developed by: Ritchie C. Shoemaker, M.D.

CholestyramineUsing various tests, Dr. Ritchie C. Shoemaker has mapped out the Biotoxin-Related Illness Pathway that helps identify and correct dysfunction for those made ill by neurotoxins from mold, lyme disease, spider bites, and other bacteria and fungi. A keystone of his approach is a computer-based eye test called the Visual Contrast Sensitivity (VCS) test that can be done via his website He also recommends a specific blood test to determine genetic susceptibility to mold illness, post-Lyme disease, and other related conditions.

For those genetically lacking the ability to excrete these neurotoxins, the main treatment is Cholestyramine (CSM), a cholesterol-lowering toxin-binding medication that is not absorbed by the body. We recommend that you get the compounded version of CSM so you can have the artificial sweetener and other undesirable filler ingredients removed. Based on the individual’s test results, other medications are used in conjunction with CSM to assist the body in ridding itself of toxins and to correct deficiencies and overages.

If you are interested in this protocol, a must-read is Dr. Shoemaker’s groundbreaking book Mold Warriors, which covers all of the biotoxin illnesses treated by his protocol, not just mold. You can also check out Dr. Shoemaker’s websites:, and

Dr. Shoemaker practices in Pokomoke, Maryland. For those unable to travel to Maryland, you can buy your local doctor a copy of Mold Warriors which details the protocol and treatment, and even has a list of the recommended tests, as well as a cheatsheet for interpreting the HLA-DR test for genetic susceptiblity.

  • Earthwalker

    Earthwalker is the username that PT founder Julie Genser created for her online interactions so many years ago when first creating Planet Thrive.

    Julie's (Earthwalker's) life was derailed over twenty years ago when she had a very large organic mercury exposure after she naively used a mouth thermometer to measure the temperature of just-boiled milk while making her very first pizza at home. The mercury instantly expanded into a gas form and exploded out the back of the thermometer right into her face. Unaware that mercury was the third most neurotoxic element on Earth, Julie had no idea she had just received a very high dose of a poisonous substance.

    A series of subsequent toxic exposures over the next few years -- to smoke from two fires (including 9/11), toxic mold, lyme disease, and chemical injuries -- caused catastrophic damage to her health. While figuring out how to survive day-to-day, and often minute-to-minute, she created Planet Thrive to help others avoid some of the misdiagnoses and struggles she had experienced.

    She has clawed her way over many health mountains to get to where she is today. She is excited to bring the latest iteration of Planet Thrive to the chronic illness community.

    In 2019, Julie published her very first cookbook e-book called Low Lectin Lunches (+ Dinners, Too!) after discovering how a low lectin, gluten free diet was helping manage her chronic fascia/muscle pain.


  1. earthwalker

    This is the protocol that gave me hope and led me to a diagnosis of Mold Illness and Lyme Disease. Mold Warriors is recommended reading for anyone with chemical sensitivities, fibromyalgia, chronic fatigue syndrome, and other symptom sets that defy explanation.

    My advice to those wanting to pursue testing for the Shoemaker Protocol would be to become a patient of Dr. Shoemaker’s. Although this entails travel and money, in the long run I believe it will save you a lot of time, stress, and headache. My experience in 2005 getting my local doctor to order the tests and then to coordinate with our local Quest offices, Baltimore Quest, and LabCorp was unbelievably fraught with human error, resistance, and I was treated very rudely by various parties. This caused undue stress which only added to the set of symptoms I was dealing with on a daily basis and nearly drove me mad. The whole process of completing all the tests took 6 months due to all the lab errors!

    Dr. Shoemaker’s office was of very little help and was unwilling to assist in the process. Any efforts on their part to share information resulted in confusion and the wrong tests being ordered. Both myself and my doctor’s Office Manager were treated unkindly by certain staff members. A promise made by Dr Shoemaker to review my test results at the end of the process was never kept.

    My doctor and I fumbled around in the dark to try to determine how to proceed once we had the test results. I went on Cholestyramine (CSM) for approximately 6 weeks and found it alleviated the severity and extensiveness of my MCS symptoms, making my daily life much more bearable. Unfortunately, the lab I was using (Hopkington Drug in Massachusetts) screwed up my second batch and sent it with a filler they were not supposed to have included. Because they had mislabeled the medication, I did not catch the mistake. I had a series of near anaphylactic reactions that week and went off all supplements and meds, including the CSM.

    I believe very strongly in Shoemaker’s Protocol, and recommend anyone with MCS, FMS, and CFS to get tested if there is a chance they have Lyme Disease, Mold Illness, or any other of the related biotoxin illnesses. His book Mold Warriors lays out his protocol and is a fascinating read. But the road to pursuing his protocol can be a very difficult one if you do not have a local doctor familiar with it or willing to do the legwork for you with all the labs. The best scenario is to become a patient of Dr Shoemaker since his office has a long-term relationship with their local Quest lab and things should go much more smoothly there.

    I have heard that many people have had great experiences as a patient of his, but others have had horrible experiences.

    Here are some tips based on my own personal experience if you do proceed with the testing locally:

    • The LabCorp MSH test requires a special kit that needs 1 -2 weeks lead time to get in. Just be aware—I wasn’t and the lab didn’t know either, so they took my blood and then a week later I was informed they had to order a kit, then I had to wait another 2 weeks to get the blood re-drawn!

    • Make sure you order the HLA DRB DBQ Disease Association test from LabCorp. (NOT the HLA-DR specific, which is what I ordered since Dr S did not specify—he just wrote “HLA DR by PCR”. That cost me $250 and was not necessary, and I had to redo the test which cost me more $$ and more time and effort.) Make sure they get enough blood. I had to redo mine because they didn’t collect enough. Almost every test I took at Quest and LabCorp had to be redone 2 to 3 times due to the technician’s error, or the lab’s screw up. It was unbelievable.

    It’s best to have 1 contact at Quest who can oversee the process for you:

    • Contact a supervisor at the Quest lab “hub” and explain that Dr Shoemaker has a special relationship with the Baltimore lab and certain tests need to be directed there so they can be included in his research.
    • Have the supervisor agree to track the blood to make sure it gets from your local draw center to the hub and then to Baltimore.
    • Have the supervisor contact someone at the local draw center and explain the situation.
    • Then follow up with that Supervisor to make sure the blood made it to Baltimore.

    • At the time of this writing, Dr. Shoemaker is the only doctor authorized to order the MMP-9 through Quest. The first time, I was told I couldn’t get it since Dr Shoemaker did not order it. The next time I decided to take a chance and I had my doctor put it on the requisition again, and somehow mine ended up in Baltimore and got processed even though I didn’t ask for it to go there! The person at the desk figured out that my doctor and Shoemaker were somehow working together since a sheet I gave them was faxed from Shoemaker’s office. I was lucky.

    • The Cytokine Panel has to go to Baltimore and from there it is sent to an outside lab in Denver. It takes approximately 6 weeks to get the results since they only do that test once a month. The Baltimore Quest lab is the only Quest with a special arrangement with the Jewish Hospital in Denver. My blood never got to Denver…supposedly a Fed Ex screw up, but then it took 6 weeks to find out. To avoid this, have Quest track the blood from Baltimore to Denver and confirm they received the blood specimens. Follow up!


  2. Carol Steinitz

    Thanks for the commentary. I was considering making appts w/ Dr. Shoemaker as I have been very ill from mold for over 2 years, and am now selling my house and still trying to find an apt. that doesn’t make me ill. I began having trouble after a long bout of undiagnosed Lyme disease. Dr. Colleen Pietrowski is someone in Lutherville, MD, Advanced Physical Health, that is familiar w/ Dr. Shoemaker’s protocol and she is very kind as well. She can order the MMP-9.

  3. ruth lyons

    i have been unable to locate a health professional
    in washington state that is schooled in dr. shoemakers’
    protocol. any direction is appreciated.

  4. earthwalker

    Hi Ruth, Sorry but I don’t know about doctors in Washington state who use Dr. Shoemaker’s protocol. You might try Dr. Dietrich Klinghardt in Bellingham, WA – I believe he incorporates elements of Dr. Shoemaker’s work but he has his own very comprehensive protocol and focuses more on lyme disease and autism, but is familiar with mold issues. You could also contact Dr. Shoemaker’s office and ask for referrals in Washington state. Good luck!!

  5. lara m

    For what it’s worth I spoke with Shoemaker’s office yesterday and they won’t give you referrals in your area. She said the options are to see Shoemaker or find a dr. who is willing to educate themselves on his protocol.

  6. sue v


    There are many other doctors who do Shoemaker’s protocol or a variation on that protocol. We are currently working with Dr. Michael Gray in Benson, AZ and there are others. You can learn a lot about mold illness at the sickbuildings yahoo group, also this website lists some other treating doctors: another source of info is

    Hope this helps. Sue V.

  7. John

    I have been sick for 5 years and just recently saw Dr. Shoemaker. I have the staph colonization in the nose and says I can’t start to heal until it is gone. I would not wish this illness on anyone. Just finished my antibiotics for on emonth and am going for more blood tests. It feels like you will never get well. Just keep hope alive and pray to God.

  8. earthwalker

    Glad you are finally getting help John. Good luck to you on your path! Julie

  9. John

    Julie, How are you feeling and what steps did you take to get better. My problem is that I had mold in the house. Had it remidiated but I think the toxins are everywhere and especially in the clothes. I am thinking of leaving everything behind and starting over. I have a place to go, but I don’t want to leave them. Do you have any suggestions for me I would appreciate it. Thanks John

  10. earthwalker

    Hi John,
    I removed your phone number, as I don’t want you to get unwanted phone calls from strangers through the Internet. Phone calls are difficult for me, email is better. I am feeling okay but still have severe lifestyle limitations due to chemical and electrical sensitivities.

    From what I have heard, it is very difficult to remediate mold. I had to walk away from everything I owned on more than one occasion. If you don’t feel well, I recommend you do the same. Put whatever you can’t bear to part with in storage and only go to a new place with things that can be cleaned well, like metal. Although depending on your mold sensitivity, even those things could bother you.

    When I was living in a mold infested apartment I took Cholestyramine for 6 weeks and it really helped my MCS. Not everyone does well on it, however. I took a special version that had most fillers removed. I also found drinking wheatgrass, a potent detoxifier, to be helpful to me.

    Anything that helps you lower your toxic load I imagine will be helpful. Reducing use of chemicals in your life, eating organic, etc. Visit the Recovery Basics section of our site for more tips: Go slowly though, as anything that increases your ability to detoxify substances can lead to increased symptoms. It’s a careful tightrope one must walk to balance symptoms and detoxification….

    Best of luck to you!! Julie

  11. ray d, crank

    in 05, we bought this moble home from a very big dealer ship here, 2 months latter we found stachybotrys+4 ? the water pipes had been busted before we got it. no inspection was done, this was illegal. the mold has made me and my family sick, allergies, rashs, infections, one after the other, breathing prob, memory prob, dizzyness, head aches, nose bleeds coughing up blood, i had no ideal this stuff could hurt you this bad? we are seeking a doctor as of now, out of state. glad we found dr,shoemaker. he will be are next stop.

  12. earthwalker

    That is really terrible Ray, so sorry you and your family had to go through this. I hope you can find relief with Dr. Shoemaker. Thankfully you identified the problem and can now move forward with treatment. Best of luck to you all! Julie

  13. Debbie B.

    Hi Julie. I am SUPER familiar with all that you’ve uncovered about neurotoxins and mold. I work with an amazing Dr in the Pgh area who has introduced me to the protocols of Dr Shoemaker. I have remediated (safely) mold in our house to successfully eliminate it, detoxed my body of toxic levels of mercury and lead, safely removed my amalgam fillings, etc.; along with a “clean” diet and constant journey of the best supplements for my bodytype, I am now left with dealing with a staph bacteria issue. I’m having a hard time deciphering Shoemaker’s protocol for the 3 (?) different antibiotics that are administered (I believe one is called Bactriban.) I did the nasal swab test, sent it to the univ of MD’s lab…but we never had it tested for antibiotic resistance. Do you have any advice Julie? I’m typically against antibiotic use, but I do believe that it is necessary in my case. I have my pro-biotic course all lined up…but I’m so unclear on an antibiotic protocol. BTW, Dr Dan Pompa in Pgh, PA is an amazing wealth of knowledge He just released his own detox product called CytoCleanse, and it is an absolutely amazing product. I think it will eliminate my use of CSM.

  14. Martha

    I’m looking for a source of affordable filler-free cholestyramine. My local compounding pharmacy quoted me a price of $200 for a 6-day supply, which is not even remotely within the realm of possibility for my budget. Julie, it sounds like you had a bad experience with your compounder. Do you not recommend them? Are there other options?

    Speaking of things I can’t afford — could someone give me a ballpark estimate on how much an initial consultaiton with Dr. Shoemaker, including testing, would be? Thanks.

  15. jeny

    I believe it was $800 minimum to be seen, when I was looking into it in late ’08. You can call and get the info packet that you’ll have to fill out. But then when you read the packet, you’ll probably see a few reasons why you might want to find another doctor. Please talk to several people who have gone to him and see what you find. I have heard more horror stories and people who were told and believe that they can’t be helped. Most of them were just given CSM or a CSM alternative. You can get that without traveling to MD and spending thousands. Contrast that to what you find from people who see real EI doctors. I just hear from too many people who regret wasting their money with him, and I’m so glad that I heard these things BEFORE going.

  16. earthwalker

    Debbie B. sorry I just saw your post. I don’t have much experience with antibiotics, sorry I can’t really offer any advice on it. I used cryptolepis, an herbal antibiotic (suggested by herbalist Stephen Buhner for use with Babesia, which I don’t have) from both internally as a tincture and also as a nasal spray to try to address a nasal staph infection. I did not retest after treatment so I don’t know if it was effective. This was about 3 years ago. I hope your doctors can help you! Best, Julie

  17. earthwalker

    The lab I used was Hopkinton Drug in MA. It was about 5 years ago. The problem I had is they mislabeled my Rx originally, so when I got the refill I did not question it – I just assumed they had filled it the same as before (without the fillers I had requested be removed). I ended up ingesting a known trigger for me for several days and then having an anaphylactic reaction to fresh coconut. I would not say I don’t recommend them. I would say that if you get a mislabeled Rx because you gave special directions and they forgot to note it on the bottle, then to MAKE SURE that you have them correct it when you re-order. Do not take anything for granted.

  18. mold survivor

    I too have experienced the problem of extreme mold exposure and toxicity. The key to dramatically moving forward was of course to begin an effective healing protocol combined with remediation or cleaning of the mold conditions or mold materials. The next step however was in my case the most important of all. Even though mold materials or building environments were cleaned, it wasn’t enough. Without a process in place to prevent new mold conditions from re-growing, it was very difficult to move forward with my health condition. I was fortunate to be referred to a company based in Michigan called Wright Way Environmental Technologies.
    They do work all over the USA so they were able to help me out in my area as well. I did months of research trying to find a company that was knowledgable in this area of air quality and air sanitization and finally found them. I was amazed at how much time they spent with me just answering questions and helping me to understand the real problem that continued to affect me even after what I thought was a thorough mold cleaning. Because of how bad I had felt, they even provided a portable version of the mold destructing technology that i was able to bring to work in my office and in my car that gave me the relief I was so desparately hoping for. Hope this helps someone else. We all need to be sharing any positive resources as I was so thrilled to get my life back on track and feeling well again from someone sharing with me.

  19. debra

    Reading about this protocol just before a new year – thank god. My life is unbearable, living in a car, I have possibly the worst mcs in this country BUT the pain, with a list of viruses as long as your arm this protocol made sense. I didnt even do a lot of research. Just followed from fatigue to fantastic Dr way of taking it. But I noted most people feel a bit better in 2 days to 3 weeks. 3 weeks into it and no change. I feel at rock bottom. I am SO disappointed. I dont know whether to continue. Of course, I realised quickly it had aspartame and other bits of junk in it. I dont seem to be reacting to it but its just more poison. Ive been taking the vitamin C as suggested until I realised it wasnt buffered and I was making myself more acidic. Is anyone better from it? Should I continue?

  20. Ida

    I too am extremely mold sensitive. I learned a lot from
    Dr. Graham, a Mycologist. I had found that nothing
    could get the mold/mycotoxins out of anything, for me.
    I bought Sol-u-mel, and two other expensive liquids.
    Metal is very difficult to decantaminate as well.
    I also fogged with these solutions that helped.
    Last year I saw on the web that Cornell, ag. dept. in Israel
    as well as other universities used Baking Soda to spray
    for powdery mildew and other fugus. It is better than
    all the expensive solutions I was given by drs.
    The ratio is 2-4 tablespoons of b.s. to one gal. of water.
    I sometimes get contaminated from going into a building
    with mold and come home and contaminate by place.
    I would immediately start getting respiratory problems,
    and this back them out. I have a cold water fogger,
    from fogmaster. Before I bought it, I used to spritz
    with a spray bottle, several times a day. It help as well.

    Another thing, I irrigate my sinuses, with very warm salt water and pinch of baking soda. I just snort this solution from a small bowl (one cup water). bending over a sink. For sinus problems, i also use
    Heel Sinusin nasal spray and for congestion Dr. Murrays, lung, bronchial, Sinus health tablets, They just melt away the congestion. People with emphysema use them.
    An E.I. dr. in L.A. told me about both of them.
    Now, I wash my clothes, shower and fog my place with B.S.
    It works. If anyone wants to reach me my email is
    About the air purifier. I looked at that website and there’s nothing there about how it works. how much charcoal,
    plastic if any. I question their claim of filtering up to 3,000
    sq. ft of space.
    Dr. Grahams’ office recommended to use prolabs in Fla,for mold tests.
    I thought I would share what I’ve ended up helping me
    through this 10 yr. journey.
    Here’s a good site. Mary is a Bau-Biologist and an e.i.
    She is very well respected for her expertise.

  21. Herbert

    I just read with great interest you post that specified HLA DRB DBQ instead of the HLA DR. Well, bummer. I just plunked down $240 for the HAL DR and would like to know how you discovered that the other was needed. I got the same info from Dr. Shoemaker’s site and also Dr Kruse’s blog.I self-treat and this is a big hit moneywise, not to mention time! Sorry for your arduous lab/doc journey. I am just really starting to go for the Shoemaker protocol but keep reading bad things about how to manage it. I believe in the basics, but getting a smooth ride seems to be elusive.

    I found Shoemaker thru a blog by Dr. Jack Kruse and it has fundamentally changed my strategy on finding true health. Big words, I know. But I have been searching all my life for how a Human operates, how foods/drugs affect the body, and finally, how we can use our spiritual nature to be in balance. Many questions are getting revealed. Please, check it out and see what resonates with you.

  22. Sue

    Hi Julie and everyone,

    I use to come to this site a few years ago. I have/had Lyme disease. I think my story is up here somewhere. Anyway, I was on antibiotics for years and a lot of supplements, chelation, liquid silver, awful vitamin C (ack, I think it almost killed me)….I was on so much for so long I can’t remember it all.

    I have gotten better and worse again and I am pretty convinced at this point that it is the biotoxins that are causing the repeat and chronic problems. And I have realized in the last few months that mold contributes….it’s so insidious.

    I just want to add what I know about Shoemaker. My husband is sick, too. He saw Dr. S in January (2012) and started on the CSM. He (Mike, my husband) is seeing improvement. It is really encouraging. He use to get wicked headaches and they are much better. There is improvement in so many areas…..I think we both have hope for the first time in years and years. So I am waiting for my appt.

    I have another friend who has seen Dr. S and has improved maybe 50%, after about 3 months. I’d take that!

    Negatives I’ve noticed so far. Shoemaker is incredibly busy….he testifies for patients and I think he is in court a lot, as well as seeing patients, writing, etc. I think there are only 3 people total working in his office. So Mike and I have found the individual attn. is lacking. Questions may not be answered for a long time. He also may not be the warm and fuzziest guy…..but I truly think he cares. A lot. There are things that aren’t perfect, but I am going and I believe it is going to help.

    Sorry this is so lengthy!

  23. Elaine Hipple

    Following Dr. M. Gray’s protocol for mycitoxicosis. Wondering if anyone out there gets severe burning in mouth, nose, digestive tract from exposure to anything in their contaminated place and what gas helped.

  24. Maureen

    Please help with Shoemaker, MARCoNs, VIP

    I read John’s replies about seeing Dr. Shoemaker and having the nasal staph. I saw him too, and fiinished treatment for the MARCoNs 5 weeks ago. Not getting better. Shoe said VIP may be my next step. Wanting to hear from anyone who has gone through this. Thank you very much!

  25. Carrie

    Hello! I was a patient of Dr. Shoemaker’s, my entire family traveled to see him Dec. 2012 due to toxic mold illness. I am the sickest, luckily my kids got better once we left our home that had stachy mold and other WDB molds in it. Dr. Shoemaker is now officially retired and I was able to get one last phone consult in, therefore I was able to start my treatment for MARCoNs and have been on Cholestyramine for 6 weeks.

    With Dr. Shoemaker no longer able to prescribe/test, I’m looking for a doctor to take over my treatment. I have looked at Dr. Michael Gray in AZ, although after 3 messages I left with 2 different people over the past 2 weeks, I have yet to receive a returned phone call. I just followed up with an email on Friday. When I did speak to someone at the front desk, she said Dr. Gray is taking on new patients, but I need to speak with a certain person at the office on mold illness patients and this is who I’ve left multiple messages with.

    My question is…has anyone gone from start to finish with Dr. Shoemaker’s protocol including VIP? If so, what is the percentage of improvement of symptoms? Has anyone worked with Dr. Gray or any other mold illness doctor with success and if so, did your treatment consist of Dr. Shoemaker’s protocol or combination? I feel like I started Dr. Shoemaker’s protocol, so I am really trying to find a physician that will strictly follow his protocol to see if this works for me.


  26. Yvette B

    My question is which book to get, Mold Warriors or Surviving Mold? My doctor told me to get Mold Warriors but couldn’t find it at my library but did get Surviving Mold. I just start reading it and have been able to identify that I may be someone who is extremely sensitive to mold. I’m looking for a protocol to make me well again, just wasn’t sure if I could find the same protocol in the Surviving Mold book too. It’s a pretty big book to get through. Has anyone read this book?
    Thank you

  27. Jonathan

    Ruth: All three doctors at The Evergreen Center for Integrative Medicine in Seattle are now treating patients with Biotoxin Illness.

  28. Jonathan

    Also, I believe that Dr. Buscher, an environmental medicine specialist over in Redmond, is also now treating it, although I don’t believe he accepts insurance while the Evergreen Center does.

    I know that the word is spreading in Seattle amongst NDs and MDs alike.

  29. Jonathan

    My big frustration: how do we make BUILDERS aware of the giant health problems they’re creating? In some sense, Biotoxin Illness is not a medical problem at all, but rather a housing industry problem that’s been created by poor home design and construction. There are many, many things they could do to help fix this problem if they could be made aware of it. It’s all very very sad.

  30. Aviva

    There seem to be so many different treatment protocols for biotoxin illness. Has anyone had success with Dr. Gray or with Dr. Rea in Dallas? Dr. Nagy attributes much of her return to health with Dr. Rea’s antigen therapy. Has anyone else found this treatment helpful? Would be grateful to hear about anyone’s experiences at his clinic. Thank you.

  31. Claudia fanto

    My daughter is being treated for mold toxicity by Dr. Bingham in the Boston area. However, mid treatment he told her he’s leaving. That makes life so hard. Do you know of another Dr. In the Boston area or surrounding areas who follow Dr. Shoemakers protocol.
    Thank you so much, Claudia

  32. Julie

    Hi Claudia,
    The only two doctors in Massachussetts that I am aware of that treat biotoxin illness are:

    Lisa Nagy, M.D.
    Vineyard Haven, MA

    Dr Trista Repassy, MD
    Natick, MA

    Maybe their offices can recommend others, if they are not close enough. Best wishes, Julie

  33. Keira

    Thank you so much for the info.
    Does anyone happen to know of any doctors treating biotoxin illness in the New York City area?

    Thanks so much!

  34. Stephen

    Hi everyone,
    I am seeing a functional medicine Dr. who works with Dr. Shoemaker. I have not started treatment yet (due to work travel), but she follows the protocol pretty closely with a few variations. All the lab test point to mold, HLA, hertsmi, urine,blood test etc and I have been diagnosed with CIRS.
    Anyway PURE Cholestryamine-one month supply $320, Lee Silsby, which is much more affordable than what I have found anywhere else. I am confident with mold avoidance, strict diet, and proper detox most can make a full recovery.

  35. Sarah

    Which doctor are you using? Does anyone know of one in nyc that follows shoemakers protocol or at least prescribes cholestyramine?

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