Updated on April 16, 2016

Take Mold Seriously

I’ve been meaning to write this post for a while – years really. Ever since I started studying the work of Dr. Ritchie Shoemaker, one point became crystal clear. If you’ve got a chronic illness (Lyme, CFS, Fibromyalgia, MS, and so on), it’s an absolute imperative that you take the time to figure out if you’re one of the 24% of the population that has a genetic weakness to toxins from mold, Lyme, certain reef fish, and a few other organisms that produce nasty “biotoxins”. If you have weak genes, you then need to determine whether or not this genetic weakness is being expressed – that your body no longer can clear biotoxins and they’re consequently making you really sick. I can’t say this strongly enough. For the time being, set aside all the other diagnoses and theories out there about why you’re sick and take the time to read this post and make a preliminary determination as to whether biotoxins are contributing to your illness. Take care of the biotoxin-factor first.

Note: When I wrote this blog I was focused on making the point about mold biotoxins. However, it doesn’t matter if the source of the biotoxins is mold, Lyme, blue-green algae, or otherwise. It’s all the same in regard to making a preliminary diagnosis and getting started down the path of lasting wellness. In other words, whenever I’m talking about mold toxins, this also means toxins from Lyme, some reef fish, and so on.

In discussing Why Mold Should Come First, I make the case that the method of diagnosis and treatment of Biotoxin Illness (sick from mold) are very exact and have an excellent chance of improving your health. In looking at the number and diversity of Mold Toxin Symptoms that overlap other chronic health conditions, it just makes good sense to address mold first and then take on any remaining health issues after. To determine if you’re “moldy” we begin by looking at symptoms using the Biotoxin Illness Test that will give you a very good idea of how “moldy” your symptoms are. The Visual VCS test is another interesting and somewhat useful diagnostic tool. If the Biotoxin Illness Test isn’t convincing enough, you can get an HLA DR gene test to determine if you have a genetic predisposition to Biotoxin Illness. If being symptomatic and having a gene susceptibility still isn’t convincing enough for you, the C4a test will show if you’re body is inflamed.

In essence, I wrote this blog because so many people I run into that almost certainly are “moldy” live in a state of denial. There are a lot of reasons for this. For example, what if the home is moldy? This will mean at a minimum expensive remediation. What about lack of health insurance coverage? Also, in my experience, moldy people just don’t think straight. Personally, I believe the mold sort of takes over and induces a physiological response that says “Oh no, it’s not mold. Leave us alone!” So I wrote this blog so people that are unsure about the whole mold factor have a straight-forward way of evaluating if mold is impacting their health.

Why Mold Should Come First

To see why looking at mold is so important and why this should be one of the first steps in treating all chronic illnesses, we need to begin by looking at the work of Dr. Ritchie Shoemaker. When you do, you realize that if Dr. Shoemaker is anything, it’s rigorous. He has meticulously documented and correlated diagnosis and treatment protocols on the over 8,000 patients he worked with in his practice. I and my brother were two of them. If you talk to him or listen to his lectures, he never deviates from his rigorous standards. He never lets “his hair down”. He never says or does anything that isn’t according to a step-by-step, one variable at a time, scientific methodology.

At first glance, this approach can appear confounding to some but it is at the same time why you can rely on his diagnostic and treatment protocols in a way that other theories and protocols cannot afford. Unlike many alternative medicine approaches that rely on untestable theories involving the complex interaction of a multitude of variables, Dr. Shoemaker’s approach works like a cookbook. Essentially, he took a whole bunch of potential diagnostic and treatment solutions and tested them one at a time, recorded the data, and then looked to see if any of them were statistically significant. The diagnostic tools and treatments that worked went into his protocol and everything else got tossed out. Sure, maybe some complex, potentially beneficial combination of variables got overlooked, but what was kept is a rock-solid core to work from. The very real difference between his work and so many others in the alternative medicine scene is the rigor in which he gathered and analyzed data. As a result, what you have is a recipe for determining with very high probability if you’re suffering from Biotoxin Illness along with a protocol with a very good chance of getting you significantly better.

To put it in another light, Dr. Shoemaker is not at all like Lyme guru, Dr. Klinghart, who looks at EMF, dental issues, heavy metal poisoning, Lyme, parasites, mold, and so on all at once as he develops individualized treatment protocols for each patient. Instead, Dr. Shoemaker intentionally plays dumb. He does this because he knows that a Klinghart approach can’t be readily duplicated or scientifically proven. He knows that any information coming from a Dr. Klinghart type of approach will be ripped to shreds by the conventional medical establishment and consequently leave those of us that suffer from Biotoxin Illness forever banished from ever getting medical treatment that insurance will cover – most alternative medicine practitioners are “pay as you play”. You get the very real sense that he doesn’t like being wrong and delights in making folks like defense attorney’s working against mold cases look bad when they try to discredit him. He’s taken the scientific method that is all too often manipulated by the pharmaceutical and medical community to push bad medicine on you and I, and used it establish a platform from which we can strongly make our case against the status quo that Biotoxin Illness is real and that those that suffer from mold illness deserve to be respected and cared for.

Don’t get me wrong, there certainly is validity to a multi-variable treatment protocol, it’s just that I don’t know how we’ll ever be able to make a case for better treatment (or should I say any treatment) without the rigor of a Dr. Shoemaker. I don’t think some people get that about him. I think they lump his body of work together with the bulk of other chronic illness theories out there and in my humble estimation, this is a big mistake. Dr. Shoemaker’s work is not just another theory that requires a lot of tweaking with questionable outcomes. It’s a rigorously proven, standardized diagnostic and treatment protocol.

Now if you’ve done some research, I’m sure you’ve run across some cases that didn’t advance beyond a certain stage of wellness on Shoemaker’s protocol. I know I’ve certainly heard various accounts about how his approach doesn’t always work. I’m sure that’s the case but then I often wonder if folks that only realized limited benefit really followed the protocol exactly? It has a lot of details that require real diligence to master. Certainly there must be some that didn’t benefit as much as expected, (I never got past treating MARCoNS with him because my home’s ERMI mold test was too high – more about this in another post) but knowing what I do about the alternative medical community, I’m guessing many that didn’t see benefit may not have stuck to the recipe somewhere along the way.

At a minimum, even if you’re not sure if Dr. Shoemaker’s protocol will get you better, by using some of his diagnostic protocol you can get a very good sense if you’ve got Biotoxin Illness and how badly it’s beating you up. It’s not like the three different Lyme tests I had done; each coming back with a different set of positive bands – as if my body got exposed, developed antibodies, and then forgot that it developed antibodies. Yeah, right. A lot of alternative medicine is this way – lots of good theories with many success stories but really hard to know if a diagnosis is accurate let alone if a treatment approach will work. It’ll continue to be this way until the alternative medicine community figures out a way to gather data cooperatively in a scientifically valid way.

That’s not what you get when you use Dr. Shoemaker’s method to find out about mold. You get very close to a sure thing. You’ll know with near certainty if you’re being made sick by mold toxins and have a protocol that has a damn good chance of making real headway in getting you better. So maybe you do have dental infections, Lyme and a couple of co-infections, heavy metal poisoning, parasites, and so on. Maybe you’re taking enough Mepron to revive the dead, have done over forty 1-hour HBOT sessions, FIR saunas until you looked like a shriveled grape, and some really far out treatments that puts you firmly in the top 5% of the most die-hard alternative medicine folks right along side with me. However, take it from someone that’s treated the gamut of chronic illness suspects with a total commitment that only someone driven by extreme, unrelenting inflammatory based borderline psychosis and anxiety can know, go after the mold first. I’ll say it again. It’s pretty easy to figure out if mold is a problem for you, and if it is, then there are very real steps you can take that will make you feel a whole lot better.

Address the mold factor first and see what’ left when mold is out of the equation.

Biotoxin Illness Test

OK, so I’m finally to the place where I can talk about how straight forward it is to diagnose mold illness. Now if you’ve listened to Dr. Shoemaker, you’re probably thinking I’m nuts; diagnosis must be really complicated and most assuredly must include having about twenty vials of blood drawn like I did when I saw Shoemaker. Nope; far from it.

When I was really sick, I spent weeks taking notes while pouring over Dr. Shoemaker’s books and DVDs. Over time, I realized even though it’s important for treatment, not all those tests Dr. Shoemaker talks about are needed when it comes to making a preliminary diagnosis. In fact, in the DVDs Dr. Shoemaker briefly mentions a list of symptoms that can be used as a diagnostic tool. More specifically, out of the multitude of symptoms associated with Biotoxin Illness, he found that a specific sub-group of 35 of symptoms could be used to make an accurate preliminary diagnosis of Biotoxin Illness without anything else!

So, do you want to know how to tell if mold is messing with you? Look at symptoms. Later, you can do a simple gene and inflammatory test to give you an even higher degree of certainty. In my book, it’s that simple. Now I know that lab work like TGF-beta 1, C4-a, C3-a, VEGF, MMP9, Osmolality, ADH, anti-Gliadian antibodies, Leptin, MARCoNS, VFW, hormones, and so on are all important but they’re primarily for developing a treatment protocol. You don’t need them when it comes to making a preliminary diagnosis.

Dr. Shoemaker – Identifying Biotoxin Illness Using Logistic Regression Methods.

The algorithm for this test developed by Dr. Ritchie Shoemaker is presented in his DVDs Physician’s Approach to Biotoxin Illness. It’s been built into the Biotoxin Test. Briefly, the test is scored using 35 symptoms. These 35 symptoms are grouped into 13 “clusters” with anywhere from 1 to 5 symptoms in each cluster. If a person answers yes to one or more of the symptoms in a cluster, that cluster is counted. If the total number of clusters counted is 8 or more, then there is a very high probability that the person has Biotoxin Illness. When 6 clusters are counted, there is a very good chance of having Biotoxin Illness, and even when only 4 clusters are counted, there is still statistical significance. The one qualifier is that the test needs to be administered in an unbiased and clinical manner. Note: Upon completion of the Biotoxin Test, you’ll be shown the 35 symptoms and the 13 clusters 😉

Click Here For
Online Biotoxin Test

Visual VCS Test

The Visual Contrast Sensitivity (VCS) test is another way to slightly increase the accuracy of self-diagnosing Biotoxin Illness. The eye test measures a person’s ability to distinguish light from dark – detect an “edge”. As it turns out, Biotoxins lower the available oxygen due to reduced blood flow to the optic nerves. According to Dr. Shoemaker, 92% of the time folks with Biotoxin Illness will fail the VCS test. Lower oxygen to the eyes may also reduce night vision and increased light sensitivity.

Looking at VCS alone, if you fail the visual test then this is a reasonable indicator that you may have Biotoxin Illnesss. However, Lyme disease, mercury, lead, pesticides, petrochemicals, hydrocarbons, and aromatic solvents, such as toluene, xylene and benzene also impair VCS scores so passing it is actually more telling than failing the test. If you pass the test, then there is only an 8% chance that you have Biotoxin Illness. According to Dr. Shoemaker, in combination with the results of the Biotoxin Test administered by a physician, if someone has symptoms in 8 out of 13 clusters and fails the VCS test, then there is a 99% chance they’ve got Biotoxin Illness.

The VCS test is a special type of visual test designed to measure a person’s ability to see shades of gray. In other words, a person may have 20/20 vision and yet fail the VCS test miserably. In general, the more tightly spaced the lines are on the VCS test, the harder it is for moldy people to distinguish edges.

To begin the test, a card with the typical visual acuity test is placed at 16 inches into a hand-held ruler that the person holds up to their chin. The person must be able to see the 20/50 line on the visual acuity card before being qualified to take the VCS test. Reading glasses are allowed. Technically, a light meter should also be used to ensure at least 70 foot-lamberts of lighting.

Once the tester has confirmed that the patient meets the minimum visual acuity requirement and the light is right, the VCS card is placed at 18” on the holder. To pass the VCS test, the person must be able to see to row 7 in column C and row 6 in column D. Columns A and B detect nutritional deficiencies. Column E may be used to monitor improvement in treating Biotoxin Illness. If even one eye doesn’t meet the above criteria, the person fails the test. Note: If a person has one bad eye or wears a far-vision contact in one eye, then the test may be administered to the good eye only and the test is still just as reliable.

VCS Factoids

1. Passing is seeing to row 7 in column C and row 6 in column D
2. 92% of those with Biotoxin Illness will fail the VCS test
3. Columns A and B detect nutritional deficiencies
4. Column E is used to monitor improvement
5. Most will see improvement in VCS one week after starting Cholestyramine (CSM)
6. MARCoNS can prevent improvement in VCS
7. Per Dr. Shoemaker, you must pass VCS before taking VIP
8. Taking CSM when Lyme is present, people get sick and VCS drops in columns D and column E
9. Improvements in VCS are a positive sign that alternative binders are working – though CSM and Whelcol are preferred

VCS Test Demonstration
Dr. Shoemaker VCS FAQ

Here are links to three online VCS tests. Unless you’re totally broke, I strongly encourage you to spend the $15 and support Dr. Shoemaker and his work. If you’re cash poor, I’ve included two links to free online tests.

Surviving Mold VCS Test ($15 – support Dr. Shoemaker)
Online CST Vision Screener (free)
Visual Contrast Sensitivity Test (free)

Now that I’ve explained the test, I have to say that I haven’t been all that impressed with it. I’ve done numerous online tests and also own a VCS APTitude Handheld Kit that I purchased on SurvivingMold.com. Prior to going to see Dr. Shoemaker, I was able to pass the online test no problem. However, in Dr. Shoemaker’s office, I forgot to bring my reading glasses. I took the test in his somewhat dimly lit office. He flicked on a special light below which I held the test cards. I was able to see the 20/50 visual acuity line without my reading glasses but I’ll be darned if I could come even close to passing the VCS test.

VCS APTitude Handheld Kit

Similarly, I’ve also seen folks that are clearly moldy based upon symptoms pass the test. Maybe they were just one of that 8%. Still, my feeling is that the better the lighting and stronger the reading glasses, the better your chances of passing the test. Even Dr. Shoemaker has commented that moldy people with exceptional vision usually pass the test much more often – tennis players, artists, designers, etc. Likewise, the accuracy of the online test depends on a monitor with good screen resolution, contrast, color hues, and so on but is still worth taking.

My take away is that if you fail the VCS test, then it adds one more percent to your Biotoxin Test score. However, if you pass the test, this by no means negates a miserably failed Biotoxin Test. For the most part, I personally think VCS is better used to monitor the success of a treatment program than it is for diagnosis but I know Dr. Shoemaker would likely disagree.

HLA DR Gene Test

I just want to remind you that the use of the Biotoxin Test, the VCS test, and the following two lab tests should only be used for a preliminary diagnosis. Dr. Shoemaker makes it clear that physicians certified in his protocols need to run a battery of blood tests before making any diagnosis. However, from what I’ve studied and experienced, I see no reason why folks that are sitting on the fence, don’t have insurance, or can’t afford to travel to see one of a handful of qualified physicians, can’t use these simple tests to make a substantially accurate diagnosis either on their own or with the support of a understanding Doctor and then take it from there.

So let’s look at a couple of blood tests that will solidify the findings from the Biotoxin Test and VCS test. The first is a gene test called HLA-DR. If you read Dr. Shoemaker’s books, he describes the underlying cause for Biotoxin Illness as resulting from a failure of a part of the immune system called the acquired immune system to create antibodies designed to remove mold toxins from the body. Normally, the body is still able to clear these types of pathogens using a backup method that is part of the more rudimentary innate immune system. In this system, the liver pulls the mold toxins out of the blood and correctly dumps them into the colon via bile from the gallbladder so they can be excreted. Unfortunately, mold toxins are reabsorbed by a recycling process in the body called enterohepatic circulation that serves to reuse bile and bilirubin. Consequently, the mold toxins (mycotoxins) are never eliminated and end up back in the bloodstream. Over time, mold toxins trapped in the body build up and cause massive and numerous inflammatory based health conditions.

Dr. Dave Ou – The Genetics of CIRS From Biotoxins

As an aside, often people confuse mold allergies with Biotoxin Illness. As you can see, the two are completely different. Remove someone with a mold allergy from the source, and the person gets better. Remove someone with Biotoxin Illness and they will not get better without treatment (unless you practice Extreme Mold Avoidance as outlined by Erik Johnson and Lisa Petrison). Furthermore, unlike a mold allergy, even small exposures can have devastating and lasting health effects for the Biotoxin susceptible person as the immune system gets fired up and never shuts down causing all kinds of havoc.

The HLA-DR gene test is a simple, one-vial blood test. I like it in comparison to other mold blood tests because the sample doesn’t require any spinning, separating, freezing, overnight shipping, and so on. Fill a lavender top (contains the strong anticoagulant EDTA) at room temperature and ship it off. Having said this, it’s essential that the correct test and lab be used. You want to use the same lab and test that Dr. Shoemaker used on his 8,000 plus patients so you can compare your results against his database. Any physician can write the script (even Psychiatrists). However, you may need to do a little legwork to figure out where the nearest Lab Corp center is and make an appointment as you don’t want to use your local lab – unless it’s Lap Corp. For confirmation of the details below, please see the most recent Physician’s Order Sheet from SurvivingMold.com.

When you talk with your Physician, make your case short and precise. Biotoxins…specialist Dr. Shoemaker methodology…simple blood test. Make sure to let him or her know that you will take care of the details about getting the draw from Lab Corp. Also, make sure to mention that he or she won’t have to interpret the results and you will not be looking to them for treatment – you’ll go to a specialist if it turns out you are susceptible. All they need is the semblance of a good reason and assurances that it won’t require any extra work or risk on their part. If they actually want to learn more, refer them to Dr. Shoemaker’s website but don’t jabber on and potentially sabotage your efforts – keep your “game face” on at all times.

Lab Corp Locations

HLA-DR Gene Test Information

• Name of test: HLA DR by PCR
• Name of lab to use: Lab Corp (must use Lab Corp)
• Type of vial to draw blood into: Lavender top
• Other: keep specimen at room temp
• Lab Corp test code: 167120 Note: must use this test code (old code was 012542)
• Diagnostic codes for insurance – Patient dependent
• 279.10 (immunodeficiency with predominant T-cell defect)
• 279.8 (other specified disorders involving the immune mechanism)
• 377.34 (toxic optic neuropathy – when patient fails VCS testing)

HLA-DR Rosetta Stone for Interpreting HLA DR Reports

The only cumbersome part about this gene test is interpreting the results. Unfortunately, Lab Corp has changed the way they report the results so you need to change the new way of reporting into the one that was used when Dr. Shoemaker first started collecting data. Essentially, what you want to end up with is two sets of numbers and letters – your two “haplotypes” – one from Mom and one from Dad. You then look at the list of haplotypes that Dr. Shoemaker found made people susceptible to mold toxins, fish toxins, Lyme toxins, and so on and see if you’ve got one – you only need one of the two to be “bad” for you to be susceptible. If you do and you failed the Biotoxin Test, this is like saying that you have the genes that make it possible to get really sick from mold toxins and you’re showing all the symptoms indicating that your body has stopped being able to clear mold toxins from your body – you are “moldy”. Note: See my blog “Deciphering HLA DR Labs” for a simpler way of interpreting test results.

Getting into specifics, on the lab report there are five categories of results. They are labeled DBR1, HLA DQ, DRB3, DRB4, and DRB5. Your job is to take the first number listed after each of these category labels (if there is one as some will be blank) and translate them into two groupings called “haplotypes” consisting of either two or three sets of numbers and letters (two or three sets of “alleles”). Take a look at the examples below to see how to find these numbers from a report and then read over how to convert them below.

   

First, it’s important to know that you usually end up with two groupings/haplotypes that contain three sets of numbers and letters, but sometimes you may only get two sets of numbers and letters for a particular haplotype. Specifically, you know you will get two sets of three alleles unless DRB1 is 1, 8, or 10. In the cases where DRB1 is 1, 8, or 10 then HLA DQ will be present but there will be nothing listed in the DRB 3, 4, or 5 categories. Everyone besides those with a DRB1 or 1, 8, or 10 will have an HLA DQ and one other allele from DRB 3, 4, or 5. In other words, you will end up with two sets of three numbers-letters unless DBR1 is 1, 8, or 10. In those cases, you’ll end up with a set of two numbers.

Second, it’s important to know that if there is only one entry for DBR1, HLA DQ, or DBR3, then both genes have the same allele – you’ve got a pair of that allele. When this happens, the allele is called “homozygous” for that particular category. Also, it doesn’t matter what’s listed after categories DBR4, and DBR5. If there is a number there, convert it using the rules below.

Third, it is up to you to combine the translated numbers-letters listed in each category into one of the known haplotypes using the list below. For example, if DRB1 is listed as 11 and 7, while DQ is listed as 2 and 3, then it is up to the you to realized since there is no 11-2-X haplotype, then what you’re looking at are 7-2-X and 11-3-X haplotypes – you’ll need the complete list of 54 haplotypes from “Surviving Mold” to use this method. Otherwise, just try to see if you can combine the alleles wherein you end up with one or two of the susceptible haplotypes listed below – as they are a subset of the complete list of 54 haplotypes. Once you’ve made the conversion, realize that only one gene need be susceptible for the patient to be susceptible. Note: From my understanding, you don’t need to worry that if you’re able to combine alleles into only one of the susceptible haplotypes below that maybe there are other combinations you’re missing because you don’t have the complete list of 54 wherein you may end up with no susceptible combinations.

• You only use the first two numbers from each category line of the report.
• If there is only one entry, instead of two, the patient is homozygous – has two of that allele.
• The first two numbers for each category are translated as follows:
• For DRB1, if the first two numbers are 03, rewrite it as 17. Otherwise, leave as is.
• HLA DQ = HLA DQ (no translating required for this category)
• When present, DRB3 = 52A for 01, DBR3 = 52B for 02, and DBR3 = 52C for 03
• When present, DRB4 = 53 regardless of what the first two numbers are
• When present, DRB5 = 51 regardless of what the first two numbers are

Susceptible HLA DR Haplotypes

• Multiple Susceptibility (dreaded): 11-3-52B, 12-3-52B, 4-3-53, 14-5-52B
• Mold: 7-2-53, 7-3-53, 13-6-52A, 13-6-52B, 13-6-52C, 17-2-52A, 18-4-52A
• Chronic Lyme: 15-6-51, 16-5-51
• Dinoflagellates (fish): 4-7-53, 4-8-53
• MARCoNS: 11-7-52B
• Low MSH: 1-5
• MS: 15-6-51
• Chronic Fatigue: 4-3-53, 11-3-52B
• Chronic Fatigue from Lyme vaccine Lymerix: 4-3-53 (Subtypes 0401, 0402, and 0404 for DRB1 are worst.)
• Gardasil Vaccine for cervical cancers should be avoided: 11-3-52B
• Low Mold Risk: 7-9-83, 9-9-53, 12-7-52B
• Benign – all haplotypes not mentioned
• Note: In his book “Surviving Mold“, Dr. Shoemaker listed 1-5 as low MSH. However, it is not listed on the Surviving Mold Website. This does not mean that 1-5 doesn’t have significance. In his FAQ’s, Dr. Shoemaker says, “In assessment of the DRB-1 1-5 over the years (together with its related haplotypes of 10-5 and 103-5, and 1-3 and 1-4) the only variable that reaches statistical significance we have seen is a reduced level of MSH in cases compared to other cases and then to controls.”
• Note: Up to 5% with a Benign haplotype may still get CIRS from mold but will recovery more easily. There are a total of 54 known haplotypes – see page 716 in the book “Surviving Mold”. Alternatively, upon completion of the Biotoxin Test, you’ll be shown the 54 haplotypes 😉
• Dr. Shoemaker’s HLA DR Chart

Surviving Mold by Dr. Ritchie Shoemaker

C4a Inflammatory Marker

The last test I want to talk about is the C4a blood test that measures inflammation. When C4a is high, it means your immune system is in overdrive. More specifically, when complement component of the immune system are activated, the C3 and C4 proteins are split into “a” and “b” parts. The “b” part binds to the toxins or bacteria in order to facilitate their removal. The “a” part remains soluble in the blood and is measured using the C4a test. As such, when C4a is high, this means your immune system is working hard trying to clear pathogens. Note: Common inflammatory tests like CBC, SED rate, ANA, C-reactive protein, along with lymphocyte, immunoglobulins, thyroid, and a metabolic profile will typically be normal for patients suffering from Biotoxin Illness.

C4a Activated by Mutant Mold

They draw a single vial of blood for C4a. Unlike tests like TGF-beta 1 that is in my experience notoriously difficult to get done properly, C4a is easier. Nonetheless, it’s almost assured that the phlebotomist hasn’t seen this test before. As such, make sure to take your doctor’s prescription and the Prescription Information below with details on how to do the blood draw for the phlebotomist. I would even recommend calling ahead and giving them a “heads up”. Make sure they draw the blood into a lavender top tube and politely comment to the phlebotomist that you’ve been told it’s very important to spin down the blood immediately and freeze it in order to get accurate results and that this is very important to you. You can take your script from your doctor to the nearest Quest Lab for the draw. You can look up and make an appointment online.

Lab Directions: TGFB1 CD4-25 C4a-C3a ADH Osmo Cortisol ADH

The reasons I like C4a are that Dr. Shoemaker uses the C4a marker in a protocol called Sequential Activation of Innate Immune Elements (SAIIE) that he used to prove that a building was moldy for court cases. I won’t go into those details here but suffice it to say that C4a will rise in moldy people within the first 24 hours of being exposed to mold toxins from water-damaged buildings and it will remain high until it is treated. In my own experience, this is exactly what happens. Also, typically C4a is way above the 2,830 ng/ml upper limit so it has a sort of dramatic impact. One caveat is that I’m assuming you are symptomatic – that you haven’t brought down inflammation to the degree that a lot of symptoms are gone by doing Extreme Mold Avoidance as described by Lisa Petrison and Eric Johnson or by taking anti-inflammatory supplements and drugs. If you have, then don’t be surprised if C4a comes back normal. Also, sometimes the presence of MARCoNS will suppress C4a.

Update November 25, 2014: In looking through Neurotoxicology and Teratology by Dr. Shoemaker, Dennis House, and James Ryan, I ran across an interesting chart related to C4a. Amongst other data, the chart shows the historical blood labs for folks with Biotoxin Illness. I was surprised to see that only 72% of cases had high C4a (>2850 ng/ml) while 89% had low MSH (<36 pg/mL) and 91% had low VIP (<25 pg/mL). This means that perhaps C4a isn't the best lab to look at if you're only going to pick one. As such, I'm torn between C4a and VIP. I like C4a from the standpoint that it's a nice marker to be able to monitor progress (VIP will always stay low regardless of inflammation levels). On the other hand, VIP has a higher correlation and based upon the new Physician’s Order Sheet (Updated 06/20/2014), VIP has gotten a bit easier as a blood draw for phlebotomists. This just brings to the fore the fact that no one marker can be used to diagnosis Biotoxin Illness. Update End

If you can’t get support from a physician, you can order your own test without a doctor’s prescription at EconoLabs – Test ID: LC-004330 for $240. Note: Lab testing labeled “complement C4” is not the same as the “C4a” test. I can’t speak to the accuracy of the test but I’m mentioning it here just in case it’s helpful

EconoLabs

The results of your test will be sent to your doctor. Get a copy of the results. You want to make sure the results say that the test was for C4a (and not C4 as this is a different test) and then check that you’re within the normal range of 0-2830 ng/ml. In combination with a positive Biotoxin Test, susceptible genes, and an inflammatory marker C4a that is only otherwise high with infections, pregnancy, vasculitis (inflammation that destroys blood vessels), and adult insulin dependent diabetes, how much more encouragement do you need to take Biotoxin Illness seriously?

C4a Prescription Information

• Name of Test: NJC-C4a (Note: Labs occasionally mistakenly do C4 when C4a is ordered.)
• Lab to Use: Quest Labs
• Attn: Specimen Management Department
• Patient takes script to local Quest office
• Specimen Draw Procedure: 2ml plasma – EDTA Lavender top tube. Draw specimen, spin down immediately and separated plasma into transfer tube and freeze. Label specimen plasma.
• Lab Code: 42658
• Diagnostic Insurance Codes – Patient Dependent
• 279.8 Immune Mechanism Dis Nec
• Other specified disorders involving the immune mechanism
• Endocrine, nutritional and metabolic diseases, and immunity disorders
• 780.79 Malaise and Fatigue Nec
• Physical weakness, lack of strength and vitality, or a lack of concentration.
• Exhaustion that interferes with physical and mental activities.
• State of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.
• An overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level.
• That state, following a period of mental or bodily activity, characterized by a lessened capacity for work and reduced efficiency of accomplishment, usually accompanied by a feeling of weariness, sleepiness, or irritability.
• 286.5 Hemorr D/O Dt Circulat Nec
• Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors
• 710.0 Syst Lupus Erythematosus
• Systemic lupus erythematosus is an ongoing chronic inflammatory connective tissue disease in which the body’s immune system malfunctions and attacks healthy tissue -autoimmune disease.

Important Note About LabCorp & C3a/C4a
Make sure if you use LabCorp that they send the blood to the National Jewish Medical and Research Center Laboratory in Denver (C3a:#840702 and C4a:#857334). If the sample is inadvertently sent to LabCorp’s own facilities, the results will not be meaningful as a completely different method and range are used. Ask the phlebotomist to make sure to write ACCESSIONING: C3a & C4a MUST BE ROUTED TO NATIONAL JEWISH on the requisition slip in large print.

VIP Prescription Information

• Lab to Use: Quest Labs
• Attn: Specimen Management Department
• Patient takes script to local Quest office
• Specimen Draw Procedure: 3ml plasma – EDTA Lavender top tube. Draw specimen, spin down immediately and freeze in plastic vial. Note: Dr. Shoemaker’s Physician’s Order Sheet June 2014 says “room temperature” – lasts 3 days at room temperature and 7 days when frozen.
• Lab Code: 84586
• Diagnostic Insurance Codes – Patient Dependent
• 279.8 Immune Mechanism Dis Nec
• Other specified disorders involving the immune mechanism
• Endocrine, nutritional and metabolic diseases, and immunity disorders
• 286.5 Hemorr D/O Dt Circulat Nec
• Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors
• 710.0 Syst Lupus Erythematosus
• Systemic lupus erythematosus is an ongoing chronic inflammatory connective tissue disease in which the body’s immune system malfunctions and attacks healthy tissue -autoimmune disease.

Diagnosing Biotoxin Illness Using Labwork

If you happen to be one of those people that has already had a slue of labwork done, depending on what tests were done, you may be able to make an accurate diagnosis without having to look at symtoms at all. Specifically, of the eight Diagnostic Labs listed below and out of the thousands of patients Dr. Shoemaker has seen, every person with Biotoxin Illness had four or more abnormal labs and every healthy control had fewer than four abnormal labs.

Biotoxin Illness Diagnosis Based Upon Lab Work

1. MMP9 too high (normal range: 85-332 ng/mL)
2. TGF-b1 too high (normal range: <2380 pg/ml)
3. C4a too high (normal range: C4a: 0-2830 ng/ml)
4. MSH too low (normal range: 35-81 pg/mL)
5. VIP too low (normal range: 23-63 pg/mL)
6. ADH high when Osmolality is low or ADH low when Osmolality is high (normal range: ADH – 1.0-13.3 pg/ml; Osmolality – 280-300 mosmol)
   When looking at labs, if plasma Osmolality (not urine osmolaity) is 295 then ADH is calculated using the formula ((295-280)/(300-280))=(X/(13.3-1)) >>> (15/20)=(X/12.3) so X=9.225 and ADH should be around 1+9.225=10.225 (+/-) 2.5. However, in CIRS individuals, it’s not uncommon to find osmolality is in the high range of normal while ADH is in the lower range of normal – you have to look at osmolality and ADH as a pair on the labs.
7. Antigliadan Antibodies (present – gluten sensitivity)
8. Anticardiolipin Antibodies (present – associated with miscarriages, cold hands and feet, stroke, heart attack, vascular problems, and Lupus)

Update April 16, 2016
In the 2016 NeuroQuant II paper titled Reduction in Forebrain Parenchymal and Cortical Grey Matter Swelling across Treatment Groups in Patients with Inflammatory Illness Acquired Following Exposure to Water-Damaged Buildings, a different criteria is used to establish patients with Biotoxin Illness – also known as Chronic Inflammatory Response Syndrome (CIRS). Instead of Antigliadan Antibodies(7) and Anticardiolipin Antibodies(8), VEGF and Cortisol/ACTH are used. In addition, the threshold for the number of symptoms indicating CIRS is raised from 4 to 5.

7. VEGF (normal range: 31-86 pg/mL)
8. Cortisol (normal range: a.m. 4.3-22.4 / p.m. 3.1-16.7 ug/dL) / ACTH (normal range: 8-37 pg/mL)

(See Surviving Mold Diagnostic Lab Tests)
Update End

Biotoxin Illness Lab Panel
Note: As of January 2016, LifeExtension is offering a Biotoxin Mold Illness Panel for $425. The panel includes MMP9, TGF-beta 1, MSH, ADH, and Osmolality. In Dr. Shoemaker’s Physician’s Order Sheet 6-20-2014, LabCorp is a recommend lab for all of the LifeExtension labs so everything looks good from that standpoint – LifeExtension now states that they send all their samples to LabCorp. However, an informed Reader wrote that LabCorp then sends MMP9 to Esoterix labs and they do not process MMP9 samples from LabCorp the same way as they did for Dr. Shoemaker when he was practicing. As such, it’s unclear if the MMP9 results are comparable to Dr. Shoemaker’s data.

Mold Toxin Symptoms Are Numerous and Diverse

If you’ve taken the Biotoxin Test, then you’ve gotten a sense of the range of symptoms Biotoxin Illness causes. What’s interesting when you look at mold symptoms and those of other chronic illnesses is just how much overlap there is. In fact, I’m not alone in thinking that a lot of folks that are diagnosed with everything from Fibromyalgia to Multiple Sclerosis are being affected by mold toxins and have been either partially or wholly misdiagnosed. For example, in the DVDs Dr. Shoemaker presents the case of a girl diagnosed with MS by specialists who is cured when put on his mold protocol.

MS Cured by Treating Mold (at 5 mins)

In addition to the symptoms in the Biotoxin Test, I’ve included my list of symptoms that I jotted down when reading various materials – not that I had all of them. It is by no means all inclusive but is an attempt to show you just how many and variable the range of symptoms are.

Cognitive Symptoms

• Short term memory
• Poor concentration
• Difficulty finding words
• Reduced knowledge assimilation
• Disorientation in familiar places
• Confusion

More Mold Symptoms

• Acid Reflux
• Anxious But Not Anxiety (for me, it can get insanely bad – maybe from lactic acid build up or gut dysbiosis?)
• Arthritis
• Asthma
• Autoimmunity (gluten, cardiolipins, the myelin sheathing around nerves, and others)
• Bizarre Dreams (when exposed, my dreams go to the “dark side”)
• Chemical Sensitivity
• CCVSI (I included this one as treating this with a Lumen pad has helped – CCVSI is poor blood flow in the back of the neck due to vein narrowing as a result of reversed blood flow – see Shoemaker’s Pulmonary Pressure)
  Dr. Paul Cheney on ME/CFS (Chronic Fatigue)
  Dr. Paul Cheney Seminar (CCVSI at 14:30)
• Depression (unbelievable how bad it can get – heavy, thick gray closing in from all around)
• Delay Recovery From Normal Activity
• Facial Tics
• Faint When Standing
• Flushing
• Hair Loss (high TGF-beta 1)
• Headaches
• Hearing Loss
• Increased Pulmonary Artery Pressure (limits blood return to heart – also see CCVSI)
• Jittery (for me it’s best described as internal trembling)
• Keratosis (rough skin patches and small acne-like bumps – high TGF-beta 1)
• Light And Sound Sensitivity (any sound out of the ordinary regardless of loudness is very jarring)
• Lung Disease – Restrictive (Interstitial Fibrosis from high TGF-beta 1)
• Nausea
• Night Sweats
• Polyps/Nodules – Nasal & Vocal Cord (high TGF-beta 1)
• Pulmonary Anomalies
• Pustular Sores – pus-filled blisters
• Over Reactive Nervous System
• Over Weight (for those high in Leptin)
• Persistent Tremor (put a loose piece of paper over an out held hand and watch it shake)
• Poor Sleep
• Poor Night Vision
• Sleep Apnea
• Sluggish Full Stomach
• Tinnitus (ringing in ears)

Mold Symptoms – Lisa Petrison

It’s really instructive to read the work of mold gurus Lisa Petrison and Erik Johnson. They have taught themselves how to quickly recognize mold based upon reading their bodies and have documented all sorts of mold toxin variants and their symptoms. In his VIP DVD, Dr. Shoemaker talks about how folks with Biotoxin Illness will begin experiencing symptoms within as little as 15 minutes inside a moldy building. I’m still working on developing this skill but from my own experience, I do believe it is entirely possible to tell if a location, building, or item is moldy within minutes and I have no reason to doubt that Lisa and Erik are picking up on all different types of toxins with varying effects based upon what part of the country a person is in.

In fact, it’s really scary to think about what’s happening on a microscopic level given my studies related to farming and soil microbiology. I think Lisa is right on in including a link to the paper by Professor Don Huber, internationally recognized plant pathologist, that describes how the use of chemicals (especially RoundUp) in farming is dramatically altering the microbial make-up of the soil (read Dr. Elaine Ingham and how the fungi in soil are being depleted in favor of bacteria) and consequently has resulted in the appearance of a super tiny pathogen that proliferates in the presence of bacteria and is making animals really sick (people are “animals” too). Below is a list of mold toxin symptoms related to the Tahoe area that Lisa has graciously given me permission to reproduce from her blog. I liked this list because it has some symptoms that aren’t typically mentioned and gives you a better sense of just how diverse the range of symptoms is.

Outdoor Toxins of Particular Relevance to Mold Illness Patients – Lisa Petrison
Dr. Huber Explains the Science Behind New Organism and Threat From Montsanto’s Roundup
Dr. Mercola Interviews Dr. Huber about GMOs

Lisa Petrison’s List

• Heart pain (in particular, a feeling of a needle through the heart).
• Heart palpitations.
• Chest pressure (a feeling of a dagger through the chest or a marble – sometimes actually swollen – at the sternum).
• Excruciating headaches (migraine-like but not one-sided).
• Extreme photophobia (light sensitivity).
• Extreme noise sensitivity.
• Cognitive problems that go beyond brain fog (e.g. inability to add numbers or recognize words).
• Weird memory losses (e.g. inability to remember the name of one’s hometown or to find the way home).
• Loss of sense of direction (e.g. driving around randomly).
• Seizures or “white-outs” (where the brain goes 100% blank for extended periods of time, sometimes even when a concerted effort is being made to bring up thoughts).
• Severe trembling.
• Paralysis (literal paralysis or feelings of paralysis; often one-sided).
• Organ pain (particularly kidney pain).
• Strong feelings of empty, hopeless depression (unrelated to circumstances).
• Strong suicidal feelings.
• Feelings of paranoia, like people who are usually your friends have become enemies.
• Strong feelings of anger and lack of inhibition in expressing it.
• Other emotions that are bizarrely inappropriate to the situation.
• Convulsions.
• Extreme MCS.
• Marked gait problems.
• Inability to sit or stand up.
• Reactivation of herpes viruses (and emergence of related illnesses such as shingles, Bell’s palsy or herpes simplex lesions).
• Severe POTS (e.g. needing to use a wheelchair).
• Extremely deep skin “dents.”
• Feeling of skin being burned.
• Sore throats that make eating difficult or impossible.
• Veins pop out of skin (look “ropy”)
• Stuck thinking (e.g. spend all day clicking on the same three websites or playing mindless Facebook games).

Other Good Mold Symptom Lists

Toxic Mold Illness Diagnosis
Symptoms of Biotoxin Illness

Initial Treatment Steps and Avoiding Mold Toxins

Phew, I’m starting to get worn down writing this post and I can just imagine how tired you must be if you’ve made it this far. As such, I’m going to make this section on the steps to initial treatment short and sweet and leave the details for another post.

Physicians Certified in the Shoemaker Biotoxin Illness Protocol
Mold Physicians (not all follow Shoemaker Protocol)
Mold Illness Medical Practitioners (not all follow Shoemaker Protocol)
Surviving Toxic Mold Doctor List

Step 1: Get Away from Mold – this is easy to say and many times not so easy to do. It requires that you are both able to figure out what the sources of mold are and then have the resources that allow you to get away from those sources. If you read some of my other posts, it’s not just your home and workplace that are of concern. Given that NIOSH claims that 50% of buildings have a degree of water damage that makes them a real problem for people with Biotoxin Illness, you can see how even if home and work are OK you may be getting exposed at the supermarket, hardware store, or any other place you spend more than a few minutes in. On top of that, I can confirm what mold gurus Erik Johnson and Lisa Petrison have been saying all along – that some outdoor locations are also troublesome. It becomes a real jigsaw puzzle.

The way to solve the puzzle is to first determine that your home and workplace are safe. In Mold Testing, I cover all the ins-and-outs related to mold testing. The ERMI DNA test, or the less expensive HERTSMI-II, done by MycoMetrics are still your best bets. The HERTSIM-II is less expensive because it only looks at a subset of molds in the ERMI test. This subset was identified by Dr. Shoemaker as being most problematic and telling in terms of if a building is habitable for moldy people.

MycoMetrics
Interpreting HERTSMI-2

If it turns out your home is moldy then you have to make the hard decision of trying to remediate the building or move. This is a huge topic that I’ve started to whittle away at with a somewhat rough post that describes some of the steps in a remediation project – I’ve learned a lot since and plan on improving that post and adding others. The determination of whether to try and remediate or move has to be done on a case-by-case basis but be aware that many have tried the remediation route and failed.

Mold Remediation 1

Step 2: Take Binders – if you’ve got Biotoxin Illness, it will take forever for your body to clear mold toxins without help. This is especially true if you’re being exposed by hidden sources. Without taking binders like Cholestyramine (CSM) or Whelcol, it’s like trying to bail out a boat-load of accumulating toxins with a thimble – your liver just can’t keep up. Unless you live in a pristine, mold-free environment, your body alone will not be able to clear all the incoming toxins. If you’re able to take the binder that Dr. Shoemaker’s data shows is capable of significantly clearing mold toxins, then you’ll be able to make headway against the accumulated toxins in your body provided you live in environments that pass ERMI or HERTSMI-2 testing. I cover in detail what binders are effective, the difference between Cholestyramine (CSM) and Whelcol, and so on in the Binders article. If you don’t take binders then the only way you’re going to have a chance of getting better is moving to a part of the country that is virtually mold free.

By the way, Dr. Shoemaker has repeatedly said that when it comes to Biotoxin Illness, that it takes very little time in a moldy building to make folks with Biotoxin Illness really sick. In other words, don’t think that you can load up on CSM and go into moldy buildings. You can’t. In my experience, it takes days or longer to clear up from a mold hit taking CSM and anti-inflammatory supplements.

It should be noted that folks with either a Lyme or Multisusceptible haplotypes can have trouble with CSM if they’ve been exposed to Lyme. Actually, some have trouble even without exposure. If Lyme was an issue and CSM is poorly tolerated, the protocol is to stop CSM and then take omega-3 fatty acids (fish oil) at a daily dosage of 2.4 g EPA and 1.8g DHA along with going on a no-amylose diet for a week prior to reintroducing CSM – although I’d try this even if I didn’t think Lyme was an issue if I was having trouble with CSM.

In addition to the oil and diet, some may also need to start with micro-doses of CSM gradually increasing up to target levels. With all these extra steps, most can tolerate CSM but there will be a few that still have trouble. In these cases, Dr. Shoemaker has said in his FAQs, “Welchol 625 working up to 2 tabs TID is an acceptable substitute for CSM for the really hard hit people who are just too weakened to take CSM at first.” And finally when all else fails, Dr. Shoemaker has commented that for really difficult cases he would sometimes prop the person up with a short course of VIP while going after MARCoNS.

Of course, I’m assuming that if Lyme was present that it got knocked out with a short course of antibiotics. Given that I’d been in a part of the country endemic with Lyme, Dr. Shoemaker did a Western Blot when I saw him – although he doesn’t trust the results for several reasons. Specific to Biotoxin Illness, we know from Dr. Shoemaker’s work that folks with Biotoxin Illness have trouble making antibodies. However, Igenex and Western Blot Lyme tests rely on the presence of antibodies to tell if Lyme may be an issue. In other words, if you’ve got Biotoxin Illness, these tests are crude markers at best.

What to Expect from Cholestyramine (CSM)

Step 3: Kill MARCoNS – you can read all about this in my post on MARCoNS.

Step 4: Take Anti-Inflammatory Supplements – this begins with taking omega-3 fatty acids (fish oil) at a daily dosage of 2.4 g EPA and 1.8g DHA – more in the article AGA – Diet – Detox.

Biotoxin Illness Treatment Protocol by Dr. Ritchie Shoemaker
Dr. Shoemaker’s Treatment Protocol by Dr. Sandeep Gupta
Dr. Shoemaker’s Treatment Protocol by Dr. Keith Berndtson

Conclusion

Well that’s it for this long post on how to tell if you’re moldy. Taking the Biotoxin Test is pretty straight forward. The VCS visual test is another point of reference but doesn’t really contribute much toward making an initial diagnosis. The HLA DR gene test and C4a inflammatory test are very telling so long as you take the time to make sure the test is done properly. Once you understand how diverse and devastating the symptoms to Biotoxin Illness are and do enough preliminary testing to strongly suggest you’ve got Biotoxin Illness, it makes sense to address Biotoxin Illness first and then see what symptoms remain.