating conditions. If you are struggling with your health, you don’t have to go through this alone – you can request an appointment here or call 212-696-HEAL (4325). When you catch chronic conditions early, the treatment is often easier, faster, and cheaper – don’t wait any longer, start today.



Mysterious Symptoms? Biotoxins Could Be to Blame

Mysterious Symptoms? Biotoxins Could Be to Blame

If you’ve been struggling with mysterious symptoms and having a hard time pinpointing the root cause of seemingly unrelated health issues, you should consider biotoxins. Biotoxins can come from insect bites, mold growing in your home, and many other sources. I’ve noticed an increasing number of biotoxin-related illnesses in my practice, especially in younger individuals and I believe this rise is happening across the country.

You see, biotoxins cause widespread chronic inflammation, which in turn causes symptoms throughout the body’s systems. This can cause nonspecific symptoms such as brain fog, fatigue, general malaise, vertigo, and headaches. Symptoms such as these can be confusing, even for your doctor, which is how biotoxin illness has largely gone mis– and underdiagnosed.

One biotoxin illness, chronic inflammatory response syndrome (CIRS), up until recently wasn’t taken very seriously (unfortunately, it still isn’t taken seriously by some medical professionals). As a result, many patients end up defeatedly going from doctor’s office to doctor’s office, at a loss for what’s happening to their body. We now know CIRS is a very real condition, and it is caused by biotoxins. CIRS is considered a subtype of biotoxin illness.

So how do you know if you’ve been exposed to a biotoxin? What are some of the signs, and what can you do? Let’s take closer look at what biotoxins are and how they affect your health.

What are biotoxins?

Biotoxins are a group of substances that are toxic to humans and biological in nature. They can be made by plants, bacteria, fungi or animals. Biotoxins are usually a defense mechanism for the creator, though not always.

Biotoxins have a wide range of negative effects on the human body, targeting different systems – such as neurotoxins, which impact the nervous system and cytotoxins, which impact individual cells.

The two biotoxins I’ve seen impacting my patients most in the past decade, are:

  1. Mold biotoxins  – mycotoxins
  2. Biotoxins created by the tick borne microbes, like Lyme disease causing microbe – Borrelia Burgdorferi

Mycotoxins and Lyme biotoxins are both proving to be a silent crisis and the medical community is only just now realizing how bad they are.

Why are these biotoxin-related illnesses on the rise?

Both mold related illnesses and Lyme disease are on the rise in America. With mold, it’s mostly due to the fact that we now build our houses out of paper and wood, which when combined with moisture is a perfect breeding ground for mold. An estimated 50 percent of American homes now contain toxic mold and an estimated 80 percent of all CIRS cases are caused by water damaged homes.

And when it comes to Lyme disease, it’s thought that the rise is due to many factors. One of which is  climate change and the elimination of predators of carriers (mostly rodents), due to deforestation and habitat damage. Lyme disease is most prevalent in New England, and I’ve personally seen a significant increase in my own patients who hardly leave urban area of New York City.

Effects of biotoxins

Once you are exposed to a biotoxin, the immune system flags the invader and works to have it broken down and removed. If someone is exposed repeatedly or in sufficient levels (living in a moldy home, for example), the biotoxin can’t fully be removed and sets off a series of inflammatory responses throughout the body.

It’s much like digging a hole in sand. If the there’s too much, can be impossible to get very far as sand continuously fills the hole while you’re digging. With your body, if you don’t remove the assaulting toxin it wears your immune systems down.

Then there are some individuals who have genetic predisposition to CIRS that is HLA gene determined. These individuals are much more sensitive to this whole process because their immune system doesn’t properly ‘flag’ the invading biotoxin or have harder time to remove them from the body.  In this case, the biotoxins are free to wreak havoc throughout the body because they are never fully removed.

This sets off a cascade of inflammatory events. Firstly, through binding to receptors throughout the body. Then, the body begins to recognize the biotoxin, which causes a cyclical upregulation of numerous inflammation causing pathways.

Essentially, biotoxins cause a vicious cycle of inflammation that requires intervention, especially if you have the HLA-DR gene. An estimated 25 percent of the population has this genetic mutation, which makes it difficult for your body to rid itself of toxins.

How do you know if you’ve been exposed to biotoxins?

When you’ve been exposed to a biotoxin, your symptoms could be acute or chronic depending on the biotoxin, potency, length of exposure, your genetic status, and more. One thing is certain though – you want to address it earlier rather than later. The longer you go untreated (especially if you’re still being exposed to the toxin), the more complex your symptoms, diagnosis, and treatment will become.

Symptoms of biotoxin illness include:

  • Shortness of breath
  • Cough
  • Sinus problems
  • Memory difficulties
  • Headaches
  • Numbness
  • Muscle cramping
  • Metallic taste
  • Fatigue
  • Weakness
  • Nerve pain
  • Light sensitivity
  • Weight gain
  • Night sweats
  • Excessive thirst
  • Gastrointestinal related issues
  • The inability to distinguish between subtle differences in color

If you suspect you’ve been exposed to biotoxins you can request an appointment here. If you’re not in the New York area, I recommend finding a functional medicine doctor who has experience in biotoxin illnesses.

Biotoxin related medical conditions

Biotoxins themselves can cause medical conditions and their inflammatory hijacking of the immune system can cause serious illnesses. Biotoxin related medical conditions include:

  • Chronic inflammatory response syndrome
  • Lyme disease
  • Autoimmune disease
  • Hormone imbalance
  • Alzheimer’s disease

It’s quite possible we are only beginning to fully realize how harmful biotoxins are. Only recently a subset of Alzheimer’s disease was identified as being caused by mycotoxins.

The Visual Contrast Sensitivity test is a good place to start

The Visual Contrast Sensitivity (VCS) test checks your ability to differentiate details, which is an indicator of neuroinflammation. A major cause of neuroinflammation is exposure to biotoxins – Mold and Lyme are some of the most common. There are other causes of neuroinflammation besides biotoxins, this is just one common cause.

The VCS test is a good place to start if you think you’ve been exposed to biotoxins because you can do it at home, it only takes 10 minutes, and it’s only $10.  If you test positive for neuroinflammation, you should request an appointment immediately. In 2015, over 95 percent of all new Lyme disease cases occurred in only 14 states – New York was one of those states.

When you’ve been exposed to biotoxins, it’s important to seek out a doctor experienced in these illnesses because they are confusing and frequently misdiagnosed. I regularly have patients who come see me that have been searching for the cause of their mysterious illness for years. If you have been struggling with mysterious symptoms, I urge you to check for biotoxin exposure.