Evidence-Based, Simplified Nutrition and Lifestyle Strategies


Understanding Mold Illness

Mold Toxicity and Chronic Illness

With significant chronic disease and autoimmune illnesses continually on the rise, many are exploring alternative, holistic approaches to taking back their health.

Mold Illness: Mold Toxicity and Chronic Illness




When people think of mold, they often don’t understand the actual consequences and dangers that this organic substance can pose. With more than 100,000 different indoor and outdoor mold species, some are far more dangerous than others. Mold toxicity is the byproduct of certain molds that produce mycotoxins leading to acute illness in most but unfortunately causing chronic disease in the genetically susceptible. There are a lot of factors at play here when it comes to mold illness, a complex subcategory of biotoxin illness. Mold illness is a more prevalent issue than ever imagined with new scientific data and clinical experience illuminating this significant problem. Research indicates that 25% of the population is susceptible to chronic mold illness and 96% of chronic sinus infections are caused by mold. With 7 million deaths linked to indoor and outdoor air pollution, understanding the downstream impacts and health consequences of toxic mold exposure is critical.  


Mold illness research conducted by Dr. Ritchie Shoemaker, the pioneer of biotoxin illness, since 1997 has completely transformed our understanding of mold toxicity along with some of the root causes of autoimmunity. While many in the Western medical space are still in the dark about mold illness, Dr. Shoemaker’s peer-reviewed, clinically-backed work has given so much hope to those suffering from chronic illness untreatable by modern conventions. Let’s explore the causes, diagnostic criteria, and treatment protocol for this legitimate condition.

What Is Mold Illness?

mold illness


Mold illness, also known as Chronic Inflammatory Response Syndrome (CIRS), is a complex multi-system, multi-symptom disease caused by general inflammation due to an immune response that’s triggered by toxic mold. Technically, mold illness is a subcategory of CIRS, but the terms are often used interchangeably since about 80% of CIRS cases are caused by toxic mold. Here is the scientific definition of CIRS provided by Dr. Shoemaker:


“An acute and chronic, systemic inflammatory response syndrome acquired following exposure to the interior environment of a water-damaged building with resident toxigenic organisms, including, but not limited to fungi, bacteria, actinomycetes, and mycobacteria as well as inflammagens such as endotoxins, beta glucans, hemolysins, proteinases, mannans and possibly spirocyclic drimanes; as well as volatile organic compounds.”   


You may be wondering how mold can be so impactful to our health when we’ve evolved alongside these organisms for hundreds of thousands of years. The recent introduction of antifungal paints in combination with water-damage building (WBD) molds has created this growing societal problem. Here are three mold categories that can impact health for anyone:

  • Allergenic molds: These types of mold are on the lower end in terms of the danger scale. They often only cause issues for those that have specific mold strain allergies and asthma. Mold allergies are more common among children than adults.
  • Pathogenic molds: Pathogenic molds are generally responsible for acute illness by causing some type of infection. These infections commonly present as an acute response that resembles bacterial pneumonia. For those with dysregulated immune systems, this can pose a more serious issue.  
  • Toxigenic molds: Since these mold species produce mycotoxins, exposure can lead to serious health issues, especially for those who are genetically susceptible. Mycotoxin exposure has also been tied to cancer and immunosuppression. Mycotoxins can be accumulated in the body through inhalation, ingestion, and even skin contact. 


While these are generalized mold categories that can impact anyone, mold illness isn’t necessarily caused by a specific type of mold. It’s most commonly caused by a genetic HLA genotype that prevents the body from properly recognizing mold contamination in order to detox it. Learn more about this mechanism below.



mold illness water damaged building


Water-damaged buildings will have a chemical soup of toxigenic mold combined with microbes, harmful chemicals, bacteria, mycobacteria, and actinomycetes. This is often exacerbated by defects in construction such as poor ventilation, faulty crawl spaces, flat roofs, basements exposed to saturated groundwater conditions, and improper remediation of water leaks.       

Who Can Get Mold Illness?

Mycotoxins have the ability to cause a range of adverse health impacts from acute mold poisoning to long-term effects such as mold illness or even cancer. Anyone can be susceptible to acute mold poisoning– the effects vary from individual to individual due to the person’s current immune system state along with how significant the exposure is. 


In terms of mold illness, about 25% of the population is genetically susceptible to this condition. This portion of the population is born with HLA-DR genes, meaning their immune system isn’t able to correctly identify the mold pathogens and detox them on their own. Complicated even more by the fact that both genetic susceptibility and experiencing a traumatic event to turn on the gene expression are required prior to exposure, mold illness can be very difficult to diagnose making it commonly misdiagnosed or left untreated. Having a high fever, illness, surgery, significant stress, pregnancy, severe toxic mold exposure, and other traumatic events may trigger a cytokine storm that activates the mold illness gene in those who are born susceptible. It’s also important to note that in approximately 5% of mold illness cases, the patients do not have this genetic susceptibility.     


Since all the various compounds and fragments from mold particles are extremely small in size, they are capable of transporting from cell to cell via the cell membrane, making it virtually impossible to detect through standard blood work. We’ll discuss the diagnostic criteria along with the treatment protocol for mold illness momentarily but first, let’s delve into how mold illness impacts the immune system and the subsequent downstream effects. 

mold illness mycotoxin pathway

How Mold Illness Impacts the Immune System: The Biotoxin Pathway

Mold is a subcategory of biotoxins that can impact the 25% of people who are genetically susceptible. The biotoxin pathway helps explain the consequences of mold illness on the immune system and overall health:

Stage 1: Biotoxin Mold Effects

Once a genetically susceptible person experiences a traumatic event that activates this specific gene expression, mold illness begins after being exposed to the interior of a water-damaged building. In the 75% of the population that doesn’t have this genetic susceptibility, the mycotoxins are correctly tagged by the immune system, broken down, and then detoxed from the blood through the liver. However, for those that don’t have the appropriate immune response genes, their immune systems never tag the mycotoxins and therefore can’t create the antibodies required for the foreign antigen. The result is mycotoxins and other water-damage building biotoxins recirculating in the body indefinitely, causing significant damage across all bodily systems.

When toxic WDB mold is inhaled by these genetically susceptible people, the complicated downstream impacts lead to a series of biochemical events. Various mold fragments and compounds instead bind to the surface receptors of virtually every kind of cell in the body. Once bonded, a continuous upregulation of multiple inflammatory pathways is set off. Cytokine production in addition to impacted nerve function from toxic mold leads to chronic, general inflammation. 

Stage 2: Cytokine Impacts

Cytokines are a type of protein produced in the body responsible for modulating inflammation. In a well-functioning immune system, cytokines are created as a response to invading pathogens and play a role in upregulating the inflammatory response.


In mold illness, the impaired immune system isn’t capable of identifying the mold and other biotoxins for antibody creation and correct detoxification. This leads to cytokines binding directly to their receptors instead of the pathogens, causing the release of Matrix Metalloproteniase-9 (MMP9) throughout the blood. Inflammatory elements are then transported by the MMP9 from the blood into tissue which can promote clot formulation and inadequate circulation. 


The cytokines have a different impact on the brain– they bind to leptin receptors, preventing these receptors from properly regulating the metabolism, immunity, and reproductive function. Another critical downstream effect of the cytokines in the brain is the reduction of melanocyte-stimulating hormone (MSH). The initial symptoms created by these cytokine effects can present as headaches, poor body temperature regulation, muscle aches, and concentration issues.

Stage 3: Decreased VEGF

White blood cells are attracted to the elevated cytokine levels in the bloodstream causing further blood flow restriction, reduced oxygen in tissue, and decreased vascular endothelial growth factor (VEGF). VEGF is a type of protein that supports new blood vessel growth. It’s also responsible for the restoration of blood supply into tissue and cells that have been oxygen deprived. Decreased VEGF can cause shortness of breath, reduced exercise capability, fatigue, and muscle cramps.

Stage 4: Immune System Implications

For certain mold illness patients that have specific immunity-related HLA gene types, these individuals may develop more inappropriate immune reactions at this stage. The immune reactions can present as blood clotting abnormalities, histamine intolerance, autoimmune issues, and gluten sensitivity. We’ve seen a variety of patients develop autoimmune conditions including Hashitomo’s disease, Crohn’s disease, and other immunity issues from mold illness. 


In all mold illness cases as well as other biotoxin cases, the complement system is continually activated leading to more consequences. Also known as the complement cascade, the complement system is a significant component of the immune system that manages inflammation, removes microbes, boosts antibody function for clearing damaged cells, and attacks pathogens. Once the complement system is chronically activated, severely disordered inflammation affects every bodily system including the brain. 


Furthermore, the combination of lowered MSH, decreased VEGF, increased MMP9 in the bloodstream, and elevated cytokines create “leaky junctions” in both the gut and blood-brain barrier. This results in “leaky brain”, allowing neuropathic toxins to enter the brain which causes substantial inflammation and the dysregulation of the hypothalamus and pituitary. The term “brain on fire” refers to this critical inflammatory state experienced by the brain.

Stage 5: Low MSH

MSH is an essential hormone that plays a key role in managing immune function, inflammation, and other hormones. Low MSH is one of the hallmarks of mold illness. The ensuing impacts of low MSH, various bodily symptoms impacted by mycotoxin circulation, and the development of autoimmune conditions in certain genetically susceptible individuals (referred to in stage four), explain the varying range of symptomology in those with mold illness.


Low MSH levels cause a minimized production of melanin which leads to non-restorative sleep and chronic fatigue. Endorphin suppression is another byproduct of low MSH, explaining the common symptom of long-term unexplained pain. Reduced MSH significantly contributes to “leaky junctions” that cause both “leaky brain” and leaky gut. Linked to developing autoimmune disease, leaky gut exacerbates the weakened state of the immune system. Since chronically activated, white blood cells eventually lose their normal cytokine response, leading to opportunistic infections and increased recovery times.

Stage 6: MARCoNS

Since all junctions in the body are compromised due to low MSH, it’s common for Multiple Antibiotic Resistant Coagulase Negative Staphylococci (MARCoNS) to survive in the nose’s biofilm. MARCoNS tends to occur in over 80% of MSH-deficient mold illness patients. The toxins produced by this antibiotic-resistant staph bacteria contribute to the continual destruction of MSH, creating a vicious cycle of decreased hormone levels and downstream effects.

Stage 7: Pituitary Hormone Effects

Another consequence of reduced MSH is the decrease in pituitary production of the antidiuretic hormone (ADH). Up to 80% of mold illness patients have impacted osmolality and ADH levels due to this. Dysregulated ADH/osmolality can present as low blood pressure, increased thirst, frequent urination, low blood volume, and static shocks.


Sex hormone production can also become down-regulated while the pituitary may upregulate the production of cortisol and adrenocorticotropic hormone (ACTH). If the mold illness continues to progress, the pituitary often then drops to significantly low or low to normal ranges.

Mold Illness Symptoms

mold illness clinical signs


Because of the biotoxin pathway, mold illness can affect all bodily systems leading to a wide array of cascading symptoms that ultimately vary from individual to individual. Here are some of the common mold illness symptoms:

  • Muscle cramps and aches
  • Ice pick or unusual pain
  • Joint pain
  • Headaches
  • Weakness
  • Fatigue
  • Non-restorative sleep
  • Light sensitivity
  • Blurred vision
  • Red eyes
  • Sinus problems
  • Cough
  • Shortness of breath
  • Diarrhea
  • Nausea
  • Abdominal pain
  • Confusion
  • Poor memory 
  • Poor recall of words
  • Concentration issues
  • Weight gain
  • Depression and anxiety
  • Mood swings
  • Night sweats
  • Dysregulated body temperature
  • Frequent urination
  • Excessive thirst
  • Tremors
  • Tingling
  • Vertigo
  • Histamine intolerance
  • Static shocks
  • Metallic taste

The fact that many of these symptoms can be caused by other conditions is one of the reasons why mold illness is regularly misdiagnosed. The multi-step diagnostic criteria for mold illness include having a certain number of these symptoms which we will explain later on. 

Common Misdiagnoses for Mold Illness

Alongside the many complications of this condition, there’s a serious lack of awareness in both holistic wellness spaces and the Western medical community. Mold illness symptoms are often mistaken with other chronic conditions. Some of the common misdiagnoses include:

  • Depression and anxiety
  • Fibromyalgia
  • Post-Traumatic Stress Disorder (PTSD)
  • Irritable Bowel Syndrome (IBS)
  • Chronic Fatigue Syndrome (CFS)
  • Somatization (ex. Hypochondria)
  • Multiple Sclerosis (MS)
  • Rheumatoid Arthritis
  • Autoimmune Disorders
  • Lupus

How Do You Diagnose Mold Illness?

Since mold illness is a complex multi-system, multi-symptom condition, an individual must go through a multitude of diagnostic criteria in order to have a confirmed diagnosis. Recent findings from the Environmental Protection Agency report that approximately 50% of homes and 85% of commercial properties in the US have water damage. 40% of people suffer from mold toxicity with 25% of the population genetically susceptible to chronic mold illness. That’s up to 40 million people in the US alone. 


If you’re exploring root cause healing and haven’t been able to fully heal for some time, can’t lose weight despite diet and lifestyle conventions, or need considerable biohacking intervention to feel better, you may want to consider looking into the preliminary diagnostic criteria for mold illness to see if it warrants blood work confirmation.

Mold Illness Diagnostic Criteria

It’s best to work through these in order since the first three steps are free and don’t require working with a provider.

Criterion One: History of Water-Damage Mold Exposure

It’s common during this step to automatically believe you don’t have any history of mold exposure since most of us aren’t aware of what water damage can look like and memory problems are prevalent for this condition. Take some time to think about all the homes you’ve lived in, schools you’ve gone to, your workplace history, as well as any other buildings you visited often. 


Water damage events can include property flooding, plumbing leaks, washing machine overflow, broken pipes, groundwater seepage, clogged toilets, roof hail damage, and more. It only takes 48 hours for toxic mold to form inside water-damaged buildings, so if the past water damage event wasn’t immediately dried and properly taken care of within that time frame, that confirms a place of exposure.


Even if you don’t recall a water damage event happening in your presence, try to remember any signs of water damage you may have noticed at properties you frequented.

General Signs of Water Damage:

  • Musty odors or smells
  • Sudden unexplained increase in the water bill

Water Damage Signs for Ceilings:

  • Bubbling, peeling, or flaking paint
  • Large, spiderweb-patterned cracks or small hairline cracks
  • Water rings that appear discolored, yellow, or light brown
  • Visible mold growth in the corners where ceilings and walls meet (more common for humid rooms such as the basement)
  • Bowed, sagging ceilings
  • Water stains that have a similar look to rust

Water Damage Signs for Walls:

  • Soft drywall
  • Discolored streaks running down the wall
  • Water rings that appear discolored, yellow, or light brown
  • Bubbling, peeling, or flaking paint/wallpaper

Water Damage Signs for Floors:

  • Buckling floor panels 
  • Warped, cracked, or bubbling floors
  • Plank edges curling upward
  • Crowning where the middle of the plank is raised up causing a rounded look

Since about 50% of homes and 85% of commercial buildings in the US have water damage, it’s very likely that you’ve encountered toxic mold at some point. While a lot of properties will display one or more of these signs outlined above, there are many that have hidden water damage. If you don’t recall encountering a water-damaged building, you may still want to consider the next two steps.

Criterion Two: Mold Symptoms

Since mold illness symptoms vary so much and can also be indicative of other conditions, just because you have some of these symptoms doesn’t mean you have mold illness. For the second step of the diagnostic criteria, you’ll notice that all the symptoms are grouped into 13 independent clusters due to how they’re caused by the biotoxin pathway. Patients that have symptoms in at least eight of the 13 clusters should seriously consider completing the next step. Even though there are various symptoms in each cluster, you’ll only need to have one of those symptoms for the cluster to be considered positive. 


Tip: Circle which symptoms you have in the graphic and see if it results in eight or more clusters. As a reminder, you only need one symptom in that cluster for it to be positive. If an online symptomology quiz is easier to take, the VCS test outlined in the next criterion offers this as an included, free option.

mold illness vcs test

Criterion Three: Visual Contrast Sensitivity (VCS) Test

Once you’ve determined that you’ve encountered a water-damaged building and have eight or more positive symptom clusters from the first two criteria, the next step is taking the Visual Contract Sensitivity (VCS) test. The VCS test can be taken for free here or use the official test option from Dr. Shoemaker for a nominal fee here. The VCS test was developed in order to discern if you have the ability to distinguish between varying low contrast levels as a marker of neurological function.  It was initially created in the 1960s by the Air Force as an objective for biomarker pilot health and is still used today. The test will display a series of images with decreasing contrasts taken over the course of ten to fifteen minutes. The results help diagnose any visual system dysfunction which is another hallmark symptom of mold illness.


As mentioned in stage three of the biotoxin pathway, the innate immune system dispatches white blood cells in response to toxic mold exposure leading to restricted capillary blood flow in those genetically susceptible. The capillaries located in optic nerves are also affected by the decreased blood flow from the reduced VEGF levels. Another one of the consequences of this is the loss of contrast sensitivity for those with mold illness.


It’s important to note that the VCS test can be slightly flawed with about 8% of mold illness patients falsely passing the test. However, individuals who have eight or more of the positive symptom clusters that also fail the VCS test have a 98% chance of a positive mold illness diagnosis.

Criterion Four: Lab Work


So you’ve confirmed that you may have encountered a water-damaged building, have eight or more positive symptom clusters, and failed the VCS test. The next step is working with a provider to run lab work. For those that haven’t failed the VCS test but have confirmed the first two criteria, you may still want to consider lab work in case you’re in that seven percentile that experiences false passes. Reach out to our team if you need help determining if your case warrants further exploration.


One of the lab tests needed will be the HLA-DR which determines if you have a genetic susceptibility to mold illness. While very rare, it is important to note that a person that doesn’t have susceptible genes can still develop chronic mold illness. This presents for about 5% of all mold illness cases. Working with the right certified mold illness provider is key to ensuring you receive the appropriate treatment regardless of what your genetics are.


During this step, you’ll also need to get other specific lab work completed. We offer the Mold Illness Testing Panel in-house that can be completed at any LabCorp. These markers are used for both a confirmed diagnosis along with monitoring clinical progress during mold illness treatment:

MMP-9 (normal range: 31-86 pg/mL): MMP-9 is a critical enzyme that plays a role in breaking down disease and damaged tissue. In mold illness, this marker is increased, in turn leading to tissue disruption in blood vessel walls, ultimately causing inflammation to the muscles, joints, peripheral nerves, lungs, and brain.

VEGF (normal range: 31-86 pg/mL): VEGF is key for supporting new blood vessel growth, boosting blood flow, stimulating circulation, and providing oxygen and nutrition delivery throughout the body. Decreased levels of VEGF associated with mold illness can cause poor blood flow and cell starvation.

C4a (normal range: 0-2830 ng/mL): The C4a marker is one of the testable markers in the complementary system and is very significant for mold illness monitoring and diagnosis. The inflammatory marker shows the innate immune response to toxic mold exposure found in water-damaged buildings. C4a quickly elevates within 12 hours of any exposure even acute. The marker will drop once out of exposure when the patient has completed certain steps of the treatment protocol.

TGF Beta-1 (normal range: <2380 pg/mL): The multifunctional protein is essential for regulating the body’s innate immune system, overall immune function, cell migration, and cell survival. With increased TGF Beta-1 levels, various cascading problems can occur including neurological, autoimmune, and other systemic issues.

MSH (normal range: 35-81 pg/mL): Nicknamed the “master gland”, MSH is responsible for managing various anti-inflammatory and hormone functions. Since more than 95% of mold illness patients have decreased MSH levels from mycotoxin accumulation, the consequence is a higher vulnerability to toxic mold, gut issues, poor sleep, hormone dysregulation, mood swings, and more.

VIP (normal range: 23-63 pg/mL): Vasoactive intestinal peptide (VIP) is a neuropeptide that helps regulate pulmonary artery pressures, cytokine responses, and general inflammation. Depleted levels of VIP are common in mold illness and can subsequently cause diarrhea, shortness of breath, and reduced exercise tolerance. VIP has a similar role compared to MSH in managing the body’s inflammatory response.

Providers may choose to test additional blood markers so they can get a holistic view of all the downstream consequences caused by mold illness. These are the essential markers needed for diagnostic criteria along with progress tracking during treatment. A limited blood marker and genetic susceptibility test is also available in-house for those looking to reduce the initial financial burden of mold illness diagnosis. 

Criterion Five: Improvement With Mold Treatment

After the first four steps have been completed and you receive confirmation that your mold illness markers are abnormal and/or have one or more of the genetic haplotypes, you’ll need to find a Shoemaker-certified practitioner. You don’t necessarily need to work with a provider that’s in your state– many of these providers offer the same services to patients that are out of state. The mold illness provider will prescribe a medication that has a specific receptor site size and charge capable of binding to and removing mold toxins and other biotoxins that have accumulated in the body. It’s critical to find a CIRS provider for achieving root cause healing, not just any practitioner that works with mold toxicity and illness since this prescription medication is a requirement for properly treating mold illness.


There are countless mold detox protocols available that incorporate over-the-counter binders such as clay and charcoal. These may help with symptom management and temporarily boost patient wellness but unfortunately will not heal mold illness. Once patients have taken the required prescription binder, they will have immediate symptom alleviation and be able to pass the VCS test generally four weeks after starting treatment.


How to Treat Mold Illness: The CIRS Protocol

There’s a lot of ignorance and non-scientifically-backed information about mold in both functional medicine and Western medicine which has exacerbated this growing societal issue. The CIRS protocol developed by Dr. Shoemaker is the only clinically proven, peer-reviewed treatment for mold illness and has treated tens of thousands of patients worldwide. The CIRS protocol contains multiple steps that address each corresponding stage of the biotoxin pathway in order to correct all consequences of toxic mold exposure.

Mold Illness Treatment Phases

The four phases of the CIRS mold illness treatment protocol are:


  1. Critical 
  2. Primary
  3. Middle 
  4. Final


Each phase will have different steps and must be completed before starting the next one.

mold illness treatment phase 1

Phase 1: Critical

This is the most important phase of the mold illness treatment protocol from Dr. Shoemaker. It’s critical to remove ongoing mold exposure and begin mycotoxin removal from the body as other steps won’t be effective until the first two are completed. Lipid replacement and limbic retraining aren’t specified in this protocol but are essential supports for helping patients better tolerate treatment. Lipid replacement also works as an important therapeutic later on.

Step 1: Eliminate Ongoing Mold Exposure

The most fundamental yet most commonly difficult-to-achieve step in the entire treatment protocol is getting out of mold exposure. Oftentimes the home, workplace, school, and even all the above can be sources of exposure. While we can’t always control every environment that we’re in, the most important one to address is the home. 


The first step in achieving mold exposure elimination is proper home and workplace testing. The most trusted tests used for this are called the ERMI and HERTSMI-2. These can be purchased from EnviroBiomics, Mycometrics, and Lis Biotech Laboratories. The ERMI is a much more in-depth report of all mold species found from dust samples in the environment and will also provide a HERTSMI-2 summary. For those with financial constraints, the HERTSMI-2 test will analyze dust samples for the “big 5 molds” most problematic for those with mold illness. These mold species include Aspergillus Penicilloides, Aspergillus Versicolor, Chaetomium Globosum, Stachybotrys Chartarum, and Wallemia Sebi. While there can be some flaws in these tests, they offer much more reliable results when compared to other mold sampling methods.


It’s important to discuss environment testing with your practitioner to ensure you’re following all the best current practices. Ideally, each finished level of the home as well as the workplace should be independently tested. Your mold illness provider will discuss the results with you as there is nuance when it comes to interpreting the results based on your geographic location. Your provider may refer you to an IEP such as Environmental Analytics for more complex environmental support. 


Once mold and mycotoxin environmental testing are complete, this will determine if your current home and/or workplace are safe or require remediation. Make sure to only work with CIRS-specific remediation companies since the remediation process required for mold illness is drastically different than the standard approach. Since both alive and dead mold fragments have the capability of triggering the immune response and subsequent inflammation in those with mold illness, making sure you’re working with the right company helps ensure successful remediation. Your mold illness provider will be able to provide comprehensive guidance when it comes to the environment piece and help you successfully get out of exposure.

Step 2: Remove Toxin Mold and Mycotoxins with Prescription Binder

The chemical soup of mycotoxins, bacteria, and other biotoxins that a mold illness patient is exposed to in water-damaged buildings requires a prescription binder for successful removal from the body. Toxin levels are corrected by this medication that’s prescribed by your mold illness provider. Cholestyramine (CSM) and Welchol are the most effective binders needed for mold illness treatment. Welchol is given for sensitive individuals – it is a quarter as effective as CSM but can be better tolerated by some. While rarer, some individuals begin the protocol severely compromised, resulting in cases in which they don’t tolerate either binder. Providers will offer alternative options to help the detox process until these patients are able to work up to Welchol. Both CSM and Welchol have the specific charge and receptor site for binding to biotoxins including all toxic mold pathogens for elimination.


Tip: Since the body is unable to detox toxic mold on its own in mold illness cases, these mycotoxins are stored in the gallbladder and excreted in the bile leading to indefinite recirculation. It’s best to eat a high-fat diet to help the CSM or Welchol with the detox. Timing some of your doses after meals is also ideal.

Additional Supports for Mold Illness Treatment:

Lipid Replacement

Mold illness can directly impact cell function which can make it difficult for patients to tolerate the prescription binder required for the protocol. Furthermore, the binder itself also can strip the fatty cell walls from cells. Lipid replacement therapy is the first preliminary step in treatment to help patients tolerate detoxing. Creating a healthy omega 3:6 ratio is accomplished by supplementing with either resolvin fatty acids or high doses of fish oil. For individuals that have significant histamine intolerance that are unable to take these supplements, eating wild-caught king salmon daily along with grass-finished beef are alternative, low-histamine ways of boosting omega-3 levels.

Mind-Body Work: Limbic Retraining for Mold Illness

Limbic retraining is an important step in the mold illness protocol and can help anyone suffering from chronic illness along with other mental health conditions, histamine reactions, and more. Part of the autonomic nervous system, the limbic system is affected by mold illness. We haven’t experienced any patients healing with only mind-body work but this is an important tool to include. Inflammatory markers such as TGF-Beta 1, MMP-9, and C4a won’t normalize through mind-body work alone. It generally requires a balance of both (and finding the right times) that enables optimal healing. If you find that limbic work is too strenuous to begin with, there are other modalities available that are less active. Mind-body supports such as the Safe and Sound Protocol offer a passive support option to help rebalance the nervous system. Emotional freedom technique (EFT, Tapping), breathing and tactile exercises, and spending time in nature can also help support this. 


Our brains automatically develop neural pathways in response to all of our experiences. This can lead to the development of inappropriate pathways. For example, have you ever gotten the stomach flu after eating a specific food and then some time afterward, gotten nauseous from smelling that same food? Even though the food wasn’t the cause of the illness, your body starts to associate the smell of it with illness.


limbic retraining for mold illness


This is especially true for chronic illness patients who experience a higher rate of sick events that the body can inadvertently associate with unrelated factors. These mistaken pathways can present as histamine reactions to chemicals, scents, or foods that you were able to tolerate before. Especially for those with mold illness, the immune system is activated but unable to identify the toxic mold pathogens leading to the mind constantly looking for the cause. 


mold illness treatment healthy mindset


We believe that healing takes place within both the mind and the body. That’s why limbic work is such an important step for mold illness treatment as well as any other chronic condition. Limbic retraining offers the opportunity to reprocess the wiring of these neural pathways in order to prevent the body from reacting to previously conditioned triggers. In our clinical experience, we’ve had patients find incredible symptom relief with limbic work alone before they’re able to start mold illness treatment. There are many free resources you can find online for limbic retraining. If you’re interested in mind-body limbic work, the Nutrition with Judy team also offers one-on-one and group program support options. Our nutritional therapists have both somatic and DNRS training.


cirs treatment mind body work

mold treatment treatment phase 2

Phase 2: Primary

Step 3: Treating MARCoNS

MARCoNS eradication is the next step in the toxic load reduction phase. Since MARCoNS exacerbate immune dysfunction, low MSH, and inflammation, this is key for unburdening the body. Depending on the severity of your MARCoNS, EDTA, Mucolox, colloidal silver, or another nasal spray can be used for treatment. The bacteria live in the nasal cavity but in rarer cases, can form deeper infections in dental cavitations and other areas of the body.

Step 4: Lower Anti-Gliadin Antibodies

Gluten avoidance is key for lowering anti-gliadin antibodies to their normal levels. In turn, this helps lower overall inflammation. Small intestine bacterial overgrowth (SIBO) is also a common downstream effect of mold illness. Practitioners may implement gut healing protocols for SIBO and other conditions at this stage or later on depending on the patient. 

Step 5: Restore Androgen Hormones

One of the many downstream effects of mycotoxin accumulation in the body is dysregulated hormone levels. Based on the patient’s markers, mold illness practitioners can restore these levels with therapeutics including supplementation as well as prescription medication.

mold illness treatment phase 3

Phase 3: Middle

Step 6: Normalize Osmolality and ADH

From stage 7 of the biotoxin pathway, ADH and osmolality levels can become out of whack. Low ADH levels lead to common symptoms of frequent thirst, frequent urination, dehydration, headaches, and static shocks. Prescription DDAVP can be utilized to help normalize the body’s capability for holding on to water.

Step 7: Reduce MMP-9

High MMP-9 leads to whole-body inflammation by allowing inflammatory chemicals to seep through leaky blood vessels. Starting a low-amylose diet is key for reducing MMP-9 and helping promote gut healing. Low amylose diets are designed specifically to support the body will healing from mold illness and can also help with SIBO and other gut issues. The carnivore diet or an animal-based diet are both great diet interventions for reducing inflammation and aiding in gut healing. We recommend opting for one of these diets for optimal support during healing. This step is critical for helping patients take full advantage of all the supplements and medications used in the following phases of the protocol. High-dose fish oils are another intervention used to lower heightened MMP-9. If you didn’t start lipid replacement therapy during the critical phase of the Shoemaker Protocol, it’s important to start it here.

Step 8: Fix VEGF Levels

High-dose fish oils also offer therapeutic value for fixing reduced VEGF levels. This in turn promotes improved oxygen delivery and blood flow for mold illness patients.

Step 9: Lower C4a

The beginning phases and steps of the protocol will help lower C4a innately if the patient is successful in completing these. If C4a suddenly increases after the blood marker has been corrected, this is typically a significant sign of re-exposure to toxic mold. Speak to your provider about subsequent steps needed to normalize this again. If a mold illness patient has completed all other steps and is confirmed out of mold exposure, the last step of taking VIP has the capability to lower the C4a level back to its normal range.

mold illness treatment repair and restore phase

Phase 4: Final

Step 10: Normalize TGF Beta-1

An elevated TGF Beta-1 marker can be indicative of mold exposure. If the patient is confirmed out of exposure, TGF Beta-1 levels should normalize as inflammation is fixed through steps one through nine of the Shoemaker Protocol. Since increased TGF Beta-1 is linked to autoimmune issues and dysfunction among physiological symptoms, it’s important to correct it. Losartan, a prescription medication, can be used as an intervention for stubborn elevated TGF Beta-1. Mold illness practitioners will monitor blood pressure if this medication is required.

Step 11: VIP – The Last Step

At this point of the protocol, patients that have any lingering symptoms can utilize VIP nasal spray to eradicate them. VIP is also capable of assisting in optimizing immune system regulation, helping optimize wellness. Mold illness patients will have to meet certain criteria and have their lipase levels monitored during VIP treatment.


After each subsequent phase has been completed and all blood markers restored to their normal ranges, the patient will be cured of mold illness and should be free from symptoms and the many downstream consequences of toxic mold exposure.

Carnivore Diet for Mold Illness

carnivore diet for mold illness


The current diet recommendation during mold illness treatment is avoiding gluten and sticking to low amylose options. A gluten-free diet offers gut healing support while minimizing imbalanced gliadin (gluten) antibody markers. The gluten-free approach also helps restrict mycotoxin food exposure (however, mycotoxin ingestion from food is not the cause of mold illness). A low amylose diet can also help with normalizing MMP-9 levels with less inflammation from sugars. We recommend the carnivore diet, which supports both a gluten-free and low-amylose diet, for mold illness recovery. Due to mold illness impacting multiple bodily symptoms and causing general inflammation throughout, the carnivore diet can be an incredible tool for helping reduce inflammation levels while also promoting gut healing. Some mold illness providers are recognizing that patients utilizing a carnivore diet when starting the treatment protocol tend to tolerate the binders and subsequent medications better, and many of these patients also have less dysregulated blood markers when compared to those on other diets.


Conversely, if you’ve been on the carnivore diet for about six months or longer and still aren’t able to achieve optimal health or fully heal, we strongly recommend looking into the diagnostic criteria for mold illness. In our experience, there seems to be a higher rate of mold illness cases among the carnivore community since root cause healing is typically what attracts us to this way of eating.

Mold Illness and Histamine Intolerance

Histamine intolerance can be a common downstream effect of mold illness. Mold exposure and mycotoxin accumulation are one of the various root causes of histamine intolerance, which is often exacerbated by impacted gut health from low MSH levels. Unless you’ve received a true Mast Cell Activation Syndrome (MCAS) diagnosis, which is extremely rare, histamine intolerance requires root cause healing and is only a symptom. Mold illness practitioners have a comprehensive histamine support toolbox with varying supplements, over-the-counter medications, and prescription options for providing temporary relief during the protocol. 


Mast cells are like our immune system’s watchdogs and work to defend the body from outside threats and invaders. When mast cells detect a threat, the chemical mediators are released which causes subsequent reactions to occur. With more than 200 of these reactions in the body, one of these chemical mediators is the histamine response.


Histamine release isn’t always related to mast-cell activation. Histamine levels are commonly elevated with mold illness since histamines are a part of the body’s innate immune system. As a reminder, the innate immune system is the side that witnesses the mold illness but isn’t able to properly address the adaptive immune system to detox the mold toxins.


Generally, when you see the C4a elevating, the histamine response will turn to create more prevalent symptomatology. When this happens, histamines are released due to gene activation and not specifically due to mast cell activation. Most patients aren’t interested in what turned on the histamines, they just want to find symptom relief from histamine reactions such as itching, facial flushing, and diarrhea.


Since some of the medications needed for mold illness treatment can be higher histamine and/or illicit histamine or herxing reaction in more sensitive patients, it’s important to notify your practitioner if you have histamine intolerance or any histamine issues. Mold illness providers will be able to support your histamine needs while you work through the protocol and oftentimes, histamine intolerance resolves on its own once the protocol has been completed and you’re out of mold exposure.

Is It Mold Illness or Mold Allergy?

When people hear about mold illness, it’s a common misconception that it’s the same thing as a mold allergy. However, mold illness and mold allergies are two separate, distinct immune responses. There are also different categories of mold outlined above: allergenic, pathogenic, and toxigenic. While very rare, it is possible for someone to have both mold illness and mold allergies. In this case, histamine regulation will take a higher priority in management for treatment. Providers will need to determine the root cause of the histamine disturbances and troubleshoot how much the mold allergy is actually impacting the patient in terms of symptomology. This could require IgE allergy testing and working with an allergist.

Mold Illness Prevention Post Treatment

mold illness mold reexposure symptoms


The mold illness treatment protocol is substantial and can feel overwhelming for anyone. However, it offers incredible hope and is a clinically-proven treatment for this complex condition. Mold illness is a legitimate condition that’s completely reversible and allows patients to get to the root cause of healing. Once the protocol is completed, mold illness patients will never have to repeat the protocol and won’t get that sick ever again. 


Providers will offer guidance and support for continued management if any subsequent exposures occur. Taking the prescription binder in potentially moldy environments during and/or after for two weeks will clear mycotoxin accumulation in the body. There are other interventions available to help these individuals live a full life and no longer in fear of mold. Patients are recommended to continue working with their providers in case of any future toxic mold exposure.

Work With the Nation’s Trusted Mold Illness Support Experts

The Nutrition with Judy team is humbled to offer comprehensive support and initial diagnostic steps for mold illness patients. Take advantage of our Mold Illness Bloodwork and Mold Illness White Glove Service as we understand how daunting the steps can be especially for those already chronically ill. Our white-glove service includes all testing requirements for mold illness, environmental mold testing, lipid replacement therapy, recommended supports and supplements, and detailed recommendations for CIRS-certified mold illness providers. Our personalized mold illness doctor recommendations only include Shoemaker-certified practitioners who can prescribe the necessary medication needed for the protocol. We’re always here to provide mind-body work, specialized gut healing, second opinions, and any additional support you need through mold illness treatment. 


nwj cirs group


For individuals seeking comprehensive practitioner-led and community support on their mold illness journey, we welcome you to join our exclusive NwJ CIRS Group Support. Join today for access to extensive resources, a like-minded community, and unparalleled care as we journey to root-cause healing together.


Start your mold illness healing journey today and contact us any time regarding the protocol.


DISCLAIMER: This content is for educational purposes only. While we are board-certified in holistic nutrition and nutritional therapy practitioners, we are not providing medical advice. Whenever you start a new diet or protocol, always consult with your trusted practitioner first.