Podcast: Healing Wisdom With Dr Bruce Hoffman

Functional Medicine Podcast

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.

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?

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. 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

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 Histamine: When Your Immune System Runs Rampant.

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

12 Tips for Living With Mast Cell Activation Syndrome

Living with Mast Cell Activation Syndrome (MCAS) usually results in widespread 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.

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 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.

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

How to Tell If You Have Mast Cell Activation Syndrome

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 MCAS 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:

  • 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 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.

Resources:

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

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

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

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

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

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

What is Mast Cell Activation Syndrome?

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

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

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

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

Any of these symptoms could indicate MCAS.

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

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

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

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

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

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

Detailed Symptoms of Mast Cell Activation Syndrome

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

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

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Mast Cells The Bad

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Histamine Intolerance & Mast Cell Activation

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Most Common General Symptoms:

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

MCAS Symptoms by Organ System

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dental – Deteriorating teeth.

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

Illnesses Associated with MCAS

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

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

Here’s a relatively common situation:

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

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

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

Histamine Intolerance is a Subset of MCAS

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

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

Diagnosis of Mast Cell Activation Syndrome

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

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

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

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

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

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

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

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

10 Non-Food Triggers of Mast Cell Activation Syndrome

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

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

10 High Histamine Foods that Should be Avoided

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

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

Conditions Associated with Mast Cell Activation Syndrome

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

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

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

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

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

Ask Your Doctor for Lab Work

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

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

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

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

Further tests that may be of help:

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

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

Treatments for Lowering Histamine and Reducing MCAS Symptoms

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

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

If you want lasting relief for MCAS:

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

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

Here is how I approach treatment with my MCAS patients:

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

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

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

Resources

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ancient Healing Methods: The Seven Stages to Health & Transformation

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.