Request an Appointment

Get started on your personalized therapy program today!

Our process includes an initial comprehensive consultation with Dr. Thomas. A personalized therapy program will be developed for you based on your symptoms and test results. There’s no limit to finding the key to ultimate health with an individualized treatment plan that includes hormone balance, nutritional and fitness programs and lifestyle modification.

Contact en Health Matters

Testing for CIRS

Visual, Genetic, MRI, and Biomarker Testing

Visual Contrast Sensitivity (VCS) Testing

Biotoxins and the inflammatory response they produce have been shown to cause nerve dysfunction, leading to a variety of neurological symptoms, including diminished Visual Contrast Sensitivity (ability to detect visual patterns). According to Dr. Shoemaker’s research, this decrease in VCS is due to a reduction in the velocity of flow of red blood cells reaching structures in the eye responsible for sending visual information through the optic nerve to the brain.  During a VCS test, the patient is shown a series of images specifically created to measure the person’s ability to detect visual patterns. A person experiencing a biotoxin-related illness will perform poorly during this test. The VCS test is highly accurate and supports biotoxin-related illness diagnosis in 92 percent of affected people with only 8 percent presenting as false negative.  The VCS test is performed at the initial visit and is repeated at each visit after to assess how well the patient is responding to the treatment.


Biotoxins that impact nerves and impair neurologic function are also called neurotoxins.

After making a clinical diagnosis of biotoxin illness and performing VCS testing, we move on to a set of specific lab tests to provide additional information that confirms diagnosis and helps gauge the severity of the illness.

Genetic Testing: Human Leukocyte Antigen (HLA) Test

To determine if a patient is genetically-susceptible, we use HLA DR/DQ genetic testing. The Human Leukocyte Antigen (HLA) system is a set of genes on chromosome 6 that encode for proteins on the surface of cells that are responsible for regulation of the immune system in humans. These proteins help our immune system distinguish between our own cells and foreign cells.

The HLA type and related immune response are a key part to whether or not a person goes on to develop the inflammation that leads to CIRS. The immune system is comprised of the innate immune system (the immunity we’re born with) and the adaptive immune system (immunity we develop after birth).

The innate immune system is non-specific and acts as the first line of defense by identifying antigens (foreign proteins) to signal the adaptive immune system by releasing high levels of inflammatory molecules (such as cytokines), split products of complement, and TGF beta-1. Unlike antibodies, the inflammatory molecules do not have a specific target and cannot remove biotoxins. The adaptive immune system provides long-term immunity by creating immunological memory after the initial exposure to specific pathogen (such as a biotoxin).

In susceptible people, the innate immune system “sees” the biotoxins and keeps signaling to the adaptive immune system. However, the adaptive immune system cannot “see” the biotoxins and does not make proper antibodies against them. The persistent carriage of biotoxins continues to trigger the innate immune system. In turn, the overactive innate immune system creates high levels of inflammation which leads to dysregulation of multiple systems in the body and development of CIRS.

Dr. Shoemaker’s review of international gene registries, matched by case controlled studies, revealed that 24 percent of the population is “mold susceptible” due to their HLA haplotype, putting them at risk of developing a chronic biotoxin-related illness from exposure to water damaged buildings. Dr. Shoemaker also noted that 21 percent of the population is “Lyme susceptible”, making these patients less likely to respond to antibiotics for Lyme disease and more likely to develop chronic illness in response to the biotoxins present after contracting Lyme disease (“Post-Lyme Syndrome”). Depending on their individual HLA gene combinations, a person may be susceptible to one or more biotoxin-related illness. For instance, one person could be “mold susceptible”, while another person is “Lyme susceptible”, and another is “multi-susceptible”.

Biomarker Testing: Transforming Growth Factor beta-1 (TGF beta-1)

TGF beta-1 is a molecule that plays an important role in controlling the immune system by producing or suppressing inflammation.  Elevated levels of TGF beta-1 indicate the occurrence of a current overactive immune response. For instance, people with asthma, multiple sclerosis, and various autoimmune diseases often have elevated levels of TGF beta-1. These elevated levels of TGF beta-1 damage normal T-regulatory cell functions that control or prevent autoimmunity, leaving the person at risk for autoimmune-related illness. Lab Values: Transforming Growth Factor beta-1, normal range < 2382 pg/ml.

Biomarker Testing: C4a

C4a is a biomarker involved in activating a specific process of the innate immune system called a complement cascade and is useful in evaluating immune response in people with exposure to water damaged buildings (WDB).  By activating immune cells called mast cells and basophils, increasing smooth muscle contraction (smooth muscle is found in blood vessels and intestines), increasing vascular permeability, and causing mitochondrial dysfunction, elevated C4a levels can lead to common CIRS symptoms like breathing difficulty, fatigue, and dysfunction in thinking and memory processes (cognitive ability). Dr. Shoemaker’s research shows that patients with high C4a levels have decreased blood flow into the small vessels called capillaries, which impacts the brain causing decrease in the patient’s cognitive ability. Lab Values: C4a normal range is 0-2830 ng/ml.

Common Terms and Definitions

Autoimmunity – An immune response where the body incorrectly classifies self cells as non-self, causing the immune system to attack the body’s own cells and tissues.

Biomarker – Measurable substance or characteristic that can show if various processes in the body are normal or dysfunctional.

Cytokines – Cell-signaling molecules that help direct immune system cells and processes.

Mast Cells and Basophils – Types of immune system cells that play a role in allergies and also in inflammation and autoimmunity.

Mitochondria(l) – A structure within a cell that manages cell metabolism and produces energy the cell needs to function properly.

Permeability – Degree to which body tissues like blood vessels and intestines allow substances or organisms to pass through the cell junctions of the tissue into or out of that body system.

T-Regulatory Cells – A type of immune cell that helps control autoimmune response in the body.  

Biomarker Testing: Matrix Metallopeptidase 9 (MMP-9)

Matrix Metallopeptidase 9 (MMP-9) is an enzyme involved in the breakdown of cell membranes in the blood vessel walls which allows inflammatory compounds to move out of the blood through vessel walls and into organs and tissues such as the lung, brain, muscles, joints, and peripheral nerves. In CIRS, cytokines trigger certain types of white blood cells to release MMP-9 into the bloodstream, increasing the amount of inflammatory compounds moving into tissues and causing widespread inflammation.   Because cytokine activity increases MMP-9 production, MMP-9 is an excellent marker of “hidden” cytokine production.  Lab Results: MMP-9 normal range is 85-332 ng/ml.

Biomarker Testing: Leptin

Leptin is known as a “satiety hormone” and is made by fat cells to help regulate energy balance by hindering hunger.  High levels of leptin increase the amount of fat stored in the body, causing weight gain. In biotoxin-related illness, cytokines attach to leptin receptors in the hypothalamus, interfering with leptin signaling and creating leptin resistance. Weight gain due to leptin resistance is common in CIRS patients. Lab Results: Leptin normal range: men 0.5-13.8 ng/ml; women 1.1-27.5 ng/ml.

Biomarker Testing: Vascular Endothelial Growth Factor (VEGF)

Vascular Endothelial Growth Factor is a signal protein produced by cells that stimulates growth of new blood vessels in order to supply oxygen to the tissues when blood circulation is inadequate. In a healthy body, decreased blood flow in capillaries and resulting low oxygen supply will trigger the release of Hypoxia-Inducible Factor (HIF). HIF stimulates the production of VEGF and erythropoietin (EPO). VEGF increases blood flow by creating new blood vessels, while EPO increases production of red blood cells; both help to increase oxygen supply to the cells. In CIRS, VEGF is suppressed due to high cytokine levels which causes poor oxygen supply to the tissues, resulting in muscle cramping and post-exertional fatigue (a period of extreme exhaustion after exercise or strenuous physical activity). Lab Results: VEGF normal range is 31-86 pg/ml.

Biomarker Testing: Anti-Gliadin Antibody (AGA)

Anti-Gliadin Antibodies (AGA) are produced in response to gliadin found in gluten. Gluten is a protein found in certain grains like wheat, barley, and rye. AGA is one of the antibodies that contributes to celiac disease. Gluten is made up of approximately 45 percent gliadin and 55 percent glutenins. The body breaks down gliadin into chains of amino acids called peptides. In order to use these peptides, our intestinal cells, tightly sealed like an interlocking gateway, have to pull apart to form openings to let the peptide go through. For healthy people, these gateway openings close immediately after allowing the peptides through. In certain CIRS patients and patients with celiac disease, the gliadin peptides cause an inflammatory and immune reaction that prevents the openings between the intestinal cells from closing properly. In this case, strictly following a gluten-free diet is crucial. Lab Results: AGA normal range is 0-19 units.

Celiac Disease

Celiac disease is an autoimmune illness in which the body launches an immune attack in the small intestine and other areas of the body when gluten is ingested, damaging the body’s ability to absorb nutrients from food and contributing to overall inflammation in the body.

Biomarker Testing: Melanocyte Stimulating Hormone (MSH)

MSH is a hormone made in the pituitary gland that plays a crucial role in regulating many other hormones, inflammation responses, and defenses against foreign microbes. Leptin influences MSH production, however, during an inflammatory response where excess cytokines interfere with leptin receptors, MSH levels drop. Deficiency of MSH is very common in patients with CIRS and often does not return to normal levels despite treatment. Low MSH increases susceptibility to mold illness, chronic fatigue, chronic pain (from decreased endorphin production), insomnia (from decreased melatonin production), sexual dysfunction, and other hormonal abnormalities. In healthy people, a rise in leptin levels would trigger the brain to create more MSH. In a patient with biotoxin-related illness, this process fails when a rise in leptin levels doesn’t result in the creation of more MSH due to cytokine interference with leptin receptors. When MSH levels don’t rise, the body produces more leptin, leading to leptin resistance and causing weight gain and protein wasting. In addition, MSH plays a key role in closing the intestinal gateway openings created in the processing of gliadin peptides discussed in the previous section and preventing inflammation. Low MSH levels allow inflammation to rise out of control and cause those intestinal gateways to remain open, leading to a condition commonly known as leaky gut (gut permeability). Additionally, 80 percent of patients with low MSH have MARCoNS (Multiple Antibiotic Resistant Coagulase Negative Staph). MARCoNS is detected through an API-Staph culture of nasal bacteria. MARCoNS secrete toxins that decrease MSH, making it critical to treat MARCoNS to bring MSH levels back to normal. Lab Results: MSH normal range is 35-81 pg/ml.

Biomarker Testing: Anti-Diuretic Hormone (ADH) and Osmolality

Anti-Diuretic Hormone (ADH), also known as vasopressin, is a hormone made in the hypothalamus that controls body’s ability to hold on to free water. Osmolality is the concentration of all chemical particles (such as sodium, potassium, and calcium) that are in the fluid part of blood (serum). In Biotoxin illness patients, a lack of regulation of salt and water balance is apparent when ADH is low (or too high) but osmolality is relatively high (or too low). Affected patients will experience frequent urination, dehydration, excessive thirst, and dehydration-related migraine headaches. As the sodium (salt) level in the blood rises because of a lack of free water, the patient’s sweat will also contain more salt. The electrical properties of the increased salt create a battery-like effect that increases static electrical shocks. Lab Results: For ADH normal range is 1.0-13.3 pg/ml; For Osmolality normal range is 278-305 mOsm/kg.

Biomarker Testing: Adrenocorticotropic Hormone (ACTH) and Cortisol

Adrenocorticotropic Hormone (ACTH) is a very important regulatory hormone released by the pituitary gland to signal the adrenal glands to produce cortisol. Cortisol is a steroid hormone produced by adrenal glands and is involved in several processes in the body, including creation of new glucose (blood sugar), regulating glycogen storage in the liver, immune regulation, and the physical response to stress commonly known as “fight or flight”. Normally, cortisol is released in a regular pattern – levels rise in the early morning (peaking around 8 am) and drop in the evening. Chronic stress caused by inflammation or prolonged illness causes cortisol production to become irregular and disrupts the body’s ability to deal with normal daily stressors such as sleep disturbance, blood sugar imbalances, or emotional stress. Usually, when cortisol levels rise or drop, a signal is sent to the hypothalamus and then to the pituitary gland to adjust the production of ACTH. In CIRS patients, this feedback mechanism is disrupted due to hormone dysregulation, resulting in symptoms such as daytime fatigue, nighttime insomnia, dizziness, and low blood sugar. Lab Results: For ACTH normal range is 8-37 pg/ml; for Cortisol normal ranges are – a.m. 4.3-22.4 and p.m. 3.1-16.7 ncg/dl.

Biomarker Testing: Plasminogen Activator Inhibitor-1 (PAI-1), Anti-cardiolipin Antibodies (ACA), and Von Willebrand Factor

Plasminogen Activator Inhibitor-1 (PAI-1), Anti-cardiolipin Antibodies (ACA), and Von Willebrand Factor are biomarkers for abnormal bleeding conditions. All three of these biomarkers play a role in blood clotting. Inflammatory conditions such as CIRS can cause elevated PAI-1, which can increase the formation of blood clots as well as fibrosis (abnormal formation of connective tissue). ACA are antibodies that target our own tissues by interfering with the phospholipid proteins in cell membranes. ACA are elevated in connective tissue disorders such as scleroderma and lupus, and are associated with first trimester miscarriages. Together, the combination of PAI-1 and ACA strongly increases the risk of stroke, heart attack, and deep vein thrombosis (DVT). CIRS patients can also develop a type of acquired Von Willebrand Syndrome, which prevents blood from clotting properly, leading to symptoms of frequent or heavy nosebleeds and heavy periods in women.

Biomarker Testing: Vasoactive Intestinal Peptide (VIP)

Vasoactive Intestinal Peptide (VIP) is a very important neuropeptide produced in many places in the body including the gut, pancreas, and the hypothalamus in the brain. Like MSH, VIP helps regulate inflammation throughout the body. VIP also helps regulate blood flow and exercise response of the pulmonary artery (the artery that moves blood from the heart to the lungs to pick up oxygen). In patients with low VIP levels, pressure in the pulmonary artery builds during exercise causing shortness of breath and difficulty with exercise. VIP replacement is the important last step of Dr. Shoemaker’s protocol, restoring health for chronically ill patients. Lab Results: VIP normal range is 23-63 pg/ml.

MRI Testing with NeuroQuant® Analysis

A newer tool in the diagnostic toolbox is an FDA-cleared software program called NeuroQuant that analyzes standard MRI brain scans for structural damage and shrinking of brain volume (atrophy). The software uses information gathered from thousands of brain scans to find these areas of damage with greater accuracy than what is often possible to find with analysis done by a radiologist.  Damage to specific structures in the brain can be linked to specific biotoxins, for example, biotoxins from mold have been found to impact different structures in the brain than biotoxins from Lyme disease. NeuroQuant is a promising new avenue in the diagnosis of biotoxin-related illnesses.