Podcast: Mast Cell Activation Syndrome With Dr Bruce Hoffman

I was recently interviewed for The Dr. Hedberg Show, where we spoke about mast cell activation syndrome and how exactly the condition is diagnosed. In this podcast, we reviewed the similarities that exist among certain conditions (fatigue, brain fog, and GERD to name a few) and how they may be indicative of mast cell activation syndrome.

 

Dr. Hedberg: Well, welcome everyone to “Functional Medicine Research.” I’m Dr. Hedberg. And I’m really looking forward to today’s conversation with Dr. Bruce Hoffman. He’s a board-certified physician, and he has a Fellowship in Anti-Aging Medicine, as well as a Master’s Degree in Clinical Nutrition. He’s a certified functional medicine practitioner. And, one of the really interesting things about him is that, in addition to his clinical training, he studied with many of the leading mind-body and spiritual healers of our time. People like Deepak Chopra, Paul Lowe, Osho, Ramesh Balsekar, and one of my favorites, Jon Kabat-Zinn.

So, Dr. Hoffman, you shared the stage with Dr. Deepak Chopra and Dr. John Demartini. And he continues to spread his inspiring vision of healing and wellness with audiences and patients around the world. So, Dr. Hoffman, welcome to the show.

Dr. Hoffman: Thanks very much, Nikolas. I’m glad to be here. Thank you.

Dr. Hedberg: Great. So I’m really looking forward to this discussion on mast cell activation syndrome. It’s something I haven’t seen a lot of in my practice. I have heard a number of lectures on this and read quite a bit about it. And it seems to be an area of your expertise. So why don’t we jump right in and just talk about what mast cell activation is, and how is this condition diagnosed?

Dr. Hoffman: Sure. I first got interested in mast cell activation syndrome when I started to work with a cancer patient advocate by the name of Dr. Mark Renneker out of San Francisco. And he alerted me to the connection between cancer and mast cell activation syndrome, particularly in gynecological cancers. And then put me in touch with Dr. Lawrence Afrin, who leads one of the major sort of advocacy groups for mast cell activation syndrome as opposed to systemic mastocytosis, which I’ll explain in a bit.

And so, I’ve been for the last three to four years working with Dr. Lawrence Afrin’s group and learning to understand the implications of mast cell activation syndrome in most of the patients that we see. Which are chronic multisystem, multisymptom patients who, as you know, have been everywhere and remain frustrated with the one disease, one drug paradigm that we learned at medical school. So, what I learned over time was how to separate between two specific conditions, one called systemic mastocytosis and the other called mast cell activation syndrome.

Mast CellBut before I begin with that, I’d like to say that mast cells are part of, they’re produced in our bone marrow, and they’re part of our immune system. And they make up a very small percentage of it. And they act as defense structures against incoming invading pathogens. So, anything that comes into our environment or into our biome, mast cells are often at the first line of defense. And they were actually discovered a long time ago, 1878, I believe, by Paul Ehrlich. And he called them mast cells because they were fat and puffy.

And the word mast in Greek means breast or the German means masticate. So, this is how the name mast cell got generated. Just for your North American readers, I say mast, and most people don’t know what I’m saying. So, it is mast in North America. People often don’t know mast cells, what I’m saying.

So, these were originally discovered by Paul Ehrlich when he developed specific staining for them. And since then, they sort of lingered on in the literature. They were linked early on to cancer, but that sort of faded out of the picture until it was resuscitated by some Italian researchers who now are doing massive amounts of work on mast cell activation syndrome and cancers. And then it really sort of resurfaced in the 1990s and didn’t really gather steam until about 2007, when two, you know, researchers and clinicians put together sort of a consensus statement on what constitutes MCAS.

There are two different schools of thought and they do tend to conflict with each other in terms of the diagnostic criteria. But basically, mast cells being part of the immune system, and regulating many of the incoming so-called antigens or toxins tend to be distributed in almost all tissues, but nowhere quite as much as on mucosal surfaces: so eyes, mouth, skin, GI tract, bladder, etc. They’re also found in other tissues, you know, lungs and heart tissues, and brain, many mast cells are activated in the brain.

And so, when they get triggered, they do tend to release many, many mediators of inflammation. And it was estimated that there were over 200 mediators of inflammation that get released by these mast cells. But Dr. Afrin in a very recent post, as of last night, said that he’s now changing his opinion that he believes there are over 1,000 mediators released by mast cells. All these inflammatory mediators like histamine, like proteases, prostaglandins, leukotrienes, all these inflammatory mediators that then set up this multisystem, inflammatory response, which can confuse diagnosticians particularly if you have been trained in single organ, you know, specialties.

So that leads to the sort of difficulty with the diagnosis as people present with many different symptoms. And unless you have an understanding of mast cell activation syndrome, and a method of sort of sifting through the multiple systems they can present, you can often get very confused and misled. So, the recent, you know, people speaking about mast cell activation syndrome is an attempt to bring some coherence to this somewhat disorganized field. And hence, establishing criteria for the diagnosis, lab tests, and then treatment protocols. So now it’s coming into its own and I think you’re going to hear a lot about it in the years to come.

Dr. Hedberg: Mm-hmm, so we’re talking about illnesses that may be so-called mystery illnesses, and multifactorial presentations like gut issues, skin, brain, and things like that. Can you just let everyone know some of the overlap that you see in various conditions in your practice that would specifically indicate mast cell activation syndrome?

Dr. Hoffman: Yeah. So, mast cells, when they release the inflammatory mediators, can present locally or systemically. So, a local condition would be something like hives, urticaria, or interstitial cystitis. Or it can be systemically like people can present with cognitive symptoms. So, they’ll have fatigue and brain fog, and associated GI symptoms, like GERD. GERD is a potentially very big diagnostic category for mast cell activation syndrome or, you know, the irritable bowel syndrome. Even the autoimmune diseases of Crohn’s disease and ulcerative colitis have been linked to mast cell activation syndrome.

Asthma is another one. Asthma, you know, if you analyze all the triggers of an asthma response, and you identify them, like, for instance, mold, allergy or mold inflammation, which are two different criteria, and you remove the trigger and downregulate the mast cell activation potential, I can’t tell you how many cases of asthma have been absolutely shut down when you treat the mast cell activation. It’s very rewarding. The same goes for GERD, the same goes for irritable bowel syndrome. The same goes for anxiety and cognitive decline. When you target the triggers and downregulate the mast cell activation, it’s very rewarding to treat these patients, and they’re very grateful. Angioedema, another one, canker sores another one, there’s many, many symptoms in all the organs that can present with this syndrome.

Afrin has written a chapter in a book. The book is called “Mast Cells,” the editor is David Murray. The chapter is chapter…I think it’s chapter 6, and it’s called Presentation, Diagnosis and Management of Mast Cell Activation Syndrome. And at the back, he gives a long, long list of every organ that can be affected from ophthalmic, to lymphatic, to pulmonary, to cardiovascular, and just goes through all the systems. Even fibromyalgia, even osteoporosis, headache, all the mood disorders, dysmenorrhea, endometriosis, many of the hematological conditions, the immunological conditions. There’s a huge long list of different organ systems that can be affected that present as isolated diagnoses to specialists, but often they miss the overriding pathophysiological basis to the condition.

And our training as MDs makes us very aware of what is called systemic mastocytosis, which is when the mast cell from a clonal perspective within the bone marrow becomes amplified. There’s actually a mutation of the KIT gene. And the mast cells become very high in numbers. So, there’s increased numbers of mast cells, which is systemic mastocytosis, which is very different from mast cell activation syndrome, which is an abnormal reaction of the mast cells, not an increased number.

So, I can’t tell you how many patients come back to me after having got the diagnosis of mast cell activation syndrome by myself with the criteria I use, go to the specialties, go to the hematologist, go to the gastroenterologist, or pulmonologist, who then does a serum tryptase and even sometimes go as far as do a bone marrow biopsy, and then come back and say, “Oh, that diagnosis is incorrect, he doesn’t or she doesn’t have systemic mastocytosis.” Systemic mastocytosis is a very rare condition, I’ve never seen one in my life. But I see almost twice a day, mast cell activation syndrome. Dr. Afrin believes that probably about 30% of the population gets affected to some degree or the other.

Dr. Hedberg: And are there any theories at this point about why mast cells become so overactive in an individual’s body. Any good research out there on that?

Dr. Hoffman: Well, there’s lots of speculation. And the most common hypothesis is that we do live in a much more sort of, you know…we’re inundated, so to speak, with multiple stressors far more than our capacity to withstand them. Our immune system, it just gets triggered because of multiple stressors. And there are many triggers for mast cell activation. Poor sleep. Stress is one of the biggest triggers. Food, I mean, food is incredible in its ability to trigger the mast cells that are in the mucosal surfaces of the mouth through to the anus.

So, we believe that our ability to…..we can no longer withstand the onslaught of our ongoing multiple stressors, whether they be environmental, emotional, nutritional. We just are in this constant state of over reactivity if you’re genetically predisposed. Now, Dr. Afrin doesn’t believe it’s necessarily a genetic condition that is transmitted through the germline. But he believes there are mutations in some of the mast cell production. And Dr. Molderings, who’s published a lot of papers with Dr. Afrin, has done a lot of research on the so-called KIT mutation, not in the bone marrow, but within the mast cells themselves, and has shown that they are these sporadic and spontaneous mutations that occur. Why those occur? I can’t say. I don’t know the answer to that. Yeah.

LAB TESTS

Lab Tests

Dr. Hedberg: So, there’s a number of functional medicine practitioners listening to this, so let’s just talk a little bit about lab tests, and some of the ones that you’re using and the ones that are beneficial. Obviously, CBC might be beneficial with elevated eosinophils, basophil, or possibly those are normal, histamine testing and things like that. What are some of the top tests you’re doing in your practice to identify this?

Dr. Hoffman: So yes, we do all the normal standard CBC and electrolytes, and liver function, etc., but those don’t usually yield what you’re looking for. And one of the challenges is that the lab testing positive results fluctuate depending on whether the symptoms are being expressed or not.

So, the first thing is you want to try and catch a person in a flare. Well, that’s difficult you know. So that’s the first challenge. And many of these tests need to be repeated over and over again until you get what Dr. Afrin likes to identify as two positive lab tests, which I’ll explain in a second. The second challenge is that you have to process a lot of these labs on ice. You have to have a refrigerated centrifuge to get accurate results. And it took me two years to get a refrigerated centrifuge. And as soon as I was able to, the positive rate of my lab has skyrocketed. Many of these lab specimens are very poorly handled. And, you know, they sit around for days and you’ll get these false positives for sure, false negatives, I mean. Sorry.

And also, a lot of the mast cell activation syndrome people or patients, they don’t always cause these abnormalities in the lab tests. Positive lab work is only obtained around 20% of the time. So, it’s quite frustrating, you know. But if you want to get lab work tests, I use sort of the minor and the major criteria. There are 10 major lab tests that we do. And then depending on the budget, we do the top 5 or 10, if we can.

And the tests that I recommend are plasma histamine, has to be chilled. And you should catch a person who’s in a flare. If they’re not in a flare, it will very often be negative. And you’ve also got to stop some of the inhibitors of histamine for five days prior to the test. Otherwise, you will get suppression of the histamine response. If people are on, you know, H1 or H2 blockers, you won’t get a positive test. And many people do take them intermittently you know.

Then we look for N-methylhistamine, which is a 24-hour urine also needs to be chilled. And then probably the one test that I get the most positives out of is the prostaglandin D2 plasma test, also must be chilled. And for that test, patients need to be off of all nonsteroidal anti-inflammatories, Motrin, Advil, or aspirin, or salicylate-containing foods. They can’t have a high salicylate diet. Anything containing aspirin for up to five days.

And then the one that is also done is the prostaglandin D2, 24-hour urine, also must be chilled with the same criteria of having to be off of all these medications. And then the last one is chromogranin A, and for that test you have to be off proton pump inhibitors and H2 blockers like famotidine. So, if you do go on proton pump inhibitors and so forth, they can falsely elevate chromogranin A.

And then after that, we’ve got prostaglandins 11 beta F2 alpha, a 24-hour urine, also must be chilled. And then the one that most MDs know about, which is serum tryptase. But this is rarely elevated in mast cell activation syndrome. It’s very important that every doctor who wishes to sort of work with mast cell patients knows this to be true. Because if the tryptase comes back normal, very often, the entire sort of clinical diagnostic differential gets thrown out, “Oh, they don’t have mast cell activation syndrome.” Big mistake, big, big, big mistake.

One of the criteria, one of the two different schools of the consensus criteria, they say that you have to have the serum tryptase elevated over 20% of baseline, or have a baseline greater than 15 nanograms per mil. But Dr. Afrin, who’s somewhat opposed to the consensus statement put out by Aiken and others, he highly disputes this finding and he doesn’t agree entirely that this is one of the main criteria to make the diagnosis. And I tend to agree with him.

Leukotriene E4, a 24-hour urine. Plasma heparin because heparin gets secreted by mast cells. And then a blood clotting profile, thrombin, PTT and INR is often done. And those are the top 10 and then after that, there’s many others; anti-IgE receptor antibodies, pheochromocytoma workup. We often do factor VIII deficiency workup, we do urinary metanephrines often. We almost always get an immunoglobulin profile IgG, IgA, IgE, and IgM. You might see IgE elevated or not. Often you won’t have an elevated IgE. So many people think “Oh, if a high IgE, then it can’t be this.” But that’s not true you can get a non-IgE-mediated mast cell activation. People then do bone marrow biopsies. People can do gastrin, serum gastrin levels. And then as you mentioned, the CBC with eosinophils and basophils can sometimes are elevated. Antiphospholipid antibodies are also often done.

And one test I like to do in the functional world is the Dunwoody Lab test for zonulin, histamine, and the DAO enzyme activity because that’s the diamine oxidase enzyme that sits on the villi that can be genetically compromised. Or because the villi are compromised, you cannot produce enough diamine oxidase. And that’s when you start to put people on low histamine diets and use the HistDAO enzyme to help break down any remaining histamine in food.

But I can tell you the one test that I tend to rely on more than any other right now, apart from the serum and urine test, is to get restaining of any gastric biopsies people have done. This has been overwhelmingly sort of helpful to some of my chronic GI tract patients in particular. So they would have gone, you know, to a GI specialist, they would have had the normal Giemsa tissue stain, and they comment on lymphocytosis. But they don’t actually comment on mast cell activation. And unless they get what’s called the CD117 stain, you won’t isolate the mast cells.

And almost 90% of people that I’ve clinically suspected of having mast cell activation syndrome turn up once they have their biopsies restained of having over 20 cells per high-power field being positive for mast cells. Which is the cut-off criteria that’s been agreed upon by numerous researchers, highly contested, by the way, by some pathologists and gastroenterologists. But we use a cut-off point of greater than 20 mast cells per high-power field to make a diagnosis of mast cell activation syndrome, particularly in the GI tract. The mast cells are very rich in the GI tract, particularly in the duodenum, not so much in the gastric tissue, but particularly in the duodenum.

So, if they ever had a biopsy in the duodenum, phone up the pathologist or write a letter and say, “Please will you restain for the CD117 stain.” And as I said, probably 9 out of 10 come back positive, very helpful. And then the patient sees that and the penny drops then they start reading up all the literature. And then they get on board for the treatment protocols which are, you know, quite…it can be onerous, and they can be extensive. But they’re very clearly delineated with multiple challenges along the way. Because people react to the medications and/or the supplements that you give them because that’s the nature of the condition.

EXCIPIENTS

pills

So, they’ll come back and say, “I can’t take the H1 blocker because I got worse.” Well, most of the time, it’s because it’s the excipient, the additive, the filler, or dye inside the medication that triggered the mast cell syndrome and it’s not the actual problem. You know, they’re not reactive to the supplement, they’re reactive to the excipient within the supplement or the drug. So those are some thoughts.

TREATMENTS

Doctors in meeting

Dr. Hedberg: Right. So once you’ve identified that someone has this syndrome, let’s talk about some of the natural treatments. You just mentioned that some of them are very difficult to follow. And some of these patients are…there’s probably a fair amount of trial and error with some of these patients figuring out what works for them. So, can you just talk a little bit about some of the treatments you’re using?

Dr. Hoffman: Sure. One of the hallmarks of this condition and one of the setups in my interaction with patients is a description of the complexity of the diagnosis and the challenges. And if you don’t have that conversation, you’ll often get a frustrated patient because they’ll come back with flare-ups and they understand it. So, I encourage that all your practitioners who wish to dive into this field really wont understand how patients can flare and how they

may have multiple triggers at any given time. And that the treatment may need to change, and that they mustn’t become frustrated, they must just stay for the long course. And they are sort of part of the team of trying to work out these multiple moving targets.

So the education is number one. I have two handouts, where I’ve described mast cell activation syndrome and mast cell activation syndrome treatment. I make sure they’ve read that. If they’re more interested, I give them Dr. Afrin’s book, “Never Bet Against Occam.” There are many patients who love to read because it’s filled with case histories. So once they get sort of an insight into other cases of complex presentation, they get encouraged to push on. So, education is first.

Second is to try and identify the triggers that trigger their mast cell activation. And this is one of the greatest challenges because there are many triggers from, you know, hot, too much heat, too much cold, stress, poor sleep, as mentioned. And then we get into the more obvious triggers, chemicals, heavy metals, dietary antigens, and then infections or inflammatory triggers like mold.

So, part of the process of working up mast cell patient is not just diagnosing the syndrome, but also trying to work up the triggers. So, in most patients, I do multiple food sensitivity profiles. I don’t just do IgG. I do IgG, IgG4, I do the so-called LEAP test. I do…am I allowed to mentioned lab names on your podcast?

Dr. Hedberg: Yes, definitely.

Dr. Hoffman: Okay. I do the lymphocyte sensitivity tests, the LEAP test. I do, as I said, IgE testing, IgG, IgG4. And I do Cyrex Lab food, I do the 10x, I think it is, with all three panels looking for dietary antigens. So, the Cyrex panel is different from the Meridian Valley food panel. Meridian Valley says it’s an IgG, IgE panel, but I disputed that once, and I’m not too sure there’s much IgE in the Meridian Valley panel. I think it’s more IgG. Whereas the Cyrex panel is more IgG and IgA. And you’ll often get contradictory findings. They’re very frustrating. That’s part of why allergists like to just throw them out, they say, “Don’t bring me this nonsense.”

But once you’ve been doing functional medicine for a long time and you have an understanding of the different complexities of dietary triggers, you can look at these profiles and you can sort of pull out the relevant data. And I encourage those of you who may be new practitioners is not to take each test literally. So, if they have a high say a banana on the one test and it’s not on the other, you want to look at the general profile of the dietary antigen testing. You don’t want to be too specific because if you get too specific, most people will have nothing left to eat. So, I’d look at the dietary antigens and most of the time, but not all the time, controversially or not, I tend to put people on the Paleo, autoimmune, low histamine diet for the first month or two. And I can’t tell you how many people immediately settle down just on that one intervention.

And I take out the high histaminic foods, and that is a very important part of it. And one of the great crazes right now is to use all these fermented foods to heal gut permeability, but it’s a disaster for the mast cell person. So, I’m always pulling people off sauerkraut, and kombuchas, and bone broth, it’s a huge trigger. So, all the fermented foods, and then all the leftover foods. As foods break down, then the proteins, the histamine gets broken down by bacteria that releases histamine. So, leftovers are no, no. We also ask people to, once they’ve cooked a meal, to put in the freezer and then to take it out and unfreeze it, but not to leave it sitting in the fridge for days.

And then things like tuna fish, huge triggers, the nightshades (tomato, potato, eggplant, peppers), huge triggers in many people. And even amongst, you know, some of the vegetable kingdom, you know, peas and beans can be triggers of mast cell activation. And so, you have to be careful when you look at the testing, you’re going to sort of see… when I look at particularly the Meridian Valley test, you can often see a mast cell patient, they’ll show up, all the legumes will be positive, all the histaminic fruits will be positive. Candida will often be positive.

And there’s like a trend you can see it and then immediately, you know this is a mast cell activation profile for food antigens. So, we remove the foods, we always treat gut dysbiosis as you know. I use two different labs for gut analysis. I use the Genova GI Effects, and I use the Diagnostic Laboratory Solution’s GI-MAPs. They contradict each other all the time, you know, one will have a zonulin of 700, the other one has zonulin as normal.

But then you just got to use your clinical acumen and your experience and correlate the labs against the symptom profile of the patient and do the best thing. I do tend to use Dunwoody Labs for the zonulin, the DAO, and histamine, as I mentioned. And then the second page of that test is all the LPS, the lipopolysaccharides, to see if there’s been any endotoxemia. And if there’s been any bacterial endotoxemia, you start entering into a whole new world of immune upregulation, which, you know, you have to down regulate in your treatment protocols and heal the leaky gut, etc. which I’m sure your listeners are very well aware of.

PHARMACEUTICALS

Stethescope sitting on open book

So A. is education, B. is testing, C. is removing the histaminic foods and downregulating inflammation in general. And then we get to specific treatments. And I differentiate between pharmaceuticals and botanicals. I tend to preferentially go to the pharmaceuticals to start with because they work quickly, if they’re going to work. And I tend to secondly, add botanicals. But I tend to be an MD, you know, it’s just my preference. I’m sure many naturopaths would go the other way. And many patients refuse to do pharmaceuticals and then I just have to use botanicals.

Pharmaceutical perspective, they must be compounded, you can’t get over-the-counter. Although paradoxically, some people do better on the over-the-counter than they do on the compounded. This is one of the challenges is what you think is going to work doesn’t work. This is why try, try, and try again, you know.

So, first thing, H1 blockers. Histamine 1 blockers, and I tend to use levocetirizine in a dose of 5 milligrams going up to 7.5, even 10 milligrams. And I think the trick to using H1 blockers is you have to dose it round the clock. You know on the box it will say “24-hour relief” that’s not true. You need to dose it at least 12 hourly and sometimes 8 hourly to create full round the clock mast cell blockade. And you’ve got your H1 blockers, you’ve got your first-generation and your second-generation. The first-generation H1 blockers like Benadryl, or ketotifen, cross the blood-brain barrier and have a sedating effect so those are often given at night.

I love to use ketotifen, I use lots of it on a dose ranging from 0.25mg, which is a homeopathic dose almost, right up 2 to 3 milligrams at night. And if there’s any issues with insomnia, it works like a dream. It’s absolutely spectacular for sedation. The problem is sometimes they over sedate when you have to lower the dose. But it also downregulates mast cell activity at night. So first-generation H1 blockers, I prefer ketotifen over Benadryl. Second-generation H1 blockers, I use levocetirizine as my preferred go-to H1 blocker.

And then I use H2 blockers, and I use famotidine in a dose of 20 milligrams twice a day, sometimes going up to three times a day. And this tends to downregulate all the mast cell activation activity in the GI tract.

One of the little tricks of the trade I’ve picked up over time is if you do the Genova GI Effects, you’ll often see that eosinophil protein X marker a little high, that’s almost a slam dunk for mast cell activation…not always because there’s other things that trigger that. But if you see that with a constellation of other positives, you follow that marker closely because when that starts to downregulate, you know, you’ve got your mast cell activity under control. So those are my first two go-to medications H1 and H2 blockers.

Probably my next is cromolyn. Cromolyn is a mast cell stabilizer particularly for people who are very food sensitive. You take it before meals. I give it along with the HistDAO enzyme. And that dose you can take it from 100 to 300 milligrams, and that can also be a major game-changer in many people’s lives. You have to play with the dose, you have to play with the different companies that make it. It’s a bit of a tricky thing, but it can really have a huge effect on downregulation of mast cell activation.

And then the fourth drug that I use, and many patients have come back to me with this fourth drug, Singulair, montelukast. This downregulates leukotrienes, which are one of the thousand mediators of inflammation. One of the things that we’ve noticed in mast cell syndrome is that when you think a patient has an upregulated leukotriene pathway, which is typical for asthma, you give the montelukast or the Singulair and the asthma is managed.

Well, it so happens that one can’t predict which class of drugs is going to work on which mediator. So, if you give a mast cell stabilizer for food sensitivities, guess what? The asthma may go away. Or if you give Singulair for asthma symptoms, the hives go away. So, thereis crosstalk amongst many of the mediators. And it’s a great mystery as to why that occurs, nobody’s worked it out yet. Dr. Afrin said he doesn’t know. He doesn’t know why this happens and he’s going to keep researching till he works it out. So those are the four drugs I use, probably the top four drugs I use over and over again.

SUPPLEMENTS

supplements

Nutraceuticals, of course, Quercetin, tops the list, no question about it. There’s a product called Natural D-Hist made by Ortho Molecular, that’s my go-to supplement over and over again. Two, three times a day seems to be the magic dose. And then using HistDAO one to two before each meal that seems to be the number one nutraceutical.

Number two would be vitamin C, either orally or intravenously, sometimes can have a huge benefit as well. Green tea has an effect. Turmeric or curcumin can have an effect but some people react to it. If you see on the food sensitivity profile, if you see that it’s positive in at least one or two tests, you can use it, but you want to be cautious because it can sometimes activate mast cell activation. You got to be careful with turmeric. Resveratrol is another one. And chamomile tea has some calming effects. So those are my sort of…they’re called the A team of my nutraceutical approach.

And the B team is sort of…there are many others like luteolin, Ginkgo biloba, Pycnogenol. Pycnogenol is a great one too I use quite a lot of Pycnogenol. Feverfew works. There are many things that can work. So, I pick and choose and go through them and change them. I ask everybody to first identify the triggers, if they can, and then to start rotating the pharmaceuticals and/or nutraceuticals and see which has the biggest blockade effect. And people soon work it out, you know. You’ve got to get a good compounding pharmacist on your side. And you got to make sure that they don’t fill the compounded pharmaceuticals with lots of fillers and dyes because some people react to that.

And then one of the other challenges…I just had a very seriously ill patient present to a hospital with anaphylaxis and she was on polypharmacy. She was on 10 different drugs. And many of the drugs she was on were triggers for her mast cell activation. And those were never identified as triggers by her medical team. And so, we asked the pharmacist to go through each drug and look for the additives. Many of them had iodine in them, many of them, there was soy extract base, and those had to be changed accordingly. And she settled down. So those are some of the challenges I have.

Dr. Hedberg: And one of the drugs that wasn’t mentioned was LDN, low-dose naltrexone, I know some practitioners are using that for this. Have you tried that or used it?

Dr. Hoffman: I do use low-dose naltrexone. It’s part of the many other…there’s many other alpha-lipoic, and so forth. And LDN is definitely part of it. And LDN has an effect particularly on autoimmune responses and downregulation of an inflammatory response. It’s not my first drug though, I don’t go to LDN as my first line. I use it if there’s autoimmunity and lots of gut permeability then I bring in LDN. And LDN is challenging because people give it at night but it can be very activating. Just yesterday, I saw a patient who since she started LDN hasn’t slept a wink. We changed it to morning.

Dr. Hedberg: Right. So how do you deal with the psychoneuroimmunology aspects of this condition? You know, some people, they develop a deep identification with their illness, and then they develop a lot of beliefs about things that they’re sensitive to. And we’re not saying that it’s all in their head, but we do know from the PNI research that what we believe, and what we emphasize, and think about, and focus on can affect the immune system and our biochemistry. So, are you using any kind of cognitive behavioral therapy or things like that, that could help some of these patients who are so focused on their condition and their hypersensitivities?

Dr. Hoffman: Yeah, because this opens up a huge area of the work that I’ve been forced to look at over time and for which I use quite a complex algorithm to sort of diagnose and treat. I’ve studied Ayurveda for years and I use the Ayurvedic model of layers and levels of healing. And when a person presents with specific belief systems around their condition, I have to sort of look through the layers and levels of what may be playing a role in that belief system.

Just very briefly, I tend to look at these diagnostic criteria. I look at the family system to see what family system they were born into and what beliefs the family system carried. Because I can’t tell you how many cases get resolved when we do what’s called family constellation therapy and look at the entanglements of the forefathers and ancestors, and how those epigenetically got transferred down to the offspring. Very profound piece of work, I cannot emphasize it enough. And I encourage all functional medicine practitioners to get a very sound footing on the epigenetic transfer of family system trauma and the entanglements that can be inherited, completely silently, unknown consciously to the patient, only uncovered through work in family constellation therapy whereby certain methodology is employed to determine what these factors may be. So that’s number one.

Number two, I look at early developmental trauma patterns, and ego strength, and defense systems of a patient. And I employ a number of ways to identify that. The number one system that I look at is looking at defense structures of the patient and the ego strength. And you can tell after, you know, half an hour, is this person…do they have good ego strength? Are they resilient or they do have a fragile ego structure? And I send people for quite a lot of psychometric testing to establish some of these criteria.

I have a psychologist I work with who is able to help me with some of the psychometrics. And we even do, you know, some of the simple psychometrics testing, and even the Burns Inventory, the ACE Questionnaire. When we do qEEGs, we do the in-depth psychological assessment that’s provided by the CNS Vital Signs software to look at which of their psychological profiles are most dominant. Is it anxiety, OCD, is it depression, etc.?

So we look at that level of their development, the ego strength and their defenses. And then we look at early developmental trauma. And as you know from literature, people who have early developmental trauma have very different brain structures. They have, you know, very often this hugely enlarged anterior cingulate gyrus. They have in their beta, their fast brainwaves, there’s two to three standard deviations above normal. Their capacity to inhibit the sort of reptilian, limbic brain is diminished. And those are challenging patients, very challenging, and you have to address that level of healing.

This is not a biological intervention. There’s not much you can do biologically unless you identify what the core ego strength resilience of the patient is. How much projection of will the patient has? Many patients will sit in front of you, project the will to heal on you. And that’s a slippery slope. If they are not invested in sort of figuring it out on their own with you, you have a problem on your hands, you know. And patients will often project their early developmental trauma of parents on to you, whether it’s positive or negative. Best to have a positive projection in the beginning. But if you are the evil father that you get projected onto you, you’re in trouble.

So it behooves all of us as functional medicine practitioners to kind of try and identify, who is this person sitting in front of me, what did they inherit, how was the early developmental life? And then what defenses are they employing to keep away feelings they don’t want to feel? And I use a psychological technique called ISTDP. And I refer that out to somebody who’s specialized in it. That person I use is also very well versed in CBT. But CBT, without the underpinnings of the complexity of the presentation, can sometimes not stick. It can be very helpful to some, but for those who are fragile with projection of will, CBT will not hold. You can’t use CBT, it washes off them, you know, they won’t be able to hold that.

The next thing I do, I do NeuroQuant MRIs on everybody as well as a qEEG. And I look at the brain patterns and I can’t tell you how helpful that is. If you’ve got this high beta brainwave, and you’ve got maybe high theta brainwaves with not enough alpha, you’ve got work to do. And then you correlate that with the NeuroQuant MRI, and we look particularly for the amygdala upregulation. Many of these people with anxiety, OCD, and belief systems around the illness, who are multiple chemically sensitive and environmentally sensitive and are triggered by everything, will have a very…..the amygdala will be 2 standard deviations above normal, being like in the 97th percentile. The thalamus will be in the 97th percentile.

Hand holding image of brain

And the thalamus is rich in mast cells. So, when the thalamus is high, the amygdala is high, you want to ask about mast cell activation, and you want to ask about early developmental trauma. Because the amygdala gets increased in size when there’s repeated stresses on the fear-based part of the limbic brain. And if I see that, I often start inquiring about other techniques to downregulate the amygdala. And that we use DNRS, as you’re probably aware of the Dynamic Neural Retraining System.

We do refer people to that, we do neurofeedback, we do biofeedback, we do vagal tone stimulation. And we start to bring in the Porges polyvagal theory of, you know, sympathetic, parasympathetic dorsal vagal shutdown. And we try to work out where in this constellation of symptoms is this patient presenting? Are they in dorsal vagal shutdown with a rigid defense and sort of no will to get better? Are they getting secondary gain? That’s a very different patient from the one who’s, you know, loved by the parents, no developmental trauma, is loved and seen by a mother, develop appropriate right prefrontal cortex to self-regulate, has financial resources, is loved by the husband, the kids are doing well, they have a home to go to. This is how it works.

And we have to work out who are we sitting in front of when it comes to addressing some of these complex beliefs about, you know, is this a biological overreactive reactive mast cell syndrome, or is this a psychologically overreactive amygdala? Or is this person highly defended? Do they have the ego structure to take on what I’m about to tell them? It’s complex, as you know. I think that…

Dr. Hedberg: Right. And it’s a difficult situation for everyone because, you know, we don’t really get a lot of training, if at all, in all these things you just mentioned. So, we have to learn these things on our own, learn how to incorporate them. And then at the same time, present these to the patient in a way that isn’t telling them that you know, “This is just all in your head” or helping them understand that some of this could be due to your childhood and the way that your parents treated you, and all these kinds of things that happen. And I have done a few podcasts with some experts on adverse childhood experiences and things like that.

So, it’s refreshing to hear you talk about all these things, and it just creates a very complex picture on how to put it all together. And you know, like you said, they come to see you and they put all the burden on you for the healing. And then, you know, you come back with recommendations that, “Well, we need to work on your childhood trauma or your relationships,” and things like that. So, this is a very difficult, you know, condition to take on as a practitioner. I mean its massive amount of mental and emotional output that you have to take on.

Dr. Hoffman: Yes, one of the commonest words I see in the referrals back from specialists is this so-called, awful term, somatization disorder. And it’s just not true 90% of one of the most stressful diagnoses for one of these patients to get is the so-called somatization disorder but it’s often handed out. You know, and, “Yeah, it’s all in your head,” this is so awful. There may be a component that is filtered through the neurological pathways and then synapses. And they may tend to have an upregulated sensory system that processes things somatically. But it doesn’t mean to say that we have to discard this as all psychological, which is very often the insurance companies like to do things like that and some of the specialties too.

I recently referred a patient to a psychiatrist for insurance purposes and I sent five articles plus a written response. “Please do not diagnose this patient as being psychiatric, he has the following conditions.” And then we listed the mast cell activation, the mold sensitivities, electromagnetic sensitivities, etc. And I sent him five papers in support of the validity of this diagnosis. I haven’t heard back yet; I’m waiting to see what the response is. We often have to advocate for our patients in this way because they do present with neuropsychiatric manifestations, but it’s as a consequence, it’s not the cause. Although there may be some issues which provoked, you know, an expression of a mast cell disorder, but you can’t separate you know, mind-body, you’ve got to work with the whole continuum.

Dr. Hedberg: Exactly. Well, this has been really excellent. How would you like people to find you online, what’s your website and contact information?

Dr. Hoffman: The website is hoffmancentre.com. And the phone number here is 403-206-2333. That’s the phone number for my clinic. I do have a number of blogs on my website, and I post to Facebook and Instagram. But my website has a lot of the histaminic articles as blogs, so they can access them on there.

Dr. Hedberg: Excellent. So, to all the listeners, I have created a transcript of this conversation, which will be on drhedberg.com. So just search for Dr. Hoffman and you’ll be able to get the entire transcript there in case you missed anything. Well, thanks for tuning in, everyone. Talk to you next time. This is Dr. Hedberg, and take care.

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.