Dr. Shoemaker’s CIRS Treatment Protocol is the only scientifically-proven way to treat Chronic Inflammatory Response Syndrome (CIRS).
However, it is also complicated and confusing. And to make things even more difficult, every person can react differently.
That’s why I’ve broken down the Shoemaker Protocol. I want to help you understand what it is, what makes it so complex – and why it is the only treatment that works to cure CIRS.
CIRS is incredibly complicated. I’ve been studying this illness for nearly a decade and it can still confuse me. If you are only starting to learn about CIRS, you may have started to realize that there’s a lot of misinformation about it on the internet. Possibly more misinformation than real, evidence-based information.
CIRS needs to be treated by relying on the evidence. Make sure your practitioner is leaning on the peer-reviewed literature that clearly outlines how to treat and manage CIRS. If your practitioner is treating CIRS based on his/her experience, look for a new practitioner.
When it comes to treating CIRS, I stand on the shoulders of giants. Dr. Ritchie Shoemaker deserves a Nobel prize for outlining the illness and treatment protocol of CIRS. Everything I write about in this post, I learned from him.
Dr. Shoemaker developed a treatment protocol for CIRS. It’s aptly named the Shoemaker Protocol, and it’s the only CIRS treatment that’s been studied scientifically.
I’ll repeat that as it is so important – the Shoemaker Protocol is the only CIRS treatment that has been scientifically studied. Not only that, it has gone through a peer review process, which means other practitioners in the field have studied it and agree that it works.
The Shoemaker Protocol is broken down into twelve separate steps. The steps need to be done in order as each step depends on the previous one being completed.
The twelve steps in the CIRS treatment protocol are:
1. Removal from exposure
2. Treat with binders
3. Treat MARCoNS
4. Correct anti-gliadin anti-bodies
5. Correct androgen levels
6. Correct ADH and osmolality
7. Correct MMP9
8. Correct VEGF
9. Correct C3a
10. Correct C4a
11. Correct TGF beta 1
12. Vasoactive intestinal polypeptide (VIP) nasal spray
I’ll go through each of these steps to make sure you completely understand everything involved in the CIRS treatment protocol.
The CIRS Treatment Protocol Step #1 – Removal From Exposure
Step 1 is all about identifying exactly what is causing CIRS in your body and finding out if you are still being exposed. For a lot of CIRS patients, a water-damaged building is the trigger. Step 1 for these people is about removing themselves from exposure to the water-damaged building. This could look like remediating their home or moving to a new location that does not have water damage.
This is the most important step of the entire protocol. If you don’t remove yourself from exposure, you’re never going to see any improvement.
How do you know if you’re dealing with an ongoing exposure?
Short answer: you don’t. At least not without proper testing. Unless the water damage is severe, you’re not going to see or smell it. The only reliable way to know if your home has water damage is to test for it.
How to properly test your home
Don’t hire a local company. They’re incredibly expensive and the vast majority of them use a method known as air sampling. Air sampling is worse than useless – missing more than 99% of actual water damage.
Instead, work with a knowledgeable CIRS practitioner who can direct you toward the most appropriate type of testing. EnviroBiomics is the go-to company for testing. An added benefit is you can easily perform their testing by yourself for a fraction of the cost of a remediation company.
EnviroBiomics uses a testing method called DNA-PCR. This testing method determines whether or not your home has water damage. Please do not use other testing methods. They have not been backed by research – at least not to the extent that DNA-PCR testing has.
Once you’re free from an ongoing exposure, you can comfortably move through the remaining steps of the Shoemaker protocol. Next, we dive into step 2 – treating with binders.
The CIRS Treatment Protocol Step #2 – Treat With Binders
There are only two binders that have been clinically studied in CIRS treatment:
Unfortunately, the majority of patients are not able to tolerate either of these substances. In fact, many patients report their symptoms worsen while taking them. Because of this, I’ve created my own binding supplements that are better tolerated by my patient population – and there is evidence to support their use (more on this later).
How long do you need to take binders?
Before starting binders, take a visual contrast sensitivity (VCS) test. Ideally, this is done in office. But the online version will work in a pinch.
The VCS test measures how your eyes process seeing contrast. Mold illness affects the nerve that communicates contrast to your brain. It’s an inexpensive way to find out if mold is behind your illness, and to track your progress as you start on the binders.
You will continue taking binders until your VCS test normalizes. This typically takes anywhere from 4-16 weeks – assuming you aren’t re-exposed. Once you pass the VCS test you can stop taking binders.
However, I recommend you always keep some extra binders in your pantry. Odds are that you will get re-exposed at some point in the future. When this occurs, you will need to restart the binders.
What about natural binders?
In a previous post, I outlined all the natural treatments used for mold illness – almost all of which don’t work. This is especially true for binders.
I’m going to take you back to high school chemistry. Chemical substances are made up of positive and negative ions. Like charges (ie positive+positive or negative + negative) repel, but opposite charges (ie positive + negative) attract, or bind to each other.
Biotoxins – the stuff we’re trying to bind and remove from your body – have a negatively charged ionic structure.
Therefore, if binding is going to occur, the binding agent needs to have a positively charged ionic structure to bind to the negative charge of the biotoxins. If their ionic structure is the same, they won’t bind.
Cholestryramine and Welchol have a positively charged ionic structure. But many natural binders like charcoal, bentonite clay, and chitosan have a negative charged ionic structure. As a result, they will not bind to the biotoxins.
Most natural binding compounds will not work for CIRS.
If you are going to use natural substances for binding, the two I recommend are okra and beets. Both of these bind to bile acids, just like cholestyramine and Welchol. However, it isn’t possible to eat enough okra or beets to bind biotoxins. You need them in supplemental form.
Here at Flourish Clinic, I have formulated a specific supplement composed of okra and beets. While it has not been peer-reviewed, I continue to see significant improvement in my patients’ VCS scores after starting this supplement. Even better, my patients do not experience the same side effects that so many have when taking cholestyramine and Welchol.
The CIRS Treatment Protocol Step #3 – Treat MARCoNS
MARCoNS are a bacterial colony that takes up residence deep inside your nose. The word MARCoNS is an acronym that stands for:
Unlike other unwelcome bacteria/fungi that may be in your nose, MARCoNS do not cause any sort of sinus-related symptoms. MARCoNS affect a hormone known as Melanocyte Stimulating Hormone (MSH).
A brief introduction to MSH
MSH is the most important hormone you’ve never heard of. It regulates your innate immune system and is incredibly anti-inflammatory. The chronic inflammation from CIRS has to do with low levels of MSH.
MSH is controlled by leptin in the pituitary gland. The inflammatory response found in CIRS damages leptin receptors in the brain and impairs your body’s ability to produce MSH.
The best way to think of MSH is as a mother hormone. This is because it gives birth to many other important hormones including:
– DHEA – which is responsible for producing other hormones such as estrogen and testosterone;
– Cortisol – the hormone that regulates your body’s stress response;
– ADH – or anti-diuretic hormone, which controls how much water the kidneys release
You have to have healthy levels of MSH to overcome CIRS. MARCoNS prevents this.
How MARCoNS affect your MSH levels
MARCoNS create a biofilm, which is essentially a goo that surrounds the bacteria. The biofilms protect the bacteria from your immune system which would otherwise attack the MARCoNS.
Once MARCoNS have moved in, they release chemicals that break down MSH – rendering the hormone inactive. This results in MSH levels being lowered even more while prompting your immune system to release more inflammation.
With your MSH levels now even lower, your immune system will release cells that result in more inflammation. This contributes to body aches and chronic fatigue.
How to get rid of MARCoNS
Remember how the R in MARCoNS stands for resistant? That’s because these bacteria are immune/resistant to at least three antibiotics. As well, antibiotics need to directly target the nasal cavity, but by definition broad spectrum antibiotics affect the entire body.
Instead, therapy needs to be targeted directly into the nasal cavity. If you guessed a nasal spray as the route of administration, bonus points for you. The only effective way to treat MARCoNS is to administer therapy into your nose!
EDTA is the recommended course of therapy. EDTA is often used to treat people with heavy metal toxicity. It is also quite amazing at dissolving biofilms. By dissolving the MARCoNs biofilm, your immune system can attack the bacterial colony.
To find out if you have MARCoNS and whether or not your treatment is working, you need to test. Everyone with CIRS should be tested for MARCoNS. Microbiology Dx is my lab of choice for anything to do with MARCoNS. If present, MARCoNS needs to be treated for 4-6 weeks and then retested. Once you’ve received a negative test result, you can move on to the next step of the Shoemaker Protocol.
The CIRS Treatment Protocol Step #4 – Correct Anti-Gliadin Antibodies
Gliadin is a storage protein (prolamin) for wheat. You can thank gliadin for bread’s incredible ability to rise during baking. The typical wheat crop is equally composed of both glutenins and gliadins.
If you suspect you’re dealing with CIRS, odds are good that wheat/bread/flour don’t agree with your body. If this sound like you, it’s because you’re creating anti-gliadin antibodies.
This does not mean you have celiac disease. But it does indicate that your immune system is strongly triggered by wheat/bread products.
What’s the connection between gluten and CIRS?
Remember the MSH hormone we discussed in step 3?
That same hormone is the reason behind your gluten intolerance. Low levels of MSH (which are a hallmark sign of CIRS) lead to a dysregulation in your immune system (more specifically, your T cells).
The dysregulation results in the production of unnecessary antibodies. Antibodies are small proteins used by your immune system to identify foreign invaders. Normally these antibodies identify and remove invading viruses and bacteria.
However when you have CIRS and the corresponding low MSH levels, antibody production can run wild. As a result your immune system creates antibodies against food proteins like those found in wheat.
How to correct anti-gliadin antibodies
As you progress through the CIRS treatment protocol, your MSH levels will start to improve. This will stabilize your immune system’s tolerance. Those strange food intolerances you used to have should start to be a thing of the past.
For some of you, the gluten/gliadin intolerance will remain, even after we finish treating your CIRS. If you still find that bread and wheat products don’t agree with you, you will need to continue on a gluten-free diet.
The CIRS Treatment Protocol Step #5 – Correct Androgen Levels
Step 5 in the CIRS treatment protocol is all about male hormones known as androgens. Ladies, this does not mean you get to skip this section – androgens are just as important for females.
Androgens are hormones, present in men and women, that contribute to growth and reproduction. They are best known for their link to male characteristics (like muscle tone and a deep voice).
While there are many different androgens, the one we need to focus on is called dehydroepiandrosterone, or DHEA. DHEA is produced in your adrenal glands, gonads, and brain. CIRS patients tend to have low DHEA levels. This reduces your energy, stress tolerance, and sex drive.
How CIRS affects your androgens
Your testes (men)/ovaries (women) and adrenal glands are the primary sources of androgen production and regulation. CIRS disrupts your hormones which results in the lowered production of stress hormones (like cortisol) and androgens (like DHEA and testosterone).
Both men and women naturally convert some of their DHEA into testosterone. The testosterone then goes through a process called aromatization that converts it into estradiol, which is an estrogen steroid hormone. If this occurs in small amounts, there are no issues.
But CIRS tends to mess this whole process up.
Too much aromatization results in low levels of DHEA and testosterone as well as high levels of estrogens. To increase your energy you need lower estrogen and higher DHEA/testosterone.
Why hormone therapy doesn’t work in CIRS
Many people try hormone replacement therapy (HRT) before learning they are dealing with CIRS. These people likely experienced either a worsening of symptoms or no change at all.
That’s because low androgens are adaptive/protective.
Only after completing the previous four steps can we start to improve androgens. Do it earlier and the therapy fails to work. The previous four steps have re-balanced your HPA axis. Only now are you ready to increase DHEA and testosterone levels.
How to correct androgens
Following steps 1-4 of the Shoemaker Protocol is often enough to help the body correct its androgen deficiency. Other times, therapeutic intervention is required. DHEA taken at 25-50mg per day is the recommended dose to improve androgen levels in CIRS patients.
Make sure to monitor levels before and after starting supplementation. You’re going to want to ensure that the extra DHEA you’re receiving from supplementation is not getting pushed down the aromatization pathway and increasing your estrogen levels even further!
The CIRS Treatment Protocol Step #6 – Correct ADH and Osmolality
Do you get dizzy after standing up too quickly?
Do you have an unquenchable thirst? Or need to pee 20+ times a day?
Maybe you’ve got headaches and migraines that just don’t seem to go away…
If you are suffering from any of these symptoms, this section is for you. Step 6 of the CIRS treatment protocol is all about balancing fluids. By this, I mean rebalancing the ways your body controls the amount of sodium (salt) and water within its cells and tissues.
As you know, CIRS lowers MSH and disrupts communication between your brain and organs. The Antidiuretic Hormone (ADH) and levels of electrolytes in your blood (osmolality) are the next set of casualties that need to be corrected before you can overcome CIRS.
Osmolality is the measurement of specific electrolytes – namely sodium, potassium, and chloride – within your blood. ADH, also known as vasopressin, is a hormone that controls fluid retention and blood pressure. Both osmolality and ADH are regulated by your HPA axis and MSH levels.
A brief intro into how your body balances fluids
Located at the base of your brain is the hypothalamus. The hypothalamus connects your brain (nervous system) to your hormones (endocrine system).
Your hypothalamus has specific cells called osmoreceptors that respond to electrolyte levels within your blood. If your osmolality is high it means there’s a high concentration of electrolytes in your blood. As a result your osmoreceptors shrink and release ADH. ADH helps you to reabsorb water which rehydrates your body.
If your osmolality is low it means your blood contains too much water and not enough electrolytes. In this situation your osmoreceptors swell and block ADH release. When ADH levels drop, the excess water is filtered out through the kidneys and urine.
People who don’t have CIRS will either have high ADH and high osmolality, or low ADH and low osmolality. CIRS disrupts this balance which makes ADH and osmolality mismatched. CIRS patients will either have low ADH and high osmolality or high ADH and low osmolality.
What happens when osmolality and ADH are imbalanced?
Depending on whether your osmolality levels are high or low you’ll experience the following:
- High osmolality and low ADH
- Increased thirst
- Increased urination
- Lots of static shocks
- Low osmolality and high ADH
- Fluid retention
- Swelling of hands, feet, ankles, or legs
How are ADH and osmolality treated?
For the majority of you, ADH and osmolality will balance all on their own as you move through the CIRS treatment protocol. Improving your MSH levels tends to balance ADH and osmolality. But some patients will still have stubborn swelling, headaches, or unquenchable thirst that doesn’t seem to get better. This section is for you!
Treatment for ADH and osmolality requires a medication called Desmopressin (DDAVP). Desmopressin is typically used to treat bed-wetting, nighttime urination, and excessive urination in diabetics.
This stage of treatment needs to be monitored very closely by your practitioner. If you notice extreme weight gain shortly after starting DDAVP, you’re retaining fluid. Sodium loss is also a potential problem in this stage of CIRS treatment. You’ll want to keep a close eye on sodium levels via lab tests as you start this medication.
The CIRS Treatment Protocol Step #7 – Correct MMP-9
We’ve bound the mold toxins, treated nasal bacteria, gone gluten-free, and started correcting your hormones.
We now turn our focus towards inflammation. The remainder of treatment is aimed at lowering specific markers of inflammation.
There are different sources of inflammation
Your family doctor probably measured inflammation in your body. This was done by testing your C-reactive protein or CRP. In all likelihood, your CRP was normal.
How could it be normal when you feel inflamed 24/7?
CRP measures inflammation within your adaptive immune system. CIRS is an illness affecting your innate immune system. The adaptive immune system is rarely affected in CIRS. This is why inflammatory markers that evaluate inflammation in your adaptive immune system are always normal.
To properly identify inflammation in CIRS, you need to use testing methods that evaluate inflammation within the innate immune system.
MMP9 is one of the innate immune system inflammatory markers.
Matrix Metallopeptidase 9 – or MMP9
MMP9 is an enzyme that is activated by the white blood cells (macrophages) of your immune system. Too much MMP9 negatively affects the basement membrane of your cells.
Basement membranes form a barrier between cells of the dermis and cells of your muscles. MMP-9 destroys these basement membranes. When your basement membrane is damaged, it basically becomes cheesecloth – very porous.
A porous basement membrane is not good. Inflammatory compounds can penetrate through the membrane and affect tissues like joints, muscles, lungs, and even your brain!
How to lower MMP-9
High doses of omega-3 fish oil are the first step in lowering MMP-9. Omega-3 oils are a type of PUFA (poly-unsaturated fatty acid). Our body cannot make omega-3 fats on its own; these need to come from the food you eat.
In CIRS, you’ll need a dose of omega-3s well beyond that which you can get from eating a healthy diet. To lower MMP-9, high doses of EPA and DHA are essential. EPA and DHA are two different types of omega-3s. The third type is called ALA. You can get ALA from plants, but EPA and DHA can only be sourced from algae or the fish that eat algae.
The daily required dose to lower MMP-9 is:
- 2.4g of EPA
- 1.8g of DHA
I recommend you take a liquid form of omega-3s for this. If you opt for omega-3 capsules, you’ll be swallowing more than 10 pills per day.
When DHA and EPA aren’t enough
For some of you, adding high doses of fish oils isn’t going to cut it. You’re going to need to take your CIRS treatment protocol one step further and follow a low-amylose diet for the next 30 days.
When you hear the word amylose, think starch. A low amylose diet is a way of eating that removes all foods that contain starch. This is not a keto diet, but it is moving you in that direction.
A low-amylose diet will also further improve leptin resistance. Leptin is a hormone that controls the hunger signal. When leptin resistance occurs, not only do you not feel full, but your body doesn’t trigger fat burning.
For a lot of CIRS patients, extreme resistance to weight loss is a common symptom. This resistance doesn’t usually respond to any dietary intervention.
This is because when you are suffering from a chronic inflammatory condition like CIRS the body releases a large number of tiny molecules called cytokines. Cytokines are small protein molecules that signal and direct an inflammatory response in your body. These cytokines damage leptin receptors within the hypothalamus of your brain.
As a result you gain weight and can’t lose body fat.
How to follow a low-amylose diet
I’ll break this section up into two parts: foods to avoid and foods to eat. Focus your attention on the foods to avoid list. If a food is under the avoid section, you should not eat this food for the next thirty days.
Foods to Avoid
- Roots and tubers: sweet potatoes, white potatoes, Beets, Peanuts, Carrots
- Wheat and wheat-based products: Breads, pastas, cookies, cakes, etc.
- Foods with added sugars: Corn syrup, maltodextrin, sugar, sucrose
Foods to Eat
- Onions and garlic
- Vegetables that grow above the dirt: lettuce, tomatoes, beans, peas, cucumbers, celery
- Fruit: All fruit is ok except for bananas
- Meat, fish, and poultry
- Condiments: But only if they’re free of added sugars
- Nuts and seeds
Ok, there it is, the low amylose diet. Follow this for at least 30-days during the MMP-9 treatment protocol.
The CIRS Treatment Protocol Step #8 – Correct VEGF
VEGF = Vascular Endothelial Growth Factor. And it’s perhaps the most important protein you’ve never heard of. VEGF stimulates the development of blood vessels. VEGF is usually only active when you’re developing blood vessels as a fetus or to help create new blood vessels after exercise/injury. (source)
In CIRS, a lot of your tissues feel starved of oxygen. This is in part why you’re dealing with chronic muscle pains, muscle weakness/heaviness, and fatigue. You can thank low levels of VEGF for this.
Just like with leptin receptors, cytokines also negatively affect VEGF levels. High cytokines = low VEGF. Without adequate levels of VEGF, your tissues are not going to be able to get the oxygen they require. Low oxygen levels in your tissues results in:
- brain fog, fatigue,
- muscle aches,
- the inability to recover from any sort of exercise.
How to increase your VEGF levels
For most people VEGF levels increase after completing the previous seven steps. However, if you are still struggling with physical exertion pay close attention to this section.
GET stands for Graded Exercise Therapy. Well meaning doctors usually recommend it to treat chronic fatigue syndrome. Unfortunately, graded exercise therapy never works. In fact, it almost always makes your symptoms worse.
But this time it won’t!
GET didn’t work for you in the past because the chronic inflammation caused by CIRS kept your VEGF at ultra-low levels. So no matter what you did you were never able to recover from any sort of exercise, no matter how simple. But now that you’ve addressed the inflammation caused by CIRS GET will work for you.
How to make graded exercise therapy (GET) work for you
You need to know one thing:
Don’t push it.
It’s important to keep this in mind as you increase your VEGF.
Always work below your anaerobic threshold. This means that if you are exercising and can’t hold a normal conversation because you’re so out of breath, you’re working too hard. Don’t push it!
Every person has different levels of fitness. For some, clapping your hands could be the edge of your exercise tolerance zone. For others, a light jog is possible. Meet yourself where you’re at. This is a marathon. Not a sprint.
How often and for how long should you be exercising?
Let your recovery time guide you. If you have recovered and maybe even feel energized a few hours after exercise, your frequency and intensity are on point. But if you notice an increase in fatigue or pain levels, or you feel wiped for a couple of hours after exercise, dial it back.
As long as you don’t push it and stay in that sweet spot your capacity for exercise will increase. Then – and only then – can you increase your exercise frequency and intensity.
The type of exercise you choose is not important. Pick the one you enjoy the most. Walking may be your starting point. And that’s ok. Don’t push it. Slowly scale up your exercise as your energy increases. When that occurs you know your VEGF is on the rise!
The CIRS Treatment Protocol Step #9 & #10 – Correct C3a & C4a
Steps 9 and 10 of the CIRS treatment protocol focus on rebalancing the complement system. The “C” in C4a and C3a stands for complement. Your complement system is an integral part of your innate immune system.
The complement system enhances or complements your body’s ability to:
- clear out damaged cells,
- remove invading microbes,
- promote inflammation,
- attack the cell membrane of unwanted invaders.
Remember, the complement system is an innate immune system reaction. This means that it doesn’t adapt; it sends out the same inflammatory response regardless of what the invading microbe may be.
Lab testing for CIRS usually reveals elevated levels of both C3a and C4a. Bringing these two markers back into normal range is the focus of steps 9 and 10 of the CIRS treatment protocol.
How to lower C3a
Lowering C3a requires high doses of statin medication – a medication more commonly associated with lowering the risk of heart disease. Theres’s a long list of complications and unwanted effects associated with statin use. However these unwanted effects come with long-term use and you will only be taking statins for a couple of months.
High doses of statin medications help to reign in your innate immune system. During step nine of the CIRS treatment protocol you’ll often note an improvement in cognitive function.
One side effect of statin medication that you need to worry about is the significant decrease in the production of coenzyme Q10 (CoQ10). Your mitochondria needs CoQ10 to produce ATP (cellular energy). To avoid low levels of CoQ10 start a supplemental dose of 150-300mg for two weeks before starting statin therapy. Continue taking CoQ10 for the entire time you’re on a statin medication.
How to lower C4a
In the early days of the CIRS treatment protocol, the medication Procrit (or EPO) was used to lower C4a. In the past Procrit was used by athletes as a performance-enhancing drug to improve their cardiovascular endurance. However, as Procrit can increase the risk of clot formation it has fallen out of favour .
Today, most practitioners use Vasoactive Intestinal Polypeptide (VIP) to lower C4a levels. I’ll speak in great detail about VIP in step twelve.
The CIRS Treatment Protocol Step #11 – Correct TGF Beta 1
The protein TGF beta 1 helps your body:
- Grow cells
- Divide cells (proliferation)
- Change cells from one type to another
- With the programmed death of cells (apoptosis)
Much like the inflammatory markers C3a and C4a, TGF beta 1 plays a very important role in the regulation of your immune system – especially your innate immune system. And because TGF beta 1 has such a profound effect on many different cellular functions, too much of it causes major problems between your innate and adaptive immune systems. The resulting effect – as I’m sure you’ve already guessed – is elevated levels of inflammation.
Most people with CIRS have elevated TGF beta 1. Out of all the other inflammatory markers we’ve already worked to lower, TGF beta 1 is the most profound. Bringing this marker back into range will help to improve the majority of your remaining symptoms.
Elevated levels of TGF beta 1 can also be what’s causing your reaction to gluten. There is a chance that once we correct TGF beta 1 you will be able to eat gluten again. However, there is also a chance that a reaction to gluten will remain, in which case I will recommend sticking with a gluten-free diet.
How to correct TGF Beta 1
High levels of TGF beta 1 are lowered through the use of the high blood pressure medication Losartan (Cozaar). Many practitioners (including me) also recommend VIP nasal spray either with Losartan or on its own.
The CIRS Treatment Protocol Step #12 – VIP Nasal Spray
VIP is the antidote to your remaining symptoms. You see, VIP has the ability to build back the grey matter of your brain that CIRS slowly chipped away. Aside from building back your brain, VIP also:
- Reduces elevated levels of MMP9, TGF beta-1 and C4a;
- Raises low levels of VEGF;
- Normalizes clotting abnormalities, including acquired von Willebrand’s;
- Regulates the pituitary systemic axes involving ACTH/cortisol and ADH/osmolality
Before starting VIP nasal spray, be sure you meet the following criteria:
- HERTSMI-2 score <10
- Negative MARCoNS colony
- Normal VCS eye test
Do not start VIP until you meet all of these criteria.
VIP is the magic bullet in CIRS treatment. To be clear, by the time you reach this stage of treatment, you should already have significant symptom improvement. VIP corrects the final deficiencies you experience. Perhaps even more amazing, VIP use in CIRS patients safely restored lost grey matter in the brain.
Some patients need to use VIP for a month. Others may use it for over a year. The recommendation is to take VIP spray until all your remaining symptoms have improved.
Ok, there you have it, the CIRS treatment protocol outlined in twelve, easy-to-follow steps. Be sure to let me know what has/hasn’t worked for you in the comments section below!