The Hydroxychloroquine and Azithromycin Controversy

In recent weeks there’s been a huge amount of attention being given to the drugs hydroxychloroquine and azithromycin. A study published last week, April 9th 2020, on 1,061 patients that were treated early on in the course of their illness with these two drugs, led to some profound conclusions. The study was conducted by French researcher Dr. Didier Raoult, a well respected but controversial French M.D. The study followed on from a smaller study with a cohort of twenty patients that yielded similar results, which are referred to in the graph below.

The data released showed that:

  • 92% had excellent outcomes.
  • Ten patients out of the 1,061 patients had to go to ICU.
  • 4% of the patients treated had persistent virus beyond the ten day treatment window determined as the cut-off by the researchers regarding whether to attribute success or not.
  • 4% had a poor outcome defined as extending their hospital stay beyond the ten days.
  • Five patients died.

Results concluded by the researchers established that:

    • The treatment was considered safe with no side effects. This is relevant as I’ve used both these drugs for many years in the treatment of chronic Lyme disease and have never seen any side effects for either of them besides nausea from azithromycin, especially if not taken with a full meal. Hydroxychloroquine use requires a six-month ophthalmology checkup to look for retinal changes, which is far beyond the timeline required for the treatment of Covid-19. I should point out that I have never seen these retinal changes in patients on long-term hydroxychloroquine use. The potential retinal damage is related to length of use and dosage. In addition, cardiomyopathy (an enlarged heart) has been detected in a few patients treated with hydroxychloroquine.i ii
    • The amount of hydroxychloroquine in a patient’s blood correlated with the success of their outcome. Different absorption rates for different patients was a consideration.
    • Some blood pressure medication was associated with much poorer outcomes. ACE inhibitors (angiotensin converting enzyme inhibitors) iii were considered to lead to poorer outcomes while ARB (angiotensin II receptor blockers) ivusers had a better outcome. I’ll be discussing these two drugs in a later post.
    • These results were seen to be promising and have resulted in the NIH preparing to begin a 500-person trial

Dr. Raoult did emphasize the importance of excluding cardiac issues before commencing the studies. Dr. Raoult has spoken out strongly about the “dictatorship of the methodologists” that insist on first-class or gold standard research trials, which are randomized and with control groups, before applying the science. He believes it’s inhumane to subject patients to control arms when there’s clear evidence that the treatment would benefit the patients. v

The details of the study

  • Patients with COVID-19 infection were treated with hydroxychloroquine and azithromycin.
  • Plaquenil 200mg was given three times per day for ten days and azithromycin 250mg was given for five days, twice the first day then once for the next four days.
  • In order to avoid cardiac problems, an ECG was performed before starting treatment.
  • A low-dose CT scan was also performed to assess any potential lung damage.
  • The evaluation of the virologic effect was done with PCR blood test before inclusion.
  • The quantification of the viral load was conducted on a nasopharyngeal sample.
  • A PCR blood test was repeated on day five to verify that the virus was undetectable or at levels too low to present a contagious risk. This test can detect pieces of viral DNA of the actual virus, although one can’t say if the viral tissue is alive or dead, only that a piece of the virus is in your body.

Please Note

These drugs are presently unavailable to most pharmacies and are only available to chronic autoimmune patients, who are on them for long-term use. Directives from health authorities in Canada have discouraged prescribing any of the recent popular drugs put forward as potential treatment for Covid-19 with the warning that there are no treatments currently available to treat Covid-19 and that we, as M.Ds, must be cognizant of evidence-based prescribing for recognized conditions. Included in the list of drugs that shouldn’t be currently subscribed were hydroxychloroquine, chloroquine, remdesivir, lopinavir/ritonavir, colchicine, and azithromycin)

hydroxychloroquine

Disclaimer: Do not take these medications without the guidance of a doctor.

References

i https://www.ncbi.nlm.nih.gov/pubmed/25672591
ii https://www.researchgate.net/publication/236601571_Chloroquine_cardiomyopathy-a_review_of_the_literature
iii Examples of ACE inhibitors include: Accupril (quinapril), Aceon (perindopril, Altace (ramipril), Capoten (captopril), Lotensin (benazepril), Mavik (trandolapril), Monopril (fosinopril), Prinivil, Zestril (lisinopril)
iv The ARBs that are currently available are: azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis), valsartan (Diovan, Prexxartan), losartan (Cozaar), olmesartan (Benicar)
v Is France’s president fueling the hype over an (Science Mag) unproven coronavirus treatment
vi www.doctoroz.com The Dr. Oz Show Medical Unit

COVID-19 How to Protect and Assess Yourself

In the current Covid-19 Pandemic we get asked a lot of questions about the best ways on how to protect and assess yourself. We've gathered some great recommendations that we've found to be very useful and came up with a few of our own suggestions.

Most of the following recommendations come from from a video conference given by Dr. Dave Price, an ER physician. Watch this video by Dr. Dave Price, Protecting Your Family ER doctor at Cornell University.

Covid-19 A Brief Summary

What is COVID-19?

A virus from the common cold family, the coronavirus has never been seen by the human body before, hence the virulence. The virus appears to have come from an animal.

Symptoms

The most common symptoms are a fever, cough, and sore throat. The virus then travels throughout the body and goes mostly to the lungs although there can also be cardiac involvement. Patients commonly present with a cough or are just not feeling good, with a cough and mild headache. Most people just don’t feel good when they suffer from the virus. The infection can last anywhere from five to fourteen days. Those with a mild case of the disease usually feel better around the fifth day. In more severe cases, those that are more affected will become short of breath between the third and the fifth day then feel better around the seventh day.

How do we get the disease?

Coronavirus is contracted almost exclusively from moving your hands to your face. You have to have long and sustained contact with someone who has the disease. The vast majority will have a fever and aches or will be someone that is going to get the disease in the next one or two days. This virus is almost entirely transferred from your hands to your face, into the eyes, nose, or mouth. Keep your hands away from your face and you're mostly good.  Super clean hands, never touching the face. Boom.

There is some suggestion you can get the virus from aerosolization, in other words because it’s airborne. However, for this to occur you need long sustained and unprotected contact for at least fifteen to thirty minutes, in a closed room with no mask. Most people get it from touching someone with the disease or someone who is about the get the disease. Covid-19 is in your community right now. I’m not attempting to scare you, but simply empower you to take the necessary steps to protect your hand to face spread.

Follow 4 Rules to Protect Yourself

1. Become a 'hand washing fanatic'

Know where your hands are and keep them cleaned and sanitised at all times. Walk around with Purell or hand wipes. Leave your door, Purell. Open the door and then Purell. If you keep your hands clean, you dramatically reduce the risk of infection and if you combine washing your hands with not touching your face, you will NOT get this. Covid-19 is mostly contracted from sustained contact with someone who has it. However, because of the risk of slight exposure on objects, make sure that you always keep your hands clean.

2. Psychologically work at the connection between your hands and face

We touch our face thousands of times a day without thinking, whether we’re scratching, picking, rubbing, or pondering. Start to monitor yourself doing this, gamify not touching your face or wear a mask indoors to train yourself in this new behaviour.

3. You don't need a N95 medical mask

When you leave the house, wear a mask or something wrapped around your mouth and nose, to stop you touching your face. Any covering of your face is good. The mask doesn't prevent the disease but simply trains you not to touch your face. So, when you leave your house, add a mask. This will prevent transmission 99% of the time. Clean hands and not touching your face is the key. The general community has zero need for a N95 mask. If you’re in a room with a Covid-19 patient who has a risk of aerosolization, you need a N95 mask. If you’re going to the grocery store and touch the cart, just make sure that you clean the handle.

4. Distance yourself from others

Keep around three to six feet away from other people. Shrink your social circle for now. Find your small group and don't break from it. Do all other socialising digitally. We’ll need to physically distance for the next three to six months, maybe longer if we see another little spike. Become used to keeping this distance and don’t allow yourself to slip with this. You don’t need to be afraid of your neighbour. The better you are at doing this, the less likely you'll catch or transmit the infection.

And that’s it. Just four very simple rules.

The only way you will get this disease is if your hands are contaminated, you touch your face, and you stand too close to a contaminated person. You don’t need to be afraid if you go out to the grocery store. The person three to six feet away from you is not your enemy.

What Should You Do If You Have a Cold?

Behave as if you have coronavirus for two days and see what direction this takes. If in a couple of days it feels like a regular cold like all your others you’ve ever had, go back to normal life. You can have Covid-19 and stay in your house, protected and perfectly safe. If someone is immune compromised in the house, such as a very elderly individual, isolate them completely from the person that’s sick or that person needs to leave the house. The same applies if someone is known to be immune compromised after undergoing chemotherapy, for example. Touching a person or touching a contaminated surface then touching your face is what will transmit the disease.

What Should You Do If You Get the Disease?

This disease is primarily spread through home and family transmission, such as from mother to daughter, from brother to sister. If you develop a fever or other symptom, isolate yourself in the house in a separate room, with a separate bathroom if at all possible.

If the person has to come out of the room, have that sick person wear a mask and wash their hands with sanitizer before leaving the room and entering the rest of the house. The sick person should touch as little as possible, clean after themselves, and then head back to their self-isolation. Don’t have sustained contact with this person and don’t do things like repeatedly taking their temperature. However, don’t be afraid to stay at home.

The healthy person in the house should not be touching the sick person or be around the sick person whenever they can avoid it. The sick person should get through the illness within seven days but remain vigilant as their recovery relates to washing hands, wearing masks and so on for seven to ten days. Once the sick person is feeling well, they can have more contact with others. However, continue cleaning your hands and put on a mask.

If You’re Sick, When Do You Need to Go to the Hospital?

You only really need to go to the hospital if you’re short of breath. That’s the clearest indication and a steadfast rule. Don’t go to the hospital if you have a fever, body aches, a cough, or you simply think you might have Covid-19. A lot of people presenting to hospitals are being sent home to wait out the four to five days of the disease. Of all the people who get Covid-19, only 10% become short of breath and need to go to hospital. Of those, only about 10% of people turning up at the hospital that have symptoms will actually be admitted to be monitored. About 1% of those will be put on a ventilator. The overwhelming majority of people come off the ventilator seven to ten days later. Going to the hospital is not a death sentence.

Telemedicine is the best way to avoid overloading the medical services. Call in with your symptoms and heed the advice given by your health authorities. In Canada, call 811 and follow their directions. However, if you’re short of breath, head to the hospital.

Do I Need to Get Tested?

No. Let people who really need it, get tested. As testing ramps up more people will have access. If you have symptoms like the flu with the features mentioned, you probably have Covid-19. If your community is having an outbreak of the disease then you may need to be tested.

Are Kids Getting Infected with Covid-19?

There have been almost no cases of Covid-19 disease in kids between zero and fourteen years old. A few newborns are getting it, which is thought to be due to contact. Kids are not getting critically ill or dying. We’re still waiting to understand whether kids are vectors and assume for now that they are. At the moment, kids aren’t dying and kids aren’t getting sick.

Transmission

The absolute vast majority of transmissions are from droplets. When a droplet leaves an infected person, it lands and is quickly picked up by an unsuspecting person, transferring it from hands to face. Very, very little transmission occurs through the air. You would have to be very close to a person spitting or coughing and have a droplet transferred to your face. This occurs in a hospital when the patient is suctioned or a similar aerosolized procedure is done. This is where a N95 mask is needed. Most nurses use an ordinary surgery mask when in hospitals attending to Covid-19 patients.

It takes approximately two days to be symptomatic. You are infective in those two days, keep a list if you can of all the people you interact with so that you’re able to inform people if you’re in contact with someone in the two days prior to you becoming symptomatic.

Health care providers that are on the front line taking care of infected patients in a closed room and doing nasal swabs without protection are getting very sick. With the proper protection nobody is getting sick, even in working in a Covid-19 hospital ward.

Is it really safe to go on a run or a walk if you adhere to the spacing directions?

Yes, it is. Take sterilising liquid with you and wipe down anything you touch. Keep your distances. Just don't get sloppy and don't assume that other people have your diligence. Wear a mask so that you continue to train yourself not to touch your face and to communicate to other people that you're taking it seriously. Wipe everything down before you touch it and don’t touch your face. A bandana is okay if you don’t have a mask. It’s not preventing you from getting the disease, but just to prevent you from touching your face.

What if you don't have a sterilising liquid?

Coronavirus is not robust. It dies immediately upon disinfection. Use your elbows or other body parts to open and close things, then wash with soap as soon as you can.

Do I need to wipe down groceries when bringing them into the house?

It’s a reasonable idea to have the delivery person leave the goods outside your door, pick it up with gloves then wipe it down. That’s certainly reasonable but the most important part is, as stated, to wash your hands, don't touch your face. Don’t pick up the package with your bare hands. Clean your hands immediately. If picking up coffee from a Starbucks drive-through, Purell your hands or disinfect your hands after taking the cup.

It is fallacy that this only affects older people?

Yes, this is affecting everyone above approximately fourteen years old. Everybody is getting this disease even without preconditions. Older people often do worse, while men are more often infected than females. The younger you are, the less likely it will happen. The older you are, the more likely you are to get the disease.

Is it true that Ibuprofen should be avoided when feeling sick?

In practice, 90% of people will get a fever and a cough. Those who become sicker get short of breath. Those who can’t walk to the bathroom need a ventilator. They usually settle out after a day and after seven days they get off the ventilators. There’s good enough data coming out of Germany now that ibuprofen should not be used since it causes more inflammation. If you have a fever use an alternative like Tylenol. Take glutathione if you use Tylenol.

Immunity

The people who get the disease are shedding the virus one or two days before they get the disease. The stories of people getting sick again are about people that haven't fully recovered. If you've had it, and are through it, you're immune. This virus is now in circulation and as it mutates over the next few years, it will become milder and milder. Five years from now it will be just a cold.

Finally, a study in China has determined that microbiome health is a more significant factor than age when it comes to coronavirus deaths.

A Positive Outlook During the COVID-19 Outbreak

The vast majority of the world’s population that has access to any source of media outlets is currently under the collective fear-driven news cycles of an upcoming apocalypse due to the emergence and spread of the coronavirus, COVID-19.  As I write this, a CCN alert flashed across my screen stating that there were 3,000 cases of coronavirus in the United States with 62 deaths. This number was updated six hours later to 3,155 cases. No doubt by this evening, this number will be adjusted upwards, a trend that will probably increase for the foreseeable future, the exact end-point being entirely unknown.

While all due caution is absolutely imperative and all medical guidance should be strictly followed, as I stated in my other pieces regarding coronavirus, parts one and two, I couldn’t help but reflect on what appears to be an innate tendency of all living systems to trigger homeostatic mechanisms that force self-correction whenever one side of its expression become too polarized to either extreme. It appears that evolution itself has to adjust course in light of new information by self-correcting evolutionary realignments.

We know from history that disasters are often followed by tremendous gains and achievements. The extreme horrors of World War II were followed by an extraordinary period of increased economic, social, and political global growth and relatedness, rather than nationalism, which was unprecedented in history. It was the same with 9/11. Immediately following those events, murder rates plummeted, and kindness and appreciation were unleashed upon civil servants, hospitals, demolition crews, and emergency medical services. Out of control real estate, airline, and hotel prices were corrected, and there was increased dedication to global causes. The list is much more extensive but undoubtedly real, when previous issues and statistics were assessed through this lens. 

One of the greatest and most well remembered political speeches of all time was delivered at the first inauguration by Franklin D. Roosevelt as the 32nd President of the United States. At that time, the nation was at the peak of the Great Depression and the speech was heard by tens of millions of American citizens.  

“So, first of all, let me assert my firm belief that the only thing we have to fear is...fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance. In every dark hour of our national life a leadership of frankness and of vigor has met with that understanding and support of the people themselves, which is essential to victory. And I am convinced that you will again give that support to leadership in these critical days.”

He went on to say, “There is no unsolvable problem if we face it wisely and courageously. There are many ways in which it can be helped, but it can never be helped merely by talking about it. We must act and act quickly.”

So, while we’re currently in the grip of the downward, fear-driven spiral that’s mostly emphasizing the potential catastrophic consequences that may or may not result from CoVID-19, how can we best compensate for those fears and reflect on the potential upside of this situation? And most importantly, what can we do to mitigate this fear-driven spiral into ennui, inaction and a potential sense of hopelessness?

What follows are some compensatory ideas that are in no way meant to downplay or minimize the suffering that many people have gone through or are about to go through. However, if we’re to embrace the homeostatic principles that there are no crises without blessings and we don’t live in a one-sided world where there are only losses without gains. So, let’s examine a few potential consequences that might arise from this present situation. 

  1. Global warming. The global warming crisis seemed to be almost impossible to reign in, despite the most well-meaning attempts by a subset of global political and environmental leaders. With all kinds of global travel grinding to a halt, it’s inevitable that at least a pause to the upward tend of global warming, primarily due to the carbon footprint induced by travel, will be inevitable. When climate change experts examine this effect in months or years to come, maybe their statistics can be used to convince others of the need for a more sustained and ambitious action regarding this omnipresent threat.
  2. Exotic animal trade. China stopped the trade in wild animals for the purpose of consumption such as dogs, rodents, yaks, snakes, porcupines, and bats when the link between animals and the coronaviruses was discussed. Officials from the Chinese Center for Disease Control and Prevention said they isolated the virus taken from a seafood and wildlife market in Wuhan believed to be the source of the outbreak. The coronavirus that caused the 2003 SARS outbreak was traced to the civet cat, a wild animal considered a delicacy in parts of South China. The civet is used in the popular dragon tiger phoenix soup, which is believed by locals to help with arthritis, stimulate poor blood flow, and revive decreased libido. The movement of humans toward recognizing animals as sentient beings may be assisted, a movement initiated and kept alive by the PETA president and founder Ingrid Newkirk and written about in her best selling book, Animalkind.   
  3. Consumerism. Our western culture is an extroverted and consumer driven one. Perhaps by sitting at home for extended periods, with the stores, at least at present, bare of many types of consumer goods, we can reflect on our impulse to seek emotional consolation outside of ourselves by buying new items that we may not need. I do realize that the beast of online shopping may be unleashed but here’s hoping that the online stores may not be able transport unnecessary consumer goods due to the transport channels being slowed down. 
  4. Possibility of increased relatedness. A series of recent posts by Rebecca Arendell Franks, who along with her husband and child has now been on forced quarantine in China for over 50 days, is quite illuminating. She said that, “Our family life has never been better. Usually, one weekend is long enough before I’m ready to send each of us back to school or work. But for SEVEN weeks, we’ve been home together with very little outside influences or distraction, forced to reconnect with one another, learn how to communicate better, give each other space, slow down our pace, and be a stronger family than ever before. I encourage you to read the link regarding this at the end of this article. 
  5. Nature emerging from the technological and human encroachment upon its domain. It’s been observed in Wuhan that the sound of birds singing has been heard for the first time in a long time since the crisis began. In Wuhan, Rebecca Arendell Franks commented, “Right now, I hear birds outside my window (on the 25th floor). I used to think there weren’t really birds in Wuhan, because you rarely saw them and never heard them. I now know they were just muted and crowded out by the traffic and people. All day long now I hear birds singing. It stops me in my tracks to hear the sound of their wings.”
  6. Learning new technologies for virtual relatedness. How does ZOOM actually work and can I teach my grandfather to hook up? 
  7. Learning to cook. Maybe we can now, instead of ordering food in or going out to a restaurant, learn to cook for ourselves and make that tasty, healthy recipe that we’ve always been meaning to get around to. 
  8. Examination of our national leader’s skill set in crisis management. 
  9. Exercise. Finally, the Peloton bike or treadmill can be put to good use!
  10. Non-drug based medicine. Examination and renewed interest, along with a certain amount of respect given, of alternative methods for treating symptoms of coronavirus, and indeed other viral related illnesses such as the three studies currently underway in China on the use of IV vitamin C for the treatment of corona related pneumonia. See blog posts part one and two for further details. 
  11. Lifestyle factors. An awareness of how lifestyle factors such as diet, exercise, sleep, and stress play an extraordinary role in immune efficiency.
  12. Business awareness. Small business will become aware of cash flow issues, staffing needs, and unemployment issues.
  13. US Federal Reserve slashing interest rates. Maybe now is the time where one can afford the mortgage on a new home that seemed out of reach a few years before. Or maybe people with fixed student loan payments can borrow money at a lower rate to pay those off. 
  14. Learning to connect with others non-locally. There’s a common misconception that in order to benefit from the full experience of another human being we have to be in their physical presence. Yet if we truly love someone and see both sides, the dark and the light, of their being, we can sit quietly, hold them in our hearts, and send deep love and appreciation to them for being in our lives. It helps if we have an understanding of the Einstein-Podolsky- Rosenberg paradox (EPR paradox) in quantum physics that showed that if one particle had ever been in contact with another particle, if they were separated across the full expanse of the universe in space and time, they’d be eternally intertwined or entangled. Einstein called it “spooky action at a distance.”  

(Please note this is a very simplistic explanation for quite a complex issue.)  

A few more quick possibilities:

  1. Increased revenues for the medical device industry.
  2. Increased revenues for the supplement industry.
  3. Increased connection to neighbours to assist with grocery runs.
  4. Appreciation for the media and their updates.
  5. Appreciation for our doctors, nurses, and miscellaneous healthcare workers and politicians for rising to the occasion and setting minute by minute guidelines
  6. Appreciation for mobile device apps, Google, Facebook, Instagram, and Twitter for keeping us informed.
  7. Appreciation and understanding of our own vulnerability.
  8.  Resetting of values and personal reflection on what is truly meaningful, including a reorganization of values and priorities.  

So, as we step back, reassessing our priorities both personally and collectively, these are a few thoughts I’ve had in these troubling and somewhat frightening times. If Nobel Prize winning chemist Ilya Prigogine is to be believed, even insentient material systems have an inherent drive to self-organization. When physical systems get pushed too “far from equilibrium” they escape this chaos by leaping into higher level states of organized order, referred to as “order out of chaos”. My challenge to all of you is, what inherent dynamic force may be at play in your life, driving you toward greater and greater wholeness, complexity, and consciousness in the midst of these very challenging times? What thoughts of this nature have come to your mind in these times?

While you contemplate these deeper thoughts, stay safe, follow your governmental and health directive guidelines, and do what you need to do to get through these times. We must attempt to move beyond the greatest fear, which is that of fear itself. 

See part one and two for specific coronavirus updates and treatment suggestions. 

Preventive and Treatment Strategies for COVID-19: Part 2

Part 1 of this series can be found here

Keep Fighting Fit

It’s only common sense to keep our bodies as healthy as we can to help us to fight off all kinds of illnesses. Obviously, we’re always going to encounter germs in our daily lives but keeping our immune systems in good condition is an excellent defense strategy. 

Follow these steps: 

  • Get enough sleep, ideally seven or eight hours each night. 
  • Try to reduce stress where you can in your life. 
  • Make sure you’re on a diet that contains plenty of plant-based antioxidants, minerals and vitamins and eat healthy food to keep your body and immune system in good shape. 
  • Make sure that you always get enough exercise whenever you can to keep everything in working order. 
  • Stop consuming all sugar
  • Stop smoking or vaping immediately. 

Wear Mask Protection

Get some N95 facemasks before supplies are gone. 

  • An N95 respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles.
  • The ‘N95’ designation means that when subjected to careful testing, the respirator blocks at least 95% of very small (0.3 micron) test particles. If properly fitted, the filtration capabilities of N95 respirators exceed those of facemasks. However, even a properly fitted N95 respirator doesn’t completely eliminate the risk of illness or death.

N95 respirators aren’t designed for children or people with facial hair. Because a proper fit cannot be achieved on children and people with facial hair, the N95 respirator may not provide full protection.

A full list of FDA approved respirators is provided below. These might already be out of stock everywhere but put orders in regardless of the backorder. 

  • 3M™ Particulate Respirator 8612F
  • Pasture Tm F550G Respirator
  • Pasture Tm A520G Respirator

Wear Eye Protection

Transmission through the eye is a common vector for the aerosolized virus. One of the common transmissions is touching public items then touching your face and transmitting it through the eye. Frequent hand washing and excellent hygiene are paramount.

Drug treatments

General

It’s important to be aware that there are at present no antiviral treatments that are effective for the treatment of Covid-19. There are currently no vaccines available for SARS-CoV-2. The present treatment approach is for supportive care and symptom management only. If people become severely ill, vital organ function support is necessary, usually in a hospital or ICU setting. 

Here’s a link to the number of drugs that as of February 2020 were being studied for the treatment of Covid 19.

The CDC also has a site discussing antiviral medications for the flu here

Chloroquine Phosphate

A Chinese multicenter collaboration group suggested this malaria drug might be useful for the treatment of Covid-19 pneumonia. In another recently published paper, the use of hydroxychloroquine, 400 mg twice daily followed by a maintenance dose of 200mg twice daily for four days, was found to be more potent than chloroquine to inhibit SARS-CoV2. Hydroxychloroquine was also shown to have fewer side effects than chloroquine while still addressing the inflammatory cytokine storm induced by the virus. 

The recommended dose of chloroquine phosphate was 500mg twice daily for ten days. 

Alinia (Nitazoxanide)

This drug is traditionally is used as an antiparasitic and has been studied for the treatment of Middle East Respiratory Syndrome (MERS) coronavirus. This drug has been shown, in test tube studies at least, to have activity against MERS-CoV and other coronaviruses. Further studies are being undertaken to determine its true efficacy. The recommended dose was 1000mg twice daily for 10 days.

HIV Drug - Kaletra (lopinavir-ritonavir)

A 62-year-old man who became Spain’s first coronavirus patient is believed to have made a full recovery after being treated with an HIV drug called Kaletra or lopinavir-ritonavir. Miguel Ángel Benítez was admitted to the Virgen del Rocio Hospital in Seville, where he received an antiretroviral drug, which has been used to treat HIV and AIDS for over ten years. The drug was combined with interferon beta, which is a protein that prevents cells from becoming infected and is administered to multiple sclerosis patients. Santiago Moreno, head of infectious diseases at the Ramón y Cajal hospital in Madrid, said that the “SARS-CoV-2 protease is very similar to that of HIV,” using a name that sometimes refers to the novel coronavirus.

Mast Cell Activation Syndrome (MCAS

In this February 2020 article it was discussed that “Coronavirus infection (regardless of the various types of corona virus) is primarily attacked by immune cells including mast cells (MCs), which are located in the submucosa of the respiratory tract and in the nasal cavity and represent a barrier of protection against microorganisms. Virus activate MCs which release early inflammatory chemical compounds including histamine and protease; while late activation provokes the generation of pro-inflammatory IL-1 family members including IL-1 and IL-33.” The article proposes for the first time that inflammation by coronavirus may be inhibited by anti-inflammatory cytokines belonging to the IL-1 family members. 

It may be that individuals with MCAS are at higher risk for developing the serious consequences of this infection and thus may benefit from much stricter control of the mast cell activation syndrome if infected. Nebulized cromolyn and/or glutathione or n-acetyl cysteine (NAC) and/or IV Benadryl may be extremely helpful in these conditions.

Alternative Remedies

In addition to the previous suggestions, there are a number of natural substances and supplements that can be of help in lowering your risk of becoming infected with the current coronavirus. Many of these approaches are not specific treatments for the coronavirus but have been studied and referenced in the literature as having antiviral effects.

Vitamin C

It’s common knowledge that vitamin C is good for us but there have been clinical trials in China regarding the intravenous use of vitamin C to help treat patients suffering from Covid-19. A dose of between 100 and 200 mg/kg body weight (this is equal to quite a low dose of between 7.5 and 15 grams for a 180 lb person) was given to patients intravenously for three consecutive days and was very effective. There are currently three clinical trials sponsored by the Chinese government studying vitamin C. Dr. Tom Levy and Dr. Jeanne Drisko from the integrative U.S. medical community are involved in the Chinese studies. Dr. Richard Cheng MD PhD, who has been studying IV vitamin C, is suggesting the use of oral vitamin C.  The one study can be found at the clinicaltrial.gov website. High dose vitamin C at 20 grams has been used in ICUs for some time in an attempt to reduce mortality from septic shock, in one study from 40% to 4%. However, most hospitals refuse to administer IV vitamin C for viral infections since it’s not considered standard of care. It’s quite likely that these Chinese studies will place high dose IV vitamin C therapy for viral infections a part of mainstream treatment in the future.   

In the United States, doctors who have pioneered vitamin and mineral therapies have also been studying the effects of intravenous vitamin C, with a February 2020 paper being published. “Early Large Dose Intravenous Vitamin C is the Treatment of Choice for 2019-nCov Infected Pneumonia” recommends this for the treatment for pneumonia resulting from the virus. 

A recommended minimum oral daily dose of vitamin C is 2,000mg. Twice daily dosing is recommended due to the water-soluble nature of vitamin C and the fact that it’s quickly metabolized. If one wants a liposomal formulation, certain brands do provide this option or you can make your own by adding https://klinghardtinstitute.com/one or two teaspoons of Body Bio PC (phosphatidyl choline) to 2 grams of powdered vitamin C and stirring it vigorously. Divide your dose and take twice daily. Watch for diarrhea if your dose is excessive.

Vitamin D

This is also very important. It’s recommended that we have a minimum of 2,000 IU and a maximum of 10,000 IU per day. The usual daily dosage for vitamin D is 1000 IU per 25 pounds of body weight. It’s best to get vitamin D levels measured and to have serum levels in Canada between 150 and 200 nmol/l. People tend to have lower vitamin D levels in the fall and winter months due to fewer hours of sunlight. However, our bodies need vitamin D to support our immune system so we need to make sure that we’re getting enough of this vital ingredient. All the cells in our bodies have receptor sites but only two types are in every cell. These are thyroid hormone receptor sites, which are responsible for metabolism, and vitamin D receptor sides. This gives you some idea of the importance of vitamin D in maintaining our overall health and wellbeing. Research indicates that vitamin D may even be more effective than the flu vaccine when it comes to flu prevention. Consequently, it’s a good idea to include vitamin D in the fight against Covid-19.

It has been reported by many clinicians that high doses vitamin D of 50,000 IU over three days is highly effective in treating acute viral infections. This dosing is contraindicated in any person with lymphoid malignancies and in any patient with granulomatous diseases such as sarcoidosis, where high calcium levels are an issue. Also, a relative contraindication is pregnancy. This is by no means an approved treatment for Covid 19.   

Zinc 

This has been shown to be effective in fighting infections and also supports the immune system. Zinc can help to prevent coronavirus and other viruses multiplying in the throat and nasopharynx, which is the space above the soft palate at the back of the nose connecting the nose to the mouth and allowing us to breathe through our nose. When you begin to exhibit symptoms of the illness zinc capsules can be taken several times a day. The recommended dose for zinc is between 40 and 50mg per day.

Silver 

This has also has some antibacterial and anti-viral properties. If you use an official product such as Argentyn 23 you have a clear idea of how much silver you are putting into your body and don’t run the risk of taking too much. If you have viral symptoms, the recommended dosage is one teaspoon seven times per day. However, this is only a short-term solution as there are side effects such as skin discoloration if silver is used for too long.

Andrographis 

This herb has been used in traditional Chinese medicine and Ayurveda for a long time. It’s been shown that the herb’s compounds have anti-inflammatory, antiviral, and antioxidant benefits. The herb boosts the immune system and is often employed to fight cold and flu symptoms. As a result it does have a role to play in treating the latest version of coronavirus, at least in the short term. One capsule twice a day is the recommended dose of the herbal supplement if you exhibit symptoms of the virus. There are a number of referenced articles that demonstrate its effectiveness against the influenza virus, particularly with regards to respiratory symptoms. Lyme patients with active disease may have a Herxheimer reaction as it increases lymphocyte proliferation and interleukin -2. 

Elderberry

Another natural short-term solution if you have typical flu symptoms, such as a cough, sneezing, and a runny nose, is elderberry extract taken up to six times a day. Elderberries come from the European elder tree, which is not the same as the American Elder, Elderflower, or Dwarf Elder. People believe the extract helps with the common cold, influenza, boosts the immune system, and reduces inflammation.

Calendula

Is also known as marigold and has been used as a medicinal herb for a very long time. The plant’s extracts have antiviral, antigenotoxic, and anti-inflammatory properties that can be used to treat some of the symptoms of Covid-19. 

Taraxasterol 

Also known as dandelion, this can also be used as an anti-inflammatory supplement. Dandelion also has antioxidant properties and some studies indicate that it has antiviral benefits and is good for our immune system. 

Propolis 

This is known to be a potent antiviral, particularly in animal models infected with corona virus. Dr. Ramzi Asfour, an infectious disease physician, suggests Beekeeper’s Natural propolis spray. Propolis increases cellular immune responses and has antiviral properties. Propolis can also be dispensed in a vaporizer (available from Ki Science) and has been shown to neutralize circulating mycotoxins in the air. 

CAUTION: Propolis is not to be taken if you have a Honey or Bee allergy.

Scutellaria

Most commonly known as skullcap, this is another flowering plant with medicinal qualities. It has been used to treat conditions such as respiratory infections and inflammation and have antibacterial, antiviral, and antioxidant properties. 

Artemisia annua

Also referred to as sweet wormwood this has been used in traditional medicine for some time and has been employed in medicines to treat malaria. There are some indications that the plant may also be used to treat some coronavirus symptoms, particularly the SARS related coronavirus.

Dr. Klinghardt, in his extremely informative PowerPoint presentation, has recommended placing calendula, licorice, scutalaria, andrographis, artemisia, and dandelion tinctures, calculated for their weekly dose, in a blender with 100mls of clean water and 14 grams of vitamin C powder. Add two tablespoons of liquid Body Bio PC phosphatidyl choline and blend for a few minutes. Put this mixture in a glass and keep in the fridge. Each day, drink one seventh of the dose.

Beyond Balance Herb Tinctures- IMN-V-III

This product contains 19 different herbs with antiviral and immune modulating effects, including licorice, skullcap, dandelion, and rosemary.

Peptides

Some patients have access to peptides with immunomodulating effects. I recently returned from a peptide conference in Los Angeles and the following peptides were suggested for their antiviral and immune modulatory effects.         

  • Thymosin alpha 1 - This is the most recommended peptide for immune stimulation. This should be used as a treatment adjuvant and a prophylactic and can help with many conditions beyond viral illness. The recommended daily dose in 450mcg.
  • Thymosin beta 4 - Natural killer cells are essential for defense against tumors and virus-infected cells. The cells are activated in by ONF-Gamma. This is activated by IL-18, which TB4 upregulates. Therefore, TB4 has ben studied for many Immune related diseases. Caution is warranted with cancer patients as it can increase the growth of cancers.
  • LL 37 (cathelicidin) - This peptide has broad spectrum antiviral/microbial, fungal effects. Peptides such as LL 37 are key components of innate defenses against infection, with both microbial and host defense modulatory functions. In addition to their well documented bactericidal potential, CHDP have more recently been shown to have antiviral properties. LL 37 has ben shown to be highly effective in preventing viral attachment to cells. It’s been used in several virus studies and has been anecdotally reported to work well with respiratory tract viruses.
  • Pentosan polysulfate - Polysulfates are highly potent and selective inhibitors of the in vitro replication of HIV and other enveloped viruses such as coronavirus. The anti-viral activity of polysulfates is a result of their shielding of the positively charged sites in the V3 loop of the viral envelope glycoprotein gpl120, which inhibits viral entry into cells and allows for immune clearance. The usual dose is 2mg/kg.
  • Selank - This is a variant of the immune molecule tufstin and has potent antiviral properties in addition to its neurological effects. The antiviral characteristics of Selank were evaluated both in vitro and in vivo against the influenza virus strain H3N2 and H5N1 and the type 1 and 2 Herpes virus. It was revealed that Selank might have a prophylactic effect during influenza infection and a therapeutic effect during a herpes virus infection. It could also be helpful with Covid-19.

The Hoffman Centre Programs for cold and flu treatment

We have developed a number of potential programs for acute cold and flu treatment. While the details aren’t specific to coronavirus many of the recommendations are applicable to dealing with virus that commonly infect us in the winter months. These recommendations are in no way a substitute for quick and rapid communication with your healthcare providers and the guidelines as issued via websites (like this one), previously mentioned at the beginning of this article.

Any treatment that you decide to undertake should start at the first onset of symptoms. The following instructions are to be followed for the duration of symptoms unless otherwise stated. 

Immediately stop consuming any sugar, since this paralyzes your white blood cells, the body’s first defense against illness. Make sure you also get plenty of sleep, at least between 7.5 and 8.5 hours per night. Hot apple cider vinegar baths twice a day will help to speed up the progression of the cold and reduce your fever, potentially halving the amount of time you may have symptoms. Add two cups of apple cider vinegar to a full bath of hot water and soak for twenty minutes, remembering to fully submerge your body. If the illness has affected the chest, you can steam water over the stove, add eucalyptus drops, and breathe in the vapor for some relief from your symptoms.

Please note that this treatment program is not to be undertaken if you are pregnant or breastfeeding.

Adult Dosage (age 16 and up)

Oscillococcinum is the first supplement to take at the first sign of a cold or flu. This works better for flu like symptoms (not cold symptoms) and you simply need to follow the directions on the package.

  • Vitamin D - 50,000 IU for three days. Contraindication to use of high dose vitamin D is lymphoid malignancies, pregnancy, and granulomatous diseases such as sarcoidosis
  • Mycelized vitamin A - 100,000 IU for three days. Contraindicated in pregnancy. 
  • Vitamin C - 1 to 2g two to three times daily (titrate dose upward to bowel tolerance)
  • Astragalus Tincture - 1 dropper three times daily
  • Echinamide Anti-Cold tincture - 2ml three times daily
  • Probiomax probiotic - 1 capsule two times daily 
  • Saccharomyces Boulardii - 2 capsules twice daily
  • Garlic/allicin - 2 capsules three times daily after meals. Open the capsule in 6oz of water and let sit for two minutes before drinking.
  • Argentyn 23 colloidal silver  - 1 teaspoon three times daily in water
  • Andrographis - 2 dropperfuls twice daily in water
  • Transfer Factor Multi Immune - 2 capsules twice daily
  • DHEA - 50mg per day for two to three days will boost the immune system and fight infection. Note that this is for adults only.
  • For muscle aches take arnica and/or magnesium malate - 2 caps three times daily
  • Add anti-viral supplements such as olive leaf extract - 2 capsules three times daily, oil of oregano (brand name ADP) 2 capsules three times per day and lysine 500mg 2 capsules three times daily

IV Treatment for 3 days

  • IV vitamin C - 15 to 35g once per day. Check for G6PG enzyme deficiency first
  • Alternatively - IV Hydrogen Peroxide, once per day

Child Dosage (2 years and older)

    • Mycelized vitamin A – 10,000 IU for three days
    • Vitamin D - 10,000 IU for three days
    • Vitamin C - Between 250 and 500mg three times daily (to bowel tolerance)
    • Echinamide Anti-Cold - Between an third and a half a dropper three times daily 
    • Probiomax probiotic  - Half a capsule twice daily
    • Saccharomyces Boulardii - Half to a full capsule twice daily
    • Garlic - Half to a full capsule twice daily after meals. Open capsule in 6oz of water and let sit for two minutes before drinking. Note that it is difficult to get a child to take this.
    • Argentyn 23 colloidal silver - Half a teaspoon three times daily in water
    • Transfer Factor Multi Immune - 2 capsules daily

Maintenance and Prevention 

Remember to stop consuming any sugar immediately, since sugar paralyzes your white blood cells, which provide your body’s first defense against sickness. Make sure you get at least 7.5 to 8.5 hours of sleep each night as well. This treatment program is not for women that are pregnant or breastfeeding.

Throat Infection

  • Zinc - 30 to 50mg lozenges. The topical antimicrobial effect can be important in infections of the throat.
  • Biocidin throat spray - 2 sprays three to five times daily
  • Propolis throat spray – 5 sprays three times daily
  • Argentyn 23 throat spray- 3 sprays three times per day
  • See your doctor for a throat swab to exclude strep throat and/or mononucleosis

CAUTION: Propolis is not to be taken if you have a Honey or Bee allergy.

Nasal Irrigation

Use a Neti Pot, particular with upper respiratory infection, for three days. 

  • Place one dropper full of Nasya wash into your Neti Pot with warm water and a heaping quarter teaspoon of pure non-ionized Neti Pot Salt. 
  • Stir until salt is dissolved. 
  • Add three drops of Echinacea Anti Cold and Core Phyto Lavage to the solution. Use this to perform the nasal wash as directed by the Neti Pot instructions on the bottle.

Air Spray

  • Add a quarter teaspoon of salt to the bottom of an empty spray bottle. 
  • Add five drops of Thieves, an essential oil by Young Living, on top of the salt as this will help to dissipate it, 
  • Fill bottle with warm water. 

Now you now have an air spray that will assist in lowering counts of viruses, bacteria, and molds in the air. 

  • Spray your home, office, and other areas a couple of times a day. 
  • You can also put Thieves drops into your palms and cup your hands over your face then inhale five or six times. 
  • This will prevent you from contracting a sinus or lung infection, especially during long distance flights.

Dr. Alex Vasquez Recommendations

Dr. Alex Vasquez is an internationally recognized author, presenter, and teacher, particularly with regards to immune related disorders. He earned three doctorate degrees from fully accredited universities in the United States and has worked in various clinical facilities ranging from private boutique clinics to inpatient hospital settings. Dr. Vasquez has published 120 books, articles, letters and editorials in various magazines and peer-reviewed medical journals, including British Medical Journal, Journal of the American Medical Association, Nature Reviews Rheumatology, and Annals of the New York Academy of Sciences.

What follows are his recommendations for viral infections and are not meant to be specific treatments for any infections, particularly coronavirus. I’ve included these references for those curious patients who are always checking out protocols online.  

Antiviral

  • Powdered Glycyrrhiza Glabra - 1.5g BID for a maximum of four weeks. Works as a tea. This is a great expectorant but avoid in heart failure patients, monitor BP and potassium
  • Zinc - Between 20 and 50mg a day
  • Selenium – 400 to 600 ug per day
  • Iodoral Iodine/Iodide - 12.5mg a day for two weeks
  • Melissa officialis - Dose variable depending on formulation
  • Carica papaya leaf extract
  • Grape seed extract (see Biotics Research Bio-Cyanidins below)

Viral Anti-replication

  • SAMe - 400mg TID plus Betaine TMG 3g BID for one week
  • Methyl-Folate - 1.6mg od for one to two weeks
  • Alpha Lipoic Acid - 300 to 400mg TID plus Thiamine 100mg (or B Complex High Potency)
  • NAC - 600mg BID to TID between meals

Immunonutrition

  • Paleo-Mediterranean Diet with no refined carbohydrates 
  • Protectamin Whey Protein - 45g a day for immune dipeptides, if dairy tolerant
  • L-Glutamine powder - 9g TID between meals 
  • Vitamin A - 100,000 IU load for three to five days, then 25,000 to 50,000 IU for two weeks (not during pregnancy)
  • Vitamin D3 - 100,000 to 300,000 IU load for one dose, then 10,000 IU for ten days to increase endogenous antimicrobial peptides
  • Nordic Naturals Arctic Cod Liver Oil without vitamin D - One teaspoon TID with meals
  • Selenium - 600-800mcg/d plus 800 IU vitamin E per day
  • Melatonin - 20mg qHS
  • Ubiquinol CoQ10 - 300mg od to protect the mitochondria
  • Biotics Research KappArest - Three capsules BID as NFKB hijacked by viruses for replication
  • Biotics Research Bio-Cyanidins - One tablet BID (contains marine pine bark and grape seed extract)
  • Biotics Research UltraVir-X - One capsule TID (Red-rooted sage, Boneset, Actratylodes, Sweet Violet, Wheat Grass, Bupleurum, Astralagus, Bee Propolis, Maitake, Black Walnut, Hesperidin, Rutin)
  • Biotics Research POA-Phytolens (Cats’ Claw, Lens esculenta extract) - One capsule TID
  • Consider broad spectrum multi such as Metagenics PhytoMulti at two tablets per day (adjust dosage of Zinc and Selenium above)

CAUTION: Propolis is not to be taken if you have a Honey or Bee allergy.

Treatment and Vaccines

  • There is no vaccine currently available to combat the current coronavirus outbreak. 
  • The best advice is to protect yourself in some of the ways outlined above and avoid contact with infected individuals or locations where you might encounter potential carriers of the virus. 
  • There’s no specific antiviral treatment that’s recommended for patients with the Covid-19 virus. 
  • Those infected should receive the medical treatment required to deal with their symptoms, including care of vital organs in the most severe cases. 

In Conclusion

  • While we still don’t know everything about the current Covid-19 virus, common sense and taking precautions and preventative measures will be a great help. 
  • The feeling in the medical community is that the virus is likely to become less aggressive and less dangerous over time, as many viruses do, although this is far from certain. 
  • Many viruses adapt, mutate, and continue to live with us everyday. Time will tell if the latest threat will follow the same pattern in the coming weeks and months.

As a final note, in the current circumstances, if you’re suffering from what you’d describe as symptom similar to flu such as a cough, fever, chills, or an aching feeling in the body, please don’t visit the office. If you have an appointment we can do a phone consultation instead or even connect via zoom online. Staying at home will allow you the opportunity to recover and also reduce the likelihood that you’ll pass on the virus to others.

Resources

 https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fprevention-treatment.html
 Courtesy of Tailor Made Pharmacy  
https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html 
 Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za ZHi 2020 Feb 20. 43:E019
https://www.ncbi.nlm.nih.gov/pubmed/32150618
 https://www.sciencedirect.com/science/article/pii/S1876034116300181
https://nypost.com/2020/03/05/coronavirus-patient-in-spain-reportedly-recovers-after-being-treated-with-hiv-drug/
https://www.ncbi.nlm.nih.gov/pubmed/32013309/
https://clinicaltrials.gov/ct2/show/NCT04264533
 http://orthomolecular.org/resources/omns/v16n11.shtml
 Epidemic Influenza and Vit D. https://www.ncbi.nlm.nih.gov/pubmed/16959053
 https://www.argentyn23.com/
 https://link.springer.com/article/10.1007/s00705-016-3166-3
 Biol Pharm Bull. 2009 Aug; 32 (8) : 1385-91
https://www.webmd.com/vitamins/ai/ingredientmono-434/elderberry
 http://insajournal.in/insaojs/index.php/proceedings/article/view/305
https://www.ncbi.nlm.nih.gov/pubmed/28480383
 Ferreira L, Effect of the ethanolic extract from green propolis on production of antibodies after immunization against canine parvovirus (CPV) and canine coronavirus (CCOV). Brazilian Journal of Veterinary Research and Animal Science 49.2 (2012):116-121. http://www.revistas.usp.br/bjvras/article/view/40267
Dr Horowitz newsletter 
 https://kiscience.com/product/propolair-propolis-diffuser-therapy-model/
 https://www.sciencedirect.com/science/article/pii/S2211383520302999
http://www.hdbiosciences.com/Download/Identification%20of%20natural%20compounds%20with%20antiviral%20activities%20against%20SARS-associated%20coronavirus.pdf
 Antiviral Research 67, No 1 (2005): 18-23
 https://klinghardtinstitute.com/
 Courtesy of Tailor Made Pharmacy.
 https://www.inflammationmastery.com/

What You Need to Know About COVID-19: Part 1

Every day brings a new update about the spread of coronavirus. There are more cases all around the world every day and naturally people are very concerned. There’s certainly not a shortage of stories in the media but is the virus as dangerous as it’s being portrayed? And is the hysteria that’s being generated potentially more damaging than the threat posed by the virus?

In Canada, you can get the very latest updates courtesy of the federal government, including the current situation in different parts of the country, the risk to Canadians, how the government is monitoring the virus, travel advice, and the symptoms, treatment, and risk factors here.

A similar range of information is available for Alberta residents here. For those of you in the U.S. you can access pertinent information here

Mass panic is certainly not going to help the situation but neither will complacency. Despite the fear being whipped up on social media and in the traditional media reports, it’s perfectly natural to be anxious about this situation. This outbreak isn’t to be casually dismissed as it is very serious and everyone needs to accept that and not be in denial. We all need to work together to get through this. We may not know everything about the coronavirus yet and vaccines, treatment and indeed cures are still some way off, but we need to determine strategies that are going to work to protect ourselves and prevent the spread of the virus. So what exactly is coronavirus?

The Virus

Coronavirus is an illness that mostly affects our respiratory system. Doctors are still learning about the virus but it is thought to primarily be airborne, which means that it can be spread from one person to another. When a person coughs or sneezes they produce what are known as respiratory droplets. These can be breathed in by other people that are nearby or left on your hands if you touch your face after coughing or sneezing. In China, the fact that the illness seems to be mainly transmitted to family members, healthcare workers and others in close contact with an infected person strongly indicates the transfer of the virus is by respiratory droplets. The droplets can also remain on objects that have been touched, such as door handles, keyboard, elevator buttons, and many other everyday items. The virus can then spread if a person comes into contact with a surface that’s been contaminated. 

It has been suggested by recent studies that asymptomatic patients are also able to transmit the infection. This means that isolation might not be as effective a weapon against the virus as was previously thought. Researchers followed viral expression through infection through throat and nasal throat swabs in a small select group of patients. The researchers discovered that there were increases in viral loads at the point when the patients became asymptomatic. Doctors in Wuhan, China, studied 425 patients that had the virus. Many of the earliest cases were linked to direct exposure to live animal and seafood markets. However, later cases were unconnected to the animal markets, reinforcing the theory that the virus is transmitted between humans. 

There are believed to be many different types of coronavirus but only 7 of them can cause disease in humans. Some of the coronaviruses that usually affect animals are also able to infect people. The diseases Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) are also caused by coronaviruses that moved to people from animals. Like MERS and SARS, COVID-19 is believed to have originated in bats. Before the illness was brought under control in 2003, SARS infected more than 8,000 people and almost 800 died. 2,465 cases of MERS have been reported since 2012 and 850 people have died. The mortality rate for SARS was around 10%, whereas for MERS the mortality rate is around 34.5%.

The coronavirus that is currently in the news is called SARS-COV-2 (formerly called 2019-nCOV). The disease that it causes has been called Coronavirus disease 2019 (Covid-19). Once someone has the virus, the symptoms can be very mild but for some people they can be very serious and endanger life. Although we’re still learning about COVID-19 it does seem to be milder in its effects than SARS or MERS, with only a 2% mortality rate. Initially, the World Health Organization (WHO) reported that the worst severe cases in China were mostly in adults over 40 years old with significant comorbidities. This means that the patient has more than one chronic medical condition. The illness also seemed to affect more men than women, although this could change as the outbreak continues. As of March 12, 2020, COVID-19 had been confirmed in more than 128,343 people, mostly in China. To date 68,324 people have recovered from the infection. By this date, the virus had caused more than 4,720 deaths and has spread to more and more countries. These websites have information on the global situation that is updated regularly. Keep in mind that an estimated 291,000 to 646,000 people die worldwide from flu every year.

Symptoms of Coronavirus

A person that has Covid-19 might not show any symptoms at all for between 2 and 12.5 days, with the average time being 5.2 days. This one can easily pass it on to others without even knowing that they are infected in the early stages. The average time from infection to symptoms appears to be 12.5 days. The pandemic worldwide appears to be doubling every 7 days and every infected person appears to infect an average of 2.2 others.

Symptoms can include:

  • Fever
  • Cough
  • Breathing difficulties and shortness of breath.

While some of the symptoms are similar to colds and flu that people suffer from throughout the year, there are important differences. With the common cold we suffer from a runny nose and there is sputum or phlegm. This is the mixture of mucus and saliva that we cough up from our lungs when we get sick. With the coronavirus there’s a dry cough but no runny nose. This may occur in a small percentage of patients (4%) but it’s thought this is because they already have some form of flu or cold symptoms.

If nasal congestion does occur with this virus, it is usually very severe. If there is an associated sore throat, it can last for three or four days. The virus might then move to the trachea and lungs, resulting in pneumonia that can last for five or six days. Breathing difficulties and a high fever are also likely at this stage of the illness. People infected might have one or more other symptoms including headaches, muscle pain and stiffness, fatigue, loss of appetite, chills and sweats, a rash, dizziness, stomach upsets, or nausea. Numbers do vary but around 90-98% of people have a fever, 80% a dry cough, and 30% have trouble breathing and extreme fatigue. Acute respiratory distress syndrome developed in about 29 % of patients infected. Even though pneumonia is involved, 80% percent of these cases are mild and the person doesn’t need to go to a hospital. About 15 % had severe infection and 5 % were critical. The Chinese CDC analysis of 44,672 patients reported that the fatality rate on healthy people with no reported comorbid conditions was 0.9%.  

In general, children, younger people, and young adults seem to get mild versions of the illness. Those at the highest risk are people aged 70 to 75 or older that have existing medical conditions such as cardiac problems or pulmonary issues such as emphysema. The virus is also more likely to affect people with weakened immune systems, kidney disease, diabetes, hepatitis B, and cancer.

Protecting Yourself

There are a number of ways that you can protect yourself from being infected by the Covid-19 virus. Many of these are things should be part of our daily routines to prevent the spread of germs and keep our bodies healthy.

  • Washing your hands regularly throughout the day with soap and warm water for at least 20 seconds each time will help to keep infection at bay. 
  • All surfaces of the hands need to be cleaned, front and back, between the fingers and under the nails. You can use an alcohol-based non-toxic hand sanitizer (60% alcohol-based) if there’s no soap and water available. However, always use soap and water rather than hand sanitizer whenever possible. 
  • Always wash your hands before eating and touching your face. This is something you may have heard quite often recently, but infection can be spread via the nose, mouth, or eyes if your hands aren’t clean. Admittedly, the virus can only survive on your hands for between and ten minutes but although that may not seem long you could touch another part of your body in that time and spread the virus. 
  • Things that are frequently touched in the home, workplace or other locations must be regularly cleaned and disinfected with wipes or cleaning sprays. The virus can survive for up to twelve hours if it falls onto a metal surface. On fabric it lives for between six and twelve hours but regular laundry detergent will destroy the virus.
  • Gargling can work to protect your throat from the virus. You can use a standard solution from the drugstore but really one made from salt in warm water is all you really need. 
  • It’s also a good idea to drink plenty of warm liquids such as tea rather than cold drinks, either with or without ice. 
  • Some people have also found bee propolis mouth spray to work well. Propolis is a substance created by bees to protect their hives against bacteria. As a spray it helps to relieve a sore throat or other mouth issues and strengthens the immune systems. It also encourages antioxidants in our bodies. Antioxidants are molecules that neutralize free radicals, which are unstable molecules cause cell damage. CAUTION: Propolis is not to be taken if you have a Honey or Bee allergy.
  • If you’re showing no symptoms and remain healthy, avoid contact with others that are sick since the virus is considered to be airborne and spreads very quickly. It’s believed that the virus can travel between six and eight feet when it’s airborne. 
  • If you are sick with the virus, avoid contact with other so that you don’t help the virus to spread. Stay away from work or school and isolate yourself at home until you can recover. 
  • If you’re coughing and sneezing, try not to do this into your hands but into the crook of your arm or use a tissue to cover your nose and mouth and ensure that tissues are safely disposed of in the garbage. 
  • If you’re sick and have no choice but to go outside your home, wear a mask that covers your nose and mouth. This will stop you from infecting others while you’re out. However, bear in mind that if you don’t already have the virus a mask this will not protect you from catching the virus from an infected person that isn’t wearing a mask.

To Follow: PREVENTIVE STRATEGIES AND TREATMENT SUGGESTIONS 

Resources

https://nas/content/live/hoffmancentre/medscape.com/viewarticle/924268.
https://www.nejm.org/doi/10.1056/NEJMc2001737
https://www.nejm.org/doi/full/10.1056/NEJMoa2001316
https://www.youtube.com/channel/UCMONnSecl445zOPy7-KXJKw?utm_source=Klinghardt+Institute+Newsletter&utm_campaign=72be1085f0-EMAIL_CAMPAIGN_2020_03_09_05_16_COPY_01&utm_medium=email&utm_term=0_e85a79fc40-72be1085f0-154835213&mc_cid=72be1085f0&mc_eid=980e013edf 
 https://www.medscape.com/viewarticle/924268.
https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
 https://www.cdc.gov/coronavirus/2019-ncov/locations-confirmed-cases.html
http://cdc.gov/media/releases/2017p1213-flu-death-estimate.html
Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China of Novel Coronavirus-infected Pneumonia. N Engl. J Med. 2020 Jan 29 
 https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html
 https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fprevention-treatment.html

Podcast: Healing Wisdom With Dr Bruce Hoffman

Dr. Bruce Hoffman joins Pandora Peoples on WOMR and WFMR radio to discuss the origins of The Hoffman Centre and the benefits of the integrative approach to functional medicine. Dr. Bruce Hoffman utilizes the ayurvedic model through a program he developed called, The Seven Stages of Health & Transformation™ that brings to light the hidden causes of what may be making you sick, and what you can do to heal yourself.

Mast Cell Activation Syndrome and Histamine: When Your Immune System Runs Rampant

There is undoubtedly an escalating epidemic of chronically unwell people in North America. The present method of looking at illness is geared toward a single organ, a single specialty, a single drug, and voila! – let’s hope for a cure. Often patients go from pillar to post to see various medical consultants according to specialty (gastroenterologists, dermatologists, etc.), only to discover there isn’t one underlying syndrome or root cause that explains all the assorted symptoms the patient is experiencing. Patients may be given multiple diagnoses with multiple treatment options or medications, often with conflicting interactions and side effects that are worse than the underlying condition they are meant to treat.

Recently, a number of new ways of looking at chronic multisystem, multisymptom diseases has emerged as pioneering physicians connect previously disconnected dots and make sense of disparate symptoms that were never understood as components of a single syndrome. The first is the trailblazing work of Dr. Ritchie Shoemaker on chronic inflammatory response syndrome (CIRS). This syndrome is induced primarily by mold biotoxins and the inflammagens of water-damaged buildings, ciguatera or pfiesteria infestations, or Lyme disease and co-infections. The second is the pioneering work of Dr. Lawrence Afrin on mast cell activation syndrome (MCAS). Dr. Afrin is a board-certified hematologist/oncologist who recently wrote a book, “Never Bet Against Occam: Mast Cell Activation Disease and the Modern Epidemics of Chronic Illness and Medical Complexity.”

Two important books that address the complex syndromes that may underlie many chronic, multisymptom, multisystem disease conditions are:

  • Surviving Mold: Life in the Era of Dangerous Buildings, by Ritchie C. Shoemaker, M.D.
  • Never Bet Against Occam: Mast Cell Activation Disease and the Modern Epidemics of Chronic Illness and Medical Complexity, by Lawrence B. Afrin, M.D.

What is Mast Cell Activation Syndrome?

Mast cell activation syndrome (MCAS) refers to a group of disorders with diverse causes presenting with episodic multisystem symptoms as the result of mast cell mediator release, often without causing abnormalities in routine laboratory or radiologic testing. Most people with MCAS have chronic and recurrent inflammation, with or without allergic symptoms. This occurs when an aspect of the innate immune system becomes overactive and releases a flood of inflammatory chemicals, which may affect every organ in the body. The symptoms of MCAS will wax and wane over time. Another way to think of this is the symptoms will flare up and go into remission, affecting different organs and body parts, over and over again throughout a person’s life, without a common unifying theme or established diagnoses to account for the patient’s presentation of symptoms.

MCAS can present subtly but may become more serious as an individual ages. If you were to chart the symptoms of MCAS on a timeline, beginning at birth you can often identify symptoms that began at a very young age.

For some, MCAS becomes a highly probable diagnosis when they notice that they have had various symptoms of an inflammatory nature over the years. These symptoms may include:

  • Allergies as a toddler
  • Various skin rashes that came and went
  • Disturbed gut function (possibly diagnosed as irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD) or small intestinal bacterial overgrowth (SIBO))
  • Unexplained anxiety
  • Headaches
  • Insomnia
  • Poor wound healing

Any of these symptoms could indicate MCAS.

You can take our Hoffman Centre for Integrative Medicine MCAS Questionnaire HERE.

Dr. Afrin believes that MCAS is an epidemic with as many as 14 to 17 percent of the US population having MCAS – one out of every six to seven individuals. It has been said that it may take up to 10 years and numerous doctor visits before someone is adequately diagnosed and treated by a knowledgeable physician—or the patient figures it out for themselves!

What are Mast Cells, Mast Cell Mediators, and Histamine?

Mast cells are types of white blood cells that release up to 200 signalling chemicals, or mast cell mediators, into the body as part of an immune system stabilizing defense response against foreign invaders (parasites, fungi, bacteria, or viruses), allergens and environmental toxins.
We need mast cells to protect us from infection, heal wounds, create new blood cells, and develop immune tolerance. However, in conditions in which these cells are dysfunctional or overactive, they can cause serious issues.

Mast cells are found in most tissues throughout your body. In particular, they are found in tissues that are in close contact with the environment such as your skin, airways, and gastrointestinal tract. Mast cells are also found in your cardiovascular, nervous, and reproductive systems.

Mast cell mediators are the preformed granules secreted by mast cells in response to an outside stimulus, which can occur very quickly, in milliseconds. Mast cell mediators include histamine, proteases, leukotrienes, prostaglandins, chemokines, and cytokines. Their job is to signal and guide other cells, tissues, and organs to respond to the hostile invaders. These mast cell mediators provoke potent inflammatory responses that can include urticaria (AKA hives—skin rash and swelling), angioedema (swelling beneath the skin surface), bronchoconstriction (airway constriction), diarrhea, vomiting, hypotension (low blood pressure), cardiovascular collapse, and death, all within a matter of minutes.

Detailed Symptoms of Mast Cell Activation Syndrome

Patients who come into my office with MCAS usually have multisystem, multisymptom inflammatory responses. These symptoms have often caused them to trudge from doctor to doctor, undergoing rounds of testing, causing them to feel extraordinarily confused as to what’s happening to their body. Because the symptoms of MCAS have so broad a reach and differ so considerably from person to person I’d like to break them down by nonspecific, general clues, and organ system signs.

See Keith Berndtson’s (http://havenmedical.com/) slide below: Permission to use slide given by author.

 

Mast Cells The Bad

 

Histamine Intolerance & Mast Cell Activation

 

Most Common General Symptoms:

  • “I’ve been sick for as long as I can remember”
  • “I overreact to bee stings, mosquito bites, penicillin and most medications”
  • “I can’t take a full breath”
  • “Whenever I stand up I get lightheaded”
  • Insomnia/sleep disorders starting early in life
  • Tinnitus/ringing in the ears from a young age
  • Vomiting as an infant
  • Abdominal pain as an infant
  • Facial and chest flushing ( a red flush when embarrassed or stressed)
  • Dermatographism—a red line appearing on the skin when scratched with a blunt object
  • Frequent infections, cold, viruses, gut viruses as an infant, adolescent or adult
  • Fatigue and malaise
  • Frequent fevers
  • Edema—“water” accumulation in different parts of body
  • Waxing and waning of symptoms
  • Food, drug, and chemical intolerances (especially fragrances). This is a very common symptom which may be exacerbated by phase 1 and phase II liver detoxification problems as identified by gene testing
  • Sense of being cold all the time
  • Decreased wound healing
  • Hypersensitivity to much in environment, including medications
  • Weight gain or loss
  • Heat intolerance
  • Frequent family history of cancer, especially intestinal or bone marrow (hematologic)
  • Generally feeling inflamed
  • Generalized lymphadenopathy (enlarged lymph nodes)

MCAS Symptoms by Organ System

Eyes – Red eyes, irritated eyes, dry eyes, burning eyes, difficulty focusing vision, and conjunctivitis (pink eye).

Nose – Nasal stuffiness, sinusitis, postnasal drip, hoarseness, laryngitis, nose bleeds (epistaxis), and intranasal sores.

Ears – Ringing in ears (tinnitus) and Eustachian tube dysfunction (blocked, popping ears).

Throat – Vocal cord dysfunction, throat swelling, sores on tongue/mouth, itchy throat, burning mouth, and difficulty swallowing

Skin – Hives, angioedema (swelling of the skin), skin flushing, itching, skin rashes, dermatographism (when scratched skin causes a red welt), chronic itching, urticarial pigmentosa (legion/hive-like spots on the skin), flushing, bruising easily, reddish or pale complexion, cherry angiomata (skin growths), patchy red rashes, red face in the morning, cuts that won’t heal, fungal skin infections, and lichen planus.

Cardiovascular – Fainting, fainting upon standing, increased pulse rate (tachycardia), palpitations, spikes and drops in blood pressure, high pulse or temperature, high triglycerides, lightheadedness, dizzy, hot flashes, and postural orthostatic hypotension syndrome (POTS).

Respiratory – Wheezing, asthma, shortness of breath, difficulty breathing deep, air hunger, dry cough, chronic obstructive pulmonary disease (COPD), and chronic interstitial fibrosis.

GI Tract – Left upper abdominal pain, splenomegaly (enlarged spleen) epigastric tenderness, nausea, vomiting, diarrhea and/or constipation, abdominal cramping, bloating, non-cardiac chest pain, malabsorption, GERD/acid reflux, cyclic vomiting syndrome, colonic polyps, and gastric polyps.

Liver – High bilirubin, elevated liver enzymes, and high cholesterol.

Neurological – Numbness and tingling (especially in the hands and feet), headaches, migraines tics, tremors, pseudo-seizures, true seizures, waxing and waning brain fog, memory loss, poor concentration, difficulty finding words, and spells of cataplexy (suddenly becoming disconnected from and unresponsive or unreactive to the world around).

Musculoskeletal – Muscle pain, fibromyalgia, increased osteopenia, osteoporosis, weakness, and migratory arthritis (joint pain).

Coagulation – History of clots, deep vein thrombosis, increased bruising, heavy menstrual bleeding, bleeding nose, and cuts that won’t stop bleeding.

Blood disorders – Anemia, increased white blood cell count, platelets, decreased white blood cell counts, decreased neutrophils, decreased lymphocytes, decreased platelets, reductions in CD4 helper lymphocytes, reductions in CD8 positive suppressor lymphocytes, reductions or excesses of IgA, IgG, IgM, IgE, a known condition called MGUS, myelodysplastic syndrome (reduced red cells, white cells, platelets), and increased MCV (mean corpuscular volume).

Psychiatry – Anxiety, panic, depression, obsessive compulsive disorder (OCD), decreased attention span, attention deficit/hyperactivity disorder (ADHD), forgetfulness, and insomnia.

Genitourinary – Interstitial cystitis, recurrent bladder infections, sterile bladder infections, and frequent urination.

Hormones – Decreased libido, painful periods, heavy periods, infertility, and decreased sperm counts.

Dental – Deteriorating teeth.

Anaphylaxis – Difficulty breathing, itchy hives, flushing or pale skin, feeling warm after exposure, weak and rapid pulse, nausea, vomiting, diarrhea, dizziness and fainting.

Illnesses Associated with MCAS

There are a number of illnesses and conditions that can exacerbate MCAS, including chronic inflammatory response syndrome (CIRS), poor methylation as determined by genetic MTHFR defects (leading to low SAMe, which degrades histamine intracellularly), deficiencies in histamine-N-methyltransferase enzyme (HNMT; degrades histamine in the liver) and deficiencies in the gut-based diamine oxidase (DAO) enzyme, which degrades histamine found in food. Histamine is one of the many inflammatory mediators released by individuals with MCAS. For those with healthy DAO levels, nearly all the histamine derived from food sources are broken down by their DAO enzymes.

But when there’s a lack of DAO, histamine can assist in creating intestinal permeability and upregulated inflammation. If a person suffers from small bowel intestinal overgrowth (SIBO) or has significant small intestinal issues (called dysbiosis), the lining of the small intestine may be disrupted. This leads to even lower levels of the DAO enzyme and hence, intestinal permeability.

Here’s a relatively common situation:

A woman who struggles with chronic fatigue and malaise throughout her life gets pregnant and suddenly feels energetic and wonderful throughout her pregnancy. Studies suggest this could be because DAO levels are up to 500 times higher than normal during normal pregnancies.

Alternatively, a person who was previously quite healthy develops a bacterial infection, is prescribed a 10-day course of antibiotics and suddenly develops severe reactions to certain foods. When looked at closely, these foods are found to contain high histamine levels. The current fads of consuming bone broths and fermented foods such as sauerkraut and kombucha only help to exacerbate this condition.

Histamine can have a powerful effect on a person’s wellbeing, making it important to be aware of the symptoms that indicate MCAS.

Histamine Intolerance is a Subset of MCAS

Mast cell activation syndrome (also referred to as mast cell activation disorder (MCAD)) is sometimes confused with histamine intolerance. The major difference is that with MCAS, a person’s mast cells secrete many mediators of inflammation, such as leukotrienes and prostaglandins, not just histamine—although histamine is an important component. Histamine intolerance is considered a subset of MCAS where too much histamine is released from mast cells, too much histamine is taken in by consuming histamine-containing foods, histamine is not broken down in the gut because of DAO gut enzyme deficiency, or not broken down in the liver because of HNMT deficiency.

However, histamine is not all bad; it serves useful functions as a neurotransmitter, helps to produce stomach acid, and is an important immune mediator when not in excess.

Diagnosis of Mast Cell Activation Syndrome

A proper diagnosis of MCAS requires the presence of several symptoms from the above list. In addition, other disorders should be ruled out by a specialist in functional medicine.

MCAS is so difficult to diagnose because it may present in so many varied ways that traditional health care providers are not always trained to assess. There is a tremendous range of possible presentations, with local and remote effects which wax and wane over time.

If MCAS is suspected at our office, I send patients home with Chapter 6 of the book Mast Cells – Phenotypic Features, Biological Functions and Role in Immunity by David Murray. This chapter was written by Dr. Afrin, entitled Presentation, Diagnosis, and Management of Mast Cell Activation Syndrome. It describes, system by system, most of the symptoms that can be attributed to this diagnosis. Patients then return the symptom check list, which we review together slowly in order to establish the clinical diagnosis. I then order the lab tests to prove its existence.

In Dr. Afrin’s own words, “The general presenting motif of MCAS is chronic multisystem polymorbidity, generally of an inflammatory theme and with assorted elements waxing and waning over time, sometimes in synchronization with one another but more often cycling with different periods and amplitudes. The range of mast cell mediators and their effects is so great that “unusual” presentations actually become de riguer.”

Lab tests can be done to check for mast cell mediators. Tryptase is one of the most common mediators released by mast cells in those with mastocytosis (abnormal numbers of mast cells), but not for those with MCAS (abnormal release of proinflammatory mediators by mast cells, but not an increased number, as in the much rarer mastocytosis). Lab tests can also check for other mediators, such as histamine and prostaglandins; however, most doctors and many labs, particularly those in Canada, will not run the tests that are required to make the diagnosis.

Sometimes patients are able to identify triggers of their MCAS. These may be food or non-food triggers. Pay close attention to what you’ve eaten and have been exposed to when symptoms worsen.

After symptoms have been identified, other conditions have been ruled out, lab tests have been analyzed, and some treatment techniques have proven to relieve symptoms, an official diagnosis of MCAS is made.

In an effort to help you notice common triggers, below are 10 non-food and 10 food triggers that commonly provoke mediator release in those with MCAS.

10 Non-Food Triggers of Mast Cell Activation Syndrome

If you’re struggling or suspect you have MCAS, it’s in your best interest to reduce your exposure to these triggers, including:

  1. Extreme temperatures – either hot or cold
  2. Exposure to mold or Lyme disease and coinfections
  3. Emotional stress
  4. Insect bites
  5. Chemicals in personal products
  6. Medications that liberate histamine or block DAO
  7. Sodium benzoate –a common food preservative
  8. Airborne smells from chemicals or smoke
  9. Heavy metal toxicity – aluminum, mercury, lead, cadmium, bismuth and arsenic are known to be mast cell destabilizers
  10. Anesthetics

10 High Histamine Foods that Should be Avoided

Studies have shown that eliminating foods high in histamine and other triggers can significantly improve symptoms. Ten of the highest histamine foods include:

  1. Yeast and alcohol
  2. Dairy (especially fermented dairy like kefir)
  3. Gluten
  4. Fermented foods, especially sauerkraut, kombucha, miso
  5. Cured and smoked meats and fish
  6. Shellfish
  7. Citrus foods – lemon, lime, orange
  8. Vinegar
  9. Leftover and aged food – especially if left in the refrigerator and not frozen immediately
  10. Berries – strawberries, blueberries, raspberries

Conditions Associated with Mast Cell Activation Syndrome

Because MCAS is a chronic, multisystem, multisymptom condition with an inflammatory theme, it’s been associated with a number of conditions and diseases, including:

  • Chronic inflammatory response syndrome
  • Irritable bowel syndrome
  • Gut dysbiosis – the gut is rich in mast cells and home to over 70% of the immune system. Parasites, bacteria, fungi, and parasites can all trigger gut mast cells.
  • Obesity
  • Diabetes
  • Asthma and allergies
  • Autism
  • Autoimmune diseases (such as lupus, rheumatoid arthritis, and Hashimoto’s)
  • Candida overgrowth
  • Celiac disease
  • Parasite infections
  • Skin conditions such as eczema and psoriasis
  • Food intolerances and allergies
  • Gastroesophageal reflux (GERD)
  • Infertility and endometriosis
  • Chemical and medication sensitivities
  • Postural orthostatic hypotension (POTS)
  • CIRS – exposure to mold mycotoxins is a potent stimulator of mast cell activation
  • Migraines
  • Depression
  • Fibromyalgia
  • Fungal infections
  • Tinnitus
  • Multiple Sclerosis
  • Cancer

In general, inflammation accompanies MCAS and most of its coinciding or associated illnesses. If you are struggling to get one of these illnesses under control, there’s a possibility MCAS could be causing further complications.

It’s a good idea to check for MCAS if you have any of the above conditions and vice versa.

You can take our Hoffman Centre for Integrative Medicine MCAS Questionnaire HERE.

Ask Your Doctor for Lab Work

MCAS can be difficult to diagnose because lab test results may fluctuate as symptoms wax and wane. Many tests may need to be repeated during times of symptom flare-ups. Poor handling of specimens by the laboratory is also a real issue affecting results. Lab testing may thus result in false negatives despite a clinical history highly consistent with MCAS. Furthermore, MCAS doesn’t always cause abnormalities in lab work, adding to the complexity of diagnosis. Positive lab work is obtained only 20% of the time.

If you’re interested in getting lab work done to check for MCAS, I recommend the tests listed below. The top five, in bold, are the most important and necessary to establish a diagnosis:

  1. Histamine – plasma – Quest 36586 – must be chilled. Normal range – 28-51 ug/l.
  2. N-Methylhistamine – 24-hour urine – must be chilled. Normal range – less than 200 mcg/g.
  3. Prostaglandin D2 – plasma – must be chilled. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
  4. Prostaglandin D2 (PGD2) – 24-hour urine – chilled. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
  5. Chromogranin A – Quest 16379 – must be off proton pump inhibitors (PPIs) and H2 blockers (Pepcid and Zantac) for 5 days before tests, since they can falsely elevate chromogranin A.
  6. Prostaglandin 11-beta F2 Alpha (PGF2alpha) – 24-hour urine – chilled. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
  7. Serum Tryptase – Quest 34484. Rarely elevated in MCAS. NR less than 11.5 ng/ml. Positive if increase over baseline of 20% or baseline greater than 15.
  8. Leukotriene E4 – 24-hour urine – chilled. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
  9. Plasma heparin Anti-XA (must be off heparin products) – chilled. Degrades quickly.
  10. Blood clotting profile – Thrombin/PT/PTT/INR.
  11. Anti-IgE Receptor antibody.
  12. Neuron Specific Enolase – Quest 34476.
  13. Plasma pheochromocytoma workup.
  14. Porphyria workup.
  15. Factor VIII deficiency.
  16. Plasma free norepinephrine – Quest 37562.
  17. Urinary metanephrines – can b done in normal Calgary labs.
  18. Immunoglobulins – IgG, IgM, IgE, IgA
  19. Bone marrow biopsy looking for the following markers: CD117/CD25; CD117/CD2.
  20. Gastrin
  21. Ferritin
  22. CBC – eosinophils, basophils.
  23. Antiphospholipid antibodies.
  24. Genetic testing looking for Phase 1 and Phase II liver detox and methylation defects.
  25. Dunwoody Labs – test zonulin, histamine, DAO enzyme deficiency.

Many of these tests require specimens that are chilled by using a special centrifuge as the mast cell mediators are fleeting and degrade very quickly if not handled properly.

Further tests that may be of help:

  1. MTHFR gene mutations
  2. MAT gene mutations
  3. DAO gene mutations
  4. HNMT gene mutations. The liver plays a role in histamine intolerance. Histamine is not just disassembled in the gut by diamine oxidase (DAO). It is also disassembled in the liver, where it is in high concentrations, by HNMT.
  5. Glutathione levels. If glutathione levels are depleted, the inflammatory mediators released by mast cells may not be adequately neutralized by glutathione, the master antioxidant. This can lead to a vicious circle where oxidative stress results in mast-cells releasing inflammatory chemicals, which need to be detoxified by Phase 1 of the liver. If glutathione is low, the liver will be unable to neutralize them, resulting in further inflammation and oxidative stress.

These tests can help you identify whether MCAS is the cause of your mysterious and seemingly unrelated symptoms.

Treatments for Lowering Histamine and Reducing MCAS Symptoms

Now, you might be thinking, “Why can’t I just take an antihistamine?”

Antihistamines don’t actually reduce histamine release. They only block histamine receptors, preventing you from feeling the symptoms. You may need a round-the-clock blockade of the H1 and H2 receptors, every 12 hours.

If you want lasting relief for MCAS:

  • Histamine 1 blockers – hydroxyzine, doxepin, loratadine, fexofenadine, diphenhydramine, ketotifen, and cetirizine.
  • Histamine 2 blockers – famotidine (Pepcid, Pepcid AC), cimetidine (Tagamet, Tagamet HB), ranitidine (Zantac). Famotidine is chosen most often as it has fewer drug interactions than Tagamet).
  • Mast cell stabilizers – cromolyn, ketotifen (both a mast cell stabilizer and an H1 blocker), hydroxyurea, quercetin.
  • Leukotriene inhibitors – montelukast (Singulair), zafirlukast (Accolate)
  • Tyrosine kinase inhibitors.

H1 and H2 blockers must be taken every 12 hours for maximum effect. It may take up to 12 months to achieve maximum therapeutic effect. The doses may need to be increased to up to three times the recommended over-the-counter dosing.

Here is how I approach treatment with my MCAS patients:

  • Eat a low-histamine diet: Remove alcohol, smoked and cured meat, tinned fish, pickled and fermented foods, berries (strawberries being one of the worst culprits), citrus, nuts, chocolate, dairy, spinach, yeast, soy sauce, tomatoes and tomato products, preservatives, and vinegar. Stop eating leftover food. This will only reduce the incoming histamine and won’t affect the mast cell overactivity within the cells of the body. A comprehensive guide regarding the low-histamine diet can be found here.
  • Promote good gut health: Cut back on gut-damaging and inflammatory foods, and increase probiotics. Use a DAO enzyme, which goes under the generic name Umbrellux DAO – two tablets, 20 minutes before each meal.
  • Stabilize mast cell release of histamine with quercetin and vitamin C 500 mg – two tablets three times daily. We use a product called Natural-D Hist from Ortho Molecular Products.
  • Use H1 and H2 blockers every 12 hours – I use, on average, levocetirizine 5 mg twice daily and famotidine 20 mg twice daily.
  • Block nighttime histamine release with ketotifen or zaditen – 0.25–1 mg at night. Excellent sleep aid, mast cell stabilizer, H1 antihistamine. Excellent treatment for eosinophilic esophagitis.
  • Treat any existing infections: Have a thorough examination done to identify and treat any potential infections in the body which are powerful mast cell triggers. Stool testing by Genova labs and Cyrex Lab Pathogen Testing (array 12) can be of assistance in identifying pathogens.
  • Identify and remove toxins and allergens: This could be heavy metals, mercury fillings, cosmetics, and household cleaners.
  • Nutrients that assist in the treatment: This includes vitamin B6, alpha lipoic acid, vitamin C and E, selenium, omega-3s, N-acetylcysteine (NAC), methylation donors like methyl-folate, SAMe, and riboflavin.
  • Herbs: Nigella sativa, butterbur, turmeric, ginger and peppermint.
  • Get into a solid routine: Getting high quality sleep and staying on schedule helps keep mast cells in check.
  • Reduce stress: Stress, through the action of corticotropin hormone, can activate your mast cells and cause them to destabilize and release mediators.
  • One of the best resources for how to deal with histamine and mast cell activation through nutrition and supplementation is the website and Facebook posts by Yasmina Ykelenstam www.healinghistamine.com.

It can be incredibly discouraging to feel so sick for so long and not find any answers. It is my hope that we continue to learn more about multisystem conditions such as MCAS and spread useful information so it may end up in the hands of those suffering.

Share this article with friends and family to help spread the word about mast cell activation syndrome. They may discover it’s more than allergies that’s keeping them down.

Resources

Yasmina Ykelenstam – excellent resource:  www.healinghistamine.com.

Dr. Afrin’s website – the main researcher:  www.mastcellresearch.com. Many links to mast cell information are available on this website.

Dr. Theoharides – another major researcher: http://www.mastcellmaster.com/

Hoffman Centre for Integrative Medicine MCAS Questionnaire: https://hoffmancentre.com/wp-content/uploads/2017/11/7.-Mast-Cell-Activation-Syndrome-Clinical-Questionniare-November-7-2017.pdf

https://www.youtube.com/watch?v=82dmZhCBuBo

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753019/

https://ehlers-danlos.com/2014-annual-conference-files/Anne%20Maitland.pdf

https://tmsforacure.org/symptoms/symptoms-and-triggers-of-mast-cell-activation/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231949/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343118/

https://www.ncbi.nlm.nih.gov/pubmed/16931289

https://www.ncbi.nlm.nih.gov/pubmed/17587883

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069946/

https://www.ncbi.nlm.nih.gov/pubmed/22957768

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545645/

https://academic.oup.com/humupd/article/14/5/485/812106/Effects-of-histamine-and-diamine-oxidase

https://www.ncbi.nlm.nih.gov/pubmed/24098785

http://ajcn.nutrition.org/content/85/5/1185.long

https://link.springer.com/article/10.1007/BF01997363

https://www.ncbi.nlm.nih.gov/pubmed/25773459

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507480/

https://www.ncbi.nlm.nih.gov/pubmed/15462834

https://www.ncbi.nlm.nih.gov/pubmed/22562473

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374363/

https://www.ncbi.nlm.nih.gov/pubmed/21244748

https://www.ncbi.nlm.nih.gov/pubmed/23784732

https://www.ncbi.nlm.nih.gov/pubmed/18394691

https://www.ncbi.nlm.nih.gov/pubmed/24060274

https://www.ncbi.nlm.nih.gov/pubmed/10415589

Dr. Bruce Hoffman is our Newest Certified Physician! | Press Release from Surviving Mold

Press Release From Surviving Mold:

Dr. Hoffman is a family physician and director of the Hoffman Centre for Integrative Medicine in Calgary, Alberta. He was born and educated in South Africa, obtaining his medical degree from the University of Cape Town. He emigrated to Canada in 1986 and pursued family practice in rural Saskatchewan. Dr. Hoffman has been practicing in Calgary for the past 25 years. Dr. Hoffman is a certified Functional Medicine practitioner (IFM), has obtained his Master's Degree in Nutrition (University of South Florida) and is board-certified in Anti-Aging and Regenerative Medicine (A4M). He has also completed additional training in the treatment of Lyme disease and other tick borne co-infections (ILADS). In addition, he is the medical director of the Brain Treatment Centre of Alberta, utilizing QEEG and neuro/biofeedback to treat brain disorders.

Dr. Hoffman first heard Dr. Shoemaker lecture in 2001 and has remained an observant student of Dr. Shoemaker’s (and allied health researchers and clinicians’) ground-breaking discoveries ever since. In 2010, Dr. Hoffman began to implement the CIRS protocols in his practice and was able to obtain, in Canada, the lab tests, and medications required for the effective implementation of these protocols. He is, at present, the only Canadian medical doctor trained and qualified in the CIRS approach to treating chronic illness. When the housing market boomed in Calgary in 2007, many homes were constructed at a rapid pace. The city building inspectors performed perfunctory home inspections, and many homes were built with less-than-adequate roof ventilation. His newly constructed duplex in Calgary was not exempt; in 2014, he noticed dark stains around the pot lights, leaking intake vents, water stains in the basement and more. Having mold in his own home was an incredible learning experience but also an awful way to gain such experience.

Dr. Hoffman is deeply grateful for the guidelines provided by Dr. Shoemaker’s team emails and the consensus statements they have written (essential reading - available on www.survivingmold.com). Calgary experienced a dramatic flood a few years ago, during which half the city and the surrounding areas were underwater for several days. Since that time, many patients have been screened for CIRS, with a large number meeting the criteria for diagnosis. With Canada having a provincially funded health care system, it was an interesting experience having to work outside the local health care system to obtain US-based labs and treatments. Dr. Hoffman has laid all the groundwork for reproducing the CIRS work up in Canada. There is, however, only a single center in all of Canada willing to perform Neuroquant MRIs (private only, paid for by the patient). Finally, as of July 2017, Canada has an available source of VIP!

From: Surviving Mold - You can read the full article here

Movement from an Allopathic Model to Whole Person Healing

Individuals as health care consumers are becoming somewhat disappointed with the mechanistic model. People want to be taken seriously; they want the complexity of their symptom presentation to be acknowledged. Today’s conscientious consumers are no longer content to merely take a pill to suppress a symptom. They have a deeper desire to know the root cause of their disease presentations, and they wish to know if there is anything they can do to influence the outcome of their healing trajectory. Also, select individuals are aware that they have a certain responsibility in their disease causation, irrespective of inherited genetics.

In today’s day and age, many individuals are looking for a more complete definition of healing—they’re not just content to treat a disease. They are looking for answers to address their sense of malaise and are seeking out a myriad of healers practicing at different stages of the Seven Stages model. It is my hope that the healers of the future will have a much more extended repertoire than just the drugs and surgical procedures they have learned at medical school. It is my hope that they will have studied many disciplines across the therapeutic spectrum, as well as having taken the adventurous step of engaging in some of their own inner process, some direct content with their own unconscious. It is my hope that they will not only have looked into non-toxic nutritional medicines, but they will also have traversed some of the rich inner material that is dormant within themselves, whether it be early bonding disruptions or early traumatic experiences, so that they may have deep compassion for the situation many of their patients find themselves in. It is also my hope that they do not rest until there is healing established within their own family systems, as it is quite apparent that an individual who is locked into the grid of a stable and loving family system has quite a different life force to draw from, not to mention an entirely different way of being in the world.

Larry Dossey comments on the loss of confidence in the modern allopathic model of medicine by commenting on many of the scandals that have rocked the confidence of health care consumers in the past few years. “The uncertainties of medicine are cause for celebration,” Dossey writes. “Modern medicine is losing some of its invincibility. Many of the rules of good health that have guided patients and physicians for decades have taken a beating from which they may not recover. The almost blind allegiance we once had to the treatments offered has been severely undermined by these studies—some of the absolute certainties are no longer as absolutely certain.”

We don’t have to look far for empirical data to back Dossey’s claims. First there was the Vioxx drug scandal, where many people died from heart disease by consuming what were thought to be relatively innocuous anti-inflammatory drugs. Compounding the problem was the fact that this particular drug had been marketed as being relatively safe. Furthermore, evidence emerged that the drug companies had known for some time that the drug had an increased incidence of cardiac side effects, but they had chosen to hide the negative findings to ensure a profit.

The allopathic model of medicine suffered another substantial shock from the hormone replacement therapy scandal disclosed in the Women’s Health Initiative. The study showed that the drugs Premarin and Provera actually increase women’s risk for heart disease, stroke, blood clots, and breast cancer. Another report revealed a shocking disclosure in the world of knee surgery; researchers proved that by performing arthroscopy surgery on a damaged knee was no more effective than administering an anesthetic, make a nick in the skin, and proceeding to not perform the surgery but tell the patient that they had. The outcome in terms of pain and symptoms after either of these two procedures, the real operation versus the sham operation, was virtually the same. The value of mammograms has also been seriously questioned, and it is unclear as to whether or not a mammogram has any influence on the number of women dying from breast cancer each year.

A Wall Street Journal article written by Ron Winslow entitled Study Questions Evidence Behind Heart Therapies, discussed a recent study which revealed that less than 11% of 2,700 recommendations commonly made by cardiologists are supported by scientific evidence. Furthermore, that many of the dogmatic recommendations and guidelines made by cardiologists are made by those connected in some way financially with the pharmaceutical companies. Another study showed that 85 % of individuals who have stents or angioplasties to treat their blocked coronary arteries didn’t need them. Furthermore, the group that did have the surgical procedures ended up much sicker than the individuals who treated their condition with drugs alone.

In light of all of these scandals and revelations, we can’t help but doubt some of the contributions of modern medicine. The historical image we have of doctors—the caring, compassionate healers who sacrifice their personal life in servitude to their passion for helping others—has been replaced by a whole new image, spelled out in popular books with titles like Why Is My Doctor So Dumb? The faith that many once had in the all-knowledgeable doctor is now inherently suspicious.

This state of affairs has not been helped by the fact that doctors are the third leading cause of death in the United States, causing upwards of 250,000 deaths per year. This study was published in JAMA, the most prestigious journal in America. Subsequently, the number has been reexamined, and some people believe that if all cases were reported (doctors are notoriously tightlipped about admitting liability), iatrogenic illness would be the leading cause of death in the United States. Iatrogenic means “induced in a patient by a physician’s activity, manner, or therapy.” The annual statistics are as follows:

  • 12,000 deaths from unnecessary surgery
  • 7,000 deaths from medication errors in hospitals
  • 20,000 deaths from other errors in hospitals
  • 80,000 deaths from infections in hospitals
  • 106,000 deaths from non-error, negative effects of drugs

That’s a total of 250,000 deaths per year, all from iatrogenic causes!

On his website, Dr. Joseph Mercola has used a similar set of statistics to calculate a slightly different equation. The conclusion is startling. Dr. Mercola was able to calculate that, statistically speaking, doctors are 9,000 times more likely to accidentally kill you than gun owners. The math is fairly simple:

  • Accidental deaths caused by physicians per year = 120,000
  • Accidental deaths per physician = 0.171
  • Number of gun owners in the US = 80,000,000
  • Number of physicians in the US = 700,000
  • Number of accidental gun deaths per year (all age groups) = 1,500
  • Accidental deaths per gun owner = 0.0000188

Therefore, doctors are approximately 9,000 times more dangerous than gun owners. Think about that the next time you go in for a checkup.

Furthermore, in three separate studies it has been shown that when doctors go on strike, the death rates actually plummet. As published in the British Medical Journal in 2000, surveys of burial societies suggest that death rates in Israel have dropped considerably since physicians implemented a program of sanctions. The Jerusalem Post surveyed non-profit burial societies, which perform funerals for the vast majority of Israelis, and found that the number of funerals has fallen drastically since the Israel Medical Association (IMA) began the sanction. According to one funeral parlor manager, the same thing occurred in 1983 during a similar action by the IMA. It lasted for four and a half months, and the only area in Israel which was found to not have a reduction in its death rate was the city of Netanya. As it so happened, there was only one hospital in Netanya, and all of the doctors who worked there had “no-strike” clauses in their contracts and were therefore unaffected by the action.

It’s become increasingly apparent that the trust we once had in the modern medical profession is now being eroded, and people are starting to ask much deeper questions of the profession.

(1) Larry Dossey (Alternative Therapies Sept/Oct 2002, Vol. 8, No.5) 32
(2) Although I am in agreement with the findings of that particular study—these two particular drugs do increase a women’s risk of those diseases—it has subsequently emerged that estrogen alone does not have the same risks associated with it. It appears that the drug Provera was mostly to blame. Many women are now adversely affected by being deprived of safer bio-identical hormones that have been shown to reduce the risk of dying from multiple disease possibilities.
(3) Wall Street Journal | Feb 25th 2009
(4) Rogers S. Total Wellness. Aug 2009 pg 1
(5) Boden et al., Optimal medical therapy with or without PCI for stable coronary artery disease. New England Journal of Medicine. April 12, 2007; 356; 15:5003-16
(6) Starfield, B. (2000) Journal of the American Medical Association. July 26, 2000; 284(4): 483-5
(7) British Medical Journal 2000; 320:1561