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In this episode, you will learn about the root causes of CIRS including Actinos and endotoxins.

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About My Guest

My guest for this episode is Dr. Eric Dorninger.  Eric Dorninger ND, LAc is a Registered Naturopathic Doctor and Licensed Acupuncturist. He graduated from Bastyr University, the leading accredited university for science-based natural medicine.  Prior to medical school, he received his B.A. in Kinesiology from the University of Colorado, Boulder in 1997. During this time he also finished his E.M.T. (Emergency Medical Technician) training and volunteered at Porter Care Hospice in Denver. This dual exposure of medical perspectives laid down the roots for Dr. Dorninger’s integrated approach to diagnosis, treatment, and healing.  Following undergrad, Dr. Dorninger served as an EMT for the Cranford First Aid Squad in Cranford, NJ. He then completed his doctorate in naturopathic medicine and his master’s degree in acupuncture at Bastyr University in 2003, after which he returned to Boulder, Colorado to complete a 2-year residency in naturopathic primary care.  In 2005, Dr. Dorninger founded Roots and Branches Integrative Health Care, a clinic dedicated to “Mystery Illness” where he focuses on elucidating the underlying causes of unrelenting chronic illness.  Dr. Dorninger is not concerned with what you have as much as he is with why you have it. He has dedicated his professional life to a deeper understanding of differential diagnosis based in the tradition of “Remove Obstacles to Cure.”  After the 2013 floods in Boulder, Dr. Dorninger noticed that patients who were initially getting better suddenly regressed. Moreover, patients he was struggling to diagnose got worse.  Fortunately, he was guided to the honest, data-driven, peer-reviewed, reproducible published work of Dr. Ritchie Shoemaker on mold and biotoxin illness. In 2014 Dr. Dorninger signed on for his Shoemaker certification training.  Dr. Dorninger is a certified Shoemaker practitioner and remains true to the Shoemaker protocol.  According to Dorninger, diagnosing underlying causes and facilitating accurate treatment plans is a grind. At Roots and Branches, we embrace the grind.  In addition to private practice, Dr. Dorninger teaches functional medicine for Apex Energetics, practices Jiu-Jitsu, skis, and enjoys watching his biotoxin-genetically susceptible kids thrive post chronic inflammatory response syndrome (CIRS) treatment.

Key Takeaways

  • What are the root causes of CIRS?
  • What is the difference between endotoxins and lipopolysaccharides?
  • Do Actinos or endotoxins trigger MCAS?
  • Should Actino and endotoxin testing always be done along with the ERMI?
  • Is there still a place for HLA-DR?
  • What has GENIE revealed about patients with CIRS?
  • How should Actino and endotoxin testing be evaluated?
  • Are soil habitat Actinos a contributor to CIRS?
  • What is the role of Actinos on the skin?
  • What drainpipe maintenance should be considered to reduce exposure to Actinos?
  • What steps should be taken to optimize our sleep location?
  • Do air filters play a role in reducing Actinos and endotoxins?
  • What is the role of Cholestyramine in dealing with Actinos and endotoxins?
  • Can Actinos be found in the blood?
  • Might there be a place for antimicrobial interventions in dealing with Actinos?

Connect With My Guest


Interview Date

November 29, 2023


Transcript Disclaimer: Transcripts are intended to provide optimized access to information contained in the podcast.  They are not a full replacement for the discussion.  Timestamps are provided to facilitate finding portions of the conversation.  Errors and omissions may be present as the transcript is not created by someone familiar with the topics being discussed.  Please Contact Me with any corrections.  


[0:00:01] ANNOUNCER: Welcome to BetterHealthGuy Blogcasts, empowering your better health. Now, here's Scott, your BetterHealthGuy.

[0:00:14] ANNOUNCER: The content of this show is for informational purposes only, and is not intended to diagnose, treat, or cure any illness, or medical condition. Nothing in today's discussion is meant to serve as medical advice or is information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.


[0:00:34] SCOTT: Hello, everyone, and welcome to episode 193 of the BetterHealthGuy Blogcast Series. Today's guest is Dr. Eric Dorninger, and the topic of the show is Actinos as a Root Cause of CIRS. Dr. Eric Dorninger is a registered naturopathic doctor and licensed acupuncturist. He graduated from Bastyr University, the leading accredited university for science-based natural medicine.

Prior to medical school, he received his BA in kinesiology from the University of Colorado, Boulder in 1997. During this time, he also finished his emergency medical technician training and volunteered at Porter Care Hospice in Denver. This dual exposure of medical perspectives laid down the roots for Dr. Dorninger's integrated approach to diagnosis, treatment, and healing.

Following undergrad, Dr. Dorninger served as an EMT for the Cranford First Aid Squad in Cranford, New Jersey. He then completed his doctorate in naturopathic medicine and his Master's degree in acupuncture at Bastyr University in 2003. After which, he returned to Boulder, Colorado to complete a two-year residency in naturopathic primary care. In 2005, Dr. Dorninger founded Roots and Branches Integrative Healthcare, a clinic dedicated to mystery illness, where he focuses on elucidating the underlying causes of unrelenting chronic illness.

Dr. Dorninger is not concerned with what you have, as much as he is with why you have it. He's dedicated his professional life to a deeper understanding of differential diagnosis based in the tradition of remove obstacles to cure. After the 2013 floods in Boulder, Dr. Dorninger noticed that patients who were initially getting better suddenly regressed, and patients he was struggling to diagnose got worse. Fortunately, he was guided to the honest, data-driven, peer-reviewed, reproducible published work of Dr. Ritchie Shoemaker on mold and biotoxin illness.

In 2014, Dr. Dorninger signed on for his Shoemaker certification training. He is a certified Shoemaker practitioner and remains true to the Shoemaker protocol. According to Dr. Dorninger, diagnosing underlying causes and facilitating accurate treatment plans is a grind. At Roots and Branches, he embraces the grind.

In addition to private practice, Dr. Dorninger teaches functional medicine for apex energetics, practices jujitsu, skis, and enjoys watching his biotoxin genetically-susceptible kids thrive post-chronic inflammatory response syndrome treatment. Now, my interview with Dr. Eric Dorninger.


[0:03:12] SCOTT: I am excited today to dig into a topic that I've found of much personal interest, but not been able to find a lot of clear information about to date, that is Actinos as a Root Cause of CIRs. Thanks for being here.

[0:03:25] DR. DORNINGER: My pleasure.

[0:03:26] SCOTT: First, talk to us a little about your personal connection to CIRS and to biotoxin illness. Why did you choose to make treating CIRS a major focus of your work? What drives your passion today?

[0:03:39] DR. DORNINGER: Yeah. A lot of people have heard my story, so maybe I'll give a little bit extra insight. Mrs. Sabrata, my sixth-grade teacher, gave me a book on Albert Schweitzer, and she thought I was going to be a doctor. For those of you who don't know Albert Schweitzer, he was a great philanthropist, medical doctor, who could play these beautiful concertos and would raise money all over Europe and then set up clinics in Africa for healthcare deprived regions, and really serve the rest of his life.

I read the story of Albert Schweitzer, and I remember just being enamored with service work. Then I thought I wanted to be a firefighter for a while. I would rescue every cat in the neighborhood and thought I wanted to be a vet. At the end of the day, all I wanted to be in is the party captain at my last years in high school and in my first couple of years of CU. Then I went through my own healthcare crisis and I'll spare you the nitty-gritty details on that. I basically dropped to my knees and asked God to stay on this planet.

I did the classics of counseling, of grieving, anger, bargaining. I made my contract to make sure that if I got to stay on this earth, that I would help others. I was having massive arrhythmia and I went to a conservative ER, emergency room in Dennison, Ohio. I said, I'm just going to try honesty out for my life. I told the nurse everything I've been doing, everything I've been polluting my body with. She said, “Serves you right. The cardiologist will be right in with you.” Did a 180 click out of the room. I was like, “That's what I get for telling the truth? Well, all right. No compassion for you.”

The cardiologist came in. He said, “The good news is you didn't have a heart attack. You had a massive arrhythmia. You got to be careful.” I said, “Well, I'm ready. What should I do to take care of my heart and my health?” He said, “Don't drink. Don't smoke. Don't eat spicy foods.” I was like, “That's it?” At the time, I was dating Brigitte Mars’, a renowned herbalist, daughter Rainbeau Mars, and had access to Brigitte's library. I would read everything about constituents of herbal medicine and the most hardcore, beautiful biochemical constituents of herbs and how to apply them.

Then I would read a book on how a Chinese practitioner would read the soul of a shoe to make a diagnosis and everything in between. It was like being in the Hogwarts of integrated medicine in her library. I started talking to friends about my health care experiences. I shared a vision of what healthcare should and could be to a platonic girlfriend of mine, Bonnie. She goes, “Yeah, that's called naturopathic medicine. There's a school for that in Seattle, and Portland, Oregon, and Arizona.”

I had to clean up my grades. I had my sense of purpose, which I think is the most concerning thing for our youth is they don't have a sense of purpose. Young men are extremely dangerous without a sense of purpose. They just have too much testosterone and power. If they don't know how to build things, they'll destroy things. I was talking to her about, why didn't they help me understand my heart and figure out how to take care of my heart and yada, yada, yada.

I went on this thing called the internet, right? It had Bastyr University address, the telephone number, National College Naturopathic Medicine, which is now National University in Southwest. I got my shwag bag and I started getting exposed to Joe Pizzorno was doing such a good job promoting therapeutic order, which was really, he's incredible, but it was on the backs of Jared Zeff and Pam Schneider, and some of the old guard who was carrying the principles of naturopathic medicine, holding that very delicate flame.

The number one step in the therapeutic order is remove obstacle to cure. You can say it in an old school voice, right? Remove obstacle to cure. We have modified it, or modernized it to identify and treat the underlying causes, right? I saw that. The clouds parted and I said, “This is what I want to do.” The patient always knows what they have. They have a headache, right? Migraine means half head pain. You tell the doctor that your head hurts and they tell you in Greek, your head hurts, right? Fibromyalgia. You tell the doctor your muscles heart, yeah, and they say, “You have fibromyalgia.” You say, yeah, I have Google. I looked that up. Algia means pain and myofibril means muscle fiber. I just told you in plain English, my muscles hurt and you told me in Greek, your muscles hurt, right?

Now let's pick on the naturopaths. Adrenal fatigue. No, I will do a dexamethasone challenge and I will get cortisol out of those tired adrenal glands. Your adrenals are not fatigued. You can have dysregulation, hypothalamus, pituitary dysregulation, where inflammation from some source is corrupting the brain adrenal axis signaling of morning cortisol. If you have adrenal fatigue, you better show me 21-hydroxylase, or anti-adrenal autoantibodies and Addison’s. That is a true tired adrenal; most of our patients.

I challenge everything, mostly politely. I realized I have to clean up my act. My grades suck, and I was asking some colleagues like, “Okay, I know I got to get straight A's and blah, blah, blah, and pass organic chemistry. But what can I do?” Someone recommended volunteering hospice looks really good on a resume. Then that University of Colorado Boulder offered an EMT, emergency room training and running with the ambulance through Longmont United, just north of CU. I did those two things and those changed my life, because they showed me the best of conventional model.

It was ironic that I was helping people die with dignity during the day and I was doing everything in my power to make sure someone didn't die with my nights. I got to see the best of conventional model and I really struggled between emergency room medicine. I thought I wanted to be an ER doc, and naturopathic medicine.

What I realized is that the ER does a great job making sure we don't die today. It's extraordinary. It's brilliant. It's amazing. It deserves celebration. Bring them a nice gluten-free cake and say, thank you for all your hard work. Then they just discharge you to your chronic illness and not enough healthcare providers were there to pick that up. That's why I went to Bastyr. Unfortunately, I fell butt backwards into some of the best mentorships, where people are still looking for the underlying cause.

The modern integrative functional medicine practitioner is getting vulnerable to modality selling and supplement sales, rather than drilling down for underlying causes. We need to use our brains to say that these could be the 100 reasons you have a headache and then we need to use validated data, call your medical directors and challenge them on clinical validation of the labs you're ordering, if you're an integrative practitioner. Then you order the data to say, “Yes, it is,” or, “Yes, it is not participating in that headache.”

And total load. The other thing I fell in love with with naturopathic medicine was multi-factorial causes of a headache. It is not a straw that breaks the camel's back. It is all the straws. That's where naturopathic medicine really got me out of this. We found penicillin, it gets rid of Strep. Everything must have a drug for symptom solution with no side effects. That's nonsense. That's my journey to getting into my next chapter, which is biotoxin illness.

[0:11:02] SCOTT: To provide some context then for listeners, we're going to talk today about Actinomycetes, or Actinos as a contributor to CIRS, or Chronic Inflammatory Response Syndrome. Actinos are gram positive bacteria, common in soil, in and on humans, also in indoor environments. They do have some overlapping characteristics with fungi as they produce mycelium. They also produce spores, as I understand. More recently, Dr. Shoemaker said that Actinos may account for 42% of the contribution to CIRS, endotoxins 28%. Even more recently, I've been learning about beta glucans, possibly 23% of the contribution. Mold and mycotoxins surprisingly, only now 7%. Wondering if you can talk to us a bit about the shift from CIRS being more mold and mycotoxin trigger to now being more bacteria and endotoxin triggered. Is this still “mold illness”?

[0:12:00] DR. DORNINGER: You probably know Dr. Scott McMahon, my bestie and brother from another mother. We co-founded CIRSx, which is basically carrying the flame of Mold Congress and the Surviving Mold conferences. Because running a conference is a real pain in the keister. You don't get paid for it. It's hundreds of hours of volunteer work. We have to keep a rigorous academic challenge conference going, where people can bring data. Everyone can learn, mull over it, chew on it, so on and so forth.

I have the privilege of being in the inner circle of Dr. Ritchie Shoemaker. I will tell you, sometimes he doesn't share in one concise statement what's been going on over the last 10 years. This concept of mold is the only cause of CIRS in a building envelope is something he's never felt. He's talked about endotoxin, which is sewer gas, poop, caca, stool, dookie, manure, doo-doo for 20 years. He's talked about water-damage building bacteria known as Actinobacteria, which Actinomycetes is one of those for 20 years.

He didn't have commercial testing to evaluate the building. He couldn't test his theories. What we had is the ERMI and the HERTSMI to evaluate for water-damage building mold. Fast forward, and PCR, which is the similar technology for ERMI, PCR is quantitative preliminary chain reaction, is basically the same technology they use on Law and Order with Ice-T and Olivia Benson for finding out who'd done it. Is it Jimmy's sperm cell, or hair cell, or someone's skin cell, where you amplify DNA. Steve Vesper, the EPA said, “Let's see if we can amplify the DNA of water damage building molds and traditional soil molds in a home.”

We didn't have that for Actinobacteria. We didn't have that for endotoxin. Then next NGS, called Next Generation Sequencing, is a megashift in technology to identify microbes. David Lark worked with helping EnviroBiomics and Gianni Rossi, he really gets set up with offering some of that. Then Dr. Shoemaker was finally able to start evaluating building envelopes for endotoxin and Actinobacteria.

The other thing with your percentages, those are mainly based with brain MRI with NeuroQuant. When we see brain atrophy on NeuroQuant, when we see brain atrophy on NeuroQuant, the majority are driven by endotoxin. I will tell you, sewer gas is way more violent statistically than molds for shrinking your brain, right? Mold will crash that caudate. Mold swells the cortical gray and the forebrain parenchyma.

Water damage CIRS, water damage building molds, swells the frontal cortex, your forebrain parenchyma and swells the cortical gray. For listeners, if you cut a Twinkie in half, that yellow cake part of the Twinkie is the gray matter. That will swell as a micro edema with CIRS water damage building molds, which feels like a hangover. For endotoxin, it shrinks, the cortical, the Twinkie shrinks, the cortical gray matter shrinks.

The majority of atrophy is seen with endotoxin, poop, sewer gas, manure, caca. Second is Actinobacteria shows multi-nuclear atrophy, many different regions of your brain shrink. Then mold is the caudate shrinks. Then what about beta-glucan? Remember for our listeners, we're talking about the microbial stew. One of the things when we were talking, you asked me about using the ERMI as a basic index for water damage. The answer is yes, but it's not enough. You still need the odor and endotoxin and Actinobacteria.

But Actinobacteria literally have enzymes that eat fungal and create beta-glucan fragments, right? What I just said is if you have fungus and Actino in the same building, you're probably going to have beta-glucans. This is why one of the biggest things I want to make sure your listeners know, this is why if you have water damage, it needs to come out. Do not let anyone sell you on an ozone bomb, or a fogger kit, or a mold plate. Because remember, I can show you mold on a plate, I can fog it and then show you a one-hour gravity plate. There won't be any microbes growing, because you may have killed mold. When you kill mold, for the listeners who aren't doing visual, I'm drawing a circle with my hands, if you do bleach, or you do an antimicrobial fog, or you do thyme oil, or whatever the flavor of the flaky day is, you are going to rupture that cell wall fragment, now draw that circle with dashed lines.

Those cell wall fragments are hundreds of times more stimulating to your innate immune cytokine. TGFbeta, C4A, MMP9 are going to flare much more, but they don't show up on a mold plate. Those cell wall fragments do get picked up by a QPCR, or MSQPCR, Swiffer cloth for ERMI and HERTSMI, and they do get picked up on a Swiffer cloth for Actinobacteria, aka Actinomycetes, and/or endotoxin, right? That's where the industry maliciously, or just through ignorance doesn't realize that they just took a house and made it more sick for our patients with a fog bomb, or an ozone bomb, or bleaching it.

The husband is often the most guilty with bleaching it. Just bleach it. Sometimes in Texas, they shoot at the mold, right? When none of that works, you got to rip water damaged materials out like a cancer. Just like you cut out a cancer with clean borders, industry standard is to go 12 to 24 inches outside of anything that got wet, whether it's dry rot, or it's damp.

Dr. Shoemaker has been beating the drum the whole time. He just finally has technology to prove thoughts he had 20 years ago. You know Ritchie, and you know that he doesn't go public with something that's not proven. He's not a feelings guy. He's a fact guy. People who get turned off by him because he can be gruff and tough, he is the most lovable, incredible, extraordinary mentor a guy could have, because he challenges me on everything in the best interest of my sick patients’ time, money and energy. They do not have unlimited time, money and energy.

When someone comes in and they did 10 rounds of IV ozone to treat their CIRS, which is nonsense, I just wasted 10 rounds of IV ozone that I needed to fix a crawl space, right? Then the cash bleeds out and the tension goes up, and the marriages divorce, and the kid gets on Ritalin, and anything's happened because Dr. Shoemaker is so mean with all of his agitated factual thoughts. He's not going to go public with something. It was not proven.

Finally, we have the technology to prove that it is the microbial stew, the water damage microbial stew that can drive CIRS. That sometimes people are getting driven by Actinobacteria, but not mold. Sometimes people are getting driven by endotoxin, but not Actinobacteria. That's where GENIE and NeuroQuant are the only two tools that don't show specificity of CIRS. Dr. Shoemaker's confirmatory lab shows CIRS, but shows specificity of which biotoxins are driving CIRS.

[0:19:44] SCOTT: I want to talk a little bit now about the endotoxin contribution to CIRS. My understanding is these are not endotoxins related to Actinos, that those are actually gram positive, where endotoxins are coming from gram negative bacteria. Are endotoxins different from what we also call LPS, or lipopolysaccharides? What are the primary sources, or bacteria that are leading to these endotoxin exposures that are driving CIRS? Then related to that, are the endotoxins ultimately then making their way into the body, like the mycotoxins might be when we're talking about mold exposure?

[0:20:25] DR. DORNINGER: Yeah, that's a mouthful there, Scott. All right, let's tease it out. Gram positive and gram negative. Don't overthink this. If you're new to biochemistry, you put this purple stain on a bug. If it absorbs the ultraviolet color, it's gram positive. If it doesn't absorb, its gram negative, right? It's just a way to separate out microbes. Gram positive bacteria are Actinomycetes. Gram-negative bacteria are endotoxin, which is synonymous with lipopolysaccharides.

Now, what that means is the outer membrane of that bacteria breaks off and that's the endotoxin. What Scott's alluding to is E. coli. If I get a GI bug, E. coli is a gram-negative bug that releases E. coli toxin, which is a lipopolysaccharide, or an endotoxin. This is why we will give, our clinic gives Welchol, cholestyramine if you have E. coli, or Clostridium difficile, another gram-negative lipopolysaccharide, or C. diff toxin releasing, because as soon as that lipopolysaccharide gets released, you literally rupture your gut lining, right? If you want to create leaky gut in the rat model, you just inject them with LPS from endotoxin from E. coli, right?

This is why Wim Hof is so flipping crazy, because he injected himself with lipopolysaccharide from E. coli to prove that he could control inflammation through his breath method. Then he did it with 24 students, 12 healthy controls, 12 people that did, healthy people that did the Wim Hof breathing and the Wim Hof breathers managed their IL-6 and their TNF. That's what we think of as I got E. coli, or I took too many antibiotics and I got Clostridium difficile and now I have raging diarrhea.

If you ever take antibiotics for the providers out there, you need to co-prescribe, not only probiotics, but also Welchol, cholestyramine to mop up the lipopolysaccharide from that gut bug. What Scott and I are talking about today is sewer gas, poop, manure, caca, doodoo, baby diapers. What about memory care homes, where adults are sitting around in their poopy diapers? These are all sources of endotoxin, or lipopolysaccharide and we are talking about the inhalation of those freshies, right? We are talking about the inhalation of those lipopolysaccharide.

Just to put this into context of where we've caught elevated endotoxin on a home, we had one neighbor who, single mom with three kids, had three dogs who had so many landmines in the neighbor's backyard. She couldn't have tea on her deck, because it just smelled like one big pile of dog poop. That's what was contaminating the inside of her house.

We've had people whose horse barns aren't well maintained and too close to the home and that will contaminate. The biggest contaminator is a simple P-trap, which looks like the tube that looks a U underneath your sink, or in a floor drain, particularly in dry climates next to heating elements. If that thing's next to an HVAC, those will dry out and P-traps are simply profound and profoundly simple. When water is in there, that blocks sewer gas so you don't smell neighbor Johnny's poop coming into your home.

We also have a lot of people who are on septic in Colorado and we've had a lot of people with failed septic, or they have a piece of flagstone over their septic access, instead of a manhole lid with rubber membrane that seals tight. If you smell sulphury smells, if you smell manure, if you let your cat who pile up and you don't maintain your kitty litter box, well, if old yeller is crapping on the carpet, these are all sources of endotoxin for CIRS. That is inhalation of gram negative, lipopolysaccharide, or endotoxin releasing organisms.

[0:24:28] SCOTT: Similar then to what we're going to talk more about with Actinomycetes, it sounds like endotoxins are really distinctly different from water intrusion, water damaged building. It could be coming from drainpipes and P-traps and things of that nature, but they're not necessarily correlated to the leak that we had in the roof that might have gotten some drywall wet, or is there a connection to water intruded buildings as well?

[0:24:53] DR. DORNINGER: Unless, it's a poop pipe, then no. We all poop in the toilets that flush into a sewer main and then go out to a septic system, or a city sewer, or we have a composting toilet. That's why we have problems with composting toilets, right? How do you keep those clean? When we're camping and I'm going to composting toilet as a recovered CIRS patient, when I breathe, pardon my French, but I sit and shit and I get out of there, right? That's why when my kids, my teenagers go into the bathroom with their phones, they go, “No phones on the potty.” Because what they do, they poop, they sit in their own stink. It's like, sit, take a poop. If you're constipated, talk to your dad. He deals with constipation all day in the CIRS population, right?

In regards to, could it be from a leak, we have found pipes that are sources of sewer gas and poop, but they are plumbing pipes, right? What you do, if you really can't find the source of endotoxin is you get a plumber to do a smoke test. What you do with a smoke test is you basically pump theater fog, like you would on a theater stage for a Dracula play, or maybe Motley Crew has come in your town, they got all that theater fog going, right? You look for leaks in your plumbing. You can find pinhole leaks.

You open all your kitchen cabinets, you go to all your floor drains. For our affluent patients, some of these patients have 7,000-square-foot compounds, and no one has used the East Wing bathroom in months, or the guest room. If you're washing your hands, flossing your teeth, doing dishes, every time you're using that sink, you're going to refill that P-trap underneath. If there's any breach in the integrity of the pipe, or the joint, or you don't use it enough and the water in the P-trap is dried out, you're going to get theater gas coming out of there. Then you can go, ah, sometimes it’s as simple as pouring a gallon of water down there once or twice a month. Other times, you have a breach in your plumbing.

[0:26:56] SCOTT: Many people have discussed the potential contribution of mold and mycotoxins as triggers for mast cell activation syndrome. Do we know if exposure to Actinos, or endotoxins, or beta-glucans may also trigger our mast cells and histamine?

[0:27:13] DR. DORNINGER: We don't know. Let's talk about, I'll celebrate Keith Berndtson a friend of mine, who's not actively practicing anymore. I think you've had him on.

[0:27:22] SCOTT: He's amazing. Yeah.

[0:27:23] DR. DORNINGER: He’s amazing. What was then Mold Congress now CIRSx, Phoenix 2015. If you go to cirsx.com, I just curated all of the talks. Historically, we just had them by conference. If you went to the conference, I have more of an audiographic memory, so I remember how Keith spoke in Phoenix 2015. Now, we've organized them by topic, GENIE, Actinomycetes, endotoxin. This just got released the other day. I spent 24 hours curating it.

Marcia Cash spent 10 hours organizing it. It looks internet 1990s. We're going to keep sprucing it up, but we just wanted to get out there so people can learn more. Keith did a great talk and then Lysander Jim, who's actively practicing a wonderful medical doctor, a good buddy of mine, he also did some talks on histamine. Then we've asked Dr. Shoemaker about this. What we're seeing is about 20% to 30% of CIRS patients are histamine releasing people.

Now, you know Dr. Shoemaker hates the word MCAS and mast cell activation disorder, because it's improper nomenclature. It's not just your mast cells that release histamine, right? There are other cells that release histamine. On GENIE, how Dr. Shoemaker figured out GENIE is GENIE doesn't just look at SNP chip technology, right? MTHFR means you have a gene. Does it tell you if it's activated, or unactivated? No.

HLA is very, very helpful for biotoxin, because of Dr. Shoemaker's 10,000 biotoxin ill, 95% had genetic predisposition from HLA, 95%. To compare that, Caucasians with rheumatoid arthritis are 58%. Hashimoto's patients are 79%, HLA predisposition. 95% genetic predisposition on chromosome 6, your inflammatory response genes, for disease is massive. If I have a mom or a dad who's sick and they're worried about four-year-old little Timmy and they don't have two bad genes, we can just do a LabCorp cheek swab for HLA for $200 and I can tell you if the kids’ genetically susceptible to going into CIRS.

It doesn't tell us, is CIRS turned on? You had to add MMP9, TGF beta, C4A, C3A for acute Lyme, to see if you had chronic inflammatory response syndrome, if you were chronically spitting out inflammation. What GENIE does is it in real time shows if these light switch genes are turned on, manufacturing inflammation to specific biotoxins. For example, the CD14, the toll receptor 2, and the toll receptor 4 gene, they turn on from endotoxin, from sewer gas, from poop. The MAP kinases in conjunction with TGF beta receptor 1, receptor 2, receptor 3 gene, those turn on with Actinobacteria.

There's genes that turn on specifically for Lyme. There's genes that turn on specifically for Lyme, six months post-antibiotic treatment. There's genes that specifically turn on for mold and mycotoxin. Defenses come up for bacteria. There's a gene, FKBP5, that just turns on and manufactures inflammation from trauma. Wow, so that's changed my view on trauma.

What Dr. Shoemaker did in classic form is he took 70-plus healthy control people and pulled a GENIE on them. Then he pulled a 100 GENIEs on documented CIRS patients naive to treatment. Didn't get on cholestyramine, we’ll call you. Looked at thousands of genes with Jimmy Ryan, who deserves just as much credit as Dr. Shoemaker for this. Those two are like Batman and Robin, it's amazing.

What he did is he took the most statistically significant gene expression, upregulated or downregulated, turned on or turned off in the CIRS patients relative to healthy controls, and that is the GENIE. The reason that, and GENIE stands for Genetic Expression Inflammation Explained. It's the first time we don't just look at a SNP chip. 23andMe, Ancestry.com, they just tell you if you have a gene. They don't tell you if the gene is turned on manufacturing inflammation, or turned off, not manufacturing energy, ATP synthase. When that gene is blue on a GENIE, it means, you're not making energy, right? You're not making chi, prana, life force.

The reason I explain all that, Scott, is on there is two of the histamine genes. When those genes turn on, you're producing histamine. Per Dr. Shoemaker, and Dr. Jim Lysander, and Keith, Dr. Berndtson’s talk, we are seeing in our over a 100 GENIEs at this – about 200, 300 GENIEs at this point. We’re seeing about 20% to 30% have the histamine genes turned on.

[0:32:13] SCOTT: I'm going to come back in just a minute to HLA and GENIE, but I want to talk a little bit first about the environmental testing. How often do you find someone's external environment tests relatively clean, relatively well from a mold, from a mycotoxin perspective, yet, they still have CIRS, which is being triggered by Actinos, or by endotoxins?

Maybe put differently, do you find testing for the Actinos in the environment is now critical? Do you think we should be maybe leading with those tests and using the ERMI as an adjunct way of exploring the environment? What are your thoughts on the importance of testing Actinos and endotoxins relative to ERMI and HERTSMI2 based on what we know today?

[0:32:54] DR. DORNINGER: Yeah, maybe it's the name, Scott, like Dr. McMahon, my homie, but you might be my brother for another mother, because I asked David Lark to specifically speak on this for CIRS X, because we have all the same question, can you use the ERMI/HERSTMI as some kind of litmus test for could there be other bacteria? We have single moms with three kids driving up homeless in the station wagon, and every dollar matters, right? The short answer is no.

Every single patient we've documented with CIRS, we now do a ERMI or HERTSMI. Remember, HERTSMI is the five most immunoreactive molds for Dr. Shoemaker's work and is about $150 cheaper than an ERMI. If you're maybe entering a lawsuit, or needing to break a lease, it's always ERMI, because having more data on a building is better than less data. We don't do lawsuits, but Dr. Lysander Jim does, Dr. McMahon does, and they want the ERMI to show things like Aspergillus niger and Aureobasidium pullulans and all these other molds to potentially show that. But we have normal ERMI/HERTSMIs more often than I'd like with problematic Actinos and/or problematic endotoxin.

This goes into the – on cirsx.com, I put $22,000 in my own money in 2022 into polishing the Actino research. That's because, for those of you who don't know, Dr. Shoemaker put millions of his own dollars, instead of having a yacht, or a second house in Vale, he spent it on figuring out biotoxin illness pathway, so me and my family could be healthy and all the patients … can be healthy. Anyone who flexes or talks doo doo to about that man has a problem with me, because he is the most honest, generous scientist who dedicated his life to figuring out this mystery illness, which is an epidemic in our country. He put in all that money.

I was like, I can throw down for 22k in donated Actino swiffers and donated Actino skin swabs. What we found is if someone moves into new construction and they didn't screw up the plumbing and the P-traps haven't dried out, you'll see these beautiful endotoxin now and you'll see this beautiful HERTSMI, but the Actinos can be high. What happens is water damaged building bacteria, pathogenic Actinomycetes need an AW, need a certain level of moisture to grow. These pathogenic Actinobacteria particularly, Corynebacterium tuberculostearicum, which we nicknamed CT and Propionibacterium acnes, which we nicknamed PA, which is also Cutibacterium acnes; Propionibacterium acnes, Cutibacterium. I know you know this, Scott, but for the listeners, those are totally synonymous, right? Those are the pathogenic Actinomycetes.

What makes them different is they have mycolic acid in their cell wall. Mycolic acid is a super waxy fat. In chemistry, you call saponification, adding soap to a fat to see how much soap you need to break down that fat is saponification. Mycolic acid is like candle wax. It is in the cell membrane of Corynebacterium tuberculostearicum, Propionibacterium acnes. What we discovered is you can have them get their start in a water-damaged building, but then they can colonize somebody, just like MARCoNS can colonize you. Then you can vector them with you wherever you go.

With some of the work we did with Larry Schwartz on this, when we were throwing down that money, the bedrooms were the highest for P. acnes and CT. That's when we started saying, well, where does someone lay and shed and spread? The living rooms were high. In my CIRSx talk on Actinomycetes, The Problem is You, right? The point I was making is, “Hey, you are now the vector.” The Dorninger family had high Actino levels. We were on a duplex, 2,400 square foot boulder house, 1,200 over 1,200. We did about 90% of our living and everyone's bedroom was on the second floor. We were high on that floor. We were very low downstairs, where we'd occasionally watch a Super Bowl, or some Nuggets game, stuff like that, right?

You can buy a new construction and the construction workers could have shed and spread P. acnes and Corynebacterium tuberculostearicum. The good news is you can double-HEPA vacuum, and then either use soap-water solution, or Fantastik, a quat for our chemically sensitive people. We do more of the soap water.  For the people who don't mind a little Fantastik, that's an excellent way to knock that down. You can vacuum everything twice, damp wipe with a disposable Swiffer cloth over and over and over again. You go over it. It's full of dirt. You rip it off, put it on. You go over the same area. It's now light tan. You rip that off. You go over it again. The soapy Swiffer or the Fantastik is snow white. Now you're done with that area. You can reset a home.

Dr. Shoemaker was using the coal tar shampoo, Medicasp. That's a gas and oil, a petroleum derivative product. It works super good on scalp psoriasis over my last 20 years in private practice. My granola organic Boulder folks, don't go for petroleum stuff. I rolled jiu-jitsu and Defense Soap was working for ringworm and stubborn Staph infections in the jiu-jitsu and wrestling community. That's no joke. When you get a bad Staph as a wrestler, and we decided to look into key tree and eucalyptus oil, which Defense Soap has, which do knock Corynebacterium tuberculostearicum or P acnes.

That's a very long-winded source to tell you what we figured out with Dr. Shoemaker is then, we have NGS sequencing now, so we can detect Actinobacteria. I got sick again from COVID while being in Actino. I'll talk about that a little later. But we pulled my blood for Actino vesicles and sure enough, topical Actinos is penetrating into the bloodstream and triggering CIRS secondary to Actinobacteria, folks.

[0:39:20] SCOTT: One thing to clarify, I had done a podcast with Larry previously on Actinomycetes as well. My understanding was that it was commonly drainpipe related as well, not necessarily related to water damage or water intrusion. But are you suggesting that there are certain water intrusions that also then add to the Actinos burden, or are those also unrelated?

[0:39:42] DR. DORNINGER: Yeah. Yeah, that's a great clarification. The answer is C all the above, you need water to amplify pathogenic Actinos. Could that come from water sitting in a pipe? Could it come from an actual leak? As soon as that water level goes up, those pathogenic Actinos have an opportunity to amplify and stoke disease.

[0:40:07] SCOTT: The piece that I think is important about this conversation is it doesn't necessarily mean that you have to have had a leak, or a water intrusion. You can have high levels of Actinos and you're living in an environment that never had a water intrusion from a roof leak, or a pipe break, or something along those lines. That was the thing that came out of the conversation that I had with Larry is well, now we're talking about CIRS, and you may not even be in a building that had actual water damage.

[0:40:36] DR. DORNINGER: Yes. In regards to what we talked about before, the audio is a little lousy on this one, because Dr. Shoemaker had to pipe in via Zoom, but Fort Lauderdale CIRSx, he talks about Actinos driving Parkinsonism. Treating the Actinos, we help neutralize Parkinsonism. I'm working with my classmate, Lori Mischley, MD, Nancy David, PhD, MPH, a little bit of an overachiever, who I call the Queen of Parkinson's. I'm trying to get her work to unite with Dr. Shoemaker's work, so we could potentially find a true underlying cause for Parkinson's. Because Parkinson's isn't a diagnosis. It's what you have. It's a constellation of symptoms. It's not why you have, right?

In regards to that, what we're noticing for what you just said, Scott, is you could have a really aging fair skin; this is the archetype we don't know yet. We need more African-American data sets. We need more Asian-American data sets. We just have right now too many. We need more Caucasians, but we need everyone represented. These Caucasian males with Parkinsonism, with fair skin, were tending to have very flaky skin. All I can tell you, anecdotally for the internet, anecdotally, is to this day, we've seen these P. acnes on the skin swabs. You want them less than 10,000 on the skin swabs, we've seen them 1.8 million, 2.8 million. One of the highest was a husband of a CIRS patient, who when he gets out of bed in the morning, it looks like his body left behind a shed snake’s skin. It's like, skin chips are left behind. He's one of the highest Actinos.

Now, we didn't get to pull blood on him yet. CIRS needs to be on his differential diagnosis, but we're treating her and all the time, minute, money, and energy are going into her first, because she's been really sick, but he was her exposure. In that, just like mold, you can live in Actinobacteria and not be sick, right? This is what we showed with Dr. Shoemaker and the COVID paper. What I'm telling you is COVID long haulers are a CIRS. What we saw is they were living in endotoxin, they were living in Actinobacteria, not mold. They got COVID, they didn't die of the COVID, but they turned on the endotoxin inflammatory gene CD14, toll receptor 2, toll receptor 4, or the Actino MAP kinases, TGF beta receptors, or both, and are now chronic inflammatory response syndrome patients.

You know what works for COVID long hauling? Shoemaker protocol. You know what's weird? When you have to tell a patient, “Hey, you were fine in your house with Actinobacteria and a little bit of sewer gas. But now we have to do a total overhaul of your house and take a biotoxin binding medicine, Cholestyramine, Welchol, Colesevelam, Colestipol, Questran and take those biotoxins in the toilet. Maybe you set up MARCoNS and then reboot your body with vasoactive intestinal peptide, all because you got this virus.

Again, we prove in that paper, COVID is a priming event for CIRS. Remember, genetics loads the gun, and then you're in your environment of Actino or you get a Lyme tick or a recluse spider bite or you're living you move near a algae bloom shed or whatever, and you're still relatively fine. Then you got a cold, or a flu, or the Lyme tick is infectious in its own right. You wake up chronic inflammatory responses. Genes that manufacture widgets of inflammation were turned off and now they're turned on, even though you didn't die of the COVID.

[0:44:19] SCOTT: Talking about genes, the HLA-DR part that we talked about, that's been what we've been focused on. That really was the primary tool for potential predisposition to CIRS for many years. I think, I heard Dr. Shoemaker even say that it's not maybe held up as well as what we now have with GENIE, where we can look at the gene expression, rather than just looking at the potential genetics with HLA-DR. I'm interested in, is there a connection between HLA-DR types that we know of, the Rosetta stone and those that are then predisposed to Actinos, or to endotoxins, or to beta-glucans? Then building on that, what are some of the things that the GENIE has taught you about your patients? What are the patterns that you observed from working with GENIE that maybe we didn't understand before we had that technology?

[0:45:12] DR. DORNINGER: Yeah. Because I believe in civil discourse and I know you're a critical thinker, I totally politely disagree with the way you talked about HLA. I still freaking love it. One of the things my wife was so good about when we were sick as a family is making sure my kids didn't think we were sick, right? There's this weird thing as a human being, as a parent, where you got to pretend you're not sick while you're totally doing everything for differential diagnosis and getting a treatment plan that will heal you, right? You don't want to wallow in victimization.

We always tell our patients, empowered, not panicked. I'll get moms and dads who will be like, “Do my kids have CIRS? Do we need to do the full work?” I'm like, “Slow your roll. Let's spend your time and the energy on mom, or dad right now, or sister or whoever. Let's get a cheek swab on your kid, because they may have inherited your non-biotoxin illness gene and be less susceptible.”

Here's how we roll with families in HLA. If you know that child has a biotoxin HLA and they were happy, go lucky, and crushing academics and socializing, in band, or in sports, or whatever, and all of a sudden, they're all depressed, they're isolating, their brain doesn't work, they're getting headaches and you're like, “Oh, college is stressful.” Maybe. I knew that kid. They were looking forward to flying the coop. Maybe they moved into a moldy dorm, or moldy fraternity house, and so on and so forth.

I like having the HLA. Just keep an eye on, hey, if your child, or your later adult child ever says, “Mom, something's wrong with me. I want to put a Gloc in my mouth. I am just not thinking right.” That was me. I had brain fog, hardcore fatigue, hardcore depression, and weird suicidal floatations that did not have anything to do with how I feel. I love life. I mean, one day I'll be ready to leave this Earth, but I'm not ready.

To have someone say, “Hey, go look at that balcony. Let's see if you can jump.” That is nothing to do with me. That is neuroinflammation. If we don't educate society on that, more people are going to accidentally take their lives. That's what I like about HLA is it just is, “Okay, I predisposed for this? Just so you know, hon, if you're ever feeling what I feel, we're going to be all over it.” You won't have to wait 23 years to get to a Shoemaker certified clinic to do a proper differential diagnosis. No BS urinary mycotoxin test, or all this other nonsense. Do a visual contrast sensitivity, has 37 symptoms, arrange into 13 groups, or clusters and do a biotoxin exposure screening, 98.5% sensitivity. If you're a positive VCS and cluster symptoms, 98% sensitivity. If you're just eight out of 10 clustered symptoms, eight out of 13 cluster symptoms, six out of 13 for kids.

We do the confirmatory labs and we got you in treatment, right? You don't have to wallow around in 20 years of disability and suicidal thought and depression and angst and broken marriages and dead libidos, and I can't do CrossFit anymore, right? We love the HLA. What HLA is is on chromosome 6, you have all of your inflammatory response genes. I think it's cool that Ben Lynch promoted MTHFR and stuff like that, but that's so downstream for inflammatory illnesses, chronic illness patients. All the actions on chromosome six, that's where psoriatic arthritis, HLA B27 gene, that's where the HLA DQ2 and 8 celiac gene is. That's where your Hashimoto's gene is, your type 1 diabetes gene, your rheumatoid arthritis gene, your biotoxin illness gene. It’s all on chromosome 6, because all of are chronically ill. 99% of them are based in inflammation.

Go to the gene chromosome 6 that has inflammation. But it's still SNP chip technology, which is just, you have a gene or you don't. Where GENIE changed everything is in real-time, we can see if specific genes are turned on transcribing, manufacturing, producing widgets, or turned off. On a GENIE, I'm going to do a little YouTube on going over my own GENIE for this. If your bubbles, which says the gene name in there is pink or red, that means it's upregulated or turned off. Think of all these genes as light switches. It’s pink red, it's turned on. There are certain genes you want turned on. How about a gene like ATP synthase? That synthesizes ATP. You want that bright lights on Broadway, flaming red just pumping out ATP.

There are other genes that manufacture cytokines that we want blue and turned off, right? Light blue-blue is the genes turned off. What you're going to see a lot on GENIE is the inflammation genes are red and the energy producing genes are blue. That's as, you know, Scott, called molecular hypometabolism, which is the fancy term for chronic fatigue syndrome secondary to CIRS, right?

What's so cool about GENIE is where a failed VCS, HLA, MMP9, C4A, TGF beta, low MSH, ACTH, cortisol mismatch, osmolality, ADH mismatch, gliadin antibodies, and VEGF. If you have five out of 10 of those off or more, you've confirmed CIRS. You don't know specificity of biotoxin exposure. What the GENIE shows is in real-time, it can say, okay, you got CIRS, is that because you're in endotox? Is that because you're in Actinobacteria? Is it because you're in mold?

Then, you can even be in mold, but not reacting to it. I just had a patient the other day who has a HERTSMI of 14, but we had a GENIE on her and her mycotoxin triggering inflammatory genes are not turned on. Should we not deal with the mold in that building? Absolutely not. We've got to deal with it, because she could catch a cold as a priming event. Now, she's also turned on those genes. When she was going to stay in a safe house, while they did the three months of work on her home, we had a HERTSMI of 12. She said, “Is this okay? This is great.”

She's a medical doctor. This is a great question, because she's immune-reactive to Actinobacteria. The Actinomycetes testing was beautiful on this rental and it had a HERTSMI of 12. We couldn't find anything better. I said, “Yes, but just don't catch a major cold or a super bad COVID while you're here, because in theory, you could turn on CIRS, water damaged building molds, too.”

The GENIE is a real-time snapshot of what is triggering the inflammation, including that FKBP5 gene. Let's say one more thing just to wrap this up on this. that is the trauma gene. I love DNRS and Gupta and Joe Dispenza’s work. I love that Joe's doing stuff with UCSD and trying to really prove the power of meditation on biomarkers and stuff like that. Our patients, we have seven of them who had the trauma gene, FKBP5, turned on from trauma, manufacturing inflammation. When they did either of those, DNRS, Gupta or Dispenza’s work, in earnest, they really did the work and we redid their genies, that gene turned off and stopped manufacturing inflammation. I was right. Where I get freaked out is where the DNRS coach, I know Annie Hopper doesn't say this, says, DNRS can treat your CIRS.

[0:52:43] SCOTT: Annie would never say that. I've had this – as you know.

[0:52:45] DR. DORNINGER: Annie would never say that.

[0:52:46] SCOTT: I’ve had this conversation with her many times, because she's always been very clear that you need to also build on a platform of environmental awareness, as you well know. I think that's just a unfortunate misunderstanding about what her position really is.

[0:53:02] DR. DORNINGER: It is an unfortunate downstream pollution of her work. That is a real bummer. It goes vice versa. The Shoemaker protocol doesn't treat the FKBP5 inflammatory gene. The Shoemaker protocol treats the endotoxin genes, it treats the Actinobacteria, it treats the Lyme genes. The biggest mistake in Lyme treatment is people forget the Welchol, Cholestyramine.

Remember, you need the antibiotics to wipe out the Lyme, but Donta et al. in 1998 publish to BB toxin-1, which needs to get mopped up. Otherwise, you're going to keep triggering MMP9 and C4 and C3 and so on and so forth. If we get honest and say, holy sugar, your meditation, your parasympathetic methods turned off a gene that manufactures inflammation from trauma, That is plenty, right? If the Shoemaker protocol turns off, CIRS inflammatory genes, that is plenty, right? What's cool about GENIE is once in a blue moon, you'll see someone who's out of CIRS, but their trauma genes on.

[0:54:09] SCOTT: I think Jill Carnahan will be very interested in what you just had to say as well, because she's talked a lot recently about how her CIRS patients really do need to do, in many cases, limbic system type work. It sounds like now, you're able to prove that from the GENIE.

[0:54:25] DR. DORNINGER: Certain patients do. What I don't like is when we project that on to everybody, because there are some people who just have done four startup companies, they're so functional, they go whacked with CIRS and they just come in and are like, “Dude, I trust you. My friend told me about you. Just tell me what I've got to do,” and they just go like this. They don't need to meditate. They need to get back to CrossFit and starting another company and creating jobs, right?

Then there's other people who have had so much trauma in their life that if they don't get back into parasympathetic, they can't sit still to even listen to how to take Cholestyramine. What's interesting about them is if they have two genes, two biotox… back to HLA, I said, guess where these genes came from? Your biological mom, biological dad. Is it time to open the door of forgiveness? Because they may have been untreated CIRS patients with agitated brains, inpatients, bipolar tendencies, drug addiction, alcoholism, trying to treat their neuroinflammation, and no one was available. They might have had CIRS before Dr. Shoemaker discovered the biotoxin pathway.

[0:55:33] SCOTT: Just then to clarify, if we look at the Rosetta Stone today for HLA-DR, we don't see Actinos, endos, beta-glucans, we don't see any of those things. Would that be the multi-susceptibles that are then susceptible to all of those things? Or can the mold and/or Lyme susceptible still have the susceptibilities that we're talking about that we're just starting to understand in more depth?

[0:55:56] DR. DORNINGER: We don't know. I'm going to plug something that's pretty cool that we're trying to do. We finally got our 501(c) established. It's the Roots and Branches Charitable Fund. This was started by upper-middle class patient of mine and ours. He had irretractable headaches, red days, where his headaches would not go away. Had all the money in the world, been everywhere, known for those having those headaches.

He is a control type 1 diabetic, who had untreated sleep apnea and CIRS, endotoxin, Actinos, and mold. He is headache free. He was grateful to our staff, just as much as he was the provider team, because our staff is extraordinary. There are human beings who picked the phone helped CIRS patients organize their life. He wanted to bonus them with a Christmas bonus to say thank you to staff, the essential workers. I said, yes, please, because we pay them well, but it’s brutal to live on the front range with administrative staff pay, right?

I said, but what I really want is I want money for indigent care. I want money for research. I want money to start a building project of Sirewall safe houses, where someone could come in, live in a safe house for three months, rock the protocol while they get their building straightened out, or a husband gets shown that he can have his life back, whatever the flavor of the day is. We finally started the Roots and Branches Charitable Fund.

Our goal is to get 2 million for 15K, so that we can just take $100,000 endowment. When I get these, don't call my office, if you are not in a station wagon homeless. You have to prioritize your money to deal with your CIRS. At some point, we want to have a big time Harvard-level endowment, where we can take care of those who just are in such a socioeconomic spot. The other thing we want to spend money on is research. As soon as we get a little money on there, we're going to go to see you, we're going to get a premed student, and we're going to have them cross reference our GENIEs with immune reactivity to endotoxin, Actinobacteria, mold, Lyme, etc., with the HLA and see if we can help grow the Rosetta stone. Because again, when Dr. Shoemaker figured that out, he didn't have GENIE, he didn't have NeuroQuant, and he didn't have the NGS and Swiffer cloths to evaluate a building for endotoxin bacteria.

[0:58:16] SCOTT: With HLA-DR, I think it is a useful tool for potential predisposition to biotoxin illness. But I'm curious, do you find that the HLA-DR becomes a predictor of treatment outcome, or do you feel that when the protocol is implemented appropriately, people with even maybe the more challenging HLA-DR types can recover equally well?

[0:58:43] DR. DORNINGER: Yeah, so we're well over a thousand biotoxin patients in. Over 500 have completely graduated. The Shoemaker protocol has never failed, regardless of HLA. For the people who are still sick, they are stuck on step one. They are still in exposure. When people say the Shoemaker protocol didn't work, I need their clearance tests, I need everything. what I see is sloppiness. We don't use urinary mycotoxins for screening. We don't use glutathione to detox biotoxins. We use quaternary ammonium. We do organic chemistry. We don't do alchemy.

If you can't show me that you've normalized the C4A, TGF beta, and MMP-9 off of charcoal, or whatever, because that's what Dr. Shoemaker did. It's not like I have a problem with any other provider. I'm of the old school academics, where we challenge each other in the name of the patient's time, money, and energy. If you don't have hard, honest data, then you have to present it as an experiment. What Dr. Shoemaker did is he tried activated charcoal. It didn't normalize those markers. He tried bentonite clay; it didn't normalize those markers. He tried chitosan. Chitosan has the same organic chemistry of Cholestyramine. The problem is stomach acid breaks it down, so by the time it gets over to your common bile duct, to pickup the biotoxins, it's no longer viable.

The reason I share that is because we have to make sure people know if they've bait and switched or cherry-picked the Shoemaker protocol. If they haven't dove deep into their buildings, they're not going to get better if they are truly CIRS. There is a strict screening criteria, VCS, cluster symptoms, have you had biotoxin exposure? You ask a gazillion list of environmental questions, hobby, ponds, and all kinds of stuff. Then there is validated confirmatory labs, right? Then after that, we now have the NeuroQuant and the GENIE that can give specific biotoxin causation.

Real quick last thing on that is this breaks my heart, because when people spend money on 10 IV glutathiones, or a whole bunch of supplements, etc., there's no money left to fix the buildings. That I cannot – I'm a blue-collar kid with white collar opportunities who was raised right. I cannot tell a lie. You need to freaking deal with the buildings. When I take a complicated case to the godfather and I say, “Dr. Shoemaker, I need help with this,” the first thing he asked me is, where's the clearance test? He doesn't just want a HERTSMI anymore. He wants HERTSMI, or ERMI, Actinobacteria, and endotoxin.

Now we're in the middle with Larry Schwartz and Andy Heyman and I are doing some work on beta-glucans. We'll figure more on that. You had that lovely guest in on plasmalogens and Dr. Shoemaker’s looking at that potential. But we have a protocol that doesn't fail now. If the science stopped right now, you could heal every CIRS patient with the Shoemaker protocol.

[1:01:49] SCOTT: I want to wrap up the GENIE conversation just on a couple of points. The GENIE, as I understand, has elucidated a lot of things. It's led to better understanding of CIRS as a condition. One of the things, and correct me if I'm wrong, because I'm learning from this conversation as well. One of the things that I understand is that the GENIE showed us that hypercoagulation is a component of CIRS in some, or many of the patients. Another thing that I believe I've heard Dr. Shoemaker talk about is that maybe from the GENIE work that we now maybe think that MARCoNS is a little lower on the list of things that are driving, or triggering CIRS, or keeping that perpetual inflammatory cycle going. Wondering if you can either confirm, or correct me on those two points?

[1:02:37] DR. DORNINGER: Yeah, let's start with the MARCoNS, because for your listeners, is a key point. You can't clear MARCoNS if you're not out of exposure. If you do, it'll be back. The reason is exposure drives inflammation, which suppresses melanocytes stimulating hormone. Melanocytes stimulating hormone participates in mucosal immunity, your border patrol.

Every time you take an antibiotic, like a Amoxicillin for Strep, it's not just the antibiotic, but it's the antibiotic with your immune system that conquer the Strep. If you just snort BEG spray, or EDTA, or EDTA silver, NSB Formula 1, Dr. Dashore’s formula, or ACS Extra Strength silver, and you don't deal with the building, you're going to really struggle getting rid of MARCoNS. That's why it steps three and step one is remove patient from a biotoxin exposure.

The other thing is when you spray that, you rupture the MARCoNS and now you have cell wall fragments and you can have a flare and C4A and TGF-b1. That's why it's so important to be on a high-dose fish oil and adequate Welchol, Cholestyramine. Do we pad and complement the Shoemaker protocol? All the time. If you didn't poop, biotoxin didn't get to the toilet. If you're constipating, or you have some gut issues, we're using all the naturopathic medicine, the func med, the integrative med to get your gut going, but we don't bait and switch, quaternary ammonium, Welchol Cholestyramine with charcoal, right?

When you are dealing with MARCoNS, you have to be out of the building. What you're alluding to is on the GENIE, you upregulate inflammation with MARCoNS. Taking straight EDTA spray, two sprays each nostril three times a day, Dr. Shoemaker showed that you suppress, or turn off the inflammation that MARCoNS is causing, even if the bug is still present. I know that's complicated, but that's six months of EDTA spray, he does with that.

What Genevieve and Leanna and Dr. Bjerke and Emily, and me do, my team, is we still say, before not able to kill MARCoNS, it's we're still having building issues, right? We're going to see that. I don't know many clinics who grind as hard with the patients on their buildings, it's our clinic, and it's a pain in the keister. It's no fun. It's so easy to give something. I'm talking to my remediator in this ear, complaining about Mrs. Smith and how she's crazy. Mrs. Smith is literally calling in on the same call, telling me that this remediator is a piece of doo-doo. This is what I do with my life.

If you don't get the buildings right, if you don't have relationships with your inspectors, your remediators, and talking about the pros and cons of getting through remediation, you're not going to clear MARCoNS well. That's how that shows on the GENIE.

Hypercoagulation. Thank you for saying that, because there's another exciting one that leads to. On the GENIE, we have coagulation genes. I almost think of this like the histamine genes. There is a subset of CIRS patients that turn on clotting genes with CIRS. Again, why did those genes make it on the GENIE? Because they are statistically higher than healthy controls when Dr. Shoemaker narrowed down the genes that should be on GENIE.

If you see hypercoagulation genes on a GENIE, those are micro, micro, micro-clotting people. We all talked about transient ischemic attacks, or TIAs. That's where you're talking to your aunt, she's like, “Hello,” and then she comes back online. You're like, “Oh, shoot. What just happened?” That might be an ambulance ride. It's even more, more micro, micro than that. You're just getting these little clotty decreases of healthy blood flow to the brain. You can have atrophy from these micro clots. Now, the other thing that GENIE shows is the tubulin A4A shows neurodegenerative diseases.

We might have exciting stuff coming out with Parkinson's, ALS and GENIE. Not going to say anymore, because that's Dr. Shoemaker's to strut about. Again, the Godfather doesn't stop creating medical discoveries that are Nobel Laureate deserving. Guys, well into 20 Nobel Laureate Prize in Medicine discoveries, but really his most powerful swan song might be how CIRS and GENIE and this model can help allude underlying causes of ALS and Parkinson's.

[1:07:10] SCOTT: Amazing.

[1:07:11] DR. DORNINGER: It is amazing. It's amazing.

[1:07:13] SCOTT: Let's touch briefly on the EnviroBiomics Actinos testing. What do you look for in a patient's environmental test to see whether or not you think that's going to still be a contributor to their condition? What do you look at from a dominance index, prevalence index perspective? Do you think that these indices that we're getting around Actinos testing are maybe better representations of the potential health of the environment than the ERMI score, for example? What are you looking for when you're testing for Actinos in the environment?

[1:07:45] DR. DORNINGER: Yeah. I wish I could have a weekly update of being in an inner circle with Dr. Shoemaker, because you're moving at the speed of light. I could die tomorrow and say, “Man, I fell ass backwards into the most extraordinary professional mentorships a guy could ever dream of. I have Dr. Bill Blanchet for preventing heart attack and stroke. I have Dr. Shoemaker. Datis Kharrazian helped me with a lot of stuff on neuroendocrine immune model, Bastyr, Tori Hudson for women's health, and Alan Gaby, and Joe Pizzorno. The list is endless.

Patrick Donovan and ER Nurse turned ND, Dirk Powell, one of the last Bastyr students for endocrinology. Dr. Shoemaker is every week, there's another level of learning. Since GENIE, he's learning quicker, because we can see in real-time transcriptomics. When we were figuring this out, the two things I can tell you, we’ll start with endotoxin, because it's easier. It says, endotoxin less than 200. What Dr. Shoemaker is doing is he's taking endotoxin Swiffer cloths, NeuroQuants. Remember, the personality of endotoxin exposure on a NeuroQuant is cortical atrophy and at least two other nuclear atrophy. That's the calling card of endotoxin NeuroQuants.

Then on GENIE, it's CD14, Toll receptor 2, or Toll receptor 4, when those turn red, that means you're seeing the transcription of production of inflammation from being in poops, or a gas, manure, doo-doo, caca. For endotoxin, it was under 200 on healthy levels for a house. The more data he got, the more GENIEs and the more NeuroQuants and the more cortical atrophy, we can now say, that endotoxin should be less than 100.

In particular, if you have neuro issues, if you got headaches, if you got depression, if you got anxiety, if you got ADD, if you got Parkinson's, if you got memory issues, if you got – you got to get that endotoxin down, right? Don't look at it as 200, look at it as should be less than 100.

For now over to Actino, the calling card for Actino on NeuroQuant is multi-nuclear atrophy. It's not the cortical gray. It's just seeing 3, 4, 5 nuclear atrophy. A lot of times, age inappropriate, right? When we're comparing, when we get brain MRI with NeuroQuant from health images, or local imaging center, then we send it into Surviving Mold for the NeuroQuant analysis. That runs through Dr. Shoemaker's proprietary numbers on, is your brain swollen, or short trunk in relative to healthy control range in your age and gender, right? That's what that is.

Sometimes we'll see 5 nuclear atrophy in a 28-year-old. That is not normal, right? In a 90-year-old, yeah, okay. We finally have a big enough data set of healthy controls to do age categorization, right? That's super important. You'll see 4 or 5, 3 without the cortical atrophy as the Actino calling card. Then you go to your Swiffer cloth and the human habitat is the Actino bacteria that have the two pathogenic Actinomycetes, or Actinobacterium,

Corynebacterium tuberculostearicum, and Propionibacterium, Cutibacterium acnes. What again makes them different, they have this mycolic cell wall that can penetrate into us and trigger our innate immune responses. We're looking for those raw data numbers to be less than 10,000 on that Swiffer cloth. Now, I might come back in a year and say, we've refined that even better because we have bigger data sets. That is the prevalence index.

The dominance index is the soil Actinos. When Dr. Shoemaker first did these indices, we didn't know if soil Actinos are pathogenic, or not, right? As of now, they are not pathogenic. When you go running after a spring rain and you smell that lovely spring smell, some of that is Actino forts. Some of that is the Actino in the soil, got some water, are amplifying and growing and they're letting off some microbial VOCs and you go, “Ah-ha, spring.” That is not pathogenic.

Thank God, because if people are doing extreme avoidance and camping and stuff like that, they should be able to get away with camping, as long as they're not camping next to an old mining shack or something that's full of Stachy or Chaetomium. The calling card on GENIE for Actino bacteria is a MAP kinase is up and TGF beta receptors are up, one, two or three. When you take Cholestyramine or Welchol, so if you pull a GENIE and you're already on Welchol Cholestyramine, you will normalize your TGF beta receptor. You'll already see that improvement.

You can get a little faked out. It's like, Actino-looking on GENIE, versus a naive treatment patient, which means they haven't taken Cholestyramine, Welchol yet. That's why there are stages. When you send in your GENIE, stage one is treatment naive. Stage two is clean building and on Welchol Cholestyramine, which is hard for us because some people are on Welchol Cholestyramine, but they're building not totally done yet. I call it a stage 1.5. Then stage three is around VIP, stage fours are off VIP, and stage five is relapse.

On when you hand in your GENIE paperwork. Back to that prevalence index and dominance index. It says, prevalence index should be less than 2.0. If I have a prevalence index of 19.2, that's just showing me that the human habitat is much higher than the soil habitat in that building. When I go to the Corynebacterium tuberculostearicum, it might be a raw score of 6,200. That's very reasonable. It might be a Propionibacterium acnes of 2,300. That's very reasonable.

We had a Corynebacterium last night on the Swiffer that was 446,000. On average, you're going to see the P. acnes is more dominant than the Corynebacterium tuberculostearicum. But both of those ideally should be less than 10,000 on each Swiffer, less than 10,000 on your skin swabs.

[1:13:58] SCOTT: Let's talk a little more about the skin swabs. That was relatively new information to me that we can now do this EnviroBiomics QPCR bacteria analysis for Actinos on the skin. Does everyone have these? Are they more concentrated on certain parts of the body? Can they be commensal in some people, but problematic, or pathogenic in others?

[1:14:23] DR. DORNINGER: Well, let's start with the last question, because that's – commensal is basically just a bacteria that's taking up real estate, right? It's just taking up space. I don't know how to answer that, because if they've got mycolic acid, they have – The way I would say it is they're a potential pathogen, because you could be fine, because they're not triggering innate immune responses yet. That's what we showed in the COVID study. People are sitting there in Actino, right? They're fine. Then they get COVID, they don't die of the COVID and now MAP kinases and TGF beta receptors are upregulated producing inflammation, driving CIRS, right?

The answer is, yeah. That's the same reason a husband and a wife can be living in the same moldy building. She's drooling with memory loss, no libido, exercise intolerant, skin rashes, etc., etc. He’s like, “My grandpappy built this hunting cabin in 1890. It's fine. I feel great.” We're like, “Cool.” Now again, air quality is good, is important for everybody, but it is the immune reactivity more than the toxicity for CIRS. That's why it's called chronic inflammatory response syndrome, not chronic toxicity syndrome.

Now, again, are there direct effects of toxins on nerves, etc., etc.? Yeah. We think you can be colonized with pathogenic, potentially pathogenic actinobacterium and be fine. If you're now turned on those, you have to get rid of the source. You have to take enough Cholestyramine and Welchol. Unfortunately, Cholestyramine and Welchol are working to turn off those genes on GENIE. If you're endotoxin, you get out of the endotoxin and those genes are still turned on, you take Cholestyramine.

What I will tell you is, it takes longer, anecdotally, through clinical observation to turn off the endotoxin genes than it does the mold genes. It's three to six months of Cholestyramine and Welchol, where in the SAIIE trials, the Sequential Activation of Innate Immune Element trials, it was six to 12 weeks of Welchol, Cholestyramine for mold exposure patients to reset.

[1:16:41] SCOTT: I want to get into a little bit of the environmental hygiene topic. What do you recommend for your patients? Is there any specific maintenance of drainpipes, for example, to minimize Actino exposure? I know some people are using hydrogen peroxide. I think Larry Schwartz talks about that. I know others are using enzyme-based solutions. What do you suggest to your patients just for maintaining their drainpipes, their plumbing pipes to minimize Actino exposure?

[1:17:10] DR. DORNINGER: Yeah, I just think it's – I would go broader on microbial growth needs organic matter, right? Wood pulp, paper. It's the three little pig story. Americans are slobs. We build with paper and pulp and OSB, right? Old school Europe is steel and tile and stone. Spores, bacteria are everywhere. You still don't have a problem in amplification until you have water. It's about protecting your home from moisture, right? It's about making sure your gutters run five feet away from the house, making sure you clean your gutters, and making sure you deal with that roof after a hell storm, or a roof that needs to be replaced.

In regards to sinks, a lot of times, people have garbage disposals and they'll just put a lot of organic matter. Much better to get a compostable bag, throw your compost in there, tie it off, and put it in a compost bin if you can. Then I do think hydroperoxide is a good maintenance of a sink as is enzyme products. Really, all you're doing is trying to keep things low on organic matter that act as microbial food and just some basic maintenance.

In regards to floor drains and unused, maybe like a mother-in-law kitchen, or showers, you have to pour water down those drains once or twice a month to refill those P-traps, particularly in dryer climates. If you're Arizona, Utah, and particularly, when they're next to heating elements. If you have a floor drain and utility closet next to an HVAC, that HVAC kicks on, you're going to dry out that P-trap. Just in making sure that the P-traps are topped off.

[1:18:48] SCOTT: Another area that Larry mentioned Actinos can be higher is in our sleeping location; bedding, pillows. Wondering what you recommend there? Do you recommend that patients use ultraviolet mattress vacuum? How often should they change their pillows? Are there specific washing guidelines for bedding? Talk to us a little bit about that area as well.

[1:19:09] DR. DORNINGER: Yeah. Laurie Rossi who wrote Surviving and Thriving Mold with Paula Vetter and Cindy Edwards, three of my absolute heroes, those women are juggernauts in restoring health in the chronically ill with CIRS, their book was 2018. I'm going to participate in helping with second edition to make sure we include the Actino and endotoxin information. Again, this is all exploded over the last three, four years, because we have the technology to evaluate for these things.

Laurie just gave me a mattress encasement link on Amazon. If someone buys a new mattress, you can let it off gas and all that vacuum it. Put a mattress cover on it that zippers, so that you can take the mattress cover off once in a while and throw it in the washing machine. Loose number. There's no data on this and never did any pre and post testing with Larry and this, but I'm thinking, every two to three months for a really in the middle of treatment person. Once a year for someone who's all done with CIRS.

We've been telling people to wash their sheets twice a week if they're going through Actino and daily showers. We've been using the Defense Soap and I use microfiber wash cloths. We just have patients buy some of those blue or yellow microfiber wash cloths from Home Depot, or whatever, have them stacked in a dry area of their shower, put a pump of original shower gel from Defense Soap, do their hair, their pits, their groin, their toes, everything. Let it sit on you for about 60 minutes and then wash it off. If you work out, it's super important to shower within 30 to 60 minutes afterwards. I'll tell you as a jiu-jitsu player, even from a ringworm and an athlete's foot and a Staph infection, but also from Actinobacteria.

Actinobacteria are no different than the bacteria in a hot mayonnaise potato salad in a summer sun. Heat will also help, and so does dampness and moisture. You're sweating your groin, your pits, those areas. Don’t work out hard and then go to bed. You're just going to Actino spread all over your sheets.

Then the other thing I want to bring up is I don't mind some of these mold branded soaps. But at the end of the day, soap is soap, right? You should go more for soap, because you're intolerant to fragrance, or chemically sensitive, or something like that. At the end of the day, what we do is we do half cup to one cup of borax. We have a top loader, because front loaders inevitably get mildewy, even though I like that they spin dryness out, so you don't use as much dryer. Just use a hand cloth. The new top loaders, put in your half cup to cup of borax first, then your detergent. Branch basics is my favorite for the ultra-chemically sensitive. Soap breaks down microbes, right? Whether it's a bacteria, or a mold, you're going to be able to soap it out.

[1:22:02] SCOTT: Did I understand correctly that rather than using a washcloth that someone then is leaving in their bath or shower, you were suggesting using the microfiber cloth and then disposing of them?

[1:22:13] DR. DORNINGER: That this is an anecdotal thing. We never did any – is a microfiber washcloth better than a cotton cloth that you just sit there? My thought is that the gift of microfiber is it traps, right? When we do John Banta’s cleaning method, which he's extrapolated off some of the asbestos industry and stuff like that, you're using a microfiber, Swiffer’s a brand, but there's other microfibers, you're putting a diluted soap spray on there and you're damp wiping a wall.

The soap breaks down the microbes, but the microfiber captures it. There, I extrapolated that if I'm going to be scrubbing this, I want to capture that, right? This is anecdotal, but I'm thinking about autism kids that were dry brushing, right? For stimulation of their parasympathetic nervous system, we’re just spreading Actinobacteria all over the house. I'm in a shower and I'm breaking down microbes and capturing it. Then what I do is I just wring out the cloth, I throw it in our bathtub, or in our – we're a healed CIRS family. The wash machine is running every day to every other day. I just throw the washcloth in with my other clothes and then I replace the stack. You don't need to dispose of those. I just don't let them hang out for three, four, five days.

[1:23:30] SCOTT: When we talk about mold and mycotoxins, there's always debate about the value of air filters. Are air filter’s helpful in reducing Actinos and endotoxins in the environment?

[1:23:42] DR. DORNINGER: Yeah. I don't have any financial relationship, any ownership stake in Air Oasis iAdapt, but everyone hears me talk about them all the time. I will tell you, when you use airoasis.com/dorninger, Air Oasis does a 25% donation of your total cost after you get a sale to our Roots and Branches Charitable Fund. They're fricking amazing. They have shown up for our veterans. They have shown up for police officers. They have shown up for single moms. They showed up for an incredible church that deals with drug addiction, but has beat down air. They are incredible people and incredible company. I love their filter. It's HEPA charcoal, UV light without ozone off gassing, a ionization and a NASA technology of this full technology. It's five filter technology.

That's just the iAdapt. I don't recommend the G series because it does give off a little bit of ozone. The reason we use them is I love that they're good guys, but if their filter sucked, there's no time for my patient's time, money, and energy. Is because Dr. Shoemaker took a patient with immunoreactivity to Actinomycetes on GENIE, put them into a 12 by 12 room and had three step-step ladders. In each, for 12 hours, they had the iAdapt Small on the bottom rung. Then the next 12 hours, positioned it on a top rung, the third rung. Then they redid GENIE and the immunoreactivity to Actinobacteria went away on GENIE. They stopped transcribing inflammation to Actinobacteria.

They were in an iAdapt tornado. That is the only filter that we have a micro pilot study on about Actinobacteria. People ask about other filters all the time and I was like, I don't know. That is a unique fivefold combination in the iAdapt. Would a traditional high-end HEPA filter have done that? Would IQ air have done that? I don't know. The iAdapt is showing valuable for Actino. We don't have data on endotoxin yet. There is data on mold and then they have some data on viruses, too. There was a 99.99% reduction in MERS, Middle East Respiratory Syndrome, which is a coronavirus that we should be freaked out about. It’s 30% death rate if you get MERS.

They have some good pilot trials. It is a good part of a home maintenance iAdapts, but it is also something we will consider if a family, or a person, or a patient is stuck in a building that they can't deal with. Then I'll try and get at least an iAdapt Small for their bedroom and not have the exhaust directly blowing on them, because a lot of people don't like to sleep in a strong wind, but kind of. They're relatively quiet. Then I'll try and get a Medium, a three cube for their living area. The key thing for any filter you use is that you move it, and that the filter is strong enough to pull air through it, right?

We get these little Molekule-like filters, you're not pulling air from the other corner before you even worry about ozone, right? You have to pull air. Even if you have an iAdapt or an IQAir, just move that thing around every 24 to 72 hours. Don't get obsessed about it and make your outlets nice and easy, so you can unplug it here and it's Wednesday and I plug it in over there.

[1:27:05] SCOTT: In our last several minutes together, I want to get some of your thoughts on treatment. You mentioned that Cholestyramine and Welchol still do play a role, even in the Actinos and endotoxin conversation. If someone's not dealing with mold and mycotoxins and are more Actino, endotoxins, do we know what the Cholestyramine and Welchol are actually binding and improving excretion of in that person? Or is it more that it's helping with the gene expression and the inflammation?

[1:27:34] DR. DORNINGER:  Yeah. Well, I pull. We know since before Dr. Shoemaker discovered the biotoxin pathway that Cholestyramine and Welchol binds endotoxin. Because you used to use it for a Clostridium difficile and E. coli. If you just Google tonight, Cholestyramine endotoxin, you'll see that paper from the 70s. The answer is yes to that.

Actinobacteria, we just know that the immunoreactivity goes down with Cholestyramine and Welchol. The MAP kinases and the TGF beta receptor 1’s neutralize. MARCoNS and Actinomycetes both produce polycyclic ether. MARCoNS, as Dr. Shoemaker proved, is a chronic fatiguing organism, but polycyclic ether is a nerve toxin. PCE can do palpitations and neuropathies. A lot of times, they can also do headaches. Think anywhere there's nerves and they can piss off those nerves, right?

We know that you're dealing with PCE with both MARCoNS and that's why it's so important to be on Welchol Cholestyramine while you're treating MARCoNS. You need to grab that PCE that your liver is trying to get rid of and take it to the toilet. All Cholestyramine does is it gets all that biotoxin-laden bile in the headlock. It takes it to the toilet, right? Then we know that there's valinomycin in Actinomycetes. I'm really glad you asked this, because the toxins in Actinos shut down the voltage-dependent anion channel, which is tunnel from your cytosol cell jelly that goes into the mitochondrial fire pit.

What should happen is I eat some food, I raise my glucose, insulin opens my cell, I uptake the insulin and glucose, and now I have a glucose log in my cell jelly. Through aerobic glycolysis, I chop that six-carbon glucose into two, three-carbon pyruvate and I need to get it into the mitochondrial fire pit to burn in the presence of an oxygen bellow and crank out 33-35 net ATP, chi, prana, money, life force, healing energy, right? No lactic acid metabolic waste product.

What happens with biotoxin, ribotoxin, but particularly Actino is that you block the voltage-dependent anion channel. You block the tunnel from the cell jelly into the mitochondrial fire pit. Now you're stuck manufacturing energy outside of the mitochondria, which is wildly ineffective. For that same six-carbon glucose, you make 8 ATP, plus lactic acid buildup as a waste product. In highfalutin Boulder triathletes, that's called bonking, right? “I can't run another step. I've had lactic threshold.” The CIRS patient gets that walking to the mailbox. What Cholestyramine Welchol does is it literally is an excavator with a dump truck that removes the ribotoxin, biotoxin, from the voltage-dependent anion channel, so that pyruvate can get into the mitochondrial fire pit again. That stuck pyruvate, two-pyruvate or one glucose in the cytosol is molecular hypometabolism. That's what it is. It's, I can't get this into the mitochondrial fire pit to make 33 to 35 units of energy. Do we know what specific biotoxin Actino…, I have to ask Dr. Shoemaker about that. He might have some insight. I don't. I just know that now, NAP kinases go down, TGF beta receptor 1s go down, and molecular hypometabolism goes away, you start making energy again.

What mimics Actinomycetes in doing that, Itraconazole, Diflucan and Fluconazole. The reason Dr. Shoemaker goes so fricking AWOL on don't use azole antifungals is because they block the voltage-dependent anion channel. You can Google, John Hopkins has an intellectual property rights to using Itraconazole as a chemotherapeutic drug, because the way you stop cancer cells from reproducing is shut off their energy. What does that do to your own cells? Itraconazole also shuts down the VDAC. This is the number one reason we freak out on doctors just throwing people on antifungal nasal sprays when there's nothing to kill, people are just chowing down Itraconazole to kill a mold that doesn't exist. It's not mold growing in your body. I've done tons of mold cultures.

I worked with HIV patients progressing the AIDS before we had good high-quality antiretroviral drugs. That was a true mycosis. That was a true IV Itraconazole issue, right? The other reason he hates it is because you get gene transfer, where the more you stress bugs with antifungals, the more they outsmart antibiotics. That's where all of a sudden, you start seeing these high rates of vancomycin resistance on MARCoNS swabs in areas where doctors are using azoles. That's what doctors do. If we want to have “do it for the children”. We want to have drugs for our children's bugs, or grandma who's in the ICU right now, we have to use these meds responsibly.

[1:33:03] SCOTT: I want to come back to this for a second, treatment-wise from a skin Actino perspective. You mentioned the Defense Soap. I've seen some topical creams from compounding pharmacies and things of that nature. Are there any other tools, topically, that you're finding helpful in your patients?

[1:33:20] DR. DORNINGER:  Yeah. I don't know. Dennis Katz, who works with Dr. Shoemaker on figuring out VIP, the vasoactive intestinal peptide, is a dear friend of mine. I love those guys at Hopkinton, which got absorbed by PD Labs. Dennis and Michael Maccione are dear friends, talk all the time. It's so great to have a brilliant pharmacist in your rolodex to call and shoot the breeze on these things. They were using a cyclobenzaprine, witch hazel combo to work on Actino, and some things transition in that whole pilot trial fell through the cracks. I don't know.

Yeah. I know that Dr. Shoemaker is using coal tar. We've been using Defense Soap. I'm going to present, we have a little Actino coffee house coming in for the Shoemaker-certified and Proficiency Partners people that I'm going to be presenting this data on. All we have right now is Defense Soap is statistically, significantly radically reducing the P. acnes and the Corynebacterium tuberculostearicum. Dr. Shoemaker saw the similar benefit with coal tar shampoo.

[1:34:28] SCOTT: When we think about Actinos, I've heard Dr. Shoemaker say that Actinos are found in the blood. Is there a potential role for systemic antibacterial agents? What are your thoughts on whether or not there's a place for that?

[1:34:45] DR. DORNINGER: I don't know, but now we're into me spending another $20,000 on figuring things out. We have a handful of people who have clean homes, and we can't get the Actinobacteria. Statistically, the Defense Soap is working, and then we have some outliers. What I did for the outliers, that took that skin swab. Again, this is stuff that we're working with the patient as an n of 1, right? This is anecdotal clinical observations. I don't want doctors out there just going willy-nilly.

We did the EnviroBiomics number 21 skin swab as a MARCoNS nasal swab, type nasal swab. They had high P. acnes and high Corynebacterium tuberculostearicum. One of the things that can knock that back is a Z-pack, azithromycin. I was looking up a Chinese study on the cultured P. acnes on Chinese population, and did culture and sensitivity in doxycycline had sensitivity to kill the P. acnes again outside the body, not in vivo. We know that a lot of our dermatologists will use tetracycline or doxycycline cream for really bad acne, which is often from Propionibacterium acnes.

We're figuring this out, Scott. A year from now, we're going to have clear thought on this. At the end of the day, and then Lactobacillus acidophilus does have potential out-competing abilities for Actinobacteria. Those are a couple of abstract studies that we're trying to get clinical validation, so that we can deliver honest data, rather than I had, or thought or a feeling in the shower today. You can measure Actino vesicles through EnviroBiomics, and yours truly was the first person to pull his blood for Actinobacteria.

This all, just like with trauma triggering the FKBP5 gene that can then create inflammation, right? Someone could have told me I'm ugly on Facebook 20 years ago, and I could still have joint pain from that. That's crazy. I need to go meditate. There's other things that you learn hanging out with the CIRSx and Surviving Mold crew, and even my incredible provider team, because they all bring such cool backgrounds, and they're so earnest with helping patients. Jimmy Ryan is the person I always try and grab lunch or dinner with, and he's the first person who really told me like, “Dude, blood is not sterile. It's sterile enough.” I'm like, “What? I thought it's either sterile, or you have a UTI, or you're going to pull a blood culture with sepsis.” No, our immune system is constantly just managing our blood.

It's Actino vesicles, almost like a lipopolysaccharide, but from a gram positive. It's these Actino vesicles, these little chips of mycolic acid that we're finding in the blood. We can only do that because we can now run blood through next-generation sequencing, NGS testing.

[1:37:51] SCOTT: Then what to potentially do if they're present? It sounds that's to be explored?

[1:37:57] DR. DORNINGER: Well, what we're doing as of now, and really the big rub on this, is all said and done a GENIE, $700 kit, $250 dry ice overnight, mail-in, $100 review by Dr. Shoemaker, so on and so forth, you're getting around $1,200 on a GENIE. That's from our clinic who doesn't upcharge labs.

If we did this right, we would get funding for 10 pre- and post GENIEs to make sure what I'm about to tell you, guarantees turning off map kinases and TGF beta receptor 1s. As of now, what we're doing is we're cleaning up the building, we're doing some maintenance on sheets, getting some iAdapts in there, running the Shoemaker protocol, just like ever, remove patient with biotoxin exposure, show me the clearance test, where is my clean HERTSMI? Where is my clean Actino with the P. acnes and the Corynebacterium tuberculostearicum less than 10,000 on the Swiffer, endotoxin, less than a 100, enough Cholestyramine Welchol to drain the body's remaining reservoirs by taking the biotoxin toilet, all the func med and naturopathic medicine we need to make sure that gut is healthy and we're pooping, and the liver is – and gallbladder discharging that biotoxin, laden bile, into the intestinal lumen, eradicate MARCoNS.

Then if we see lots of atrophy on NeuroQuant, we're going to do vasoactive intestinal peptide to regrow brains. That's what we're doing and it's working. What I'd love to know is, should we consider something like a round of doxy around a Z-pack, or high-dosing Lactobacillus acidophilus. Obviously as a naturopath, we’re using probiotic, if we’re using antibiotics, we’re using probiotics, to get there quicker, or to totally neutralize.

I mean, we've had a handful of dermatological MRSA cases in our clinic, where if there's one cell of MRSA left on your skin, it comes back, right? At the end of the day, again, postulation, I think we're going to find that managing and overturning the biome is more important than we think.

[1:39:57] SCOTT: Talking about functional medicine, naturopathic medicine approaches, with endotoxins, lipopolysaccharides, there are some practitioners that look at ways to support the lining of the gut, to minimize intestinal hyperpermeability, things like bovine immunoglobulins, and so on. How important is working on intestinal hyperpermeability, or leaky gut to reduce endotoxin transfer from our environment into our gut and potentially into our bloodstream?

[1:40:27] DR. DORNINGER: Yeah, I think it's super important. My only issue with functional medicine – I obviously do functional medicine. I teach weekends for Apex Energetics and a lot of Dr. Kharrazian’s work, I write some stuff for them. I don't like the word for what we do at Roots and Branches, because we really do diagnostic medicine. In that therapeutic order, step one of naturopathic medicine is identify and treat underlying cause. That's a lost art. It's hard to find MDs who want to really wholeheartedly dive in there. I'll give you an example with gut lining in a minute here.

Number two is re-establish healthy regimen. That's diet lifestyle, right? A good nutritionist can do that, an MD can do that, so on and so forth. Step three is stimulate the vital force. Get some acupuncture. Take the best homeopathy. Jump into cold river. Wim Hof breathe, meditate. All those things are stimulating your innate healing responses. Step four is tonify systems. That is targeted in our clinic, lab-driven, nutraceutical support. Step five is correct structural integrity. I'm good friends with Eric Goodman, who created Foundation Training. Pete Egoscue’s Pain-free work is incredible. There's a whole bunch of biomechanic methods that teach the patient how to train the muscles to load their bones. Step six is drugs and surgery. We're not anti-drugs and surgery. It just shouldn't be offered as a first resort.

Let's talk about, what does a gut need? What does an intestinal lining need to heal? What's the number one ingredient? Oxygen. Why aren't you screening the patient for apnea if they have leaky gut? What's the number two? Fuel. Number one important ingredient for physical life is oxygen. Number two is fuel. If I have insulin insensitivity, if I have hypoglycemia, if I think I'm in ketosis, but I'm not, and that Keto-mojo meter shows me at 0.7, how am I going to make energy? Cash money ATP to remodel my gut lining.

What about electrolytes? How am I going to create ATP without sodium-potassium? T3 thyroid hormone. The gastric ulcers in animal models and hypothyroid are real. Then my anabolics. I need estrogen, progesterone, DHEA, androstenedione, testosterone to rebuild, remodel. Then, yeah, love me some gut powders, whether it's L-glutamine, or DGL powder, or some of the bovine immunoglobulins, we do all that. But you don't want to have do a gut restore cleanse with a gut powder, like an Apex RepairVite, or a Design for Health GI Revive. There's a lot of great brands out there. You don't want to Bastyr in the 90s. I know all the great companies that make great products.

In a 63-year-old postmenopausal woman whose progesterone is 0.1, progesterone helps anabolize and heal the gut. I think Dr. Heyman did a really good job really talking about MSH's role in mucosal integrity. Not just mucosal immunity, but also mucosal integrity. If you have CIRS and you're working on leaky gut, but you're not dealing with removed patient from biotoxin exposure, you're putting band-aids on a patient. There's a time and a place for that, but just explain to the patient. If you're not an earnest dealing with the building, don't deal with these patients, right? That's where my whole spiel for the CIRSx welcome talk was we need screeners and we need screeners and treaters.

If you're interested in CIRS, but you get overwhelmed by the whole thing, you don't want to talk to a remediator, or every time you drive home about how they're botching your patient's building, right? Then just do a VCS. Do a cluster of symptoms. Evaluate biotoxin exposure. If it's there, send to someone that you trust, Shoemaker-certified clinic who's not adulterating the Shoemaker protocol. Call them and say, “Do you skip steps? Do you bait and switch the Shoemaker protocol?” No. Cool. I can refer to you. Let them run the protocol.

What we do for a lot of providers, they trust us to not poach their patients, right? Our job is to take a chronically ill person, they're doing a lot of good func med stuff. They got the diet and lifestyle stuff. Maybe they screen them for oxygen, maybe they got them in bioidenticals, whatever deals. Take them in. We deal with the CIRS and then they graduate, right? They should keep that provider for their pap and their occasional check-in and their heart scan and all the other stuff in healthcare.

[1:44:52] SCOTT: A couple more questions and then I'll let you go. You've already been super generous with your time. This next question is from one of our listeners and that is that Actinos release a compound called trimethylamine, or TMAO, which can attract other Actinos. Some have a condition called trimethylaminuria, where the body is unable to break down these TMAO compounds and release it through sweat, or other channels of elimination. Does this potentially make us more susceptible to issues with Actinos, either in terms of their ability to colonize our skin, or our susceptibility to CIRS when we are exposed? Do you potentially recommend against the use of phosphatidylcholine, or choline that could lead to increased TMAO in some patients?

[1:45:40] DR. DORNINGER: It's a great question. The answer is, I don't know. The way I would evaluate that is look into TMAO in a patient with Actinos, put them on Welchol Cholestyramine and see if those levels reduce. This might be, again, where we find maybe they need hyper-dosing of Lactobacillus acidophilus, or maybe they'll need some doxy, or Z-pack in the future. We don't know. It's a really curious question.

[1:46:05] SCOTT: Then a second question from a listener, what is the role of MASP2 activation from Actinos? How does that tie into C4A and potentially ongoing immune activation? Is there a way to reverse MASP2 activation? Is there a place for tools, like immune modulators that can help modulate the immune response in CIRS, like for example, low-dose naltrexone?

[1:46:31] DR. DORNINGER: The latter part of that is very easy. Louise Carter, bless her heart, she does Colabs in England. Basically, she's dedicated her life to getting the diagnostics necessary for CIRS for England and all of Europe. She did six GENIEs for LDN patients, low-dose naltrexone patients. What we saw is a reduction in general cytokine production, but no treatment of CIRS.

This made sense to me, because in 20 years of clinical practice, I mean, I went to Bastyr in the late 90s, 2003, we were using LDN 20 years ago. I would have these patients come in with miracle turnaround in their symptoms on LDN. In other patients, we would do nothing for them. We also know that maybe it's a cancer prevention thing for people as well, but just from an inflammatory standpoint. I think if we would have had GENIEs on them, we would have seen that cytokine profiles. If they were upregulated, LDN will help those patients. If they're not upregulated, maybe they don't feel some big benefit off LDN.

In regards to MAP kinases and their relationship to C4A, I don't know a specific correlation there. What I can tell you is when you do the Shoemaker protocol, both come down. We get the proper C4A, remember, if you're getting LabCorp C4A, don't even bother. You put futhan in it, which is a preservative that completely changes the science. Dr. Shoemaker ordered C4A and C3A from a woman named Patty. She recently passed three years ago. We call her the queen of complement. Incredible scientist at National Jewish.

In certain regions of the country, quests will courier for National Jewish and other regions they won't. Fortunately, National Jewish is in our backyard, so we can still occur the old way. I will tell you, when you run a GENIE, when we have C4A, C3A, and when we have MP9 and TGF-beta, and do the Shoemaker protocol proper, they all normalize. It's pretty awesome.

[1:48:36] SCOTT: My understanding is that LabCorp TGF-beta 1 is not really the place to go anymore either.

[1:48:43] DR. DORNINGER: We have five Shoemaker-certified clinic…we have five people doing CIRS cases here. No one that I know orders more TGF-beta than us. Freaking LabCorp did not call us to tell us they changed their methodology. People were popping off. I mean, we're used to seeing a 16,000, or a 7,000 or another. I don't know where everyone's coming back with 25,000, 40,000, so on and so forth. We call our LabCorp rep, and says, “Oh, yeah. They changed the methodology.”

I mean, have the decency to call us and say, “Just so you know”.  So, your absolutely right. Quest is still pulling TGF-beta.  Real quick, if we want to run through that, C4A, C3A is National Jewish, and Quest can courier for that. TGF-beta, we're getting through Quest. MMP9 is Quest or LabCorp. Alpha-melanocyte stimulating hormone is only LabCorp. MARCoNS is MicrobiologyDx. ACTH cortisol can be from either. VEGF we're doing from either. ADH-osmolality is only LabCorp. Quest switched to copeptin, which is very complicated to switch to the old methodology.

This is the constant battle my wife and I literally put well over one to 200 hours a year on maintaining our right to the diagnostics to figure out patients. Then we try and disseminate that to all the providers willing to take this on. It's my staff that really deserves that, and it's sucked that that happened and no one knew, because you just wasted patients' time, money, and energy on a marker.

[1:50:22] SCOTT: Yeah, I happened to run TGF-beta 1 on myself and suddenly, it was my tire, which led me to contacting the Eurofins ViraCor people and figuring out that pretty much everything had changed.

[1:50:33] DR. DORNINGER: Yeah. What's different about you than the majority of us and whether it's not enough time and are all overwhelmed is you called, right? You should challenge and call every medical director of every lab. It's CLIA certified. It just means there's no dog poop and flies around. It doesn't mean that a lab is clinically validated. That's what's so special about Dr. Shoemaker is he clinically validated the screening, the diagnosis, and the treatment of this illness.

[1:51:02] SCOTT: My last question is the same for every guest, and that is, what are some of the key things you do on a daily basis in support of your own health?

[1:51:10] DR. DORNINGER: Well, I really fell ass backwards into the greatest reason to exist on this planet, which is helping others. I'm not going to have the majority of my life. I spend reading papers, coordinating, trying to educate other doctors, talking to mitigators or mediators, and when we get the pop of graduation, there's no better feeling on the planet. I like to powder ski, a hot date nights fun. Nothing is like seeing the chronically ill get productivity, creativity light back.

Honestly, what I do for a healthy basis is do what I love professionally, and that brings a lot of joy. I love rolling jiu-jitsu. I've always loved the martial arts, but you can train jiu-jitsu and not get kicked in the head and really just get out stress and agitation. I love hanging out with my kids, my younger's into team sports and the big hoops guys. I play a lot of hoops with him. My older's a parkour guy. I love hanging out with family. I make time for God and have him speak into my heart on ego and service and why are we doing all this and remember what's important and money will never fill me up, like service does.

Just keeping on track with why we're doing all this and that's about it. I love to Wim Hof really cold plunge and do some fun stuff like that. When you take the HLA of 24%-25% of the population has these genes. I think that's might be underrepresented relative to bigger data sets, but that's on a 10,000 chronically ill and a lot of healthy controls. You say, we have the EPA estimates 50% of the buildings are water damaged, and the last time my wife and I went house shopping, 19 for 19 Boulder homes were water-damaged. We would have to budget 300 to 500K to fix them. It wound up in a new built town home. That's a 100 million people that are stuck in the rheumatologist and the infertility doc and the psychologist and the psychiatrist and the neurologist and the func med doc.

We want to continue spending our days changing healthcare from what you have to why you have it and getting everybody access to the underlying causes, so that they can get accurate treatment plans that restore productivity, creativity, joy, patience, capability in their life.

[1:53:46] SCOTT: I loved this conversation. My transcriber may quit after listening to you, but it was so information packed, information dense. You were super generous with your time, and I just really had a fantastic time. Thank you so much for being with us today and sharing a lot of – I'm sure that is not close to all of your knowledge, but definitely appreciate you.

[1:54:12] DR. DORNINGER: I just wanted to say, I love your podcast. I view you as a fellow colleague in critically thinking and truth seeking and caring about real bottom barrel answers for the chronically ill. I can see you wear your heart and your brand on your sleeve and you pour your life and soul into helping others and getting accurate information out there. I really appreciate what you've done to preserve Dr. Shoemaker's work and also, just creating an open platform for any ideas.

We're not anti-ideas. We just challenge everything politely, because the chronically ill is time, money, and energy are riding on what we're doing in healthcare. I really am grateful for what you put out on the airwaves. Thank you.

[1:54:56] SCOTT: Thank you so much.


[1:54:57] SCOTT: To learn more about today's guest, visit drdorninger.com. That's D-R-D-O-R-N-I-N-G-E-R.com.

Thanks so much for listening to today's episode. If you're enjoying the show, please leave a positive rating or review as doing so will help the show reach a broader audience. To follow me on Facebook, Instagram, Twitter, or TikTok, you can find me there as @BetterHealthGuy. If you'd like to support the show, please visit BetterHealthGuy.com/donate. To be added to my newsletter, visit BetterHealthGuy.com/newsletters. This and other episodes can be found on YouTube, Apple Podcasts, Spotify, Google Podcasts, and Amazon Music.


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