Person Hub · Biotoxin Medicine

Dr. Ritchie Shoemaker — CIRS, the Protocol, and What It Looks Like in 2026

Shoemaker did what nobody else in environmental medicine had done: he made mold illness measurable. Here's the disease model, the 12-step ladder, the biomarker panel — and the three places patients reliably stall.

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Quick answer

The short version

Dr. Ritchie Shoemaker, MD is the physician who defined Chronic Inflammatory Response Syndrome (CIRS) and built the first biomarker-driven treatment protocol for mold and biotoxin illness — a sequenced 12-step ladder verified with labs (C4a, C3a, TGF-β1, MMP-9, MSH, VEGF, VIP) at each step. Integrative You runs a hybrid: the Shoemaker biomarker spine as the objective scoreboard, with Klinghardt-style drainage-first sequencing and titrated combination binders so highly reactive patients can stay on protocol.

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Full-length, free, and covering the Shoemaker biomarker picture alongside the hormonal fallout most protocols ignore.

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The 12 steps, in one screen

Remove the exposure (ERMI / HERTSMI-2, remediation, workplace and car)
Bind biotoxins (cholestyramine, Welchol, or titrated combination binders)
Eradicate MARCoNS (deep nasal culture, compounded antimicrobials)
Correct antigliadin antibodies (3-month gluten-free trial, re-test)
Correct androgens (without premature hormone replacement)
Correct ADH / osmolality
Correct MMP-9 (low-amylose diet, therapeutic omega-3s)
Correct VEGF
Correct C3a (and investigate Lyme when elevated)
Correct C4a
Correct TGF-β1
VIP replacement as the restorative endpoint

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Frequently asked questions

Who is Dr. Ritchie Shoemaker?

Dr. Ritchie C. Shoemaker, MD, is the physician who defined Chronic Inflammatory Response Syndrome (CIRS) and built the first reproducible, biomarker-driven treatment protocol for mold and biotoxin illness. His book Surviving Mold and the biomarker panel he developed (C4a, TGF-β1, MMP-9, MSH, VEGF, VIP) remain the objective scoreboard used across environmental medicine.

What is the Shoemaker Protocol?

A sequenced 12-step treatment framework for CIRS: remove exposure, bind biotoxins, eradicate MARCoNS, correct antigliadin antibodies and androgens, normalize ADH/osmolality, MMP-9, VEGF, C3a, C4a and TGF-β1, then restore VIP. Labs are re-checked before advancing to the next step.

Is CIRS the same as mold illness?

Mold illness is the umbrella term. CIRS is the specific biomarker-defined inflammatory cascade that occurs in people whose HLA-DR/DQ genotype prevents normal biotoxin clearance — roughly a quarter of the population. Most CIRS is mold-triggered, but Lyme, ciguatera and cyanobacteria can trigger it too.

Do you follow the Shoemaker Protocol at Integrative You?

We run a hybrid. We keep the Shoemaker biomarker spine because it is the only objective scoreboard in this field, and we layer on Klinghardt-style drainage-first sequencing and titrated combination binders so fragile patients can actually stay on protocol.

How do I know if mold is my root cause?

Start cheap: a Visual Contrast Sensitivity (VCS) screen, HERTSMI-2 dust testing on your home, and HLA-DR/DQ genotyping. If those point the same direction, the full CIRS panel and urinary mycotoxin testing are worth running. A $47 Health Decode gives you a clinician-grade root-cause map first, so you are not guessing which thread to pull.

Shoemaker, CIRS and mold: the questions people actually ask

Who is Dr. Ritchie Shoemaker?

Dr. Ritchie C. Shoemaker, MD is the physician who defined Chronic Inflammatory Response Syndrome (CIRS) and built the first biomarker-driven treatment protocol for mold and biotoxin illness.

His contribution was making mold illness measurable. Before the CIRS model, biotoxin patients were assessed on symptoms alone; Shoemaker tied the picture to a reproducible panel — C4a, C3a, TGF-β1, MMP-9, MSH, VEGF, VIP — and to the HLA-DR/DQ genotypes that predict who cannot clear biotoxins normally. His book Surviving Mold remains the reference text.

What is the Shoemaker protocol?

A sequenced 12-step protocol: remove the exposure, bind biotoxins, eradicate MARCoNS, then correct antigliadin antibodies, androgens, ADH, MMP-9, VEGF, C3a, C4a and TGF-β1 in order, finishing with VIP replacement.

The defining feature is that labs decide when you advance. Each step is verified before the next begins, which is what separates it from symptom-led mold treatment. It is also why the protocol takes time, and why skipping a step tends to stall progress several rungs later rather than immediately.

Is CIRS the same as mold illness?

No. Mold illness is the umbrella term; CIRS is the specific biomarker-defined inflammatory cascade seen in people whose HLA-DR/DQ genotype prevents normal biotoxin clearance — roughly a quarter of the population.

Most CIRS is mold-triggered, but Lyme, ciguatera and cyanobacteria can trigger the same cascade. Conversely, someone can be genuinely unwell from a mouldy building without meeting CIRS criteria. The distinction matters because it changes which testing is worth running.