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Understanding Chronic Inflammatory Response Syndrome (CIRS)

0 2 years ago

By Natasha Thomas, M.D.

What is CIRS? A Deeper Look at Biotoxins

Chronic Inflammatory Response Syndrome (CIRS), also known as biotoxin illness, describes a group of symptoms, lab findings, and targeted test results associated with biotoxin exposure, especially in genetically-susceptible people. Most of what we know about biotoxin illness is the result of practice-based studies done by physician and researcher, Dr. Ritchie Shoemaker. His research dates back to 1997. When practicing family medicine in the rural coastal town of Pocomoke, Maryland, he linked a previously undefined illness to a toxin produced by a fish-killing dinoflagellate known as Pfiesteria. Since then, Dr. Shoemaker has linked this same kind of illness to toxins from water-damaged buildings, as well as toxins associated with tick-born microbes. Over time, Dr. Shoemaker developed a thorough description of this illness and called it Chronic Inflammatory Response Syndrome (CIRS). Through his practice-based research, he also developed methods to diagnose and treat this illness, bringing back health to thousands of patients worldwide.

Exposure to Biotoxins

Routes of exposure may include:

Inhalation in WDB: Occurs when a patient is exposed to biotoxins through breathing while inside a water-damaged building (WDB). WDB can harbor a dangerous mix of various chemicals, mold, bacteria, and inflammagens that together create a “biochemical stew,” which causes illness. CIRS is not caused by one particular element of this biochemical stew, but rather the combination of these things causing multi-system inflammation. Shoemaker estimates that 80 percent of CIRS cases are caused by repeated exposure to water-damaged buildings. These cases are designated as CIRS-WDB.

Tick or Spider Bite: Patients may not always realize they have been bitten by a tick, though the infections ticks carry can include Lyme disease (Borrelia burgdorferi) and Babesiosis (Babesia microti), among others. The bite of the recluse spider species may also cause biotoxin illness.

Ingestion: Patients who have eaten reef fish contaminated with dinoflagellate algae (that produces Ciguatera toxin) may develop an illness. Exposure to the Ciguatera toxin occurs when eating reef fish that have eaten smaller fish that consumed the toxin producing dinoflagellate.

Direct Contact with Contaminated Water: Patients may be exposed through direct contact with water contaminated by toxins in areas of fish kills such as Pfiesteria and Cyanobacteria, including inhalation of airborne or aerosolized toxins from this source.

Most biotoxins have the structural form of ionophore or amphipath. These are extremely small molecules capable of moving from cell to cell through cell membranes without being carried in the bloodstream. This ability of biotoxins to pass through cell membranes with ease means they are difficult or impossible to find in standard blood tests. How do biotoxins get into the body and why doesn’t the immune system take care of them? As mentioned, biotoxins can enter the human body through inhalation, ingestion, tick or spider bites, and direct contact with contaminated water sources. The biotoxins can cause acute illness, but for people who are genetically susceptible, they can cause lasting chronic illness. For many people, biotoxins are recognized by the immune system correctly, broken down, and removed from the body. However, genetically-susceptible people have immune systems that do not recognize the biotoxins and fail to remove them, leaving the biotoxins circulating in the body indefinitely, and causing inflammation throughout the body.


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