Welcome to the Tampa Blog of Dr. Matt Lewis

I’m glad you’re here. I have more than six years of postdoctoral education in functional medicine and over a decade of experience in clinical nutrition. Through my Tampa-based practice, I help patients by identifying the underlying causes of low thyroid, fatigue, weight gain, and other chronic health issues and provide holistic treatment through nutrition, lifestyle, and other natural approaches.

By: Dr. Matt Lewis D.C., DACBN, CFMP®

I don’t know how many people are aware, but thyroid medication is the 4th most prescribed medication just below pain medication, cholesterol, and blood pressure. I think it’s quite interesting considering that low thyroid is associated with increased pain, elevated cholesterol and high blood pressure. 

What’s more is that most cases of hypothyroid are actually caused by Hashimoto’s. I know this may all sound confusing, hypo this, hashi that! It’s simple to quickly get a handle on thyroid disease. Hypo – means low. Most people who suffer with thyroid problems are not producing enough thyroid hormone. The main reason is due to an autoimmune attack on the thyroid, whereby the immune system is creating excessive amounts of antibodies that actually destroy the thyroid gland. This can happen suddenly due to pregnancy or menopause when the immune system can be triggered as a result of hormonal fluctuations. It can also be a response by the immune system to a stressful life event, infection, and commonly exposure to environmental toxins. 

The Symptoms May Include

  • Fatigue
  • Hair loss 
  • Weight gain
  • Puffy face
  • Trouble tolerating cold
  • Joint and muscle pain
  • Constipation
  • Dry skin
  • Dry, thinning hair
  • Decreased sweating or hot flashes 
  • Heavy or irregular menstrual periods
  • Fertility problems
  • Depression
  • Anxiety 
  • Slowed or rapid heart rate
  • Goiter
  • High blood pressure

Lab Findings May Include

Elevated cholesterol 

Low T3, T4 (thyroid hormones) 

Elevated TSH 

Elevated reverse T3

Elevated thyroid binding globulin (usually the result of high estrogen or hormone based contraceptives) 

Low Iodine in a 24 hour urine sample or blood test 

Low selenium in a 24 hour urine sample or blood test 

Elevated CRP- inflammatory marker produced in the liver 

Elevated thyroid antibodies (the hallmark sign of Hashimoto’s Thyroiditis) 

A Holistic Approach To Low Thyroid And Autoimmune Disease

I have treated many patients with hashimoto’s and what I can assure you regarding treatment is that it’s individual. One of the major sources of frustration for a patient who has been seeing their internist or endocrinologist is that all that happens (generally speaking) is that they are provided with a lab test for TSH and T4, and maybe a thyroid antibody test, based on those results a script for synthroid or levothyroxine (T4) is then prescribed. If your doctor is more aggressive in treatment on rare occasions you will be provided with a different thyroid medication that contains the active thyroid hormone T3. While this can be helpful to you the patient, it is extremely limiting when it comes to resolving the cause of your symptoms and the autoimmune response that remains following medication. Recall, in most cases of low thyroid the person actually is having an immune response that is attacking the thyroid. Do you feel that should be addressed? I certainly do! Well, it’s not conventionally addressed and this leads to a short term benefit when starting thyroid hormone prescriptions, followed by symptoms that seem to nag on or return. 

Now, I am going to tell you what the main triggers that I have seen consistently with hypothyroid in my twenty years practicing holistic medicine. These are not in order. 

  1. Gluten reactions. People who have autoimmune thyroid disease (you would only know if your doctor checked your antibody levels and told you the results were positive) are mildly to severely sensitive to the inflammatory impact of eating gluten. You won’t like this, but they are also mildly to severely sensitive to dairy. Yikes!! How do I know this? Because for twenty years I have helped hypothyroid patients adjust their diets, in part pulling out these foods and each time I have witnessed mild to overwhelmingly positive changes in their symptoms. That said, this is may not need to be a permanent change in diet, maybe just some lifestyle adjustment in the long term is enough to benefit you. This needs to be determined on an individual basis. I caution you not to go at this alone. There are too many variables to consider and careful monitoring of symptoms and labs can make all the difference in the long term with respect to healing and knowing what to do for your best long term outcome. While I was writing this blog, one of my recent new patients had come in for a follow up due to a previously elevated TSH. At twenty five years old her doctor had prescribed her Synthroid. She reported feeling no different on the medication and stopped taking it. Years later she still had an elevated TSH, the hallmark of hypothyroidism. Three months into holistic treatments and her most recent thyroid test for the first time in years (no thyroid medication prescribed) is now normal! The cause of her hypothryoid was multifactorial and had to due with diet, nutrient deficiencies, stressful life events, and a hidden gut infection. 
  1. Environmentally acquired illness. Something in your environment has made you sick. The most common culprit is working or living in a water damaged building or home. This could have been years ago or near the time of diagnosis. Thyroid disease can be brewing for many years before full onset. Let’s avoid the thinking that if my environment is good today, what came before does not matter. That is not the case! Environmentally acquired illness may also come from pesticides, herbicides, and other chemicals found in our food supply, heavy metals, mercury, arsenic, cadmium, personal care products and more. Here we need to consider not just one toxicant but the variety of daily exposures over time. The thyroid is very sensitive to chemicals. 
  1. Nutrient depletion as would be the case with low iodine, selenium, magnesium, zinc or other factors important for normal thyroid and immune support. In the office I test patients for these nutrients among others to make sure we are not missing the details of each person’s case. Remember treatment is required as individualized as are the causes. 
  1. Hormone imbalances that include estrogen dominance, low progesterone, or excessive cortisol production. Also checked via labs and symptoms. Usually caused by genetic variances and triggered by a stressful life situation or chronically feeling overwhelmed. 
  1. Infections including EBV, HSV, HPV, GI infections (usually hidden). Lyme or Lyme coinfections. This will lead to chronic GI inflammation, leaky gut, and alterations in the good bacteria in the gut. Often times people with thyroid problems are experiencing GI symptoms of bloating, gas, belching, loose stools or constipation. 

Based on the list above, I hope you can see that treating Hashimoto’s or low thyroid requires more time and energy than simply running a TSH and T4 to adjust thyroid hormone. There are also many people who have normal TSH but are still showing signs of Hashimoto’s via elevated antibodies and may at this time have no need for thyroid hormones, but instead focused treatment of the causes. A watch and wait approach will only increase the autoimmune responses. 

If you are interested in having comprehensive testing and analysis of the causes performed you can reach me for a phone or in person consultation in my Tampa Bay holistic medicine practice. 

Testing will likely include labs for thyroid antibodies, reverse T3, vitamin levels, hormones, and key inflammatory markers. Additional lab testing may include stool testing, heavy metals, or tests for mold exposure. 

Initial consultations are one hour, please schedule your consultation online using the following link. http://doctormattintampa.com/schedule-an-appointment/

By: Dr. Matt Lewis D.C., DACBN, CFMP®

If you have been experiencing chronic health problems that seem to be unexplained it’s possible you stumbled upon my blog in an effort to find solutions.If you are a current patient in my Tampa holistic medicine practice, I may have asked you to read this blog to help better understand some next steps in your treatment plan. In this post I am going to share with you the importance of checking your home to be sure you are breathing clean air. I will also share resources so that you may start to improve your health immediately. 

Some tells. If you play poker you probably heard of a “tell”. This is a signal made by another player that essentially foreshadows her hand. Over twenty years of practice I have picked up on some tells that often suggest there is an indoor environmental issue at home. A few appear obvious while for some symptoms the connection may be harder to comprehend. 

  • Wake up with allergic type responses- sinus congestion, runny nose, red eyes, sneezing, coughing 
  • Wake up fatigued even after a good night’s sleep (also seen with adrenal issues- see blog post) http://doctormattintampa.com/?s=adrenal
  • Interrupted sleep pattern with no reason (i.e. the dog isn’t barking and the kids are not waking you) 
  • When you leave for vacation, work, or even just for the day, symptoms are worse when you return home. In other words, you generally don’t feel well when your home. (or at work if it’s a workplace exposure). One of my patients recently told me that he spoke to a friend about how he became ill in a water damaged home, he was sharing his story, when his friend told him his wife at 40 years old had become so ill, she was using a walker and was getting ready for a wheel chair. The friend decided to have the wife stay in a hotel for the week to see if removing her from the environment would help. Well, not only did it help but in a few short days at the hotel, she was walking without a walker. They later found a water intrusion in the home that was creating mold.
  • Different parts of the house set you off. You feel different in your bedroom than you do in your living room. One example here is a patient that I had who was hanging out all the time in the family room. She felt worse in that room than her own bedroom. Later we found a source of hidden mold in that room! 
  • Your downward health spiral started when moving homes or at a certain job.
  • The most common signs of bad air in the home are fatigue, loss of concentration, and BRAIN FOG! The brain is sensitive to the indoor environment. 
  • Please understand that a water damaged building causes the immune system to become out of whack. Now that may not sound very scientific but that is what ultimately happens. The immune system will drive inflammation in the brain and the brain inflammation will start to shut down or dysregulate digestion, hormones, glandular function, metabolism, and urinary function. This is why so many symptoms can be sourced back to the air you breathe.

While these symptoms can be present for other reasons, we should be careful not to ignore the condition of the air we breathe while we move around the house and during sleep. Especially, when you find yourself stuck without good cause for the above symptoms. In my patients who have chronic digestion problems, fatigue, brain fog, poor sleep, and a host of autoimmune conditions, I have found that if we ignore the patient’s indoor environment, be it a source of mold, dust, water damage, or toxic chemicals, the patient will have minimal responses to treatment and some will not get better at all.

I have also observed patients and commonly physicians, deny, minimize, or flat out refuse to accept that the home or work indoor environment is at least in part causing or exacerbating their health problems. Just as often it’s the landlord or spouse who refuses to accept the facts.

Ok, at this point you have decided to check the home for air quality and exposure. What are some of the best ways to proceed? You have two options. 

  1. DIY – Do it yourself. Start to visually inspect your home and collect samples. 
  2. Hire a professional IEP- Indoor Environmental Professional  who will inspect your home and collect samples. 
  3. Start some type of remediation of the indoor environment. 

As I break down the options here, let’s start with the understanding that according to Michael D. Schrantz, an Indoor Environmental Professional,  a “perfect method” for visually inspecting, testing and cleaning the home does not exist. There is no absolute, or 100% standard that can be applied. People respond differently to indoor environments in the same way they do to viewing a movie. One person can rave about the movie and the other can criticize it all day. One person can be sick in a given environment, while the other feels perfectly fine. 

Therefore, when we begin to assess or apply cleaning strategies to the home in question we should agree to move forward with an open mind. The solution is found when the patient finally feels like themselves again. 


Let’s talk about doing your own home inspection. You can start a few ways. I would suggest that first you start by thinking about your home. 

  • Have there ever been leaks that were repaired? How long did it take before the repair was made? Were the wet building materials removed from the home? 
  • Did you ever have flooding in any part of the home? When and how was it repaired? 
  • Have you ever had your HVAC vents cleaned? When? What about the AC coils? Do you regularly clear the lines and check for fluid backup? Do you regularly service the HVAC and check at least visually for signs of moisture or mold? 
  • Do windows condensate in your home? 
  • Are there signs of visible mold on a ceiling, base board, under a sink, in a bathroom? 
  • Musty smells anywhere in the home? Bathroom, carpet, closet? 
  • Do you have a crawl space or attic? Has anyone checked it recently for humidity issues or visible growth? Is there condensate on any HVAC returns? 
  • Is the home generally dusty? How often do you dust, ceiling fans and all? 
  • Are you backed up to a lake or pond? Is there mold growth on the outside of the home that can be tracked inside? 
  • Start to make a list of any of the above. This is not meant to be comprehensive, but a place to start. There can be hidden sources of mold in a wall cavity.. Here we are first concerning ourselves with the low hanging fruit. 

The above checklist can be done by a professional or at least started on your own. Obviously, a professional will come in and know exactly what to look for and will start to measure things like humidity, dust samples, air samples and more. 

Let’s suppose you want to start by collecting a sample in your home. 

Samples you can collect on your own include: 

  • ERMI
  • Petri Dish Samples 

ERMI -The Environmental Relative Moldiness index (ERMI) was developed by the U.S. Environmental Protection Agency, Office of Research and Development (ORD) as a research tool to investigate mold contamination in homes. The company I generally recommend (I do not receive compensation) is https://www.envirobiomics.com/product/ermi/. I often suggest test number one on their menu. Pricing is determined by how quickly you want the test completed.  You have an option to select the time frame. I recommend selecting the swiffer cloth and not the vacuum sample. 

The ERMI test was later adopted by physicians who wanted to know the general status of a person’s indoor air quality. The benefit of this particular test is that it measures DNA fragments of mold. This is critical because here we are not checking for mold spores as would be done in an air sample test. ERMI checks for mold fragments. These fragments are known to have a variety of allergenic or immune stimulating properties. One spore breaks down into 300-500 fragments. Think about a dandelion in its seedling stage. You can pick up one dandelion, blow on it and there are hundreds of seeds that are dispersed.

If you sample the air in your home, it may show some mold species present if there are large amounts or obvious water damage exists. However, it is quite common to test the air and not find enough spores to be considered a problem in the eyes of the inspector or based on industry standards. 

Air samples while at times helpful can pose a problem for the patient who does not feel well and is now told based on a single air sample that “all is clear”. Consider that air has a unique flow and different parts of one room can have clean air while another air pocket has excessive spores. To obtain a more valid air sample, it would be best to collect over a period of a few days or weeks and in different parts of the room. This is not practical. 

ERMI is a test that has been used by physicians over the last 15-20 years to validate if the patient will respond to treatment. It has been studied in peer review literature and documented to predict that given a certain score the patient can start to heal. Is it perfect? No. 

I have found that sometimes there are false negatives. The patient has the test and it’s normal but they still have a problem that needs to be found in the home and when an inspector shows up the problem is found. However, more consistently when I suggest a patient order the test, it comes back as showing over exposure to certain mold fragments that are known to incite the immune system and cause the symptoms listed earlier in this blog. 

The ERMI test is easy to do yourself. You will be provided with a swiffer cloth from the lab upon ordering a kit. You simply collect samples from a variety of surfaces in your home. You can collect what is called a composite sample taking dust from different areas of the home, providing a general idea of what is lurking in the dust. Or you can go direct to an area where you suspect a concern, i.e, in the air handler or vents. Now, we always expect to find some mold fragments, as no home is “mold free”. However, we are looking for certain types that relate to water damage and also certain quantities. Dust itself can cause symptoms, so just performing the test sometimes sheds light on the air quality and the number of particulates that may be present in the air. Now you have a benchmark so that if the vents need to be cleaned or a room needs to be remediated, you can check it post remediation and we can know that you should start healing based on the published data.

Let’s be sure not to mistake ERMI with what a home inspector would generally use as an acceptable test to determine causation. ERMI is a tool that you and I can use to start making some determinations about your treatment and understand how important your environment is in your specific case. An environmental professional can also choose to use this test to answer questions about remediation and further discover the root cause of the problem in the home. If you are going to litigate, I would suggest you have pictures of any water damage, air samples, swabs, and complete documentation by a professional inspector.

Petri Dish Samples  

Another relatively inexpensive way to get started is to use Petri Dishes to assess for mold spores. This is quite different than the ERMI and in my opinion less preferential as it does not provide information of spore equivalents or particles using DNA. Those are the 300-500 fragments discussed earlier. What it can do effectively is check for 50 different genera of mold. The plates can be placed in different parts of the home that are suspect or in areas where you spend a good deal of time. I would suggest doing sampling a few areas. 

The company I suggest here (I don’t receive compensation) https://immunolytics.com/default.aspx 

A Word About Remediation

There is a great deal discuss with respect to remediation and I would prefer to leave this to the indoor environmental professionals. However, as with all professions there are going to be differences in the quality and understanding of the professionals selected to assist you. I am going to provide some insight from what I have learned in both seminars on environmental acquired illness and from my time in practice observing patient responses to treatment. 

First let me remind you that there is no “perfect solution”. There are however some great guidelines. 

  1. Find the source of the problem. As with your own health, finding the root cause will always trump masking symptoms. One example I hear too commonly is “I bleached the mold and now it’s gone”. It’s not! Killing mold spores can serve to split them up into fragments actually aggravating the patient. Besides, what’s the source? Some companies will come in and spray antimicrobial chemicals that are said to be safe. For some this may actually work, while others become sicker as the contents of the microbes you are killing are released into the air. Let’s proceed with caution. 
  2. If you have not cleaned your AC unit or vents, please do so. There are instances where dust has built up in the vents, causing health problems and allowing for mold growth. We should also emphasize that there is more than mold in a water damaged building. There are dozens of potential “inflammagens” (things that inflame your body and cause illness) These can be from bacteria that produce endotoxins or volatile organic chemicals from construction materials, viruses, and many other microorganisms. Cleaning can go a long way. I often speak to patients (no judgement here) that were not aware of how to maintain the HVAC system and have lived in a property that has never had the vents cleaned. Sometimes that’s all that is needed. Often, especially here in Tampa there is going to be mold in your AC that builds up due to condensation or a backflow. The coils of the AC need to be cleaned and the lines cleared. This should be checked at least yearly and better yet every six months. For the sickest patients, more may be required than a simple cleaning. I should also point out that when the dust is “shaken up” during cleaning this could elicit more symptoms for some. The AC specialist should take precautions when cleaning the vents by running a HEPPA air scrubber, sealing the duct work during cleaning and possibly venting the air to the outside. These techniques are not ordinarily performed. For some it will matter. I am working locally here in Tampa with a group of professionals who are helping my patients to complete these tasks and are willing to take the precautions. Other remediators or HVAC professionals may skip steps due to ignorance, expense or convenience. Make sure you hire someone you feel is trustworthy and understands that you are not feeling well.
  3.  Clearly, if visible mold is present and there are wet materials they need to be removed. Proper containment is needed  Once that happens, depending on the severity of the findings in the home and the patient’s illness, we need to start to consider how mold in one part of the home may have dispersed through the air, rendering spores and fragments throughout the home or building. In this case, the home may require air scrubbing and what is called small particle remediation. Porous furniture and drapes may need to be replaced or properly cleaned where possible. Again, here there are no “perfect” solutions and each case is unique. Now, the main caution here is to ensure containment during remediation. It defies logic, but I often hear a patient say they were worse after remediation because of the poor containment techniques employed. You should not be in the home during remediation! Yes, a patient who was renting an apartment was allowed to be in the home during remediation and became violently ill as a result.
  4. Lastly, I would start by filtering your air regardless of what might be happening in the house. This does not replace the advice listed above. It’s just a way to hopefully breath some better air. Buy a stand alone air filter. I like HEPPA. I also like Air Oasis, Molekule, and many more. The key is to put the free standing unit where you are sleeping to filter the air your breath while sleeping.

Taking Back Your Health

Taking the time to assess your home in the early stages of treatment can save you lots of grief in the long run. Many patients seek treatment after visiting both conventional and holistic medicine providers only to find out the source of their problems was lurking in their AC system or other areas of the home. Precious time, money and quality of life has been depleted. It’s not worth it. It is imperative that you get those people in your life who will be making decisions with you regarding repairs, testing, and treatment on board. Their support will make or break your healing in many ways. I always encourage my patients to come into the office with their spouse or partner so that everyone is able to understand the seriousness and consequences of the environmental and health problems and make educated decisions along the way. 

Once the health problems have kicked in it sets off a chronic inflammatory response that now requires treatment. Many symptoms may improve after remediation or moving. However, just as many people continue to suffer with ongoing fatigue, brain fog, pain, mood swings, anxiety, and don’t feel the same as they did before exposure. They are often misdiagnosed with other conditions or start having autoimmune issues. It’s way better to find out the home is a problem, minor or major, correct it, receive treatment and move on. Now, I realize patients reading this blog may find that they have been exposed to a water damaged property for many years, not knowing it was the problem. Or possibly working in a water damaged building for years before coming to the understanding of what has triggered many of their symptoms, concerns and quality of life. I want you to know that given the right testing, treatments, and attention to your environment, results in your health will follow. 

If you want to learn more about the diagnostic process and treatment for people suffering environmentally acquired illness due to a water damaged building please read the following blog. http://doctormattintampa.com/chronic-fatigue-syndrome-healing-your-frustrations/

If you believe you are experiencing symptoms that may be related to an environmental issue and you would like to have a one hour consultation to review your health history, current symptoms, and set a plan of action, follow the link to schedule your in office or phone consultation. 


By: Dr. Matt Lewis D.C., DACBN, CFMP®

Have you ever been told it’s all in your head? I mean, did you ever have the feeling that when you speak with your doctor, the look on his or her face is saying “you must be making this all up”? 

In my Tampa holistic and functional medicine practice, I regularly see patients who have many chronic symptoms. Symptoms that on the surface are seemingly unrelated and bizarrely appear to have no known cause. Many of these patients have been diagnosed as Chronic Fatigue Syndrome or exhibit multiple symptoms in multiple systems of the body. It appears as if they have some type of autoimmune condition(s). Although, some have been diagnosed with a specific autoimmune condition, many elude diagnosis. The doctor often suggesting “let’s retest in a few months or a year, it looks autoimmune, but I don’t see anything in your labs yet”. 

Case Study 

A forty year old female administrator recently presented with complaints of memory loss, lack of motivation and anxiety, all brain based symptoms, ok that fits. She explained to me that she has low sex drive, stomach pain, rashes that come and go and is always tired. When, I let her continue to state her concerns, “I also have cramps in my legs and I wake up stiff, my joints hurt, and at times I find it difficult to breathe. I sleep well enough but wake up tired.” There was more! “I have tingling in my hands and I feel weak”. This is suddenly sounding way more complex! 

The patient went on to tell me about her experience seeing other doctors. Because she had a chronic cough as well, she had been provided multiple antibiotics over the last year and one doctor tried her on proton pump inhibitors for reflux and sinus congestion that seemed to be related. Both treatments helped for a few weeks, only to have the problems return. She was also taking an antidepressant that has helped somewhat but clearly not addressing the underlying problem. 

What’s being missed here? Why can’t this patient get an accurate diagnosis and treatment to resolve her many concerns? What we found was simple and yet profound. The patient was experiencing a problem related to her home environment. I asked her to run a test in her home, collecting dust that was sent to a lab to identify mold in the environment. We found elevated levels of toxic mold. She had no visible areas of mold, nor water damage that was obvious in the home. Once we had the house inspected by an environmental professional, it was clear the air conditioning unit was the source of the problem. Once we had that cleaned up, she was ready for treatment and responded nicely. Within a few short months her energy was 80% improved, cough, cramps, weakness, joints, rashes, all resolved. Could we have accomplished this if we did not find the mold hidden in her dust? 100% no. 

What this patient was experiencing was an immune system issue that was either being caused by or exacerbated by exposure to mold toxins. This is an environmental issue that is nearly always missed in the current healthcare system, leaving patients feeling sick, tired and frustrated with their doctors. These types of patients will often find their way to my office. Unfortunately, the longer the problem has gone unresolved the more challenging it can be to correct. The good news is, when the right steps are taken, the patient will improve and can ultimately heal. 

“Your Labs Look Normal”

Time And Education Is Essential To Healing Chronic Health Problems

In this blog I will explain how we go about establishing a diagnosis to enable those with environmental illness to discover the cause and start to resolve the problem. Please understand there is more to environmental illness than water damaged buildings, HVAC problems and mold. However, this is the problem in the majority of cases. Fish kills, eating reef fish with ciguatera, heavy metals, drinking water, lyme disease, spider bites, are also culprits in environmental illness and will not be discussed here. 

Why do you keep hearing“ it’s all in your head” or “ your labs are normal”.  Most doctor visits are too short. This is simply due to restrictions placed on the doctor by your insurance carrier. Ten to fifteen minutes with your doctor every few months, or twenty minutes with a specialist who was not educated enough to ask you about your environment is doomed to produce weak outcomes. 

I made the same mistake in practice for many years. Until I became fully aware of the environmental pressures people face at home and work. Once you see it, you cannot unsee it. Once you see patients getting better you become insistent on discovering the cause. Asking over and over, trying to find the culprit in the patient’s environment. After all, these are patients who have tried diets and exercise, multiple medical visits and yet still suffer. There has to be a reason! 

I will not repeat this mistake. The patient in this story had chronic fatigue, she was always tired and did not respond well to exercise. 

To properly identify a true case of chronic fatigue caused by exposure to a water damaged building or what is known as a Chronic Inflammatory Response Syndrome – Water Damaged building (CIRS-WDB) it takes knowing what to ask and then listening . 

It may only take 15-20 minutes in a consult to decide if CIRS-WDB should be considered as a diagnosis for the chronically fatigued and forgetful patient. However, it takes roughly three hours or more time with the doctor to fully establish your diagnosis and begin treatment. This is because we must rule out everything else that could possibly be causing your symptoms, review previous tests taken with other providers, and order and review our own tests specifically associated associated with CIRS-WDB. 

A Few Things To Consider

There is a good deal of education that is required for the person or family living in a water damaged building to take action and recover their lives. There are many variables at play. 

Here are a few examples of what may need to happen in a home and the decisions that are undertaken by the family or individual in that home. 

  1. Do you own or rent? This can impact decisions as to moving or repairing. 
  2. Who is going to find the problems in the house? Can I do it myself? Can I trust the inspector? 
  3. What is the scope of work that needs to be done to make the home safe again for the struggling patient? Who can I trust to do the work properly? 
  4. How will I know the home is safe again? 
  5. Will I need to move? Change jobs? 

Here are a few examples of the questions that need to be asked by the person who has become ill from living or working in a water damaged home or building and is struggling with chronic health concerns, brain fog and fatigue being the most common unrelenting symptoms. 

  1. What labs are needed to diagnose and monitor the chronic illness that has resulted from exposure? 
  2. What do the treatments entail to help me heal from exposure to a water damaged home or building? 
  3. Can I heal from this? 
  4. What is the impact to my children? Could this be causing some of their seemingly minor or major health concerns? 

Finding Answers To Complex Health Concerns

When I see patients with complex health concerns I break it down into three steps. 

  1. Is this problem being caused or exacerbated by an environmental exposure? While not every patient will have this problem, it is imperative to ask the right questions if the symptoms match. Think of it this way, it would be remiss to ignore environment as a cause if a patient has been to a variety of doctors who have been unable to form any solid conclusions. Having twenty years of experience in holistic medicine I can assure you the number of patients who seek out my care with environmental issues that are unknown to them are far greater than one might expect. (hint: this is why they are not getting better) You can find additional information regarding Chronic Inflammatory Response Syndrome as you continue to read this post and at the following link. http://doctormattintampa.com/mold-its-usually-not-allergy-its-a-biotoxin-illness-named-cirs/ 
  2. What tests can be run to confirm diagnosis and find the cause? In the paragraphs below this will be further explained. What patients should understand is that testing to confirm diagnosis of CIRS is available, and in some cases completely necessary. In simpler non progressive cases or due to financial restraints, tests can be minimized so long as the patient is responding well to treatment.  Treatment for environmental exposure always includes removal from or correction of exposure source. In some cases it’s a simple as air filtration. In others it requires a deep cleaning of the HVAC system or the entire home. In more complex situations, remediation is necessary along with removal of water damaged building materials. Each case is unique. Each patient will require their own unique plan of action, dictated by the circumstances, i.e extent of health problems, water damage, finances, spousal support, and personal resources. This is not a minor undertaking, but it is doable and necessary.
  3. I start treatment while coming up with a plan for each patient and  family to determine what  needs to be done in the short term and long term to regain health. Treatment may include the use of binders to soak up mold toxins that are traveling through the body causing illness, establishing health dietary protocols to strengthen the body, using a variety of supplements to handle ongoing symptoms and increase energy, and running diagnostic testing to further the treatment plan. Ultimately using peptides if required to reset the immune and endocrine system and restore health can be a final step. The treatment must go in the correct sequence and is determined as the diagnosis unfolds. 

How Are Patients Diagnosed With A Chronic Inflammatory Response Due To Environmental Exposure 

CIRS -is a multi-system, multi-symptom Illness that is caused by exposure to a one or more biotoxins. While there are numerous potential causes for CIRS by far the most common is exposure to a water damaged building, be it a school, workplace and commonly home.

Water intrusion may be obvious or hidden problems can and often do exist. Especially, when we consider the constant use of HVAC systems and the interplay with humidity and temperature here in Tampa, it’s no surprise that this is an ongoing issue for many people locally.

Most people understand that mold can grow given the proper conditions. There are three important points that need consideration for those who are not feeling well and those who are treating them.

  1. Mold and moisture are not always visible and more likely to be hidden in a home or building. However, hidden mold makes its way into the air and ultimately exposes those breathing it. 
  2. When we have a water damaged home or building it’s not just the mold that’s the problem! Mold is just one ingredient in the “toxic soup” found when organic matter starts to decay. The “toxic soup” consists of a wide variety of inflammagens in the form of VOCs (volatile organic compounds ), endotoxins, beta glucans, actinomycetes , bacteria, and viruses. All of these mix together and create a potent burden on a person’s immune system.
  3. The amount of damage in the home and the dose of “toxic soup” is not as relevant as the person who is breathing it . A subset of people are dramatically more sensitive to the contents of the building and even when they eventually get out of exposure will remain chronically sick and inflamed until treated.

This lack of understanding by the patient suffering and the medical professional has left many people feeling tired, depressed, breathing poorly, anxious and just plain miserable. Common diagnosis associated with CIRS include: 

  • Chronic Fatigue Syndrome
  • Fibromyalgia
  • Leaky gut
  • SIBO (small intestinal bacterial overgrowth) 
  • Asthma
  • Sinusitis
  • Somatization (doctor saying it’s in your head) 
  • Pulmonary Hypertension 
  • In more extreme cases Multiple Sclerosis, Dementia/ Alztheimer’s 

The Diagnosis of CIRS Is Made Using A Variety of Modalities: 

To be clear, not all patients will require this aggressive testing protocol. Some will. Many can go through steps 1-5 and find recovery. The key is aggressive follow through with the treatment protocols and the removal from exposure. 

  1. Visual Contrast Testing is an inexpensive and reliable method to show reduced oxygen in the capillary beds of the optic nerve extending to the brain. You can take this test online at survivingmold.com for fifteen dollars. A negative test does not rule out CIRS. A positive test can help confirm diagnosis and monitor treatment. 
  2. Symptom survey. When you fill out the functional medicine analysis online Functional Medicine Analysis, this will help to identify the symptoms related to CIRS and can be reviewed at your consultation. 
  3. Previous history of exposure can help to paint the diagnosis. Current exposures can be tested for. I recommend using envirobiomics.com for testing. Start with ERMI, test number 1. https://www.envirobiomics.com/shop/ I do not receive compensation from any company. Your home or work test can be reviewed during consultation as well. 
  4. Blood testing for MMP9, C4a, TGFB1, MSH, HLA DR, Vitamin D, Hormones, Cortisol, ACTH, Gliadin Antibodies, VEGF and many more further establish the diagnosis. 
  5. Response to treatment. When a patient starts treatment the diagnosis of CIRS is further confirmed. In other words, the expectation is that you get better. If you are not, then it’s likely this is not the problem or the cause of the environmental issue is still present. 
  6. For those with memory deficits, brain fog, concentration problems or neurological issues, Brain MRI with NeuroQuant only available currently in one Tampa MRI center can measure changes in the size of various important brain structures due to inflammation or atrophy. This further identifies the damage created by chronic brain inflammation that can be due to exposure and has been shown in clinical studies to be corrected using peptides and sequential treatment with binders. 
  7. Nasal Swab tests for hidden colonization of bacteria – establishes breakdown of immune system and formation of biofilms – only provided by selected labs- generally not associated with insurance. The cost of this test is a few hundred dollars and can make a world of difference in sinuses and brain fog once treated. 
  8. Echo stress testing for measurement of pulmonary hypertension – in progressed cases this can be a necessary step to identify the cause of abnormal breathing, swelling and establish a rationale for ongoing treatment with healing peptides, namely Vasoactive Intestinal Peptide. 
  9. VO2 max testing to establish a lack of oxygen utilization contributing to fatigue. 
  10. Urine mycotoxin testing is used, although not completely reliable or well established in medical literature. Some doctors and labs argue that if interpreted with caution it can be helpful. 

I hope the above information has been helpful. It’s not in your head!! 

Now you know more about CIRS than most medical professionals. If you would like to be seen either in my office or via phone consultation please follow the instructions here. http://doctormattintampa.com/schedule-an-appointment/ 

By: Dr. Matt Lewis D.C., DACBN, CFMP®

I recently had a patient whom spent twenty years with chronic GI complaints, visiting greater than five gastrointestinal specialists. In that span of time, not one of the GI specialists ordered a stool test. I found that surprising and too common. The patient found it frustrating!

Can you imagine having a gut issue for over twenty years and no one thought to perform a stool test?

This particular patient had already been through a series of tests including endoscopy, colonoscopy and abdominal sonogram, due to abdominal pain, reflux symptoms and inconsistent bowels ranging from hard or dry stools to watery diarrhea. To be fair, the tests she  had were able to screen for a variety of conditions including celiac, h-pylori infection, gastritis, polyps, colon cancer, and esophagitis to name a few.

However, the patient was told there was no pathology (this basically means your not dying and we can’t find what’s wrong, so you must be ok). The patient was happy to hear she had no pathologies and unhappy with the proposed solution. She was offered  prescription Bentyl and after trying it for several months was unsatisfied with the results.

In my Tampa clinic I use a few different labs to test for GI problems. One such test is the GI Map test provided by Diagnostic Solutions Lab. Here are some of the highlights of this test.

Finding Microorganisms

The GI map tests uses a method for amplifying the DNA material of various bacteria, viruses, parasites and protozoa in the stool. The technique is termed  qPCR (A quantitative polymerase chain reaction). The benefit of qPCR is confirming the presence of DNA material for each tested microorganism present within the stool sample and assigning a specific quantity. Since we all live with various microorganisms in our gut and throughout our bodies it’s normal for many organisms to be present. However, when certain microorganisms are able to grow, either pathogenic or opportunistic in large numbers this can create clinical symptoms and persistent inflammation in the GI tract.

Clinical symptoms may include, nausea, vomiting, loose stools, bleeding, mucus, or abdominal pain. This is usually found in acute infections. For some with chronic GI inflammation the symptoms can vary including, chronic gastritis, bloating, constipation, abdominal discomfort, belching, gas, chronic bad breath and undigested food in the stools.

Assessing Healthy Gut Flora

Healthy gut flora are the good guys (microorganisms) that beneficially colonize the digestive tract. This would be analogous to the probiotics a patient may take. In reality, we all have a unique microbiome (universe of microorganisms inhabiting our bodies). That sounds terrible, but it’s really great! These good guys help us to make vitamins, digest food, reduce inflammation, support production of happy chemicals like serotonin and boost immune function. I appreciate that the GI map test shows what good microorganisms are colonized in our gut, along with the bad ones that can be present.

The GI Map test includes looking at levels of bifidobacteria and lactobacillus among other healthy bacterial flora. The doctor and patient can see if there is a good balance and make clinical decisions about what probiotics may be most helpful if the balance of good bacteria is to low, or if the bad bacteria is overgrowing. This imbalance of gut bacteria is termed dysbiosis.  

Having  healthy levels of good bacteria or the opposite (dysbiosis) is a product of lifetime dietary habits, history of antibiotic use, antacid or proton pump inhibitor use, previous infections, travel, drinking soda, sweetener use, stress levels, exposure to water damaged buildings, hospital stays, and much more. A holistic approach to gastrointestinal health is to unwind the lifetime of stress to the digestive system.

Inflammation Markers

If you read about health, then you know what inflammation is. It’s probably the most important method used to combat a variety of acute and chronic triggers to our immune system. However, we don’t want it hanging around. I often check inflammatory markers like hsCRP, ESR, Homocysteine, and Uric Acid that are often missing from patients previous lab work and can provide valuable insight as to the level of inflammation systemically.

Typically it’s a simple CBC and Metabolic Chemistry that is  run without paying attention to inflammation. In a more thorough approach when inflammatory lab markers are ordered they may still be negative. In this case be maybe looking in the wrong place!

If the inflammation is in the digestive tract, why not look there?

By examining the stool we are able to gain valuable information so the patient can start healing. We can see markers for inflammation that are sensitive, reliable and are local to the GI tract. If levels of calprotectin, beta-glucuronidase, or zonulin are elevated inflammation is confirmed. If sIgA (secretory immunoglobulin A)  levels are high or low this speaks to an immune response and inflammation as well. sIgA is the primary immunoglobulin used by the immune system in all mucus membranes, (gut mucosa, lung, sinus, bladder, vaginal) with large quantities in the gut. This is a first line defense against invading microorganisms and controlling internal immune responses.

Low levels indicate that the patient is immunocompromised or is struggling with a chronic infection (a finding I often see in my patients who have rather normal lab findings from previous physicians).

Calprotectin is a marker that can distinguish between IBS (irritable bowel syndrome) or IBD (irritable bowel disease). Aggressively high levels can indicate IBD, an autoimmune response possibly colitis or Crohn’s. It can also be moderately elevated in response to an infection, food allergy or other insult to the digestive system. Listening to the patient and asking for clues on the initial paperwork helps me to identify what the problem might be. Then after treatment we can check the markers again and see what kind of progress we are having. If a referral is warranted I can now send the patient back to the GI specialist with additional information that can be helpful in finally obtaining a more complete diagnosis and adequate treatment. I often find that the holistic approach will resolve most of the GI complaints and help manage those with a chronic organic disease. By having a stool test we can know better what the actual diagnosis is and for many patients that alone can reduce anxiety and a pathway to healing.

Leaky Gut

Zonulin is a protein made by the body, indicating that the lining to the digestive tract is breaking down, this is what is termed as “leaky gut”. If the gut becomes porous, LPS a bacterial toxin can pass into the bowels and upregulate the immune system, causing all kinds of nasty symptoms.

Often I see this presenting as anxiety, brain fog, fatigue, and weakened immune function. Overtime the leaky gut can cause LPS overstimulation to the immune system leading to autoimmunity, attention deficit, and a chronic inflammatory response. We call this “Brain on Fire”. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660627/

Small Intestinal Bacterial Overgrowth And Poor Detoxification

Beta-glucuronidase can be elevated when there are challenges with phase 2 detoxification or over exposure to persistent environmental toxins. This may indicate the need for liver cleansing or support with herbals and finding the source of toxins. High levels can also indicate dysbiosis or small intestinal bacterial overgrowth (SIBO). In that case, seeking out the cause of overgrowth and treating for SIBO may be indicated. Other considerations are poor detoxification of estrogen metabolites coming from either contraceptives, hormone replacement therapy, internal sources of estrogen elevations or environmental exposure to xenoestrogens., found personal care products. The source of toxins is often associated with exposure to a water damaged building and the range of inflammagens found within. See my blog on biotoxin and mold illness for further discussion. http://doctormattintampa.com/mold-its-usually-not-allergy-its-a-biotoxin-illness-named-cirs/

Additional Markers

GI Map is comprehensive. It also looks at markers to assess pancreatic function (elastase). Elastase is an enzyme only made by the pancreas to support digestion. Low levels of elastase may indicate pancreatic insufficiency, cystic fibrosis, or simply insufficient acid production in the stomach due to infection, prescription medication or other causes.

The stool is checked for fat levels. High levels indicate poor absorption of necessary fats and may indicate celiac disease, gluten sensitivity, gallstones, or low acid in the stomach (the opposite of what most doctors are treating for when they prescribe proton pump inhibitors like nexium, prilosec, and omeprazole).

Red blood cell quantities are also measured indicating upper GI bleed potentially causing anemia or possibly coming from hemorrhoids. The quantity of red blood cells can help distinguish where the bleeding is coming from or how serious the condition. Higher elevations can indicate the need for colonoscopy to rule out polyps or colorectal cancer.

Treatment for Gastrointestinal Health

In summary, stool testing provides a window into the interplay between microorganisms, environment, diet, previous antibiotic or proton pump inhibitor use, good bacteria, immune function, brain function and symptoms of gastrointestinal health. In holistic medicine it has long been said that the gut is where health starts and where health fails. Knowing your stool test results can help you and your clinician gain a better insight into what the appropriate diagnosis is, what is causing the problems, and inform treatment decisions.

Using stools tests has helped many of my patients not only monitor treatment but return to a happy and healthy life without nagging gut symptoms all the time.

In my Tampa holistic medicine practice patients start by filling their functional medicine analysis. http://mattlewisdc.livingmatrix.com/self_register_patients/new

This tells me your health story before you arrive at the clinic. You may also receive a copy of the analysis at your visit for your reference.

If you would like to be seen in my office please fill out your analysis today and proceed to schedule using our online calendar. /http://doctormattintampa.com/schedule-an-appointment/

If you would like more information please read about my practice here.  http://doctormattintampa.com/understanding-my-personal-approach-to-doctoring/

By: Dr. Matt Lewis D.C., DACBN, CFMP®

I often ask patients the following question. Have you notice a decline in your memory or cognition over the last 3-5 years? Too often, regardless of age the answer is flat out “yes”, or a more unsure, “I think so”. The next question, how are you sleeping?, is inevitably followed by an resounding “not well”!

The Center for Disease Control (CDC), data indicates that 35% of Americans over the age of 18 are not receiving enough sleep. Twenty percent of senior citizens over the age of 65 are experiencing Mild Cognitive Impairment. As you will see in this article, Mild Cognitive Impairment is associated with sleep and cortisol function. Poor sleep at any age is a limiting factor for performance in all areas of life.   https://sleep.biomedcentral.com/articles/10.1186/s41606-017-0016-5

Hippocampus, Sleep and Your Memory

If one area of the brain (mesial temporal lobe) starts to shrink, early cognitive decline may result. Each area of the brain provides a window into various disease states, some are more widely known to impact dementia. The mesial temporal lobe contains a number of important structures, one of those being the hippocampus. The hippocampus is responsible for short term memory, converting short term memory to long term memory. The hippocampus can degenerate in response to excessive cortisol secretion, head trauma, hypoxia (lack of oxygen), chronic infections, and long standing chronic stress.

The circadian rhythm or what is referred to as your biological clock helps you fall asleep, stay asleep and feel alert and energetic throughout the day.

Your sleep/wake cycle is regulated by the hormones cortisol and melatonin. A lifetime of stress, poor relationships, work related problems, financial troubles, poor eating, and exposure to toxins all cause disruptions in cortisol secretion. Years of working night shift or poor sleeping patterns are great ways to cause changes in melatonin and cortisol balance.

For years I have indicated to patients that one of the first signs that we are losing health is the loss of good sleep. If you wake up at 3AM wondering what you are doing up, this is one warning sign that your cortisol balance is compromised and could be your first sign of hippocampal or brain degeneration. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561403/

I day does not go by that I see patients who are having trouble sleeping. Here are some of the common sleep related complaints:

  • Can’t fall asleep
  • Can fall asleep but can’t stay asleep
  • Wake several times per night (as few as 1-2x and as many as 10-20x)
  • Wake up in the middle of the night and can’t fall back to sleep
  • Night sweats and panic in the middle of the night
  • My spouse is snoring
  • My dog is making noise
  • My legs are restless at night
  • Sleep well but don’t wake up rested  

The good news is that all of the above reasons for poor sleep can be corrected with the right understanding of the problem and sorting out the causes (including the dog barking)!. Looking at this another way, it is important for the doctor and yourself to ask the question, what is is that’s impacting your hippocampus?

Is stress causing excess secretion of cortisol, essentially frying the brain. When cortisol is constantly available in the brain it acts on the receptors of the hippocampus changing the way neurons or brain cells fire. Over time this wears them out and we have atrophy or degeneration. Stopping this process is possible and you don’t have to be a victim of dementia or early cognitive decline as long as preventative measures are taken. Most of the patients who seek my assistance are not past the point of no return.

Many have been struggling many times for decades, yet there is still an ability for healing to occur and restoration of sleep and memory. Some, are showing damage to the brain structures in the form of atrophy – think loss of muscle mass- in this case loss of brain mass. When this happens there has usually been severe stress, poor diet, and or environmental exposure to a biotoxin like mold. The reason they are unable to get better is because the doctor’s are telling these patients, you are fine. Take this sleeping pill, anti-anxiety medication, and you will improve. Or worse, “we don’t know what’s wrong with you, come back if things get worse”. This approach only delays appropriate treatment.

Memory Loss – The conventional approach is failing!

Clinical interventions that are not showing promise over the last thirty years are pharmaceutical based, while holistic, environmental and lifestyle interventions are actually leading the pack when it comes to memory.

As mentioned earlier, memory is a function of the hippocampus. When the hippocampus burns out, loss of memory follows. This means that we need to pay close attention to the signs of memory loss early on and not just chalk it up to some of the common excuses we hear that lack adequate explanation.

For example: A 55 year old patient will tell you they are losing their memory, they can’t recall words like they used to and they notice their vocabulary is harder to access. In the same breathe, they may say, “but you know, I am getting old”. The doctor echoes what the patient says and the loss of memory is ignored. Or it may just be the other way around. The patient echoing the doctor. This is unacceptable in today’s health care system, given clinical interventions do exist and success is often determined by how quickly we act.

Prescription medications are used when the problem of dementia is already diagnosed and to make things worse the last twenty to thirty years of research has not created any “breakthroughs” or “blockbuster” wonder drugs to alleviate the loss of memory and reverse the condition.

Pills in model head

The other big excuse is genetics. A sixty year old female will say “my mom had dementia and I am afraid the same will happen to me”. Yet, the doctor offers no solution, only careful monitoring at best, awaiting the “inevitable”. Again, unacceptable by any standard. So, this same patient will decide to take Ginkgo Biloba or some similar remedy. In fact, not a bad idea!

Unfortunately, this lacks the clinical intervention of monitoring memory losses or gains using acceptable clinical tools that track success of therapy. In my clinic, I always start with testing the brain using standardized memory tests that are reliable and reproducible. This way the patient can see the results of our efforts together to improve memory. This is an addition to using the MRI/ Neuroquant technology and less invasive for those who may not require MRI.

The holistic approach to sleep, memory and hippocampal health

Why are we losing battle against early cognitive decline and Alzheimer’s? Unfortunately, conventional medicine in spite of the present technology  is sticking to the old dogma that dementia, early cognitive decline and certainly alzheimer’s has no prevention or cure. Sad but true. There are literally hundreds of published case studies refuting this and yet the same old excuses are being used! Thankfully doctors like Dr. Dale Bredesen, author of The End of Alzheimer’s are starting to breakthrough and more patients are becoming educated along with their providers.

Since 2006 NeuroQuant Software has been approved by the FDA. Neuroquant technology allows your provider to view your brain MRI beyond the ordinary measures. It is very common for patients to go for a brain MRI due to symptoms of early cognitive decline, neurological symptoms of tingling numbing, facial pain, symptoms associated with Multiple Sclerosis, head traumas, or dementia. When the MRI report comes back the patient is happy to hear the results are normal. They are then left stuck with symptoms in the absence of any meaningful explanation.

Here is where NeuroQuant technology can really make a difference in diagnosis and clinical outcomes for people suffering with symptoms. Neuroquant measures the volume of your different brain structures compared to healthy controls of the same age and gender. Changes in brain volume can be signs of disease states or early warning signs. Think about your brain structures like muscles, each carrying out specific functions. What if one of your muscles start to atrophy or become smaller? You lose function. It appears to be similar in the brain. Structures can also swell as occurs with injury. Either way, this identifies a change in brain structure.

Real time changes in memory and other brain functions like attention are screened initially and  the monitored for progress using computer based cognitive screening including the following tests: verbal and visual memory, finger tapping (motor testing), attention and continuous performance test. https://www.sciencedirect.com/science/article/pii/S0887617706000837

A pathway to improving your sleep and memory

In my practice, I often have people that come in with multiple chronic symptoms ranging from poor sleep and brain fog to digestive problems, asthma, and environmentally acquired illness. One common symptom they share is lack of quality sleep. If you are not sleeping well,  it is nearly impossible to heal. One part of your treatment plan is to get you sleeping better while we sort out the causes of your concerns. In my seventeen years of experience sleeping medications are not required to accomplish improved sleep. This can be done through several natural methods once we take the time to discuss what the issues are regarding your sleep and layout a plan to have you sleeping soundly. When sleep improves, alertness and memory will follow!  

If you have found this information helpful and are in need of improving your memory, sleep, and overall quality of life, I invite you to use the appointments tab on this site to schedule your one hour initial consultation with me. http:// http://doctormattintampa.com/schedule-an-appointment/

Here you can read more about how I approach each patient individually. http://doctormattintampa.com/understanding-my-personal-approach-to-doctoring/

By: Dr. Matt Lewis D.C., DACBN, CFMP®

It’s been a few months since I have updated my blog. So, where was I?

It’s been a challenge to write while balancing my Tampa Functional Medicine practice, family life, and studying. I figured all that out, sort of! I am happy to be back to writing!

The purpose of my blog is to educate health care consumers on a range of health care topics, and most importantly help you to find the root cause of your health concerns. Since starting my blog, I am happy to say there are many patients who have reached out for more information in a one on one setting.

Besides that, what has really left me busy in the last few months….I have been in the “hole” reading through a borage of papers and books concerning CIRS-Chronic Inflammatory Response Syndrome. Over the last four years I have been engaged in testing patients for CIRS- mostly due to mold (more accurately, exposures to biotoxins in water damaged buildings) and Lyme biotoxin. I decided to take the plunge to learn the Shoemaker Protocol for CIRS- biotoxin illness through Dr. Ritchie Shoemaker and I am currently in the certification process.

In January 2019, I attended the Meeting of the Minds Conference in Ft. Lauderdale, FL. It was a three-day conference, bringing together mold remediators, inspectors, and physicians who treat CIRS patients. If you are not familiar with what CIRS is-let me explain.

What is Chronic Inflammatory Response Syndrome – CIRS?
Chronic Inflammatory Response Syndrome occurs when a genetically susceptible individual is exposed to a biotoxin and as a result becomes chronically ill over a period that usually spans years. The most notable exposures are to a host of biotoxins and inflammagens found in a water damaged building or home. This is more common than you might think. According to the World Health Organization, 50% all buildings/ homes are water damaged in the United States. Another common cause is the toxins associated with Lyme disease. There are other causes of CIRS, but for now these are the two most commonly recognized, i.e. living or working in a water damaged building or post Lyme disease.

Below is the extraordinary list of inflammagens found in a water damaged building: It’s not just mold!

Symptoms of CIRS
The Most Common Symptoms Include:
• Brain fog, loss of concentration, loss of verbal recall
• Chronic fatigue- usually misdiagnosed as chronic fatigue syndrome
• Muscle aches and pains- usually misdiagnosed as fibromyalgia
• Abdominal pain or GI dysfunction – often misdiagnosed as leaky gut, SIBO, IBS
• Respiratory symptoms, chronic sinuses, coughing
• Anxiety or depression

There are more symptoms. In fact, there are 37 symptoms grouped into 8 clusters for purposes of analysis. If a person has 8 or more clusters there is a greater than 80% chance that they in fact have CIRS. These symptoms must be reviewed with a health provider with a proficiency in CIRS. Other reasons for the symptoms must be ruled out and some symptoms on the check list require a deeper dive, or interrogation by the practitioner to discover more about the symptom.

For example: I have had patients when asked “do you get leg cramps?”, they say “no, not really”. However, when I ask again in a more specific manner “do you have cramps in your legs at night that are painful or wake you up”, “or do you feel your fingers lock at times?”, the response may change. “Oh, yes, I do, but it’s just one or two times per week”. This is relevant, there is a reason for the cramping, and it should be accounted for in order to properly diagnose. It’s also nice to see that symptoms of cramping often resolve in a few short weeks following treatment.

Genetics Play a Role in CIRS
When encountering a biotoxin the normal immune system response it to tag it, bind it, and eliminate it from your body. For those with certain types of HLA-DR genetic codes they are less capable of eliminating toxins and more likely to acquire a chronic inflammatory response that will cause a host of unrelenting symptoms. Reduced biotoxin elimination allows toxins to remain in the body.
The HLA-DR genetic variances are geared towards increasing inflammation throughout the body, hence the diagnosis- Chronic Inflammatory Response Syndrome. This is accounts for 24% of the population that is genetically susceptible. Of course, not all those 24% will be exposed or will suffer once exposed. The genetic predisposition explains while some in a home that has hidden or exposed mold will become ill, while others will feel just fine.

When I consult with patients, it’s quite common that most people in the home have at least some of the symptoms associated with CIRS. Those who are least affected don’t usually attribute the problems to mold or the indoor environment, but once we discover the AC unit that needs cleaning or the musty odor that was coming from the closet, maybe a leak in the plumbing and clean up the problems, their symptoms often go away! Those with CIRS will remain sick even after the exposure is improved. They might find some symptoms resolving but not completely. They can go from twenty symptoms to ten, but the inflammation remains. The CIRS patient requires proper diagnosis and treatment and so rarely do they get it! When was the last time a doctor asked you “Are you exposed to any musty smells or visible mold at home or work?”

If you can’t get rid of the toxin, the immune system stays indefinitely charged. A CIRS patient can leave the water damaged structure or be treated for Lyme disease but remain with symptoms and chronic illness.

CIRS Targets the Brain
The chronic inflammation that ensues creates a type of cytokine storm. Cytokines are immune messenger chemicals that tell the body to create more inflammation. In CIRS patients, cytokines act on the brain, particularly grey matter nuclei in and around the hypothalamus. These cytokines irritate the receptors in these very important control centers of the brain, leading to abnormal secretions of neuropeptides and hormones. In lay terms, this means the control centers of the immune system, temperature regulation, hormonal control and cognitive function start to shut down.

CIRS is Not an Allergy
CIRS patients can typically present with over 20 active symptoms that are seemingly disconnected to the many patients and the physicians they have visited.
Let me be clear here, CIRS is not an allergy! It is not an allergic response to mold. It is an inflammatory response to mold that is caused by an upregulation of the innate immune system and increased cytokines. You can also have symptoms that appear to be an allergy, but that is a distinct entity from CIRS. Why is this so important to understand? Because, allergists will say you have a mold allergy. Does that explain your brain fog or gut problems? No.

How about when the doctor says I checked and you have no allergy to mold, yet you are suffering. Well, I can tell you one thing if you don’t have an allergy that is identified you are now one step closer to a CIRS diagnosis. Patients with CIRS often present with what appears to be mast cell disease (allergic type responses), but this is due to activation of complement cascade with C4a leading the charge. This is tested as part of the Shoemaker protocol and diagnostic workup. Go back and look at the symptom checklist, is it all allergy? No way!

Diagnosis and Treatment

A trained practitioner can spot CIRS. CIRS can be identified in children and adults. Children will present with 6 clusters of symptoms, while adults will usually have 8. Children will often express behavioral issues or anxiety, stomach pain, and congestion. This could be severe or mild in terms of neuro-cognitive symptoms or development. Children or adolescents with POTS postural orthostatic hypertension are often found to have CIRS. Adults will have brain fog, loss of concentration and many other aggravating symptoms including restless sleep. You can refer to the list provided early in this post.

• Typical blood tests are usually normal. Using conventional labs like LabCorp and Quest, CIRS can be diagnosed. We look for altered hormonal balance by checking markers like MSH, VIP, ADH, and ACTH. You don’t need to be familiar with these now, but you will if you have CIRS. Immune markers are checked including TGFB1, MMP-9, and C4a, same rule applies. In future blogs I will go through these in more details. For now, we need to understand that these need to be checked if you meet the symptom criteria and have a history of previous or ongoing exposure. I should also mention that there is a lot of misdiagnosis going on here. CIRS can cause autoimmune responses and appear similar to Lupus, Gluten sensitivity, and be the underlying cause for thyroid illness.

• Brain MRI is usually normal. When we add Neuroquant to the MRI, we find the problem in the grey matter nuclei of the brain, there is atrophy or loss of size in specific brain structures. Neuroquant is a technology that can more finely measure structures on an MRI, checking for changes in volume against controls. Neruoquant testing can help differentiate Mold or Lyme, each showing a different fingerprint on the brain. Most patients I check have CIRS due to water damaged building. Some have had Lyme and then can’t improve because they are in a water damaged environment. Either way, it’s CIRS that often needs to be treated, once the cycle of antibiotics has failed for Lyme patients.

• Nasal swabs will show hidden biofilms that are not infections but antibiotic resistant bacteria that are releasing their own form of biotoxin, furthering the out of control immune response in CIRS. This is termed MARCoNS. Multiple Antibiotic Resistant Coagulase Negative Staph.

• Genie testing, a genetic test that looks at gene activation and what proteins are being made by the messenger RNA in real time can be used to asses the inflammatory response. This is not a 23&me test that tells you about genetic SNPs that will never change. This type of testing can tell the provider and patient what genes are currently activating. What is being expressed at this very moment in time. CIRS patients have a specific pattern where the genes for mitochondrial function and inflammation are being over expressed. This is cause for concern with regards to autoimmunity and chronic fatigue. Follow up studies can show the genes functioning more normally, showing a resolution of the Chronic Inflammatory Response.

• Diagnosis my also include Stress Echo, Vo2 max and additional lab testing. This is can help rule out other conditions as well as confirm CIRS, and monitor progression of CIRS treatment.

• All throughout treatment we redo tests to see the positive changes and move to the next phase of treatment. Treatment starts with binders and finishes with peptides if necessary. Vasoactive intestinal peptide can literally reset the immune system and result in improved expression of genetics, as well as improvements in brain MRI as seen on Neuroquant.

• It is not advised to start any treatment with binders, (prescription or natural) until a full assessment and diagnosis has been made.

Now that you have read through this article in its entirety, if you believe that you may be suffering with CIRS, don’t wait to be seen. The longer it takes to address CIRS, the more challenging it can become to treat. I know, because I too was exposed several times to a water damaged home and workplace, and I have the genetics for CIRS. Like many of the CIRS providers I was led to focus on this in practice out of my own experience. It took me over seven years to find an answer, and I already knew a lot of doctors! Now that I am equipped to handle CIRS cases, I am overjoyed seeing how well patients can heal even after feeling sick for so long without answers! I am here to be your guide.

Shoemaker R, House D. A time-series of sick building syndrome; chronic, biotoxin-associated illness from exposure to water-damaged buildings. Neurotoxicology and Teratology 2005; 27(1) 29-46.

Shoemaker R, Rash JM, Simon EW. Sick Building Syndrome in water-damaged buildings: Generalization of the chronic biotoxin-associated illness paradigm to indoor toxigenic fungi; 5/2005; Pg 66-77 in Johanning E. Editor, Bioaerosols, Fungi. Bacteria, Mycotoxins and Human Health.

Shoemaker R, House D. Neurotoxicolhttps://www.survivingmold.com/Publications/VIP_AN_GALLEY_PROOF_3_20_2017.PDFogy and Teratology 2006; 28: 573-588.http://www.fungalresearchgroup.com/files/61153352.pdf


Disclaimer: The information in this blog post is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this post should be construed as medical advice from Dr. Matt Lewis, D.C., DACBN, CFMP®, nor is this post intended to be a substitute for medical counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.
About the Author: Dr. Matt Lewis, D.C., DACBN, CFMP®, specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing in Tampa, Florida. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his Diplomate status in Clinical Nutrition from the American Clinical Board of Nutrition, his CFMP® from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), he has learned how to restore his own health and vigor to prevent the onset of these and other illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa.

By: Dr. Matt Lewis D.C., DACBN, CFMP®

Persistent fatigue is a tough mystery to solve. Causes include anemia, anxiety, depression, infection, cancer, chronic fatigue syndrome (CFS), poor diet, too little or too much exercise, poor sleep, liver or kidney disease, and the list goes on. One of the most overlooked conditions that can cause fatigue is autoimmune gastritis— a chronic inflammatory disease in which the immune system mistakenly destroys parietal cells— cells that produce the stomach acid and intrinsic factor (IF), which the body needs to be able to absorb vitamin B12.

As a result, people with autoimmune gastritis often suffer from pernicious anemia — a condition in which the body is unable to absorb the vitamin B12 needed to manufacture healthy red blood cells. Without sufficient numbers of healthy red blood cells to carry oxygen throughout the body, it is no surprise that people with pernicious anemia suffer persistent fatigue.

When we think about autoimmunity, a few specific conditions come to mind including rheumatoid arthritis (RA), multiple sclerosis (MS), juvenile diabetes, hyperthyroid, and Lupus. Of course, there are others.

What we don’t often consider are the less discussed or less aggressive autoimmune conditions that can have a large impact of how we feel day to day, lead to more progressive illness, and are often associated with the development of additional autoimmune conditions.

Unfortunately, conventional medical doctors often overlook autoimmune gastritis in patients who report chronic fatigue. They may test for anemia and treat it with iron supplements or test for B12 deficiency, see that your B12 level is fine, and never consider whether your body is actually able to absorb and use that B12. Even worse, some people who report fatigue are simply diagnosed as having Continue reading…

By: Dr. Matt Lewis D.C., DACBN, CFMP®

The Plant Paradox Book CoverQuick-fix diets often single out one component of food and blame it for all of our health woes. Shortly thereafter, products begin popping up on shelves that are fat-free, gluten-free, wheat-free, sugar-free, and so on. That brings me to a recent diet that is beginning to gain traction — the lectin-free diet promoted by Dr. Steven Gundry in his book The Plant Paradox: The Hidden Dangers in “Healthy” Foods That Cause Disease and Weight Gain.

In his book, Gundry asserts certain plant proteins called lectins are primarily responsible for a wide range of chronic illnesses, including obesity, autoimmune disorders, and cardiovascular disease. Critics argue that Gundry fails to back up his claim with scientific research, using only his own and his patients’ results on the diet as clinical evidence of its effectiveness.

Others question whether his dietary recommendations are sound. For example, the lectin-free diet calls for replacing whole grains with white bread and white rice, even though these refined grains have been linked to spikes in blood sugar levels.

Where do I stand on The Plant Paradox? Somewhere in between Gundry and his critics. Placing a limit on the amount of lectins consumed in some populations — people with arthritis and autoimmunity, for example — certainly makes sense. However, I believe the book Continue reading…

By: Dr. Matt Lewis D.C., DACBN, CFMP®

As a Tampa doctor trained in functional medicine and integrative healthcare, I take a patient-focused, integrative approach to doctoring. That is, instead of merely diagnosing and treating illness, I focus on restoring health by addressing the root causes of illness, which are unique to each patient. These causes of illness include everything from genetic susceptibilities to environmental toxins and pathogens to diet and exercise and even psychological and emotional states.

This approach to doctoring is standard practice in functional medicine. However, each functional medicine doctor has his or her own approach to doctoring and to managing his or her practice. In this post, I describe my personal approach to doctoring and practice management, so you can:

  • Compare my approach to that of other doctors.
  • More effectively team up with me to restore your health, if you choose to become one of my patients.

Earning Patients

I do very little marketing to build my practice. Instead, I earn my patients through referrals from several sources:

  • Other patients — typically a friend, relative, or colleague I helped with a similar health issue or concern.
  • Conventional doctors who are “stuck” with a patient’s health issues and realize a different approach is needed (especially those who have had experience with my methods and witnessed the profound improvement in these most difficult cases).
  • Other natural healthcare providers who do not practice functional medicine but understand its value and prefer an approach that helps their clients avoid the automatic application of pharmaceuticals or invasive medical tests and treatments.
  • Personal trainers or nutritional or health coaches whose client are frustrated because they have plateaued.

I am not the only provider in functional medicine who can attest to how well patients perform when they have a different option and more time and attention during office visits. Unfortunately, in the current healthcare system, too much is Continue reading…

By: Dr. Matt Lewis D.C., DACBN, CFMP®

Year after year, parents, mostly moms, bring their children into my office seeking treatment for chronic ear, sinus, or respiratory infections. Their stories are remarkably similar — they have been bringing their child to their pediatrician or family doctor who has prescribed round after round of antibiotics, rarely, if ever, mentioning a cause for the recurrent infection or suggesting an alternative treatment plan.

In conventional medicine, the traditional thinking is deeply entrenched — the go-to treatment for any suspected infection is an antibiotic.

However, this approach is deeply flawed for several reasons, including the following:

  • Antibiotics are effective only for treating bacterial infections. Ear, sinus, and respiratory infections are often viral or fungal infections that antibiotics cannot clear up. Rarely do doctors test to determine the nature of the infection before prescribing an antibiotic.
  • Antibiotics kill both harmful and beneficial bacteria. Beneficial bacteria are essential for healthy digestive and immune systems. The antibiotics your child is prescribed may do more harm than good in the long run.
  • Infections often occur in places that antibiotics cannot effectively reach or penetrate, such as the Continue reading…