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Chronic inflammatory response syndrome (CIRS)

Chronic Inflammatory Response Syndrome (CIRS)-Kingsway Compounding

We are seeing a significant increase in the number of patients being treated for mould toxicity and Chronic Inflammatory Response Syndrome (CIRS).

A CIRS patient is one that is suffering from “an acute and chronic, systemic inflammatory response syndrome acquired following exposure to the interior environment of a water-damaged building with resident toxigenic organisms.

The toxigenic organisms include, but are 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 (VOCs).”

Dr Richard Shoemaker was the first person to make the connection between the biotoxins and bioinflammagens produced by moulds and bacteria that grow in water-damaged buildings and CIRS.

The chronic systemic inflammatory response to the biotoxins and bioinflammagens that can occur in genetically susceptible people leads to various symptoms that involve multiple bodily systems. These symptoms are the result of a dysfunction in the innate immune system mediators, which fail to regulate the inflammation.

Signs & Symptoms

Dr Shoemaker has documented over 30 signs and symptoms that he has seen in patients suffering from biotoxin exposure. The following list includes some of the more common symptoms that are seen:

  • Fatigue and weakness
  • Chronic abdominal problems including nausea, cramping, diarrhoea
  • Difficulties in concentration and memory problems
  • Confusion and disorientation
  • Muscle aches, cramping and joint pains not associated with inflammatory arthritis
  • Headaches
  • Cough, shortness of breath, chronic sinus congestion and asthma-like symptoms
  • A tendency to experience static shocks
  • Light-headedness and vertigo
  • Hypersensitivity to bright light
  • Blurred vision, tearing, burning or red eyes

Please note, that it requires much more than just recognising a few relatively subjective symptoms and signs to diagnose CIRS and/or separate it from other conditions.

An extremely thorough systemic approach is used to help diagnose and help determine the cause of the illness. This includes visual tests, an extensive list of questions, a thorough medical history, a head to toe physical examination and a series of lab tests. Once a diagnosis has been made treatment should begin as soon as possible.

Dr. Shoemaker's 11 Step Treatment Protocol

At present, the treatment of choice for CIRS patients is an 11-step protocol developed by Dr Shoemaker. Only one step may be followed at a given time and it involves strict adherence.

Step 1: Remove Exposure

The first and most crucial step is the removal of exposure. Although CIRS can have multiple causes, Dr Shoemaker notes that most cases (approximately 80%) are from water-damaged buildings (CIRS-WDB).

Step 2: Remove Toxin from Patient's Body

The second step of the protocol is focused on removing toxin from the patient’s body. Currently, cholestyramine (CSM) is the drug of choice. It contains multiple electrically charged sites that are the right size and charge to bind with the toxic ionophores that cause CIRS.

However, CSM can also bind to some of the minerals and vitamins in foods and supplements. Such vitamins and minerals include, vitamins A, D, E, K, B12, folic acid, beta-carotene, calcium, iron, magnesium, phosphorus and zinc.

So strict supervision from a trained practitioner is essential during CSM supplementation. Individualised formulas containing these nutrients can be compounded at Kingsway, to be taken in conjunction with CSM, if required.

Symptoms usually diminish with 3 to 4 weeks of toxin clearance in the stool. Removal of dietary amylose while taking CSM is also important, as it can occupy binding sites on CSM that would otherwise bind toxins.

About Cholestyramine (CSM)

Although CSM works well to remove toxins from the body, it can be difficult to use as the dosage instructions are quite specific. A usual dose is 4gms of powder up to four times a day; taken 1 hour after meds/supps and 30 minutes before a meal that contains healthy fat (3 x daily) and again 1 hour before bedtime meds/supps. Compliance is the key success with CSM.

An interesting point to note is, of the patients who remove all the toxins from their environment some will get completely better from just this step alone. Another percentage will see complete improvement after the use of cholestyramine (CSM), and then another small portion will be able to stop at step three, and so it continues with a smaller number of patients in each step.

All patients travelling through this 11-step protocol must be strictly monitored by a trained CIRS practitioner. It requires significant patient cooperation and painstaking attention must be paid to the sequence of therapies and the repeating of lab tests.

Cholestyramine is available from Kingsway. We only compound a pure pharmaceutical grade (USP) powder, which does not contain any preservatives, additives, fillers, colours or flavours.

If you have any questions regarding this or anything else related to this article please feel free to visit our website at or call the office on 1300 564 799.


  1. CIRS Treatment. Dr Keith Berndtson – The International Congress on Natural Medicine (2017). Metagenics
  2. Biotoxins and Chronic Inflammatory Response Syndrome (CIRS). Dr Keith Berndtson – The International Congress on Natural Medicine (2017). Metagenics
  3. Workshop: CIRS in Australia – The International Congress on Natural Medicine (2017). Metagenics
  4. Chronic Inflammatory Response Syndrome – Overview, Diagnosis and Treatment. Dr Keith Berndtson, MD. 2013.
  5. Dr. Shoemaker’s 11 Step Treatment Protocol (2/22/2013)
  6. Harkness, R., et al., Mosby’s Handbook of Drug-Herb and Drug-Supplements Interactions. St Louis: Mosby, 2003

Please Note: This article is intended for medical practitioners only and is not intended as a substitute for a medical practitioner’s advice.

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