The Cell Danger Response: Restoring Cellular Health with Phospholipids and Bioactive Lipids

The Cell Danger Response: Restoring Cellular Health with Phospholipids and Bioactive Lipids

Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine, and today is no exception. I am delighted to be with a very longtime colleague, Dr. Bruce Hoffman. We’ve got an exciting sort of depth conversation planned for you today. Let me actually spell out why it’s going to be a deep conversation just listening to his extensive training will suggest where we’re going.

So Dr. Hoffman is a Calgary, Canada-based integrative and functional medicine doctor. He is the director of the Hoffman Centre for Integrative Medicine, also The Brain Center of Alberta, specializing in complex medical conditions. He was born in South Africa and obtained his medical degree from the University of Cape Town. He’s got a master’s in nutrition. He’s a certified functional medicine practitioner through the Institute for Functional Medicine.

He’s board certified with a fellowship in anti-aging and regenerative medicine. He’s trained in the Shoemaker Mold protocol. He’s a certified Ayurvedic practitioner. He’s trained in Bredesen ReCODE brain treatment, in the MAPS autism training. He’s a certified family constellation therapy specialist. He’s trained in ILADS for Lyme and co-infections.

He’s also a contributing author to the recent paper, which is available. In fact, we’ll link to it on our show notes, from Dr. Afrin’s group titled Diagnosis of Mast Cell Activation Syndrome: a Global Consensus-2. So mast cell activation is something that he’s also focused on. I actually also want to bring to your attention more, just kind of the rich depth. I mean, clearly, Bruce, you’re a lifelong learner, but I think you’ve really kind of taken these things in. I just want to give you a little more of his background.

He’s trained in Chinese medicine, and homeopathy, and German biological medicine. You almost went to get board certified in psychiatry. You wanted to be a Jungian analyst. I found that really interesting, Dr. Hoffman, in your history. And so you bring that to your work now with patients. So you did some of that training, even though you didn’t move into psychiatry, but you did some of that training. You worked with Jon Kabat-Zinn, with Deepak Chopra, with Dr. Klinghardt, with Ken Wilber.

I mean, first of all, welcome to New Frontiers.

Dr. Bruce Hoffman: Thank you, Kara.

Dr. Kara Fitzgerald: And what haven’t you done?

Dr. Bruce Hoffman: It sounds like I don’t have a life.

Dr. Kara Fitzgerald: It’s extraordinary, I want to spell it out. I know that you’re just doing this amazing work with your patients, and you’re fusing this intense training that you’ve undergone, and that you continue to experience into what you described as the Seven Stages of Health and Transformation. So it’s not like you do a weekend course and then the books go away, or the PDFs are put away.

I mean, you’re actually working with these tools and making them into something your own. And it’s called the Seven Stages of Health and Transformation. And I know that you’re working with very complex patients in Canada, and actually beyond Canada. I know people are drawn to your work from all over the place. And so, I want you to talk about the seven stages, and what your approach is to these complex patients that are coming to see you.

Dr. Bruce Hoffman: Yeah, sure. When I was a young teenager, I was exposed to a schoolteacher in South Africa who was very different. And he took us out of our sort of South African apartheid, white, privileged background and sort of threw us into … threw me in particular into an alternative universe whereby I was exposed to the world of psychotherapy, psychoanalysis and eastern thought.

And I had, at a very young age, an experience which they call satori, which is this sense of seeing space-time as a continuous whole and not seeing cause and effect as being linear. And it was a sort of … Many people have these. They are sort of called awakening experiences or high experiences. And that just sort of catapulted me into a different way of looking at things, and then initiated in me a curiosity about all aspects of the human psyche and human development and human potential.

And originally, I sort of got interested in Jungian psychoanalysis and wanted to become an analyst and went to med school only to become an analyst. And I was actually accepted into the psychiatric residency, but actually didn’t go through with it. I worked for two years in psychiatry in the military. I had to go to compulsory military training. But I didn’t actually do my residency.

And I do feel quite privileged in the sense that by not taking that particular route, I was able to keep expanding across all layers and levels of experience. And what I found was when I ended up just being a family doctor in rural Saskatchewan, and seeing the limitations of drug-based, which Majid Ali beautifully named it N2D2 medicine, name of disease, name of drug.

Once you start to see the limitations, and then you start to look at the potential of human achievement and what they can aspire to, one sort of moves out of just treating disease to trying to get your patients to look at optimal potential of their entire existence. And so, what I do now through the seven stage model is view pathology, or the so-called disease states or complex symptomatology, as this entry point into a dialogue with a patient.

But I’m also looking at other aspects of the psyche and the experiences to see what it is that their soul, if you will, is asking to come through. What is it that they’re trying to achieve? Symptoms to me are etiological. They’re sort of pointing towards hidden subjects that need to be brought to the surface. I never see symptoms as linear. I always think of them as what is the body attempting to do by throwing out these particular imbalances?

And with that approach, and using my early exposure to Ayurveda and Advaita, which is a system of Hindu philosophy that I was exposed to by the schoolteacher, and I was able to build a model called the Seven Stages of Health and Transformation, which looks at the human experience as being divided, which is a silly term, because there is no division. But it’s conceptually divided into these layers and levels of experience.

The first level being the outer world, the external environment. And that’s sort of level one in this conceptual field. And from that, we draw everything to do with what’s going on in the chemosphere, outside of ourselves, the toxicology and the infectious load. And we look at that from etiological point of view. That’s level one.

Level two is the physical structure, which is made up of biochemistry and structural aspects. And that is what we do in both traditional medicine and in functional medicine, and in all the structural modalities like chiropractic, and bodywork, et cetera. And then level three is to do with the brain, the peripheral, and the autonomic nervous system, and its electrical effects on physiology and biochemistry. And then what are the manmade EMFs effects on that.

And then level four is to do with the emotional body. And as we know, that many people have these adverse childhood experiences, which then get laid down neurologically in the brain as specific defects particularly in right frontal lobe development, and activation of the amygdala, and the fight-flight response with down regulation of the vagal nerve. And because I have this brain treatment center, you can diagnostically look at this and treat it accordingly.

And then level five is to do with ego development, how people negotiate the slings and arrows of this … The world is a tough place. We’re sort of always somewhat vigilant against the next thing that’s going to arise. And so, we develop in the first half of life a very different set of strategies from in the second half of life in terms of how we develop our ego, which is our sense of how we negotiate the world and our belief systems, our values and our defenses.

People grow up with a way of orientating themselves, but they also remain highly defended to those things which are most traumatic. And depending on early childhood experiences, defenses can be highly helpful or healthy, you could say. But they can also be highly pathological when people suppress anything that comes close to an early experience of trauma, and the so-called PTSD response.

So level five is everything to do with the ego and how it negotiates its way in the world. And the first 30 years are all about ego development and they’re characterized by certain drives, drives of the libido, drives of full power, drives to know oneself. And all the great psychoanalysts of the 19th century were very … They had great insight into these mechanisms.

But they’re now used therapeutically in a system called ISTDP, where psychologists look at different structures that people bring to the therapeutic encounter and work one on one with them in transference and countertransference to try and get behind that which they’re defending against and which is asking to be brought forward. So that level is very important.

And then level six is that what we call the soul. This is the most authentic part of who you are, the most instinctual part of who you are, which never really comes to any sort of conscious assertion until the second half of life, I would say. Carl Jung, the great psychoanalyst wouldn’t look at patients before the age of 40. He said they’ve taken up two drives. There’s no conscious awareness of their deepest self to work with. And so he wouldn’t work with anybody under the age of 40, which is rather strange, but it’s true.

Dr. Kara Fitzgerald: It’s very interesting in this anti-aging obsession that we have, isn’t it? I mean, clearly, there’s some wisdom, but keep going.

Dr. Bruce Hoffman: Yeah. So, in our personal, when we’re born and we’re born into our experiences, very often when you’re not seen by your parents adequately, and being seen by parent, you don’t have to be perfectly seen but a good parent who will always support and challenge a child accordingly. But if there’s any neglect or abuse and neglect-trauma appears to be even more traumatic to a child, an abuse trauma.

The child will develop a provisional self, an adaptive self to go out into the world in order to achieve what it’s meant to achieve. But the authentic self, the instinctual self will often go underground and then be hidden by these defenses and this comes up. I can’t tell you how many people present to me in sort of midlife … Midlife being anywhere from 35 to 55. It starts at somewhat of a younger age when entropy starts to set in.

And they are being driven to ask deeper questions of themselves and to reclaim those parts of themselves, which they know instinctively, they left behind in their pursuit of safety and being seen. So their provisional selves go out, achieve something in the outer world, but there’s something crippled and something quite damaged, or well preserved. Some innocence, well preserved, but it’s hidden from sight.

And people in midlife generally kind of know that. And they want to often go back and retrieve those hidden parts of themselves that they know are manifesting as symptoms, but they have no conscious connection with them. So part of the work I do is trying to find out what … I don’t ask this question out loud, but I’m asking it while I’m interfacing with a patient is, what are these symptoms telling me, and what does the soul want?

What is the innate wisdom and innate creativity of this patient that needs to be brought to the forefront? And that’s the fundamental question that sits there while I’m looking at all the functional medicine, toxicology, biochemistry, hormones, mitochondria. I’m always having these conversations in my head, what does the soul want? What is being asked of this person? What do they need to manifest in order to bring parts of themselves back home?

And that is the second half of life quest really, how do you gain your creative, instinctual self. And not only that, but there’s also another hidden part and that’s a hidden part of your family system. Family systems carry secrets and carry hidden entanglements that often manifest themselves epigenetically and get expressed through biochemistry as symptoms.

And I’ve done some marvelous work with, or I haven’t. But I’ve partnered with Mark Wolynn, who is an exceptionally gifted functional family constellation practitioner. And we looked at, once a year, we used to do a workshop where we looked at the symptoms of patients who came to my clinic and try to link them to any inner entanglements or the family system two to three generations before the patient is even born.

And it’s extraordinary what entanglements you find and what dynamics you find, which can manifest as symptomatology in the patient. And this research is very well established now to all the major universities, that there’s an epigenetic chapter of trauma through the generations. And then lastly, is spirit. The level seven is the spiritual body. And that’s the part of ourselves that’s transcendent to any ego-based space-time demands. And that’s where you surrender to some intelligence greater than yourself and just sort of stay open to that potential. And that’s sort of the whole realm of what we call the one mind beyond space-time.

So I use that model. So when patients present, I’m just trying to sense, they come … One of the great tragedies that I find, or one of the great challenges, not tragedies so much as challenges, is that when you become well versed in functional medicine, people will present and they’ll write in their entry forms. You ask them, “Why are you here?” And they’ll say, “Well, I’ve got mast cell,” Lyme or mold, and whatever.

And they will sort of have reduced their entire symptomatology to what they believe to be a lab test or a symptom that they’re experiencing. And it’s never the case. It’s never the case. Those are just inquiries as an entry points into a much deeper dialogue, in my experience. And so, I’m always curious. Yes, you may have a trigger called Lyme or a trigger mold and mast cells have gone awry. Yes, that’s true.

But really, what’s the deeper reality that we need to sort of work with? And sometimes I get to it, and sometimes I don’t. Sometimes I just treat mast cell, and Lyme, and mold and be done with it. But other times, not. Yeah, sorry?

Dr. Kara Fitzgerald: I mean, what an extraordinary entry into our conversation, thanks for all of that. I mean, it’s amazing. And I can just tell that you are sitting with all of these levels. And I think that, in functional medicine, they talk about gathering before the patient encounter.

Dr. Bruce Hoffman: Yes, that’s right.

Dr. Kara Fitzgerald: And I can hear that you’re gathering at all of those levels, which creates a possibility in the encounter. It’s been extraordinary. So is this written? Have you written about this? Have you-

Dr. Bruce Hoffman: Yeah, I’ve written. I’ve got podcasts with transcripts, and I’ve written a book, which unfortunately, sits on my laptop.

Dr. Kara Fitzgerald: You can link to it on our show notes then. I’m kidding. But it’s powerful. And, well, we’ll bug you about it so that we can link to what you’ve got available in our show notes. It’s an expansion on functional medicine principles in a very important way. So that was one question. And then the other thought that I was having and you started to touch on is, so the presentation, this phenotypic presentation of mast cell activation, or Lyme, and it’s true that our patients will come to us with pretty rigid ideas on this, and what it means.

And as you said, either you move beyond it or you don’t, and you address it and life goes on. But you alluded to in the beginning of your unpacking the seven stages, you alluded to sort of these as having information in and of themselves, like what kind of a … Is there kind of a personality type or somebody who comes with a certain type of a family constellation structure that might be more vulnerable to Lyme and co-infection or might be more vulnerable to autism or MCAS? And can you speak to that?

Dr. Bruce Hoffman: Well, the interplay is complex as you know, from genetics to diet, to sleep, to rest, to toxicology. And to ever increasingly, obviously, to early developmental experiences. I can’t emphasize how profound those experiences play on auto-expression of biochemistry. It’s unbelievable.

Dr. Kara Fitzgerald: I want to just say as an aside that I am with you on that. I mean, we’ve just published a study in looking at DNA methylation, so looking at the epigenome. And one of the things that’s just stopped me in my tracks is this idea of biological embedding, which is exactly what you’re talking about, where the signatures of the psychic experience are laid down on the genome.

Dr. Bruce Hoffman: It’s quite extraordinary. And if people come and they see me, say for mast cell, and then they find themselves doing acute EEG, and the NeuroQuant MRI, and doing neuropsych questionnaires and they go, “Why are you doing all this? I’ve got mast cell.” Well, mast cell is the expression of your, mitochondria undergo the cell danger response. They released ATP, ATP caused the granulation of the mast cell, and the release of a thousand mediators.

So yes, you had mast cell activation syndrome, but what’s underlying, what are all the triggers in functional medicine, the antecedents, mediators and triggers that provoked this mast cell to go crazy? The brain is the interface between one’s epigenetic and early developmental experiences, and one’s outer experiences. The brain is the interface, and if you look at acute EEG, and even a NeuroQuant MRI, you can read biographies of those. They’re so alarmingly informative.

And so, I look at a body-based stress assessment. I look at heart rate variability, as we all do. But then I look at acute EEG, and I look at this sort of juxtaposition of the delta-theta-beta-alpha brainwaves, and you can really see imprints of early developmental trauma. And you can see people who are stuck in fight/flight responses, people who stuck in Porges’ polyvagal, dorsal vagal responses.

You can see it right there in the biochemistry and the physiology. And you know that that person, say, who’s stuck in Porges’ dorsal vagal shutdown response, that’s a whole different patient and somebody who just got a few allergies. You’re dealing with a whole different kettle of fish there. And you can’t just jump right in and just do your normal functional medicine and try a few supplements … It’s a whole another experience, which you have to be sensitized as a practitioner to those layers and levels of complexity. And I use these tools to interpret it.

If you look at it and do a NeuroQuant MRI, you can see the amygdala hypertrophy at like 97 percentile. It’s like twice the size of the standard, the paired match group. You can see amygdala hypertrophy. You can see the thalamus hypertrophy, and the thalamus is rich in mast cells. You can see white matter being decreased, and so forth and so on. You can see all sorts of fingerprints of these complex triggers that can create symptomatology in these complex patients.

Dr. Kara Fitzgerald: Absolutely. It’s just extraordinary. So somebody comes in a typical allergy, seasonal allergy, maybe they’re bad, and so you’ll just treat them accordingly and get them balanced, but it’s relatively straightforward. But you’ve got somebody else also coming in and sneezy, allergic, et cetera, et cetera, but you diagnose this amygdala imbalance. I mean, you go down this whole different direction. Just roughly describe your entry into treatment with these two, with similar phenotypic but very different underlying causes.

Dr. Bruce Hoffman: Well, first of all, I don’t see patients anymore with just simple allergies. I wish I did. But those, I would just treat with H1 or H2 blockers, and Quercetin and vitamin C like all of us know how to do. But people with complex illness who have these multiple layers and levels of imbalances, I throw quite a large diagnostic net. I mean, I do a lot of tests. I’m criticized for it because of costs. But I also know myself well enough to know that without it, I’m going to be just another practitioner along the long chain of practitioners who took a little swipe at something and didn’t get much done, and didn’t look at the complex interface of all the different parameters.

So I do throw a large diagnostic net and do ask for the tests we know so well. Food sensitivities, gut microbiome, histamine levels, zonulin, DAO. I do all the mast cell mediator markers. I do all the ION panels and things like levels in methylation. I do all of that. I look at toxicology.

But I also do quite a lot with the brain, heart rate variability, autonomic nervous system functioning, and often refer for psychometric assessment to look for psychiatric diagnosis, whether they’d be cluster B personality disorders or whether they’d just be mood disorders. So I refer out for those. And I gather all this data. I also refer a lot to dentists and chiropractors particularly NUCCA chiropractors, visceral manipulation therapists.

We do a lot of diagnostics and trying to gather an insight into what hierarchically will be the entry point into this person’s therapeutic experience. I left out the most important, which is I look, apart from food and gut, which of course trumps most things. We look at the mitochondrial functioning and we look at the fatty acids because as you know, the mitochondria, the canaries in the coal mine, and they’re the first thing to sense any danger whether the danger is perceived or real, chemical or imagined.

And we have this credible capacity now through the IGL test in Germany to look at mitochondrial functioning and through BodyBio or the Kennedy Krieger fatty acid test to look at fatty acids. And those are the two tools that have trumped everything else in my practice.

Dr. Kara Fitzgerald: Wow, what is that? Tell me just briefly what the IGL is and then we can link to the … And the Kennedy Krieger and we’ll link to both.

Dr. Bruce Hoffman: So before this test came along, we in functional medicine would look at mitochondrial dysfunction, all we really had was a cheek swab. We had the organic acid test, but now we’ve got this ability to look into about 300 lab parameters that tell us the following: A, mitochondrial numbers, if they’re normal or if they are low in number. And mitochondrion, as you know, when they’re low in number, they must be undergoing some form of autophagy or cell death which ties into Naviaux’s cell danger response theory, that when we’re under threat, perceived or real, mitochondria start to self-destruct and release their ATP extracellularly, that then sends off a whole inflammatory cascade that oxidizes lipid peroxide, cell membranes and leads to this innate immune activation, mast cell activation, et cetera, et cetera.

Dr. Kara Fitzgerald: What’s the specimen? What’s the specimen for that test, sorry?

Dr. Bruce Hoffman: Blood. It’s a blood test.

Dr. Kara Fitzgerald: Both are blood tests, okay.

Dr. Bruce Hoffman: Yeah. So, it goes off and then they measure ATP production. They measure percentage of ATP that’s blocked. They measure cell free DNA. I mean, DNA that’s outside the cell shouldn’t be there.

Dr. Kara Fitzgerald: Where it shouldn’t be here.

Dr. Bruce Hoffman: They look at DNA adducts, toxins sitting on the DNA interfering with protein expression, interfering with the DNA expression of all the factors that go to make up messenger RNA and enzymes, et cetera, et cetera. It looks at phospholipid production. Phospholipids, phosphatidylcholine genome, most potent of all the cellular membrane ingredients.

It measures phosphatidylethanolamine, the phospholipid on the inner membrane which transfers electrons and the electron transport chain. It looks at outer phosphatidylcholine. It looks at cardiolipin synthase enzymes to see if they are making cardiolipin which is part of the inner membrane. It looks at whether you have what your amount of cardiolipin is so you’re looking at your phospholipids content.

It also looks at mold markers, markers for fungal metabolites. It looks at microtoxin metabolites. It looks at superoxide dismutase level. It looks at occupation of cell membranes. It looks at glutathione peroxidase, glutathione transferase. It looks at cell membrane voltage, incredibly helpful. When you’re looking at membrane voltage below 170 millivolts, it’s like 150.

And you’re looking at intracellular calcium excess or magnesium-potassium deficiencies. It looks at methylthionine levels. It’s incredible insight into toxicology and mitochondrial homeostasis. And from that, combined with the Kennedy Krieger fatty acid panel, which looks at your polyunsaturated omega 3, omega 6 levels, and it looks at renegade in very long chain fats and it looks to see if you’re myelinating adequately, et cetera, et cetera.

You can really transform a person’s biochemistry into something that ships them from this so-called cell-doubt, cell-danger response into a healthy response. And it takes an average four to six months of hard-work. But if you address the mental, the mind-body, the defense, the psyche and the biochemistry and toxicology in a hierarchical manner, and sometimes you got to stop biochemical work and you got to go work psychologically or even spiritually sometimes.

But if you start working with complex patients in this way, you’ll very soon know when to stop by a chemical work and to work at another level. If you’re sitting behind a desk and the patient is in front of you, and you’ve done beautiful biochemical work and you know that your work is impeccable and the patient is still sick, you know you’ve addressed the wrong level and it’s time to look at another level.

Dr. Kara Fitzgerald: I would imagine that you’re not … I mean, you said hierarchical, and I think that is true. But you’re doing it concurrently as well. I mean, you must be.

Dr. Bruce Hoffman: You always are. You always do it concurrently, but you learn to sense when it’s time to address, say, amygdala overactivity and vagal nerve shutdown as opposed to doing intravenous lipids and butyrate. Sometimes you’re doing all these beautiful biochemical interventions repeating the nutrition, food, gut and hormones and the patient stays resistant and/or hyperreactive.

And then you know they got an overactive amygdala and/or underactive vagal nerve. And so, you’ve got to shift focus and go down a different path. And just having done this for a long time, I’m sure you have experiences. You get to know when you probably are working at the wrong level.

Dr. Kara Fitzgerald: Yes, it does. This is such a simple thing, but in my residency, we don’t do IV therapy in my clinic here in Connecticut. We mostly do telemedicine these days. But in my residency, back when you and I used to talk, that was also in a clinic setting as well. And just that IV experience, I thought about it because I know you’re doing IV. We set up the environment to bring the energy down and so, even for those individuals who don’t want to hear it, that there’s a psychological component to their presentation.

There’s sort of backdoor ways to enter into that healing relationship or that healing, meeting the needs for healing in that space even when patients don’t want it.

Dr. Bruce Hoffman: It’s such a dance that goes on in this complex relationship between the so-called healer and the one who’s coming for your help. That if you’re not cognizant of the complexities that may arise, one can attempt to impose therapeutics onto a patient when the psyche is not intending to cooperate. It has no intent to allow that vulnerability.

And if you don’t know sort of the trauma of that person, the defenses, the fragility, the resistances, you can often rarely get into a difficult therapeutic encounter. And so it behooves us as healers, whatever the word may be, to stay very conscious of our own projections and our own inabilities and our own blind spots when we’re interfacing with patients.

And yes, they may have amygdala upregulation. They may be fragile and highly resistant. But does that mean that we get rid of them and say, I can’t help you anymore? Does that mean that we have to dig deeper into our consciousness to try and meet them where they are. And if we can unlock the door that’s previously been not open to them, we can assist in unlocking that door, there’s an incredible flood of therapeutic material and healing material that gets unleashed.

So I don’t like to do neuro biofeedback and amygdala training. If the psyche of that patient isn’t receptive to it, so it-

Dr. Kara Fitzgerald: Absolutely.

Dr. Bruce Hoffman: … a lot of conversation and a lot of negotiation sometimes around some of these issues. And people can remain hyper reactive and highly fragile and resistant. And that behooves us to just stay with that patient if we can until something shifts in the psyche and so often it does. Often it does.

Dr. Kara Fitzgerald: Yes, that been my experience as well that when they don’t achieve what they came to me to achieve or they get through some but not all, then perhaps they are open to a broader inquiry. I want to just ask, so I want to talk about, I want to get to your interventions. I know people will be very interested in how you’re addressing some of the mitochondrial issues that you’re seeing. But I just wanted to ask in your time and practice …

I mean, your practice now is self-selecting for challenging cases because you’ve been doing this for a long time and you’re just recognized as an expert, but are you also seeing sort of uptick in these kind of complex patient presentations?

Dr. Bruce Hoffman: It’s all I see now and sometimes, I wish it wasn’t.

Dr. Kara Fitzgerald: Right, I want to go back to insulin resistance case there.

Dr. Bruce Hoffman: Hormone replacement therapy, sure. But I am excited by the challenge. As you know, there’s no rest. I’m in my 60s and I don’t think I’ve studied more now. I mean, when I was a young medical student, that is nothing. This is boot camp all over again. You better stay ahead of all the research and all the latest series and all the latest issues that come across us.

But yes, am I seeing more complex cases? Absolutely.

Dr. Kara Fitzgerald: And there’s a change though, would you just say there’s sort of a change in the challenge of cases? I mean again, just going back to when you and I talked a lot, SIBO might be a challenging case. But those days seem …

Dr. Bruce Hoffman: SIBO is like one of 24 things that need to be looked at. As we’ve expanded our diagnostic possibilities and as new researchers have come up, Afrin and his mast cell activation syndrome along with the other writers and the other researchers, that’s thrown a huge level of insight into a certain presentation that we didn’t have 10 years ago. So, we have that and Naviaux’s mitochondrial cell danger response, unbelievable what that’s done to our consciousness as practitioners.

It just opened up … Now, before when we did functional medicine training, we learned about food, gut, hormones and nutrition. But now, that’s a subset within a subset of complexity. And that stuff, we have to know backwards, otherwise, we can’t get to anywhere. But what else do you bring to the table? And now, we’ve got to bring in all these other things, all these other factors into the healing relationship.

And it is far more complex. There are a lot more sicker people. And they are still looking for N2D2 solution. Even the ones who are educated, they will come and say, “I’ve got mold, Lyme, as I said in the beginning, and can you treat it?” I say, “Sure. But is that what you really have, or is that just what’s showing up as a presenting feature?” People come with false positive antibodies on Lyme test, and they say, “I got Lyme.” “Oh, it’s three on the Armin Lyme EliSpot. Is that really Lyme disease? Is that a false positive?”

And so you got to know all these subtleties. You got to constantly be in touch with the researchers and the lab directors and you got to listen to all the experts in our fields. You got to shine the light of the single aspect. And you got to know how to incorporate that clinically in patient because patients are smart now. They come with all their research.

Dr. Kara Fitzgerald: Yeah, they are.

Dr. Bruce Hoffman: And they know stuff and sometimes, it’s misguided. Sometimes, it’s spot on and they intuitively can often sort of guide a path that is previously hidden from you. They were often uncovered and helped shine a light down a certain pathway. People are smart.

Dr. Kara Fitzgerald: I want to talk a little bit about your approach. I mean we could look at mast cell activation or I mean, the mitochondria. The conversation I think is pretty provocative and one that’s interesting. I mean, are there core biochemical imbalances that you’re looking for?

Dr. Bruce Hoffman: Absolutely, yeah.

Dr. Kara Fitzgerald: Can you just talk about some of these? Let’s pull together somebody with mitochondrial dysfunction, like I want to just kind of pull together how you’re going to address it and maybe what you’re looking for in laboratory and other tools of evidence and then how you’re actually addressing it clinically?

Dr. Bruce Hoffman: Yeah. When people present their history, two, three-hour history, you do your biochemical workup. Take a very extensive dietary history. Usually get dental workup, get sleep studies, NeuroQuant MRIs, brain studies, et cetera. And once you have those in front of you, what do you do first of all? The first thing I do is always look, I use my traditional medical insight and I look at straightforward pathology.

Free T3 is low and the TSH is high, B12 is low. I’d look at straight biochemistry and I never bypass it. I pay very close attention to traditional medicine’s biochemical imbalances, and look at nutrition in great detail. And it behooves us now with all these complex illnesses to know all those approaches to nutrition that are out there whether it’d be GAPS or paleo autoimmune low histamine, et cetera, et cetera.

So, I look at traditional biochemistry. I look at nutrition and then I use nutritionist chef health coach, Justine Stenger, on our staff to take a dietary history and start to introduce a dietary approach which is commensurate with their presentation. And most of the time, it’s a paleo autoimmune low histamine diet, sometimes low FODMAPs, sometimes low oxalate. But generally, I find getting people off some of those major foods that are inflammatory and getting onto paleo autoimmune low histamine diet quietens the microbiome to an extent that we can begin to repair.

So, traditional biochemistry, nutrition, dietary approaches and then start to look at all the things that most functional medicine doctors look at. The food sensitivities, status of a gut, nutritional levels, macro and micronutrients, antioxidants, toxicology, heavy metals, chemicals, mold, fungi, mast cell activation in great detail, and look at hormone levels.

And I look at hormones in three distinct compartments. I don’t just look blood levels. I look at blood, saliva and urine all on the same day to look at the different compartments of how hormones are attached to transport proteins, how they show up at the cell surface and how they get metabolized through the methylation pathways. I’ll look at all three to start with.

And then I look at infectious agents, and I tend to do quite extensive infectious disease workups, both B cell and T cell assessments. I find if you just do T cell, do ELISpots, it’s not enough. And if you don’t do B cell, you often get very confused and go down the wrong pathways.

Dr. Kara Fitzgerald: What tests are you using? Tell me what tests are you using?

Dr. Bruce Hoffman: I’m using the ArminLabs. I do the ELISpot, and I use IGeneX. I do the IGeneX ImmunoBlots and I do the co-infection panels. I use Galaxy labs for the Bartonella. And I do also use MDL labs for some of the other infections, Garth Nicholson’s lab. Those labs are usually used to look at infectious load. And then, so once I had that diagnostic roadmap, and then therapeutically as I said, I’d correct any traditional metabolic imbalances, thyroid, hormone, whatever.

Dr. Kara Fitzgerald: So, you’ll start … So, you’ve got diet. And then you’re going to start them on some thyroid if they need it, some magnesium, some B12, et cetera. So, you’ll do those foundational first step?

Dr. Bruce Hoffman: Yes. And often if there’s great dysregulation in the qEEGs and/or in the stress assessments, and/or in the MoCA cognitive assessment or the CNS vital signs or TOVA, I’ll often start them in neurobiofeedback. I’ll start them on biofeedback programs and start them on neuromodulation techniques using different devices that we use from traditional feedback to Vielight to photomodulation. We’ll use different techniques.

So I often start those concurrent with food and traditional interventions whether it’d be hormones or nutrition. And if the toxic burden is extremely high, I never go ahead and start to detoxify them day one. And I never treat infections in the beginning. Even though Naviaux is very clear that unless you get rid of the threat, you’re not going to change the cell danger response.

So, I usually start out by using oral and intravenous lipid therapy or membrane therapy to try and provoke a mitochondria backing to more of a healing response. And I found that profoundly influential and help in patient outcomes.

Dr. Kara Fitzgerald: What is that?

Dr. Bruce Hoffman: I do a power drink or a membrane stabilizing shake, if you will, where we put into a blender phosphatidylcholine from BodyBio. BodyBio is the only phospholipid I use because of its very high phosphatidylcholine content, which doesn’t break down in the gut. And it contains the phosphatidylethanolamine. It contains all the subfractionations of phospholipids.

So, I use BodyBio phospholipids and BodyBio balanced oils, usually the 6:3 ratio and 4:1 ratio. You put that in the shake along with minerals and electrolytes and then any other ingredient that has shown up in the test that could be instrumental at restoring some homeostatic imbalance. So for instance, if they have low aminos on the ION panel, we use amino acids. If they have low glutathione, we use liquid glutathione as well as oral glutathione as well as oral NAC, all the standard things we learn as functional medicine doctors.

We put in tons of Resveratrol if we can. People tolerate it. And we use usually half a cup or quarter cup of blueberries. We found most people don’t seem to react adversely to blueberries. And then learning from Dr. Kharrazian, we chop up … On a Sunday, I advise patients to go and get every vegetable they like provided it’s not histaminic or oxalates or something on their testing shows they shouldn’t. Organic, chop it up, put it into the freezer. Every day in your shake, you take a couple of tablespoons or half a cup and you put that into the shake with the phospholipids.

And then that becomes a liposomal polyphenolic compound that then crosses the blood brain barrier and exhibits this antioxidant effect intracellularly. So, that’s been a gamechanger for my practice along with intravenous therapies. I start with very, very low dose phospholipids, sometimes vitamins and minerals just to provide the micronutrients for the enzyme systems, sometimes with intravenous amino acids.

But generally, I move over slowly but surely into phosphatidylcholine and glutathione intravenously, not to provoke a massive detoxification response but to try and repair cell membranes. Cell membrane repair is better done with oral phosphatidylcholine, but the IV phosphatidylcholine conjointly with the oral not only helps the cell membrane repair but it also starts to gently sweep adducts off the toxins that are sitting on the DNA of the mitochondria.

But it’s not aggressive. It’s very gentle. Later on, we start to use butyrate and other short-chain fatty acids to further the removal of adducts in toxins.

Dr. Kara Fitzgerald: How are you introducing those?

Dr. Bruce Hoffman: Intravenously and orally. I use them quite a lot. I use oral butyrate and IV butyrate quite a lot.

Dr. Kara Fitzgerald: What’s the oral butyrate? I mean, it’s kind of smelly, but in a capsule like in an enteric-coated capsule? What do you-

Dr. Bruce Hoffman: You can get different kinds. There’s the cal-mag butyrate. There’s the sodium butyrate. There’s sodium potassium butyrate. So, you got to look at the electrolyte balance of the patient and then introduce the specific butyrate formulation that is going to be most helpful for that person’s biochemistry.

So, if they’ve got intracellular calcium deficiency, you’re going to use the calcium one. If they have POTS syndrome … By the way, that’s one of the greatest. One thing I learned 10, 15 years ago was to make sure every patient does the 10-minute, cheap, lying standing test. If you misdiagnosed POTS, that patient is never going to get better.

And I know you’re familiar with it but I do suggest that any young or new practitioner, just get yourself an Omron blood pressure cuff. Every patient that comes in your door, lie them down, do their blood pressure and their pulse after they’ve laid down for a minute or two. Stand them up one minute, three minutes, five minutes, 10 minutes, look at their blood pressure and pulse and look for drops in systolic blood pressures and look at rises in pulse rates.

And those patients don’t perfuse the mitochondria or the brain and they won’t improve until you get increased perfusion to their cellular structures into their brains. They just won’t. You have to treat that first.

Dr. Kara Fitzgerald: And are you addressing it with this protocol?

Dr. Bruce Hoffman: I address that with the standard POTS approaches with increased fluids with salt, a lot of salt, two to three teaspoons of salt. Salt sticks compression stockings and I liberally use Florinef and Midodrin and other medications. And it’s a gamechanger. It’s absolutely a gamechanger in certain patients.

And many people are misdiagnosed. There’s a combination of sort of different … You can get orthostatic hypertension. You can get postural orthostatic tachycardia syndrome, and you can just get pure tachycardias. And they’re different and if I need to differentiate, I send them to cardiologists.

And we have one particular one in our city who does tilt table testing. He’s written lots of papers, very experienced. And so we refer to him to sort of introduce further medications if need be. And patients always know about the triad of dysautonomia and mast cell and gastric motility issues. Many patients present with mast cell activation, POTS, and Ehlers-Danlos syndrome with dysautonomias and gastric motility issues. And they’re called triad or pentad patients as per Afrin’s group.

Dr. Kara Fitzgerald: Why are we seeing more of these people?

Dr. Bruce Hoffman: I think the stresses imposed upon our modern society are overwhelming our defenses. We just become extremely vulnerable to this incoming toxic load. We’re not genetically resilient enough to withstand this onslaught, whether it’d be electromagnetic fields or chemicals or foods. Even the fact that we could open the fridge five times a day, eat what we want, I mean that’s a stressor on our system, it’s unbelievable.

We’ve got out of sync with our innate biorhythms and there’s been a huge movement in the functional medicine community through biodiversity and regenerative agriculture. And we’re paying lip service to this need, but I don’t know. I think our DNA and I think microbiomes will eventually adjust to these incoming onslaughts. I don’t think we’ll be extinguished. It always appears that stresses on the system create greater resilience down the line and barring a sort of huge six apocalypse. I think we will become more resilient as we sort of evolve through this toxic phase that we’re going through.

But right now, I think we’re very vulnerable and we are under a lot of stress, under a lot of toxic load.

Dr. Kara Fitzgerald: Well, we’re kind of heading towards the end of the podcast. This is to clinicians, and so this is going to create a lot of interests in your approach to care. I guess I have two questions. One is, where do people learn more about this model that you’re working from? This sounds so powerful, and I certainly appreciate you’re casting a very wide net and people are coming to you because of that and so forth.

But as you described such a careful start to the journey … By the way, we’re going to try to piece together that shake recipe. That was so awesome. We’ll put it on the show notes, people. It’s just the most sophisticated shake yet, so I want to see if we can pull that together and put something on the show notes.

But I mean you must be seeing some pretty good outcome just after this evaluation and you’re pushing the ship from the shore. I mean you must be seeing some good change. And if not, I’m sure you’re just really going back to rethinking.

Dr. Bruce Hoffman: I don’t have a research assistant in my office, so it’s hard to know outcomes. One believes that one’s practice is achieving remarkable outcomes, but I think unless you have a statistician in there, a hardcore research, we’ll never really know. But what I’ve noticed … By the way, a lecture I did is on my website. I lectured to the ICI Conference and it’s on my website. We are doing one and a half hour synopsis of the seven stages.

Dr. Kara Fitzgerald: Okay, perfect.

Dr. Bruce Hoffman: I think it’s the most insightful sort of snapshot of the levels and layers and complexity that’s possible. So, the outcomes we have from what I can tell, because one never really knows the drop-off rate. I don’t think it’s very large. When patients present with complex illness and you do your due diligence and you throw the net far and wide and the patients can keep up with it, and many patients can because they’re so educated and so driven, they’re so sick and tired of seeing hundreds of people and not getting any better.

And you’re looking at your data and you’re looking at mitochondrial function and fatty acids function and ION panels and things and you do repeat them from time to time. It has been my experience that within six months on average, on average, the test itself reverts from highly problematic to restored function, the IGL test. You will see mitochondrial numbers go from low to normal. You will see phosphatidylcholine go from extremely low to normal. You will see glutathione levels come back. You will see microbial toxins disappear. You will see mercury, lead, cadmium, glyphosate levels disappear.

But concurrent with that, the patient will tell you, “I feel completely different.” And we keep objective, we do different score systems. But I use the old MSQ from IFM. And patient’s levels drop from 180 to 20 once you start working from the mitochondria outwards into the whole complexity of the mind-body and familial inherited system. If you start using a broad map and you just don’t run down too many rabbit holes, and you keep your head above you and you just work it through. And if you hit the blank wall, you just ask more questions. You don’t give up.

Somewhere along in that experience, the patients, they feel better, their symptoms improve and they move through that cell danger 1, 2, 3, into the cell danger 3 response, the healing response. And they feel amazing. We have a large amount of patients who do experience that once they’d gone through their process, but we always preface it with, “Look, this is only as successful as the amount of effort you put in. If you stay passive, there’s nothing we can do. You have to be a cooperative partner in this experience. If you have side effects, you don’t throw baby out with the bathwater. You come to the table. We find out what happened, and you work through this process. And if you can’t, you get yourself somebody, an advocate, who can help you.”

In that sort of dynamic and with the staff, the great staff I have and the support systems and the ability to rerun lab tests from time to time, I would hazard a guess that the majority of our patients get better, the majority. I wish I had the statistic to tell you, but I don’t.

Dr. Kara Fitzgerald: Maybe now is the time to get a PhD student in your practice. It would be really nice to gather. I know you’ve been at this for a long time. It’d be nice to maybe get some data.

Dr. Bruce Hoffman: I think I should, yeah.

Dr. Kara Fitzgerald: Yeah, get a student, that good PhD work. Well, Dr. Hoffman. It was just really lovely to connect with you and talk about this. Folks, we will gather as much as we can for the show notes and link over to the site to some of the content that he’s referencing. And if you think of anything else, just let us know. Thanks for joining me today, for this really nice dive into what you’re doing.

Dr. Bruce Hoffman: Thanks, Kara, and nice to speak to you again after all these years.

Dr. Kara Fitzgerald: Right, absolutely. And hopefully, I’ll see you in person at AIC, not this year but next year.

Dr. Bruce Hoffman: Yeah, maybe, who knows? I quite enjoyed this sort of remote telemedicine, teleconference …

Dr. Kara Fitzgerald:  Thank you kindly, for your time. Much appreciated.

The podcast was originally posted on Dr. Kara Fitzgerald’s website here.

Functional Medicine 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.

Full Transcript

00:12

You’re tuned in to 92.1 WOMAR, FM Provincetown and 91.3 WOMAR, FM Orleans, the voice and spirit of Cape Cod. I bid you welcome to another episode of Healing Wisdom. I’m your host Pandora people’s chartered herbalist and psychic medium healing wisdom explores Mind Body soul connections as we discussed the healing effects of the arts, metaphysical concepts, intuition and the spiritual aspects of everyday living. Healing wisdom begins in the heart. Our theme music is provided by mystic Pete

01:00

Hello, hello, hello, hello, Cape Cod and beyond. My guest today is functional medicine Dr. Bruce Hoffman, founder of the Hoffman Center for Integrative and Functional Medicine. His center encourages people to become involved with the process of health, restoration, self-master their health issues and make health a primary value. Dr. Hoffman has dedicated himself to research and education in cutting edge health care wellbeing and living a meaningful life. Welcome, Bruce, thank you so much for being with us.

01:28

Excellent. Thanks Pandora

01:29

So first off, what inspired you to go from an allopathic practice or a traditional practice to an integrative approach to functional medicine,

01:39

Curiosity more than anything and frustration at the drug-based model, you know, when you go to med school, you learn this is called n squared d squared, medicine = name of symptom name of drug. Although it’s interesting, it really limits your diagnostic and therapeutic options. So, when a patient presents say with complex illness, where there’s a mind -associated issue, and or environmental issue, nothing you can do with a drug based model, you know, you just diagnose a disease find a drug or refer to a specialist. And that’s it. It’s over. Whereas in an integrative model, you look far and wide for what they call in functional medicine, antecedents, mediators and triggers. So, you look upstream, you know, and in a functional model that I use functional medicine workup that I use, I’ve expanded beyond pure functional medicine into what I call the seven stages to health transformation. And I use an Ayurvedic model to explain the different layers and levels that come to the table when you’re trying to diagnose and treat somebody. Anywhere from the family systems into which they originated into the early emotional experiences and ego development and defenses, through to unresolved emotional traumas through the brain states and brain functions and then into biochemistry and toxicology. So, it’s a much broader diagnostic roadmap that we use ana a therapeutic roadmap, and I just found the drug-based model limiting. I enjoyed being a traditional MD. But now that I practice a much more expanded paradigm, it’s much more exciting and your results are tremendous when you apply this sort of wider model, you know.

03:17

Yes, indeed. So, after studying traditional Ayurvedic medicine, traditional Chinese medicine, homeopathy and looking at health care, from a mind, body, spirit perspective, I’m wondering what fundamental conclusions you’ve drawn about wellness that led you to your inspiration and the creation of the Hoffman Centre.

03:37

Wellness is a strange term because it denotes what I really try and help people with, which is to try and live in a state of maximum wellness, maximum potential. And that moves everybody from a disease-based paradigm into what we you know, what is called a wellness paradigm, but is somebody living at their maximum potential, are they fulfilling the desires of their most innate, instinctual talents and abilities, and illnesses and symptoms often sort of create a, what would the word be, they create a block in that person’s trajectory towards optimal performance of their destiny? And so, we use symptoms and diagnosis to, to sort of ask a lot more deeper questions and dive right into the potential reasons why a person may not be fulfilling their ordained destiny. And that’s what I love to do. And so that’s why I created the center to try and explore those possibilities with people and it’s very rewarding, and not everybody, somebody may just have something that’s physically based but many people with chronic illness have led many layers and levels of stressors on their systems, and the detective game of trying to diagnose and treat is what inspires me to keep doing what I love to do. 10 Center.

05:00

Very cool. I’m wondering what some of your fundamental theories that you’ve developed are as a result of your work that you could share with us or what some of your underlying ideas are, that are part of your mission.

05:18

Certain things that stand out, when I have somebody sitting in front of me with a complex illness, a) you’ve got to take into account all the basic lifestyle factors, diet, sleep, exercise, stress, if you don’t look at those in great detail and sort of dissect them into the multiple subsets, you know, like a diet, for example, there’s many different diets that you can therapeutically apply and what may fit one person may not work for the other. You have to really know your nutrition and dietary issues in great, great detail. A high histamine diet versus a ketogenic diet versus a paleo autoimmune diet versus the Ayurvedic Vata pacifying, that there’s many, many permutations, you got to know those things thoroughly. So that’s huge. And as you know, diet affects the gut microbiome. And the gut microbiome affects the vagus nerve and the vagus nerve runs into the brain. So, your brain-gut microbiome is huge. If you’re not looking at the gut-brain microbiome you can’t really work out what’s going on. So, diet is big. The gut microbiome is big.

Dentistry, I use a lot of dental insights in order to try and ascertain what may be going on particularly with people’s brains, because the inferior alveolar nerve in the lower part of the jaw runs back into the brainstem as well. So, you get a lot of toxic buildup in root canals, cavitation sites, etc, etc. So, dentistry, a lot of respect for dentistry. Everybody to get a panorex X ray and a 3D Cone Beam CT scan of the jaw, and then I send them to a biological dentist to do a complex workup and treat accordingly. So, dentistry is big. Diet is big.

Sleep, sleep, almost everybody I see has a sleep study, not one of those sleep apnea tests they take home. Do a full in-house sleep study. And I rely on that tremendous extensive can’t tell you how many people suffer ill health from sleep issues, sleep is huge. Which brings me to the whole thing of emf, electromagnetic field exposures, radio frequencies and electrical fields, magnetic fields. That has become a very dominant part of my intake history taking to see what people are doing, how much screen time, are they using blue light blocking glasses, are they turning off their routers at night? So, I take that all of that into account? Huge, huge, huge.

And then another piece that is huge in my work is I really don’t start to work with somebody unless I understand the family system into which they originated. The ancestral lineage not from a genetic but from an epigenetic perspective, what are the experiences of their mothers and fathers and grandparents? I find that is where I really begin my curiosity through taking a history. Are you in relationship with your mother or in your relationship with your father, if people say I can’t stand my mother, I can’t stand my father, I don’t want anything to do with them’ I know right then my task of healing is being brought to a halt. You can’t heal somebody who isn’t aligned with their family system in a flow of love, can’t do it. It doesn’t work. You can treat a symptom but you’re not going to help that person reach their maximum potential if they’ve shut down the influences of their parents or their ancestors, because people are half their mother, half their father, if you say no to your mother or say no to your father you are saying no to half of your life force. And that needs to be worked through. And I use family constellation therapy for that. And things like that, you know?

08:45

Yes, I was going to ask what you do for that for that situation? Because that, you know, there are a number of folks who are.  Is it family therapy?

08:57

No, it’s not family therapy, its family constellation therapy. Its different form family therapy

09:01

Can you explain that?

09:02

Well, you take a history or you ask people certain questions about their family of origin. What do you blame your mother for? What do you blame your father for? Those are the first question. And if they have a whole string of complaints that begins the diagnostic and therapeutic process. It was developed by Bert Hellinger, called family constellation therapy. He just died a few weeks ago, actually. And it’s a method of working people up through understanding the entanglement of the family system. We try to understand the laws that operate in family systems and those things that lead to good outcomes and those things that blocked the flow of energy in a family. You have to sort of study it and learn it.

09:46

Yes, it’s very, very intriguing. I’m wondering if you could just mention briefly, you described turning off your routers at night. So, these electromagnetic fields that we’re constantly in relation to in this digital age. They are really, truly bad for us.

10:03

Depends, yeah, there’s certain subtypes of people are more susceptible than others. And some work is  being done on basic detox for liver cytochrome p 450 enzymes. Liver enzyme pathways, detox pathways, people with certain liver detox enzyme susceptibilities do much worse, in terms of the electromagnetic hypersensitivities. So, when you sleep at night, you should be in a very deep parasympathetic healing state. Most people you see, particularly say in inner cities, have about two volts running through their body from the electrical fields around them. And then they have these electromagnetic radio frequency fields. This is from the cell phone towers and routers, like if you live in a condo, you’ve got everybody’s router beaming into your bed at night. And when you’re sleeping at night, you are meant to be in this very deep, relaxed state. But if you are surrounded by radio frequencies and electric fields and magnetic fields, you’re in a stress state. And that opens up the blood brain barrier, opens up the gut barrier, leads to suppression of melatonin, the whole glymphatic system or brain detox system doesn’t work, you’re in big trouble. And it’s not being emphasized enough, you know. And then with dentistry, if bite problems and grinding, you don’t detoxify through the glymphatic system and down through the, you know, through the lymphatics that go down through your internal jugular vein and other parts of your neck and thoracic region. So, you want to know these things. I send in Baubiologists or building biologists into homes to measure all of these things before I start treating people with cognitive difficulties or sleep difficulties. They go turn off routers, they help people with sleep, you know, screen time, they use blue light blocking glasses, they do all of these things. So, it’s an integral part of the work I do?

11:41

Well, that’s very exciting. I’m just wondering, I used to erase floppy disks by just touching them. So, I obviously have some sort of electromagnetic thing going on. would that mean that I would be more susceptible to energy from digital influences or to electromagnetic? Well,

12:01

I don’t know. I used to feel tingly and confused when you arrived cell phone towers. They go crazy. They can’t handle it.

12:10

Well, I used to be affected by Bluetooth. So yeah, perhaps perhaps. So environmental and lifestyle factors are considered by functional medicine doctors to be as you’ve been speaking about it very important, especially in complex situations with patients with chronic illness. So have certain input environments or lifestyle factors been linked to chronic Lyme disease.

12:31

Well, lyme disease is an immune disease, right? So, the bug gets entry if your immune system is compromised. So, you need to have reduced natural killer cells for Lyme disease to take hold. And so, to treat Lyme disease, you know, there is a whole emphasis on using whole rotating antibiotics and, and using herbs and/or pharmaceuticals to treat it. But really, it’s an immune incompetency disease. So often when you have a compromised immune system, you’ve got to look at factors that may have led to that and one of them, apart from the genetic imbalances in immune competency is stress. Stress is the greatest suppressor of the immune system. We know, people with stress they get viruses, they get colds and things; that’s the same principle, your surveillance system of our immune system gets compromised under chronic stress. And what causes chronic stress. Well take your pick, hundreds of factors cause chronic stress, it doesn’t just have to be a boss that gives you a hard time, it can be poor sleep, it can be poor diet, there’s many things that cause chronic stress. That dental infection that hasn’t been treated; they all can cause chronic stress in the body. So, for Lyme disease, the thing you got to look for is immune competency and that’s why one of the tests we do is called natural killer cell function, or CD 57. And we look at that to see if that’s suppressed. If that’s suppressed, your ability to fight Lyme disease is compromised and Lyme disease and co infections can run rampant. So, it’s just one of the things we look. There are genetic components to this as well. One researcher has done work on the genetics of people with Lyme disease, and specific markers that are upregulated. And then anything that compromises your overall resilience and homeostasis and mitochondrial resilience, anything, diet, any other factors, lack of exercise, obesity, any of them.

14:23

And if you’re tuning in just now, you’re listening to healing wisdom on WOMR 92.1 FM in Provincetown and WFM are 91.3 FM in New Orleans and streaming at Womar.org. We are speaking with Dr. Bruce Hoffman, functional medicine doctor, founder of the Hoffman Center for Integrative and Functional Medicine.

What are risk factors in Alzheimer’s? Have you seen significant improvements in patients with Alzheimer’s using integrative approaches?

14:53

Yeah, Alzheimer’s is very fascinating. I don’t know if you’re aware of the recent work that’s put out by Dale Bredesen and his group. He wrote a book called The End of Alzheimer’s. And I wrote a summary of that book on my website, there is a blog on it. Alzheimer’s is fascinating. He’s worked out that there’s six subtypes of Alzheimer’s disease and 36 biochemical pathways that need to be addressed. And he basically says that Alzheimer’s has six subtypes. The first can be anything that’s inflammatory, then anything that’s deficient is number two, anything that’s blood sugar, glucose, insulin related is number three, anything that’s toxic, like mold and heavy metals is number four, anything that’s cardiovascular related is number five, and anything that is head injury related is number six.  Those are the six subtypes of Alzheimer’s disease. And there’s many biochemical pathways that you look at when treating Alzheimer’s. So, for instance, all the deficiency issues, one of the main deficiencies in Alzheimer’s is all the hormones: growth hormone, testosterone, estrogen, progesterone, DHEA. So, we look at all of those pathways and try and repeat them, when we are treating Alzheimer’s:  inflammatory, all inflammatory chronic conditions, you know, eating an inflammatory diet, mold, illness, heavy metals, look and treat all of those issues. People with high blood sugar, high insulin, insulin resistance, treat that, that has a huge effect on people’s brains. And then a key underlying factor that seems to be very problematic if anybody has what’s called the Apoe 4/3 or 4/4 gene, that predisposes to a much higher risk later on in life of Alzheimer’s disease. We test for that gene, hopefully, you know, if you have a 3/4 or 4/4 gene, you should really increase everything you can in terms of lifestyle factors to make sure that gene doesn’t get expressed later on in life. There’s a whole website devoted to people with the Apoe4 gene, what they need to do in order to down regulate the risk? Well,

17:08

Yes, it’s interesting, because I know with my own grandmother who suffers from Alzheimer’s and my mother-in-law, and also one of my clients, it’s amazing how quickly an anti-inflammatory diet can help heal the brain. I mean, it seems like overnight, a person can have access to memories that they didn’t have before.

17:31

The other thing we do is, down regulating the gut microbiome and neuroinflammation through the vagus nerve. But we also assess all the fats. I test with the Kennedy Krieger fatty acid analysis and we look at all the Omega 3/6/9 and saturated fats and we treat very aggressively with the ketogenic diet and high fat intake, particularly something called phosphatidyl choline. Choline is one of our key nutrients to help restore brain function back to normal. In fact, the patient I saw just now had a huge deficiency in phosphatidyl choline with cognitive deficits.

18:11

Wow, can you dispel the mold myth mold illness is not an allergy, correct?

18:21

You do get IgE mold allergies, but we do not worry about that. That’s the least of one’s worries. Mold is a huge trigger of the innate immune system causing a condition called CIRS; chronic inflammatory response syndrome. And that plays havoc with your inflammatory cytokines, which then down-regulate areas in the brain, particularly the melanocyte stimulating hormone, MSH. And MSH controls many things; sleep, pain, gut function, and all the sex hormones and the diuretic hormones. So, when you get exposed to mold and you get inflamed from mold, and it appears that only 25 to 35% of people have a susceptibility to mold illness. They don’t downregulate the mycotoxins that are expressed. And they get very inflamed with consequences to their brain, consequences to their hormone’s, consequences to  mitochondrial and to oxygen delivery, sleep, gut function. Amazing. So moldy allergies is the least of our worries.  I don’t see people with mold allrgies, I see people for mold toxicity, mold inflammation. It’s a whole different subset, not taught, not understood. Respirology don’t know about it. The insurance companies certainly don’t want to know about it. It’s a huge problem. And I treat mold illness all day. Huge. Most homes are moldy.

19:46

Yes, many, many homes on Cape Cod, for example, are moldy. There’s just a ton of dampness and can you talk a little bit about mold illness?

19:55

Yeah, well, I work like as much as I work with a dentist and I work with building biologists for EMF’s, I work with mold, remediating indoor air specialists, we send people into homes to do a visual inspection. Anybody that I suspect, with mold illness, we have a questionnaire. And if people score very high on the questionnaire, we immediately suspect mold. And then we ask questions. Do you have any water damage? Do you have any damp areas? Do you have any condensation on your windows? Do you have any visible mold downstairs, or air conditioning? Have your ducts been cleaned lately, a whole bunch of questions. Then we send in the mold inspectors to go and do a good visual inspection, which takes hours. If somebody walks in with an air sample and waves it around and says you don’t have any mold in the air, run for the hills, because that’s was not a proper mold assessment. We also send people home with ERMI kits where they actually take swabs for DNA particles of mold, they take a swiffer cloth, mold samples from dust collected, or they vacuum the carpets and they collect the DNA spores and send it off to a lab to measure it. And then if they’ve got mold in their home, we assess the degree of the mold. And then we send in a remediation crew, and then we start to treat the mold illness. And there’s about 12 steps in how to treat mold illness. First step is to get out of the moldy home. Second step, bind the mold with binders like cholestyramine or charcoal or whatever. And then there’s a whole series of other steps that you do.

21:29

What are your thoughts on ozone for killing, mildew and mold?

21:33

Doesn’t work?

21:35

Oh, no.

21:38

It affects our immune system. Yes.

21:42

Mold exposure causes inflammation upregulation of the innate immune system which causes inflammation.

21:51

Yes. So I’m wondering about andropause. And why is it worth talking about? It’s not something that you know, people talk a lot about menopause, but not so much about andropause.  And I noticed that was on your website. I’d love to hear

22:06

Andropause. Yeah, it’s grumpy old men. Yeah. Men age slower than woman so they’re not as you know, andropause, it takes a year or two.   Women and perimenopause take about a year, but they notice when they start getting hot flashes and night sweats, it’s pretty quick. Men, their testosterone levels fall slower. And they don’t go into like an acute sort of jump off a cliff so to speak, it’s a slow, gradual decline, they put on weight, they get grumpy, they get depressed and they ache.  Their libido goes down, erections go down. And when you start measuring all the sex hormones, you find that they are deficient or you know, low normal. And that you know, usually in the age 50 onwards, and we measure all those hormones and treat accordingly and it can have tremendous effect when you start treating, particularly testosterone, dhea, sometimes growth hormone very seldom, melatonin, and then using thyroid hormone and adrenal support, some can make a tremendous difference to people’s wellbeing. So andropause is a real and undiagnosed, under treated condition. It is very rewarding once diagnosed and treated appropriately, you know.

23:28

Yes. Now this might seem like a strange thought. But I’m wondering if there is an evolutionary reason that people as you know, over a certain age tend to get up earlier. And earlier. And you know, if the oldest troubled sleep, maybe has, you know, if that’s really how people were living, organically naturally. I mean, I know, overall, people are dying, at much older ages, and so on and so forth. But I always wonder about this early rising business that seems to happen and be so much a part of our hormonal evolution over our lives.

24:06

You mean why older people sleep less.

24:08

Yes.

24:11

So succinctly said,

24:15

Multiple factors for that, you know, I mean, it’s definitely based on diminishing hormones, particularly, melatonin, melatonin levels go down as we age, too.  Melatonin is a major brain antioxidant. It’s also what turns on the suprachiasmic nucleus, which tells you that it’s nighttime. So, melatonin deficiency, as we age, affects the suprachiasmic nucleus and affects the ability of somebody to stay asleep for longer periods of time. There are many, many factors, but that’s just one of them.

24:53

As we go into colder months, it’s very important that we use preventative measures and make sure that we’re as healthy as we can in the fall so that going into winter, our immune systems are as strong as possible. I’m just wondering what your thoughts are on just simple things, people can start doing better to take care of themselves in the colder months?

25:14

Well, the thing that I always worried about the colder months is when people go indoors, and they shut themselves in. And so I always want you to worry about the indoor air quality, and these tightly sealed homes. So, when we not exposed to the outside sunlight, when we get sealed into our homes for six months of the year, the question is, what is the quality of your home? What is the quality of the indoor air? Are you being exposed to mold spores and mold toxins, volatile organic compounds, off gassing? That’s the thing I’m most concerned about in winter months, and many, many patients will tell you “ in October when winter comes, I get sick, I get worse, I get depressed”, or I get this or that”  a lot of it’s to do with the fact that they get sealed into their homes, and they don’t spend any time outside, you know. So that’s what I started to think about – quality of indoor and environmental indoor homes.

26:16

Okay, so we have one more minute left. So, my final, final question is just, if you could, if you could tell everyone, one or two things that would help improve most people’s lives, you know, mind body spirit, what would that thing be?

26:34

If you’re not connected with your mother and your father, if they are alive or dead, go do some work and try and reconnect yourself to their life spirit and to their love. If you’ve got a complaint about your parents,  go do your work. I really mean that.

26:57

If you cannot say yes to your mother and father for giving you life, your work is incomplete. If you are in complaint about your mother and father, you have got work to do. They gave you life, be grateful. All the rest was just an excess. It’s just the fact they gave you life that was enough. That if you’re not aligned with them, and the flow of love isn’t from you, to them to your children, you need to do your internal work to try and correct that. That’s what I say is the principle, the cardinal aspect of healing.

27:29

Thank you so much, Dr. Bruce Hoffman for joining us today on healing wisdom.

27:34

Okay, thank you very much. Thank you so much. Bye.

You’ve been listening to healing wisdom. I’m your host Pandora people’s certified chartered herbalist and psychic medium. You can find healing wisdom podcasts at Womar.org. Contact me with any feedback questions or show ideas at peachy pandora@yahoo.com. A big thanks to the Wizard of operations Matthew Dunn. Join me again next week.

Recommended Events with Mark Wolynn

Event 1: Break The Cycle of Inherited Family Trauma

It didn't start with you...but it can end with you.

A workshop with Mark Wolynn

Unconsciously, we relive our mother’s anxiety. We repeat our father’s disappointments. We replicate the failed relationships of our parents and grandparents. Just as we inherit our eye color and blood type, we also inherit the residue from traumatic events that have taken place in our family. Illness, depression, anxiety, unhappy relationships and financial challenges can all be forms of this unconscious inheritance. In this workshop, you’ll learn how to break biologically inherited patterns through family constellations and healing practices based in neuroscience so you can live a healthier, happier, more fulfilled life.
Event Dates:
Saturday, March 9, 2019 & Sunday, March 10, 2019
Event Location:
Calgary Delta South
135 Southland Dr SE
Calgary, AB
T2J 5X5
Event Time:
10:00am - 6:00pm
Event Cost:
$450
Registration:
Contact Kari Dunlop - (403) 852-7997 | kari@markwolynn.com

Register Online: http://www.markwolynn.com/workshop/4553/#register

Event 2: Symptoms as Clues for Resolution

A workshop with Mark Wolynn

An experiential one-day workshop that will deepen your understanding of inherited trauma and its influence on health. We’ll learn to identify family dynamics and un-spoken loyalties that contribute to the development of physical and psychological symptoms, and work with chronic conditions through interactive group work and family constellations. Participants will learn how to explore their own symptoms as clues for healing and learn how to use dialogue, imagery, ritual, healing sentences and body-centered practices based in neuroscience designed to break the cycle. This workshop is ideal for mental health practitioners, therapists, coaches, and anyone interested in personal healing.
Event Dates:
Monday, March 11, 2019
Event Location:
Calgary Delta South
135 Southland Dr SE
Calgary, AB
T2J 5X5
Event Time:
10:00am - 6:00pm
Event Cost:
$245
To register and for more information:
Contact Kari Dunlop - (403) 852-7997 | kari@markwolynn.com

Register online: http://www.markwolynn.com/workshop/symptoms-as-clues-for-resolution-3/#register

Is Your Histamine Intolerance Actually Mast Cell Activation Syndrome?

Are you wondering if your histamine intolerance or allergic reactions are actually an issue with your mast cells? Or maybe you’ve experienced chronic symptoms that seem like allergies for as long as you can remember?

Histamine is an important but potentially dangerous mast cell mediator and part of the immune system response. Histamine is secreted by mast cells into surrounding connective tissues when there’s an exposure to an allergen. Mast cell histamine works by increasing the permeability of blood vessels and allowing white blood cells and proteins to access affected tissues more easily.

Histamine intolerance is a condition that’s growing in recognition. However, it is mostly considered a part of a much wider problem which is defined as Mast Cell Activation Syndrome (MCAS); a situation in which part of the innate immune system becomes hyperactive and releases multiple inflammatory mediators, of which histamine is one.

Histamine intolerance is considered to be present when there is just too much histamine in your body for it to cope. This is further exacerbated by the fact that histamine is also present in many foods and so a person’s histamine burden may be further amplified by their diet. This histamine isn’t broken down due to a DAO gut enzyme deficiency, or a HNMT deficiency in the liver. A comprehensive guide regarding the low-histamine diet can be found here.

Histamine intolerance is a subset of MCAS

Mast Cell Activation Syndrome is often confused for histamine intolerance. The difference between the two is that when a person has MCAS, their mast cells secrete many mediators, not just histamine. Though, histamine is still a major component of MCAS it’s only a piece of the puzzle.

Histamine intolerance is actually a subset of MCAS. If you’ve discovered you’re histamine intolerant or recently received a diagnosis, you should also be tested for MCAS.

Conditions associated with MCAS

Because MCAS is a multisystem condition with inflammation at it’s core, it’s been associated with a number of other conditions including:

  • Chronic inflammatory response syndrome (CIRS)
  • 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
  • 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
  • Postural orthostatic hypotension (POTS)

If you’ve been diagnosed with one of these associated conditions, it could mean that being diagnosed with MCAS is more likely. Make an appointment with a doctor who specializes in MCAS and begin the diagnostic process. It can be somewhat of a journey, but once you know you have MCAS there’s a lot that can be done to relieve your symptoms and improve your life.

For a comprehensive guide on Mast Cell Activation Syndrome, you can read my in-depth article, Mast Cell Activation Syndrome and Mast Cell Histamine: When Your Immune System Runs Rampant.

[embed_popupally_pro popup_id=”5″]

Resources:

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

12 Tips for Living With Mast Cell Activation Syndrome

Living with Mast Cell Activation Syndrome (MCAS) usually results in widespread mast cell activation syndrome symptoms that are seemingly unrelated. Unfortunately, most people go many years or even their whole life without a diagnosis.

If you’ve been diagnosed with MCAS or suspect you have this condition, the best course of action is making a series of lifestyle changes and working with your functional medicine doctor. Fortunately, many of the changes are easy to implement and you’ll see the benefits from implementing them fairly quickly.

Try not to get overwhelmed by this list, instead pick one or two items and incorporate them into your routine. Add a few items week by week, and soon enough you’ll have a comprehensive plan that has the potential to significantly improve your symptoms and your quality of life.

1. Adopt a low histamine diet

Avoid leftover foods, alcohol, cured meats, canned fish, pickled and fermented foods, berries, citrus, nuts, chocolate, dairy, yeast, soy sauce, tomatoes, vinegar, and preservatives. A comprehensive guide to a low histamine diet can be found here.

2. Avoid triggers of MCAS (non-food items)

Avoid temperature extremes, mold, emotional stress, insect bites, chemicals in personal products, medications that liberate histamine of block DAO, sodium benzoate (common food preservative), airborne chemicals, smoke, heavy metals and anesthetics.

3. Work on your gut health

Good gut health is a cornerstone of overall wellness and will help you get your MCAS under control. Cut back on food that damages the gut or causes inflammation. Take probiotics and a DAO enzyme (generic name Umbrellux DAO).

4. Stabilize mast cell mediator release

Stabilize mast cell release of histamine with quercetin and vitamin C.

5. Use H1 and H2 blockers every 12 hours

Try using 5 mg of levocetirizine twice daily and 20 mg of famotidine twice daily.

6. Block and reduce nighttime histamine release

You can block nighttime histamine release and get a better night’s sleep by taking 0.25 -1 mg of ketotifen or zaditen at night.

7. Treat existing infections

Treat any existing infections to help your body heal and reduce mast cell triggers. Get a thorough examination with your functional medicine doctor and test for any pathogens.

8. Identify and remove toxins and allergens

When you have MCAS, you’ll do your body a world of good by reducing its toxin burden. You can reduce your exposure to toxins in your daily life through cleaning up your personal care products and opting for natural solutions, using natural household cleaners, and removing mercury fillings.

9. Take helpful nutrients

Support your health with important nutrients that assist in treatment. Some of these include vitamin B6, alpha lipoic acid, vitamin C, selenium, omega-3s, N-acetylcysteine, methyl-folate, SAMe, and riboflavin.

10. Add supportive herbs

Take nigella sativa, butterbur, turmeric, ginger, and peppermint to support your MCAS treatment.

11. Get into a routine and stick to it

Try to stick to a routine because your body’s cycles are closely linked to your daily activities. This will also help you get high quality sleep, which is essential to reducing the impact of MCAS on your life.

12. Reduce stress

Stress can activate your mast cells and cause them to release mediators like histamine. Reducing stress is important for anyone living with MCAS.

For a comprehensive guide on Mast Cell Activation Syndrome, you can read my in-depth article, Mast Cell Activation Syndrome and Histamine: When Your Immune System Runs Rampant.

Mast Cell Activation Syndrome Diet

Another great resource for dealing with histamine and MCAS using a mast cell activation syndrome diet and exercise is through Yasmina Ykelestam at Healing Histamine.

[embed_popupally_pro popup_id=”5″]

How to Tell If You Have Mast Cell Activation Syndrome

If you’ve been searching for solutions to your mysterious health symptoms, they could be caused by Mast Cell Activation Syndrome.

Mast cell activation syndrome (MCAS) is an immunological condition where mast cells inappropriately secrete mast cell mediators. Mediators include but are not limited to histamine, which can cause widespread and chronic inflammation.

This mediator release can be excessive and/or chronic and result in long-lasting symptoms in almost any cell of the body where their receptors are found. This can potentially affect every organ system in the body.

Some experts believe as many as 14 to 17 percent of the US population have MCAS, which is one out of every six to seven people. It’s also been estimated to take up to 10 years to reach a mast cell activation syndrome diagnosis. This is mostly due to the lack of awareness surrounding MCAS.

Because mast cell activation syndrome goes unnoticed for years, I’d like to dig a bit deeper and uncover some of the symptoms and lab work available that can help with MCAS diagnosis.

Symptoms of MCAS

Patients who have MCAS typically have been struggling with inflammation-related symptoms over the years, which commonly include:

  • Having allergies as a toddler
  • Various rashes that came and went
  • Gut conditions (that may have been misdiagnosed)
  • Anxiety
  • Headaches
  • Insomnia
  • Poor wound healing

While these are common MCAS symptoms due to mast cell mediators occurring throughout the body, a person can be affected by symptoms that are more widespread. These can include, but are not limited to the following questions:

  • Feeling as though you’ve always been sick
  • Overreaction to bee stings and mosquito bites
  • Shortness of breath
  • Feeling lightheaded when you stand
  • Insomnia
  • Ringing of the ears
  • Facial and chest flushing
  • Frequent colds, infections or fevers
  • Food, chemical, and drug sensitivities and intolerances
  • Heat intolerance

You can also find a comprehensive list of MCAS symptoms in my in-depth article, Mast Cell Activation Syndrome and Histamine: When Your Immune System Runs Rampant.

You have the option to get testing done with a doctor to help confirm the MCAS diagnosis. I recommend you have these tests done with a doctor who’s experienced in MCAS because it’s still largely unknown, even in the medical community.

Lab work for MCAS

Working with a doctor who specializes in MCAS is your best bet as you’ll need to get testing on multiple occasions since the symptoms of MCAS wax and wane. False negatives are a common occurrence with MCAS testing. In fact, positive lab work is only obtained 20 percent of the time. However, testing can still give you a lot of valuable information regarding your mast cell mediator status. Testing for MCAS is quite complex and requires specialized handling of tissue samples.

The most important MCAS tests are:

  • Histamine – plasma – Quest 36586 – must be chilled. Normal range – 28-51 ug/l.
  • N-Methylhistamine – 24-hour urine – must be chilled. Normal range – less than 200 mcg/g.
  • Prostaglandin D2 – plasma – must be immediately chilled and spun in a refrigerated centrifuge. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
  • Prostaglandin D2 (PGD2) – 24-hour urine – specimen collection must be chilled. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
  • 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.

There are others you can have taken, which you can find in more detail in my in-depth article, Mast Cell Activation Syndrome and Histamine: When Your Immune System Runs Rampant.

More information regarding a low-histamine diet may found found in my guide here.

[embed_popupally_pro popup_id=”5″]

Resources:

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?

What is MCAS? 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. Mast cell activation syndrome 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 MCAS 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, a DAO deficiency, 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 and mast cell activation disorder, 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 mast cell disorder 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 MCAS symptoms. 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

Ancient Healing Methods: The Seven Stages to Health & Transformation

Patient: “I have an earache.”

Doctor: 2000 BC “Here, eat this root.”

1000 AD “That root is heathen, say this prayer.”

1850 AD “That prayer is superstitious, drink this potion.”

1940 AD “That potion is snake oil, swallow this pill.”

1985 AD “That pill is ineffective, take this antibiotic.”

2000 AD “That antibiotic is artificial. Here, eat this root.”

—Author unknown

An integrated approach to healing is not a new idea. It has appeared in various forms since antiquity. In fact, what is now termed traditional or allopathic medicine has only been dominant for about 100 years, but the tendency to be focused only on outer ways of healing has been dominant for at least the last five hundred years. Alternative or complementary medicine is, in fact, the true traditional medicine. “We have been calling genuinely traditional medicine—used for at least 2500 years—‘alternative’ only because today’s newcomer ’traditional’ medicine has misappropriated that attractive word, and truly traditional medicine has not shouted theft.” In order to see how healing has evolved, let’s journey together backwards in time for twenty-five centuries to Ancient Greece.

Traditional medicine, according to the more accurate definition, was well established in Classical Greece from 450 BC to 380 AD. Traditional medicine as practiced in this era, was a truly integrated approach, where equal emphasis was placed on both the inner and outer aspects of healing. Scattered throughout southern Europe were about four hundred temples of Asclepius, the ancient Greek god of healing. In order to heal their physical symptoms, people would have to travel from their town or city to the temples in outlying areas.

The first implication of this arrangement was that they actually had to do something. They had to be intentional about their healing; they had to mobilize themselves and change location. This intentionality is not just about physical location, but also about a change in attitude or psychology as well. Some effort and discipline were needed, and there was inevitably some hardship. Modern research has shown that the further one travels to seek help, the better one’s prognosis, particularly with regard to cancer. So there was logic and wisdom in the methodology of the ancient Greeks. They required that their patients travel far distances to get the healing they sought. Today, an individual may not take a physical journey for her healing, but rather a psychological one in which she moves from one attitude in the beginning to an entirely new psychological place. There must be a tremendous urge that arises from within the person seeking the healing for her to live as much as she is humanly capable at her maximum potential as a fully embodied and conscious human being. She must be willing to challenge many of her preconceived notions about herself, delve deeply into her conscious and unconscious material and be willing to take on the archetype of the seeker who wishes to be healed. This, in my experience, is the real crux of a healing and transforming experience. Unless there is a fundamental shift in consciousness, true healing and integration of your life is impossible.

When people came to the temples of Asclepius, they began their healing experience in the outer sanctum, where the concerns of the physical body were addressed. They fasted, studied nutrition, detoxified, and were massaged with anointed oils. In my office, most people expect to be addressed initially at this level of healing. They want to know that, for their particular diagnosis, there are some physical remedies that can be applied. They are, however, fortified and lulled into a false security by the beliefs propagated through mechanistic medicine: if they are suffering from a symptom, there must be only a physical explanation and hence, only a physical treatment. I believe this attitude is fundamental to human nature and typical of our collective understanding of disease and illness at this time. This approach to healing is entirely appropriate, albeit limited, and forms the basis of the methods of healing we bring to bear at Stage Two of the Seven Stages model. The research that links mind, body, and spirit (Stages Two through Seven in the Seven Stage model) to physical healing, although it exists, has not yet achieved respectability among mainstream practitioners. It will probably take another few decades before the research achieves a level of reproducibility that will convince the skeptics to sit up and take notice.

Back to the ancient temple of Asclepius. After they had completed the rituals and practices of outer healing, Greek patients would move into the inner sanctum of the temple, where the priests officiated. In the middle of the temple were stone pillars carved with symbols of twin snakes winding around and down the pillars. The twin snakes or serpents were the symbol of healing in Greek mythology—the balanced serpents of the conscious and the unconscious, the inner and the outer. This was to acknowledge that health is not just an external matter. Patients were also required to take an oath, swearing allegiance to the gods Apollo and Asclepius. They also were asked to give an offering of a honey cake, implying that in order to gain something, they had to let go of something that was no longer working in their lives, to allow for renewal. Elliot Dacher describes this ritual:

“(And) the offering and devotion to the god, which was an outward projection of the healer within, was an acknowledgement of and symbolic surrender to the more profound healing forces buried in our mind and spirit, unseen because they are as yet unknown”

It was expected that the patients, when they went into the inner temple, would stay for a number of days, if not weeks. In fact, it was encouraged that they not leave until they had had some sign, usually in the form of a dream, signifying that healing was either underway or complete. They were asked to reference their inner wisdom, the healer within, an essential requirement in any healing experience, where the limited vision of consciousness as experienced through the five senses is enriched by messages and symbols from the unconscious. These dreams were then interpreted by the priests and permission was then given to continue on the healing journey. In undertaking this part of the experience, they were acknowledging that they were not coming for a quick fix or a physical cure, but were prepared for an encounter with the deeper medicine, the healing force within

The twin snakes, the Caduceus, are the symbol of healing used in modern medicine. It has been acknowledged for at least the last few thousand years as a symbol of power inherited from the past, with its origins in the world of myth which, as Robertson Davies has written,is still a potent, if rarely recognized, force in our daily lives.” What exactly does this symbol signify? Myth tells us this is the staff of Hermes, the Greek version of the Egyptian god Thoth. Thoth is the god with a man’s body and the head of a bird, the ibis. He was worshipped as the creator of the arts and the sciences, of music, astronomy, speech and the written word. The staff is said to represent the power of the gods. Greek legend has it that one day Hermes was walking along and saw two warring snakes fighting with each other. He took his staff and struck it between them to separate them. They curled themselves around the staff, “forever in contention, but held in a mutuality of power by the reconciling staff,” as Davies wrote. And now the symbol of modern medicine is the staff of Hermes, separating two opposing forces, not letting one outshine the other, not letting either win the battle in their struggle for supremacy.

The two opposing forces are Wisdom and Knowledge, and the caduceus is a reminder that medical practitioners must maintain a balance between the two. Knowledge, in this framework, is what one learns from the outside: the doctor brings his many years of arduous training to bear on the diagnosis. Wisdom is what comes from within, where the doctor looks not at the disease but at the bearer of the disease: “It is what creates the link that unites the healer with his patient, and the exercise of which makes him a true physician, a true healer, a true child of Hermes. It is Wisdom that tells the physician how to make the patient a partner in his own cure”

Both of these sources of wisdom must be accessed by not only health care providers in the application of their healing arts, but also by the patient, in order to maximize the healing transformation. The patient must acquire as much external knowledge as she can, from as many different sources as she needs, while also being cognizant of the fact that not all healing is about external remedies or potions. An inner journey is required.

Alastair Cunningham (2005) has described the broad terrain of this dichotomy by dividing the different routes to healing into two broad categories:

[Spontaneous healing] is what the body does by itself, without any deliberate intervention by the owner of the body, or by others. There are many spontaneous or automatic healing mechanisms operating constantly in the body and mind; for example, healing of wounds, the immune response to foreign micro-organisms, or, at the mental level, the lessening of anxiety or depression with the passage of time. Assisted healing, by contrast, denotes some kind of active intervention, by the person herself, or by others.

He further divides the latter form of healing into two forms. Externally assisted healing is “applied to the sufferer from outside, either by oneself or by others.” This is what occurred in the outer courtyards of the healing temples. In modern times, external assistance can be in the form of “drugs, surgery, [or] healthy behaviors like exercise and good diet.” Internally assisted healing “is caused by changes initiated within the person…by changes in thoughts and emotional reactions…to try to affect the health of the body or the mind.” This process is what is broadly referred to as mind–body or self-healing, and occurs only after deep introspection and a shift in attitude about one’s beliefs, values and preconceptions.

Further to these two ways of healing is that which is transcendent to both. Deepak Chopra, in an address to the Institute for Noetic Studies (IONS) conference, Washington, 2005, spoke about the fact that there are three essential ways of perceiving reality:

1) Through the eyes of the flesh — This requires our sensory perception. Science utilizes sophisticated technology, referred to as the “prostheses of our senses,” to extract information from the physical world. He gives the example that if we want to see if there are craters on the moon we use these “eyes of the flesh” to collect the relevant data. In mechanistic, externally-assisted healing, we are highly dependent on knowledge at this level.

2) Through the eyes of the mind — In this manner, information arrives, through our senses, and then is interpreted against the backdrop of our own personal knowledge base, ideas, thoughts, perceptions, values, beliefs, etc. It is this internal dialogue, the nature of which, being of a mental construct, that often has to be “re written”: so to speak, so that new information can replace the old. This occurs in the mind, not in the physical world.

3) Through the eyes of the soul — Chopra quotes William Blake:

We are led to Believe a Lie

When we see not Thro’ the Eye

Which was Born in a Night to perish in a Night

When the Soul Slept in Beams of Light

Blake describes here the concept of true reality lying beyond the illusion of our senses.

Thus if we wish to know this deeper aspect of ourselves, this timeless, eternal, non physical self, we cannot use the eyes of the flesh or the eyes of the mind. One has to traverse the territory of the inner landscape, the world of transcendent consciousness that is beyond the experience of everyday waking reality. This landscape is beyond both mind and body. This experience has been highly sanctified and respected as an essential component of any one person’s healing journey. Upon seeing reality through the “eyes of the soul”, ones sense of self is no longer entirely fixated on physical or psychological reality. It is as if you see with another eye, another perspective, often called the witnessing self, where the concerns of the body and that of the psychological self, fade into the far distance, and what is left is this sense of presence, this sense of a timeless and eternal Self. All concerns about physical reality, health and illness, disappear into the expanded realization that we are not our physical bodies. We “wake up” to our true, extraordinary reality and transcend day to day concerns of ordinary, pedestrian life. In this sense we are ‘eternally healthy” and have no concerns with the fears and limitations of a limited physical lifespan. There is a deep, abiding, unshakeable inner silence and knowing. It is as if our souls have woken up to their existence and to their relevance.

In the East, with its profound dedication to the inner process of healing, there has long been a tradition of orientating oneself towards this experience through various yoga traditions: Bhakti yoga is the path of love and devotion; jnana yoga is the path of intellectual rigor and discipline; hatha yoga is the path of physical mastery of the body and the senses; and karma yoga is the path of selfless service. By dedicated and rigorous adherence to these spiritual practices, the possibility of transcendence to only sensory and mental ways of seeing the world is possible. The path to transcendent consciousness is arrived at via the third way of perceiving reality that Chopra describes. The West has not had the same exposure to these well-defined disciplines.

This awareness of transcendent consciousness is a relatively recent development with the emergence on the planet of the great sages Buddha, Lao Tzu, Confucius, Socrates and the sages of the Upanishads. Previous to their appearance on the world stage, human experience was limited to everyday reality as dictated by the senses and the mind, motivated largely by a desire to seek pleasure and avoid pain. The master control of these behaviors was the autonomic nervous system and its twin controls of pleasure seeking and/or the fight/flight response. Seeking pleasure, avoiding pain, feeding, procreation of the species and fending off approaching danger were very much the only operational systems of day-to-day existence. Once these sages spread their teachings, human beings were able to transcend mundane states of living and taste reality for the first time—not reality as is witnessed through the five senses, but transcendent reality, the state of pure awareness so well described in metaphysical texts. This process is an inner one, one that requires deep enquiry into the core nature of one’s reality.

Modern allopathic medicine has skewed itself more heavily in the direction of the Caduceus’ Knowledge, which has resulted in some of the most successful medical advances of modern times, but has neglected Wisdom, and the necessity for this inner exploration of an individual’s landscape of consciousness, which holds the promise of this deeper healing, beyond merely treating symptoms or diseases of the physical body.

Let’s again return to the temple of Asclepius. Once the patients had been in the temples and had their inner transformative experiences interpreted by the priests, they were then escorted outside of the temple to large amphitheaters where traditional plays, such as the Oedipal Trilogy, the trilogy of Orestia, the journeys of Odysseus, and the great dramas of Sophocles, Aeschylus and Euripedes were enacted. The largest theatre in ancient Greece was at the healing temple at Epidaurus, and with its perfect acoustics, it is still in use today. The purpose behind exposing patients to these dramas was to illustrate to the patients that what they considered to be very personal, dramatic experiences had their origins in antiquity. Behind an individual’s personal experiences lay the archetypal dramas of health, illness, love and hate, living and dying that have been playing out for centuries. This exposure was meant to reinforce that whatever problems the patient had, others had those problems, too. By reflecting on the themes that were enacted in these plays, those of lust and betrayal, revenge and shame, suffering and salvation, the individual could engage in deep inner therapy where the meaning and lessons of their own lives could be compared to those enacted on stage.

Wisdom could be imparted and the experience gained could be contemplated, against the backdrop of the patients own lives.

Furthermore, many of us have been through great traumas in our lives, from romantic betrayals to divorce and bankruptcy, death of loved ones, and stories of loss and gain. This realization would lead them to lighten up somewhat, to take themselves a little less seriously, knowing that we are mythical beings living out mythical lives. In Ancient Greece, as in our world, one of the greatest dangers to living at ones maximum potential, is making the mistake of taking oneself too seriously!

Many of us have taken heroic journeys—spending the first half of life conquering and creating a safe haven for our emerging egos, only to find in the second half of life that nothing of the senses truly satisfies our soul. Nothing outside of ourselves really satisfies our deep existential longing for a fulfilled, related and meaningful life. Once we wake up to this awareness, we then shift our awareness from an outer-directed life governed by trying to satisfy outer authorities (our parents, our peers, or societal expectations), to an inner-directed psychological or spiritually-based life where the questions we ask are more about the meanings behind apparent reality. We access our inner voice, rather than relying on the “outer voice” and opinions of others. Some of us have struggled with these life transitions and thought we were quite unique in these experiences, but throughout antiquity, these stories and dramas have repeatedly unfolded. We are all participating in this greater story of life. Every one of us is living stories out of the Bible or the Bhagavad-Gita or Greek mythology or Roman mythology, and when we, like the Greeks in the amphitheater, see that we’re just re-enacting the perennial human dramas, we lose some of our anxiety over it. We can begin to let go of the sense of existential anxiety that tells us we’re not getting it right.

Furthermore, within the Asclepian temples, in the surrounding gardens and walkways, there were statues completed by some of the great sculptors of the day such as Phidias and Praxiteles. There were also scholars involved in ongoing philosophical debates, “engaging the mind in self-reflective exploration of the meaning and nature of life. Beauty, truth and virtue were all aspects of the good life and a more profound well-being.”

In summary, Greek healing methods suggested that there is an interweaving of both the inner and outer experiences through the evolution and shift of consciousness. Outer remedies were required, but inner ones were just as significant. For every movement on the outside, there had to be the possibility for a movement on the inside as well. The Asclepian temples provided a multitude of experiences across the spectrum of the patient’s physical mental and emotional lives and these “multiplicity of experiences together formed a healing ecology of body, mind and spirit”They were the first and most enduring example of a truly integrated medical approach.

It is important to realize from the Asclepian times onwards, this movement between the outer (physical) healing and the inner healing, from the Scientists to the Vitalists, from the rational to the mystical, has been perpetuated throughout history. At certain periods, the outer traditions have held sway, such as what we now experience in Western medicine, and at other times, more inner directed practices have been dominant. According to Elliot Dacher, there have been two major periods where the outer and inner ways of healing have been equally balanced, the first being the times of ancient Greece and the second in renaissance Europe.

These were what we call crossover periods, times in which the previously dominant way of viewing the world was in decline and its opposite was on the rise. And for a brief shining moment, inner and outer ways of knowing and healing were in the proper balance and harmony. When this occurs, there is a corresponding flourishing of the arts, science, healing, and of human life itself.”

It is apparent, with the recent interest in all forms of healing, that we are once again in a major crossover period in our history. We have developed extraordinary competence in technological advances and outer ways of healing, but have largely ignored the compensatory opposite, the significance and mastery of the inner life. As with all things that we tend to focus on exclusively, the equal and opposite component will eventually force a balance towards a central integration. This illustrates the obvious yin and yang of day to day dualistically experienced life. It is exciting to witness this present integration, when we have so many opportunities to implement the lessons from this incredible synthesis of ideas.

Originally, the Cnidian School of healing in Ancient Greece viewed the body very much as we view it today: as a mechanistic entity that, when it breaks down, needed fixing. Hippocrates, 460–370 BC, did not agree with this approach. He was more interested in the individual as a unified whole, and all the variables and causative factors that contributed towards a state of sickness or disease, especially the inner attitude of the patient. He viewed symptoms as the body’s attempt to heal itself, and he used remedies and potions taken from nature that assisted the body by exacerbating the symptoms in order to facilitate the body’s own restorative mechanisms.

Hippocrates was also very cognizant of the power of dreams in revealing diagnostic and therapeutic insights. “He theorized that during the day the sense organs are dominant and the soul is passive; but during sleep the emphasis shifts, and the soul then produces impressions instead of receiving them.” So we see that even way back in antiquity, there was interplay between the mechanistic traditions and the more holistic traditions, between the outer and inner methods.

A few centuries later, a famous Roman healer by the name of Galen (ca.130-ca 200 ce) saw the body in a more mechanistic light, made of parts that needed to be separated from the whole in order to assist in healing. Unlike Hippocrates, who saw symptoms as an attempt of the body to heal itself, Galen was the first to consider the body’s symptoms as the actual problem that needed specific treatment. He initiated the separation between seeing symptoms as the problem versus seeing them as a necessary defense of the body to initiate its own spontaneous healing. Galen did have some redeeming features in that he was quite respectful of the capacity of dreams to impart important information to the patient, and to the physician—to the point of carrying out surgical operations based on them (Dossey, 1999, pg. 4). But from our perspective, Galen represents a step away from the holistic approach, to a more mechanistic, physically based “scientific”orientation.

After Galen, the trend swung back towards the more vitalistic orientation and the Christian healing traditions emerged. During this time, there were no remedies as such; there was just faith and the inspiration and presence of the Christ-like healer himself. Here the emphasis was not so much on physical remedies but on the power of God or Christ, inspired by faith, to initiate the healing required. A few kernels of physical medicine remained, but these were replaced by the common belief that illness was due to punishment from God for sins or transgressions of God’s will and that any attempt to treat them with physical remedies, was a transgression of God’s will. Paul Strathern writes, “Other illnesses were thought to result from possession by devils, or were caused by witchcraft, or arose as a result of spells cast by pixies and elves. The only way to cure such afflictions was prayer, penitence or calling upon the assistance of an appropriate saint” For example, St. Anthony was the saint prayed to if afflicted with ergotism, a fungus-infected rye. If ingested, it led to tremendous burning of the intestines which led the inflicted to dance with agony. This was interpreted by onlookers as being possessed by demons. If one had rheumatic fever with spasmodic movements called chorea, you prayed to St. Vitus for relief. I remember as a medical student seeing young kids in the hospital wards in Cape Town, affected with this consequence of rheumatic heart disease, a terrible affliction that responds quite well to large doses of penicillin. If one compares the approaches to epilepsy as practiced by the Greeks, one realizes how far medicine had turned away from a more comprehensive approach and descended into superstition and ignorance, a millennium later.

Paracelsus (1493–1541) was an extraordinary, controversial figure who primarily followed a more holistic, integral approach to healing. He was the first healer we know of who possessed an understanding of both the vitalistic and the mechanistic aspects of healing, and is considered by many, including the Prince of Wales, to be the father of modern medicine. He experimented with different dosing of substances, ushering in the modern science of chemistry. He retained and developed further some of the ideas initiated by Hippocrates, including that of treating with similars—the idea that the substance which initiated a disease, in the correct dose, will assist in the cure. “Never a hot illness has been cured by something cold, nor a cold one by something hot. But it has happened that like has cured like.” While contributing quite significantly to the idea that certain diseases needed specific treatments of their own, he also understood that many diseases were the result of chemical imbalances in the body. While impressively advancing the cause of scientific medicine, he retained deep mystical leanings and was intrigued by the work by the alchemists of his day, whose mystical interests were to turn the base issues of humanity into a golden spiritual purity. Paracelsus had a deep respect for the innate healing force of Nature, and like Hippocrates, believed that this inner healer was superior to any remedies applied from the outside.

Until the 1500s, we had inner and outer healing traditions entwined with each other. For some of the time, one of the traditions would hold sway, only to be overtaken as the other gained momentum. Descartes, who lived during the first half of the seventeenth century, was the first to separate the internal process—the moods, the emotion, the mind—from the body in a process today called Cartesian dualism. “According to Descartes, the body is one sort of substance and the mind another because each can be conceived in term of totally distinct attributes. The body (matter) is characterized by spatial extension and motion, while the mind is characterized by thought.

Newton, who flourished in the late seventeenth and early eighteenth centuries, took dualism and materialism even further. He demonstrated that the universe, according to his calculations, was entirely mechanistic, following strict, precise laws. The implication was made that if the world and the universe existed independently and outside of human experience, then the body must behave in much the same way. Thus, if the body is a machine, interventions must be external and aimed at fixing what is broken. In their haste to replicate the precision in logic being demonstrated by physicists, doctors began to dissect the body into smaller and smaller parts in order to understand the whole.

The first dissection of the human body in 1543 was the beginning of our understanding of anatomy and the mystery of the complexity of the physical body, and the beginning of the dominance of modern or outer medicine. From this time forward emerged a tremendous amount of knowledge that gave rise to modern medicine as we know it today. Era 1 Medicine in the 1850s, says Dossey, is when medicine first began to become a science. We’ve had now had four hundred years of this model, with absolutely amazing achievements. We’ve developed an extraordinary wealth of external knowledge, but now have an under-developed understanding of internal or more subjective methods of healing; we are lacking in integral vision when it comes to healing.

Dossey has collected quotations from individuals who view reality from this fixed, external, mechanistic point of view:

What is the brain but a big slab of meat?
– Marvin Minsky, MIT

When I die, I shall rot and nothing of my consciousness will remain.
– Bertrand Russell

Consciousness; our thoughts are nothing other than the byproduct of neuropeptides; they have no real relevance.
– Francis Crick, the individual who discovered the structure of the DNA Double Helix

The implication of such statements is that our inner subjective experiences are irrelevant; there is nothing more going on than neurotransmitters, generated by the brain, speaking to each other. And so our inner experiences are completely disregarded as a real and crucial element of our healing, and we are completely divorced from the influences of our cultural traditions and the systems in which they are embedded. I believe this to be an entirely untenable approach to healing and one that has built into its existence its own
demise. Fortunately, there are new approaches to consciousness studies as written by Daniel Siegel and Alva Noe, who illustrate how the mind is quite distinct from the brain and how the brain is shaped by the mind, the body and the environment constantly interacting with each other in meaningful coexistence. The brain, in this case, is seen as an appendage added to the mind to increase its computing power19.

There you have the past, from the temples of Asclepius through ancient Rome, onto the Enlightenment, and down to our present day. Science today predominantly focuses on external factors, as we have seen. As we enter a healing journey, we will see how the external and the internal are entwined, equal in importance, and unable to be separated, like the two
snakes on the Caduceus staff.