CIRS Shoemaker Protocol Step #7

As we covered in the last five blogs… you’ve caught onto the idea that chronic inflammatory response syndrome (CIRS) and erythromelalgia (EM) can be related. You’ve learned that the first step in recovery from CIRS and therefore EM is removal from exposure. This can mean moving away from or remediating a moldy home but can have other implications if something other than mold is driving your illness. You learned that the second step in treatment is taking a binder to remove the toxin that your immune system can’t see and therefore tag and remove.  This is typically a prescription medication- either colesevelam or cholestyramine. You read that the third step involved treating something nicknamed “MARCoNS” that can live deep in the nose of those with CIRS. These multiple antibiotic resistant coagulase negative staphylococci can impair the boy’s ability to produce normal amounts of  melanocyte stimulating hormone (MSH). This is a problem because adequate MSH is pivotal to recovery from biotoxin-induced illness. You read that the fourth step is testing to detect antigliadin antibodies. We defined the difference between gluten sensitivity that can happen in CIRS and celiac disease. You’ve learned about the importance of correcting abnormal androgens (AKA- out-of-whack hormones). In Shoemaker Step #6 you learned all about correction of dysregulation in the production of antidiuretic hormone (ADH)–also called vasopressin–and a disproportionate serum osmolality which commonly seen in CIRS. What could possibly be left to do?!

Step #7- CORRECTING ELEVATED MMP-9

MMP-9, more formally known as matrix metalloproteinase, is an inflammatory marker [4]. When this enzyme is elevated, pathological tissue destruction can occur. MMP-9 when overproduced can “deliver inflammatory elements from blood vessels to the brain, nerve, muscle, lungs, and joints” [9]. Ouch! Disabling pain may result [2]. An elevated MMP-9 weakens the blood brain barrier and can result in neurological symptoms and cognitive dysfunction…things like fatigue, “brain fog”, poor short-term memory, difficulty word finding, and more [2].

-Treatment for MMP-9 elevated above 500 includes high dose omega 3 fatty acids. More specifically, supplementation with EPA 2.4 grams and DHA 1.8 grams daily will be recommended [3].

-A low amylose diet may also be considered [7,8]. Food high in amylose trigger spikes in blood sugar. If this temporary dietary change is right for you, your medical provider, will explain next steps. This diet can be a challenge as even a carrot can create issues?! Crazy, huh. I have created a cookbook to make adopting this diet easier. It’s exactly what I wish I would have had when I was told to go “no-amylose”. Don’t worry… the diet isn’t forever. You just need to follow it until your MMP-9 dips back down below 332.

-To learn more about why CIRS providers use a reference range different from the one suggested by many labs refer to Dr. Scott McMahon’s evidence-based explanation.

When MMP-9 normalizes and the inflammatory cytokine storm ceases, you will be feeling boatloads better. Here’s to and cheers to lowering MMP-9!

You can read about CIRS Shoemaker Protocol starting from the beginning at Step #1 here.

You can read more about my journey as a medical provider hellbent on healing her own erythromelalgia here.

Read about healing my chronic inflammatory response syndrome (CIRS) and how that connects to EM here.

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[1] S. Low, W. Robbins and V. Tawfik, "Complex Management of a Patient with Refractory Primary Erythromalalgia Lacking a SCN9A Mutation," Journal of Pain Research, vol. 10, pp. 973-977, 2017.

[2] R. Shoemaker, K. Johnson, J. Lysander, Y. Berry, M. Dooley, R. James and S. McMahon, "Diagnostic Process for Chronic Inflammatory Response Syndrome (CIRS): A Consensus Statement Report of the Consensus Committee of Surviving Mold," Internal Medicine Review, vol. 4, no. 5, pp. 1-47., 2018.

[3] M. DiTulio, "Surviving Mold," 23 March 2015. [Online]. Available: https://www.survivingmold.com/DRAFT_OF_SCIENTIFIC_SUPPORT_-_DITULIO.pdf. [Accessed 23 October 2021].

[4] R. Shoemaker, Proficiency Partners Lecture, 2018.

[5] Surviving Mold, "12 Step Protocol Overview," [Online]. Available: https://www.survivingmold.com/legal-resources/12-step-protocol-overview. [Accessed 23 October 2021].

[6] R. Shoemaker, S. McMahon and A. Heyman, The Art and Science of CIRS Medicine, 2018.

[7] R. Shoemaker, Surviving Mold, Baltimore: Otter Bay Books, 2010.

[8] J. Abel, "Surviving Mold Shoemaker Protocol Certified Physicians," [Online]. Available: https://www.survivingmold.com/docs/Shoemakers_Protocol_for_publishing.pdf. [Accessed 24 Octover 2021].

[9] L. Leo, "Surviving Mold Shoemaker Protocol Certified Physicians," [Online]. Available: https://www.survivingmold.com/docs/Treatment_of_CIRS_Leonard_Leo.pdf. [Accessed 24 October 2021].

[10] Surviving Mold, "Biotoxin Pathway," 12 December 2005. [Online]. Available: https://www.survivingmold.com/docs/biotoxinpathway.pdf. [Accessed 25 October 2021].

[11] J. Janus and E. Johnson, "PHG Foundation- University of Cambridge," 1 December 2020. [Online]. Available: https://www.phgfoundation.org/explainer/transcriptomics. [Accessed 30 October 2021].