What Is It? ME/CFS or CIRS? Understanding the Overlap Between Two Debilitating Conditions

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For many people grappling with chronic illness, the journey to a proper diagnosis can be long, confusing, and disheartening. You may feel like you're caught in a revolving door of symptoms—crippling fatigue, brain fog, widespread pain—only to be dismissed, misdiagnosed, or left without answers. For years, many patients have been told they have Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), a condition characterized by profound fatigue and post-exertional malaise, but lacking a known cause or effective treatment. Yet another, often overlooked, diagnosis—Chronic Inflammatory Response Syndrome (CIRS)—may explain what ME/CFS cannot.

This article explores the difference between ME/CFS and CIRS, how they can be confused, and why recognizing the role of toxic environmental exposure and biotoxins may be crucial in finding the right path to healing.

A Personal Reflection: Searching for the Missing Link

Like many others, I spent years searching for answers, unable to reconcile the intensity of my symptoms with vague diagnoses. One memory that stands out is an exposure to a toxic environment—not just affecting me, but others around me as well. The shared nature of that exposure made it hard to ignore.

Over time, I began to suspect that this toxic event had triggered something deeper—an ongoing inflammatory process affecting multiple systems of the body. What if the fatigue, cognitive impairment, pain, and immune dysfunction weren’t just random symptoms, but part of a biotoxin-induced cascade that had been overlooked?

This is where CIRS enters the picture—a diagnosis that not only made sense but also explained what others had missed.

What Is CIRS?

Chronic Inflammatory Response Syndrome (CIRS) is a multi-system, multi-symptom illness caused by exposure to biotoxins—toxic substances produced by living organisms. These biotoxins can come from:

  • Mold in water-damaged buildings

  • Tick-borne infections like Lyme disease

  • Ciguatera fish poisoning

  • Blue-green algae (cyanobacteria)

  • Other environmental toxins

CIRS occurs in genetically susceptible individuals who are unable to properly detoxify and eliminate these biotoxins. Instead, the immune system becomes chronically activated, leading to widespread inflammation and dysfunction across many bodily systems.

It is estimated that up to 25% of the population may carry the genetic susceptibility to develop CIRS, yet it remains underdiagnosed and under-recognized, often mistaken for conditions like ME/CFS, fibromyalgia, or depression.

FeatureCIRSME/CFS
CauseBiotoxin exposure (mold, Lyme, toxins) in genetically susceptible peopleUnknown/viral triggers often suspected
BiomarkersYes — clear lab abnormalities (e.g., MMP-9, C4a, TGF-beta1, MSH, VIP)No universally accepted biomarkers
Diagnostic TestsYes — VCS test, HLA-DR genetic testing, NeuroQuant MRI, specific labsDiagnosis based on exclusion and clinical criteria (e.g., ICC, IOM)
Key SymptomsFatigue, brain fog, respiratory issues, pain, mood swings, temperature dysregulationFatigue, PEM, sleep disturbance, cognitive dysfunction, orthostatic intolerance
Environmental TriggerStrongly linked to mold or biotoxin exposureNot necessarily linked to environment
Treatable Root CauseYes — remove exposure, detoxify, modulate immune systemNo cure; symptom management only
Recognition in MedicineEmerging but still controversialMore widely accepted, but poorly understood

Symptoms of CIRS: A Closer Look

CIRS manifests across multiple systems. While there is overlap with ME/CFS, CIRS often presents with more respiratory, neurological, and hormonal disturbances.

Common CIRS Symptoms:

  • Cognitive: Brain fog, memory loss, confusion, word-finding difficulties

  • Fatigue: Debilitating tiredness, poor recovery from activity

  • Neurological: Headaches, dizziness, numbness, light/sound sensitivity

  • Respiratory/Sinus: Chronic congestion, cough, shortness of breath

  • Musculoskeletal: Muscle cramps, joint pain, morning stiffness

  • Mood: Depression, anxiety, mood swings, panic attacks

  • Autonomic: Temperature instability, night sweats, excessive thirst

  • Other: Digestive issues, increased urination, skin sensitivity, metallic taste

Diagnosis of CIRS: Beyond the Symptoms

CIRS is not diagnosed based on symptoms alone. A full workup includes:

1. Symptom Assessment

  • Meeting at least 8 out of 13 symptom clusters from a 37-symptom roster.

2. Visual Contrast Sensitivity (VCS) Test

  • Measures the ability to distinguish contrasts, often impaired by biotoxins.

3. Genetic Susceptibility (HLA-DR Typing)

  • Certain HLA genotypes prevent efficient biotoxin clearance.

4. Inflammatory & Hormonal Markers

At least five abnormal markers support the diagnosis:

  • MMP-9 (elevated)

  • TGF-beta1 (elevated)

  • C4a (elevated)

  • MSH (low)

  • VIP (low)

  • C3a/C5a (complement activation)

  • ACTH/Cortisol (imbalance)

  • ADH/Osmolality (fluid imbalance)

5. NeuroQuant MRI

  • A specialized brain scan revealing inflammation or volume changes in specific areas—often seen in CIRS but not typically in ME/CFS.

6. Environmental and Microbial Testing

  • Mycotoxin testing (urine or blood)

  • MARCoNS (nasal bacterial swab)

  • Home/environment testing for mold or water damage

What Comes After a CIRS Diagnosis?

1. Remove the Source

  • Remediate or leave water-damaged environments.

  • Treat Lyme or other infections if present.

2. Bind & Remove Toxins

  • Use of binders (e.g., cholestyramine, activated charcoal) to eliminate circulating biotoxins.

3. Immune Modulation

  • Shoemaker Protocol addresses immune imbalances step-by-step, including:

    • Correcting hormone levels

    • Replacing deficient VIP

    • Treating MARCoNS infections

4. Address Co-factors

  • Gut health, sleep, stress, mitochondrial function, and nutrient deficiencies all play a role.

ME/CFS vs. CIRS: Is It Really Either/Or?

For many, it may not be a question of one or the other. Some with ME/CFS may have underlying undiagnosed biotoxin exposure, while others with CIRS may meet ME/CFS criteria but have a treatable root cause that was missed.

The medical literature increasingly points to overlap between these syndromes—especially as environmental toxins, chronic infections, and immune dysregulation are better understood.

In fact, in a growing number of cases where ME/CFS is diagnosed, CIRS may be the more accurate diagnosis—especially when patients recall a clear exposure to mold or have objective lab abnormalities consistent with the Shoemaker model.

Final Thoughts: A Silent Epidemic With Hope for Healing

As the excerpt from the literature review notes, CIRS is a silent epidemic, affecting a substantial but under-recognized portion of the population. Its symptoms mimic ME/CFS and other chronic conditions, but unlike those, CIRS often has a clear cause and a structured treatment path.

The most important takeaway? You are not imagining your illness.

Whether it’s ME/CFS, CIRS, or both, your symptoms are real, and the path to understanding them may lie in asking the right questions, looking deeper, and considering environmental and immune triggers that conventional medicine too often overlooks.

Resources for Further Exploration

  • Surviving Mold by Dr. Ritchie Shoemaker (CIRS expert and protocol developer)

  • International Society for Environmentally Acquired Illness (ISEAI)

  • Mold Illness Made Simple – patient education on CIRS

  • MEAction Network – advocacy and research on ME/CFS

  • Neil Nathan, MD – specialist in complex chronic illness

References:

Chronic inflammatory response syndrome: a review of the evidence of clinical efficacy of treatment https://pmc.ncbi.nlm.nih.gov/articles/PMC11623837/#:~:text=Chronic%20Inflammatory%20Response%20Syndrome%20is%20a%20multisymptom%2C,Inflammatory%20Response%20Syndrome%20is%20the%20Shoemaker%20Protocol.

GWCIM is affiliated with Dr. Jonah Yakel and his “The CIRS Brain Solution” medical coaching program https://gwcim.com/services/shoemaker-protocol-cirs-mold-toxicity/

CIRS: Why Testing for Mycotoxins May not be Enough and What To Do Instead 
https://www.colabeu.com/education-hub/article/cirs-why-testing-for-mycotoxins-may-not-be-enough-and-what-to-do-instead

© 2025-2030 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9  

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