Heal Your Chronic Illness and Take Your Life Back

Heal Your Chronic Illness and Take Your Life Back

Mary Vallarta:

Hey everybody. Welcome back to the virtual summit. I’m your host, Mary Vallarta.  As you know, we are here to talk about healing your chronic illness and taking back your life.  Basically how to balance your mind, body, and spirit to restore your health and vitality.

Mary Vallarta:

Today I have Dr. Bruce Hoffman and I am super excited to chat with him. Before I get into the questions, let me tell you a bit about who he is. Dr. Hoffman is board certified in anti-aging medicine, has a master’s degree in clinical nutrition, and is a certified Functional Medicine practitioner. In addition to his clinical training, Dr. Hoffman has studied with many of the leading mind, body, and spiritual healers of our times, including Deepak Chopra, Osho, Ramesh Balsekar, and John Kabat-Zinn. He has shared the stage with 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. Once ensconced in the practice of family medicine, he quickly realized that his interests in medicine were broader than just drugs and surgery. The allopathic medical practice was limited to treating symptoms and illnesses but fell short of restoring the patient’s health entirely. So Dr. Hoffman embarked on a journey to understand what constitutes the human experience and what the triggers and mediators are that perpetuate human suffering.  He wanted to do this not only to help patients be free of disease but to realize their maximum potential.  Dr. Hoffman welcome. That is quite a resume.

Dr. Bruce Hoffman:

Nice to be here.  I’m looking forward to this conversation and seeing what we can come up with.

Mary Vallarta:

Me too. I’ve been looking forward to this conversation. I’m super energized to be speaking with you. Let’s get into it.  Dr. Hoffman, I love how you’ve combined the strengths of Western medicine with the mindful and spirit-centered approach of Eastern medicine. As your bio states, you didn’t actually start out this way. You were practicing Family Medicine. What pushed you to go into the path of functional and integrative medicine that takes mind, body, and spirit into account?

Dr. Bruce Hoffman:

Well, the part leading to where I am now is quite interesting in that when I was a young boy in my teenage years, I went to boarding school and I had a teacher there. My teacher was very interested in not only Western psychology, particularly the work of Carl Jung but also very interested in Eastern mythology and religions, particularly the work of a subset of the Vedantic Hindu medicine called Advaita. Advaita takes the point of view that there is no “there out there”. Everything springs from one source. So there is just one mind, one consciousness, and there is no separation. It’s a very specific way of looking at reality. Many of the quantum physicists who came onto the scene at the turn of the century had a very similar point of view. When they dissolved matter into light, they said, all light is continuous. There is no separation

Dr. Bruce Hoffman:

So this ancient, theological concept, was being married with Western physics. My teacher, Roger, I just hung out with him and we explored all these things and so I became very interested. When I was about 15 years of age, I had what they call a Satori experience, where I directly experienced this One Mind, One Reality. It descends upon you, and you just know that to be true. Before too long, you descend back into your dualistic past, present and future, gain and loss reality and the awareness is lost.  I still remember that. Then I had a second experience like that in my thirties. So having had two experiences of One Mind, One Reality. It sort of cemented, in my body based understanding, that was behind all systems of appearance.

Dr. Bruce Hoffman:

Nonetheless, I continued my high school education. My mother applied for me to go to med school. I had no idea. I find myself in med school. I wanted to be a poet, go hang out with all the beat poets in San Francisco, but my mother thought I should have a more formal education. So she applied for med school and I found myself in med school. Actually, after six years of medical training, I became a Family Physician and fell in love with it. I actually loved what I did. I ended up in Saskatchewan, Canada, practicing Family Medicine. When I got to Canada practicing Family Medicine, it was very apparent that that system of medicine is very limited in terms of what you can offer. We call it the N2 / D2 system of medicine. Name of disease, name of drug. That’s about it.

Dr. Bruce Hoffman:

But what happened was then I also came across a video by Dr. Larry Dossey, one of the great thinkers of the last 50 years in the field of integrative medicine. I watched Larry Dossey sort of draw out this long explanation as to how he combined East and West into his medical practice and his thought process. That triggered another huge explosion of interest and reignited my childhood experiences with my high school teacher and Advaita and psychology. All of a sudden this whole roadmap just opened up and I thought, this is a very interesting possibility. So I then just started learning as much as I could about the human experience. I became a student of as much as I could possibly absorb across all spectrums of human reality from toxicology to illumination. I started to develop a roadmap and with different teachers and different experiences and different ways of seeing and being exposed to different systems of information.  I did Ayurvedic training and they talk about different bodies, different systems of the body.  I spent time with a very well-known doctor from Germany who lives in Seattle by the name of Dr. Dietrich Klinghardt.  I spent years studying with Deepak Chopra and David Simon, et cetera, et cetera. And I just started to develop a roadmap for looking at the human condition from traditional medicine, then expanding it a bit to Functional Medicine and then moving to the brain and then to the emotions, then to the mental field, then to the soul and then to the spirit, which is beyond all confines to space/time. So I developed this roadmap of experiences at each level, diagnosis at each level, potential treatments at each level, because many people will want to go to an acupuncturist, which is at level three in this energy model, but they really should be seeing an oncologist or they’ll go to an oncologist where they really should be doing trauma work.

Dr. Bruce Hoffman:

I tried to sort out all these different possibilities across all layers and levels and help teach/write a new curriculum, really for doctors or healers. Not really doctors. MDs should keep doing what they do. They do it well. Every patient that sits in front of me says well, why doesn’t my doctor know this.  Well,  because it wasn’t his interest and he didn’t train to know this. So give it up. Don’t even ask the question, don’t waste your time. We need a new curriculum for a new expansive model. That’s been my life calling, my life passion, and to which I’m still a student. I mean, I study more now than I did when I was young. I just keep expanding the knowledge base.

Mary Vallarta:

I think that’s what makes your work so fascinating to me. You have sort of like a 360-degree view since you’ve been on the MD side, the family medicine side, and then you’re now continuing to learn more about the Eastern methodologies. So you’re kind of taking everything and putting it all together to make these roadmaps that you’re talking about.

Dr. Bruce Hoffman:

It’s not just Eastern, Mary,  it’s all systems of knowledge, you know, from phenomenology to theology, to psychology East to West, to up and down, it’s all layers, all levels. It’s not only Eastern insights. Some of it is Eastern, but it’s not only Eastern insights.

Mary Vallarta:

I see. Interesting. So integrating all that together is very fascinating and it gives you more of a well-rounded perspective. As you mentioned, MDs aren’t trained to have that type of approach. That’s why there’s a time and place where that’s going to be appropriate. There’s also another time and place where something else might be more appropriate for a patient. So I think that’s important to note. There is a lot of research coming to light on the important role that food plays on one’s ability to prevent disease and sometimes also reverse or heal. As you pointed out, there are such things called trauma. You’ll recommend people see some trauma specialists or stress. What are your thoughts on having more emphasis or focus on things like mindset, changing internal narratives, and healing emotional trauma when it comes to healing?

Dr. Bruce Hoffman:

One of the great challenges of working with patients is when they present with complex multi-system illness, which is the only kind of patient I see these days, they are still very in that diagnostic mindset of “what do I have”? Usually singular, what one thing do I have? Is it mold or Lyme or Mast Cell or whatever? Then they start to think diagnostically and therapeutically in an allopathic way. When you start to have a broad spectrum of understanding the human condition, and you start to understand all the antecedents, mediators, and triggers that eventually ended up in biology and pathology/disease, you can’t stop yourself from taking a far more comprehensive history. So the healer of the future can commit both acts of commission, as well as acts of omission. It’s not what he knows, but it’s also what he doesn’t know.

Dr. Bruce Hoffman:

So if you’re sitting in front of a patient and they are presenting  with symptomatology at this moment in space-time, it behooves you to ask every single possible trigger that may have led up to that presentation. It’s our Western understanding and consensual reality that diseases kind of fall out of the sky. It’s like, Oh, I’ve got rheumatoid arthritis. Then you can go to the doctor and get an immune modulator, or you can go to a naturopath and get an herb, but it’s still that singular mindset. When we look at patients from a more complex model, we have to start looking at not only diagnosis from a Western perspective, because you need to know that, that it’s an inflammatory and immune system-based disease based on autoimmunity, which has its links in leaky gut, et cetera, et cetera, and the genetic predisposition.

Dr. Bruce Hoffman:

You’ve got to know that, but you’ve also got to understand how people arrive at a point in time with a diagnosis. You know, people, they inherit epigenetically the traumas of their forefathers. So if you don’t ask a history of their forefathers and the ancestors you are missing out on a piece. Then they get born into a family system, and whether or not they were adequately seen by the mothers in the first 10 years and by their fathers in the second 10 years and peers, and by the loved ones in the third decade, they don’t adequately myelinate the three different brains that grow up, the reptilian, limbic and adult brains. So if they are not self-regulated by external parental figures, they don’t learn to self-regulate themselves and they have a fragile personality structure very often.

Mary Vallarta:

So how do you help them uncover all of this information?

Dr. Bruce Hoffman:

You’ve got to take a very thorough history. I take a two and a half to three-hour history and ask all of these questions.

Dr. Bruce Hoffman:

Then those experiences, your epigenetic transfer, ancestral trauma, early childhood experiences that all gets then translated into your perception of reality, your internal dialogue, your thoughts, your value systems, your beliefs, and your defenses. So many people stay highly defended from feelings that arose in the first 30 years of life because they are too painful. So they’re defended and they are traumatized. That then translates into electrical messages in the brain, which you can read on a qEEG. I have a brain treatment center, which reads qEEGs. You can see hallmarks of early trauma on the brain. You’ll see the one brainwave, the [1] beta brainwave highly red, highly amplified. That then gets turned into chemical signals. That then starts to interact with your phospholipid cell membranes, which you can measure, which then turn on receptors, which then turn on genes, which then turn on proteins, which then turn on all the biochemistry that runs your life.

Dr. Bruce Hoffman:

So you have this whole cascade of possible antecedents that can set you up for what’s happening at this moment with so-called symptomatology or disease expression, but it’s not just rheumatoid arthritis. It’s way back in the ancestry, trickling all the way down to physiology. And then you have the environment coming in. That plays havoc with your, your detox pathways and sitting on DNA. Sitting as adducts on your DNA and mitochondria affecting their expression of lipids and proteins. So if you don’t ask all these questions, you’ve got a limited roadmap and you got a couple of tools in your toolbox. You’ve got to have a very broad toolbox, and that’s why education becomes important. We have to educate healthcare providers of the future to broaden their toolbox. Not only to broaden their toolbox but also to broaden their self-understanding as well.

Dr. Bruce Hoffman:

If a healer approaches a patient with a hero type approach, I’m all-knowing, and you’re all sick. They also perpetuate a very lopsided point of view. The patient’s well side doesn’t get activated. They don’t activate the healthy part of who they are. They identify with the disease, the doctor as the hero is going to fix them. That’s a very lopsided relationship. Often patients sort of, in order to survive that lopsidedness, they just don’t activate their intent to do what is required for them to activate the healer within. The healing archetype within. Without activating that there’s no outcome.

Mary Vallarta:

Right. So would you say your approach is also about giving power back to the patient? Like letting them realize that they have a big role to play in their healing?

Dr. Bruce Hoffman:

We try to. Some people are highly defended.  People have value systems, a hierarchy of values. People will say that their health is a high value. They come to you to treat their health or help them treat their health. When you start to take a history, you’ll find out, particularly with men, by the way, this is like a big male thing. Their highest value is their career, making money, health is secondary. They often delegate their health to the loved ones, their spouses, or somebody else. They don’t really want to rob Peter, their career-making money, to pay Paul, to invest in their health. So they don’t raise health up as a value. Unless patients are prepared to raise health up as a value and become a participant in their own healing experience, they remain passive and they have what we call “projection of will”.

Dr. Bruce Hoffman:

They project their will to heal onto you. If you rise up in the healing archetype “I’m all-knowing, I’m going to fix you”, you start working harder than the patient. It’s a very lopsided relationship, almost doomed to fail. So you’ve got to try and enter into their system and sort of feel where they are in their own evolution.  Is health a high-value? How healthy is their ego strength? Is it fragile? How much projection of will do they have? Do they have outer resources to assist them or are they without resources? Do they have personality disorders? Do they have what it takes to take on such an extensive journey? And, of course, finances.  Most of this isn’t funded by healthcare systems and nor should it be because it would bankrupt most of them.

Mary Vallarta:

Right. Also, one of the most important questions for them to know the answer to is why do they want to heal? Why do they want to get better?

Dr. Bruce Hoffman:

On the first page of my 70-page questionnaire is “Why are you here, How can we help you, What is it you want to achieve?” and how committed are you to making the changes necessary? It’s interesting when it comes back 50% or 75% committed. Immediately I say we have to have this conversation first and find out what that’s about. Because if people haven’t been seen by their parents, if they haven’t been supported and challenged in a healthy, supportive, challenging way, which is how love evolves and how you develop a concept of self. You only develop a good concept of self, good ego strength if you are both supported and challenged by your parents, not just supported. If they don’t have a healthy sense of self, they can’t take on what is being required of them to sort of move through this experience. They just don’t have the resources to do so.

Mary Vallarta:

Right. That’s very true.

Dr. Bruce Hoffman:

You have to find out where they are with that, you know, and where is health in their value system. You really have to ask that question before you launch into “tell me about your disease”. You have to find out who this person is sitting in front of you and where they are at in their hierarchy of values as to doing what it takes to get better. You know, there are many possibilities for healing. The first possibility is just treating disease. Get this symptom out of me. I want to do it quickly without money and without me being involved, just give me a pill. Mahatma Gandhi said the tragedy of modern medicine is that it works. There’s that possibility. Then the other possibility is they see symptoms as teleological. Those symptoms are actually asking them to enter into their own life, to try and find out why they are this way in space-time. Then they see mind, body connections.  That the way that they construct reality may influence the systems they put in place to support them and the way they perceive things and what they eat, it all plays a role. So they become more conscious of their own advocacy. That’s the second possibility. The third possibility for healing are those people who do not only want to be free of disease, which is sometimes not possible, you’ve always got some symptomatology and, but they want to live at the highest maximum potential. To do that, they have to go through a lot of personal development and personal growth to know their value systems, to know how inspired they are. To find out what wakes them up every morning. Are they called from above by some spiritual purpose or do they just get out of bed and just sort of see what happens?

Mary Vallarta:

Right.  So that brings us back to the why.  Let’s talk more about maximum potential, because I know that’s a big part of your work. Can you describe what maximum potential is?

Dr. Bruce Hoffman:

Well, when a person wakes up in the morning inspired by what they do, that’s living at your maximum potential. They are living at their maximum potential. It’s a vision of what they are here to do on this planet while they’re in a body. In psychology, it was called a daemonic calling. Your inner constellated self calls you from above to become who you’re meant to be. So you’re just inspired to do what you do, and you know what you are meant to do and you throw all your life force into that outcome.

Mary Vallarta:

Which is basically their higher purpose.

Dr. Bruce Hoffman:

Their highest value, their highest purpose. They don’t need to be motivated to get out of bed. They get out of bed and just do what they do. They stay up very late at night trying to manifest it. Their life force is invested in it. There’s that old image that I love, if you will go to a university and you stand outside and you look at the different levels of a university, the undergraduate student’s lights go out at four o’clock, the postgraduate at six o’clock, the doctoral students at 10 o’clock and the Nobel prizewinner’s their lights get switched off at one o’clock in the morning. They are just called into the daemonic calling. They just know who they are and what they meant to do.

Mary Vallarta:

…and that’s what pushes them, yes.

Dr. Bruce Hoffman:

But that’s only the third possibility. The fourth possibility of healing is when you know that you are part of a connected whole. You don’t identify with your body, your emotions, your mind. You identify with that aspect of you that is beyond all of that.  Your deepest self, your soul, which is sort of linked to this one mind, this eternal consciousness. You know you’re not your body, you’re not your mind, you’re not your thoughts, but instead, you’re part of this continuous oneness and you stay connected to that in that field of consciousness that is that. I’ve had patients die, fully healed, connected to that aspect of themselves. They just know who they are. They know they are not their bodies, they’re not their minds,  they’re not their thoughts, they’re not their actions. They are beyond that.

Mary Vallarta:

That reminds me of the concept of  Satva  in Ayurveda.

Dr. Bruce Hoffman:

It’s called Brahmi in the Vedantic model.

Mary Vallarta:

Oh, nice. I’m just getting into more Vedic studies. I’m in Ayurveda right now, which I’m really loving. That’s really what inspired my own healing journey.

Dr. Bruce Hoffman:

I took my model from Ayurveda because I studied it for years and went to India and did an internship there.

Mary Vallarta:

That’s my dream. I want to go to India and study it one day.

Dr. Bruce Hoffman:

But they have these koshas, these bodies. I took that model and added a few and I made the seven stages to health and transformation model based on Ayurvedic and Vedantic scriptures.

Mary Vallarta:

Oh, got it. So what are those seven stages? Can you share them with us?

Dr. Bruce Hoffman:

Yes. Spirit, soul, mind, emotion, energy, physiology and structure, environment.

Mary Vallarta:

Okay. Interesting.

Dr. Bruce Hoffman:

Yeah. They are based on the five koshas from the Vedantic philosophy, the five bodies, the five layers.

Mary Vallarta:

So obviously when your patients are working with you, I can only imagine some of them get challenged. Right? Some of them might get frustrated during this whole process. So how do you go about helping them and supporting them push through or be comfortable with feeling this discomfort? Cause a lot of times people run away from discomfort.

Dr. Bruce Hoffman:

Again, it’s incumbent upon me if I’m doing a reasonable job, not to impose my model on them, but just ask what they want.

Mary Vallarta:

Ok, going back to that.

Dr. Bruce Hoffman:

Some people just want to not have asthma.  They’re not interested in seven levels of healing. I respect that. Then I pull out all my functional medicine, toxicology tricks, and just treat asthma.  Treat triggers of asthma such as mold and food sensitivities and Mast Cell blockade and mitochondrial resuscitation. I do all my functional medicine things. Other people come to me and say, I’ve been sick my whole life and they give you 50 symptoms. And you know, immediately that that person probably has not had the most advantageous experience from either ancestrally or from birth. Almost definitely you can tell that. The adverse childhood experiences studies show that people who’ve had adverse childhood experiences had three to four times increased health disadvantages as they mature.

Dr. Bruce Hoffman:

So you know when people tell you they’ve been sick for as long as they remember. You immediately go into early childhood trauma history and it’s always there. You can always tell. Interrupted bonds with their mothers. They have merged with mothers. They were sent off to boarding schools at young ages. They go to intensive care units and incubators and the mother has problems with the father so the mother takes her eyes off the child and doesn’t myelinate the child’s sense of self. Then mother’s offline. Then they have stillbirths and miscarriages and they’re all there in the history almost every time in a complex illness patient.

Mary Vallarta:

Hmm. So basically you meet them where they’re at.

Dr. Bruce Hoffman:

Yes, I tend to meet them where they’re at. You try and work out each level.  At level one what’s going on? Is it food? Is it mold? You do your normal medicine. Then you ask deeper questions. Are some of these symptoms teleological? Are these symptoms bringing patients to you because they have to heal a part of themselves that they never integrated in their evolution? For instance, I had a patient with MS whose father was a very famous sports coach and she never felt seen by her father, always neglected. She had a superego that is highly punitive, and she didn’t feel ever seen. So she was constantly beating herself up and attempting/strivinh to become more than she could possibly be. She tried and tried and tried, but dad was always coaching the team.

Dr. Bruce Hoffman:

Then the dad, when she was 18 or 19  I believe, her father got fired from the team. The next day she developed MS. The next day. That symptom was saying, dad, you were never there to take care of me. Now, look at me, I’m sick. He rose to the occasion. When he was fired, he was at home and he could be with his daughter. It was set up that way, that the symptoms drew that complexity together for it to be resolved. When she got that installed that she used that to use that in healing. It was very powerful. I have many, many cases and stories like that, where symptoms guide people to heal a part of themselves they’ve left behind.

Mary Vallarta:

Right. That is fascinating.

Dr. Bruce Hoffman:

Symptoms don’t fall out of the sky.  They have intent. In my experience.

Mary Vallarta:

Yeah. I think that the more I speak to all of the experts that I’ve talked to so far, the more I’m realizing that symptoms are really an opportunity for people to get to know themselves on a deeper level.

Dr. Bruce Hoffman:

I did a workshop with Mark Wolynn who is one of the great family constellations authors and workshop leaders out there. Once a year, we’ll do a workshop on illness and your family system and early developmental trauma. Almost to the person, we can link the rising of symptoms to events in the lifespan that needed to be resolved and healed. Once we linked them and made them conscious and gave them the homework to do, there was a vast new release of healing potential because you don’t heal until you have a new internal dialogue, a new story, a new narrative. If you have the old narrative, you create the same biochemistry. People with a new narrative, they have a new insight. It releases a potent internal life force that then constellates the biochemical pathways downstream to advocate healing.

Dr. Bruce Hoffman:

So we would do this workshop. Mark was a master at family constellations. Patients would sit next to him, and we would ask what their problem is and they’d say thyroiditis or leaky gut or Mast Cell, mold, whatever.  Then you’d say, well, tell me about your mother. Tell me about your father. Tell me about your grandparents and your siblings. Then he’d put up people in this constellation and worked with them energetically as to what was going on in the system and how their symptoms correlated with the dynamics of the system, the entanglements of the system. They could see how their symptoms didn’t just arise from nowhere. They were contingent upon some of these entanglements that needed to be healed. Once they saw what they hadn’t perceived before because children will often tell themselves a story that’s not true.

Dr. Bruce Hoffman:

They’ll say their mother was mean and angry, but their mother lost two children before they were born. The mother got very little from her mother. The mother was always bothered about the father who is out doing something or other. So the mother just had a little bit to give and unless the child sees that, and sees the mother through new eyes, the judgment of the mother will be there.  A person is half their mother, half their father. If they start judging half of themselves, guess what? They’re not open to the healing force, which is their whole self.  So everybody ultimately has to realign with their parental mothers and fathers. If you don’t say yes to your mother and father, your healing is going to be limited, no matter what you’ve experienced.

Mary Vallarta:

Because it’s pushing yourself away. They’re half of you like you mentioned.

Dr. Bruce Hoffman:

That’s the setup for auto-immunity by the way.

Mary Vallarta:

Oh yeah, because you’re rejecting yourself and autoimmune, right? Oh my God, that is powerful. I don’t even know what to say right now, but it shows how important it is to really understand yourself, but also understand your parents.  Also understanding your grandparents because your grandparents affected your parents’ psyche. It affected how your parents treated you.

Dr. Bruce Hoffman:

No question. 100%. There’s a one-to-one correlation.

Mary Vallarta:

So Dr. Hoffman, switching gears here a little bit because I’m also quite interested in anti-aging medicine, but I don’t know too much about it. Could you tell us a little bit about what that is?

Dr. Bruce Hoffman:

It’s a myth.  I’ve trained in it but there is no anti-aging medicine. It’s a nice sort of slogan for slowing down the process of aging. Okay. We all age. You’ve got the hormones of youth and you’ve got these drives.  In the first 30 years, you can do no wrong. You just push yourself through everything. Then entropy sets in and you start to sort of come apart slowly but surely.

Mary Vallarta:

You’re noticing it now.

Dr. Bruce Hoffman:

No question. The wrinkles and the skin sags.

Mary Vallarta:

The low back pain

Dr. Bruce Hoffman:

Then you get the inflammatory diseases of aging. Then you get separated into either heart disease or cancer or one of those things. They are all driven by genetics and environment and lifestyle and mind/ body.  The more inflamed you are by your lifestyle, the more unresolved you are with multiple triggers, the more interleukin six and tumor necrosis factor and all the inflammatory signalings are flying around, destroying your mitochondria, which then reduce your ATP, which then reduce your life force. So what we do in anti-aging medicine is try and slow down that trajectory before all is lost.

Mary Vallarta:

Yeah. There’s no way that you can stop yourself from aging. It’s just really about how to stop those symptoms of aging or delay them, right?

Dr. Bruce Hoffman:

Modify it so that your entropy isn’t like this.  Then you drop dead one day because your gene pools run out,  it’s time.

Mary Vallarta:

Yeah. It reminds me of my grandmother. She died, but she didn’t really die of any disease or illness. I think it was just because she was older and her body was just tired.

Dr. Bruce Hoffman:

The genes give up.  Everything ends.

Mary Vallarta:

Yeah. So share some of the most important things you’ve learned from your spiritual teachers. You’ve named a lot of big names, in your bio, like Deepak Chopra and Osho.

Dr. Bruce Hoffman:

So, here’s the answer. You probably won’t want this one.

Mary Vallarta:

Give us the real answer, not what you think we want to hear.

Dr. Bruce Hoffman:

People who’ve had difficult upbringings, who’ve had some complexity in their early developmental years, will often go to find spiritual teachers to take the part of the good parent that they feel they didn’t get. So whenever I have patients come in who have spiritual teachers and gurus, I’m very suspicious. Having had very many spiritual teachers and gurus myself. Having been to India three times and sat on many mountain tops meditating. So that’s the first insight that I really want to emphasize. It’s not wrong. It’s just when people don’t heal with their individual mothers and fathers, they’ll find a great mother and father that will look upon them benignly.

Dr. Bruce Hoffman:

You’ll find a lot of the great spiritual teachers who went to Burma and Thailand and India in the seventies, all of the Western students of spirituality. There are a lot of them. Jon Kabat-Zinn is one of them, Jack Kornfield is another. They all went and meditated for 15, 20 years, put on red robes and then came out of the forest, went back into cities of America, started to see people and all of a sudden realized, hold on a second, we are just performing spiritual bypass. These people have got messed up lives and they all went and became psychologists.  They all needed to heal the early traumas that people were trying to bypass to develop spiritual awakening. So that’s one of the greatest insights I’ve seen over the years. It’s not that spiritual teachers can’t provide some insight, but I always get a little uneasy when I see a guru sitting on a big white pedestal.  Then there are all of these devotees.  And I’ve done that for decades.  I’m judging myself.

Dr. Bruce Hoffman:

Then I just always ask, what is it about this experience that was being bypassed? What is it that they are trying to gain? What, what layer and level is still unfulfilled in their evolution? That’s what my curiosity is because an awakening experience into Satori is a sort of a brief exposure where you go beyond mind/ body and you actually know that everything is unified. There is no past/present/future. There’s nothing to fear and you’re sort of eternal,  immortal and you’re never born and you never die. That is what happens when you awaken.  But to sit in front of a guru to try and get that experience, I’m not sure that’s the best use of your time.

Mary Vallarta:

Yeah. I think it’s just an illustration of how you’re still searching for answers outside of you.

Dr. Bruce Hoffman:

That’s what Advaita says.  The essence of Advaita, which I learned at 15 was the very act of seeking prevents you from being who you are because you are that. So what are you seeking? You are already that thing.

Mary Vallarta:

What are you seeking? Exactly. I get that. That is really good advice when you think about it.  The answers are not out there. They are in here.

Dr. Bruce Hoffman:

Carl Jung said the urge to be whole is evolutionary. You can’t avoid it. Dianne Connelly said all sickness is homesickness. You try to come home to the most integrated aspect of who you are.  You can’t just go and sit with a guru.

Mary Vallarta:

That won’t give you the answers.

Dr. Bruce Hoffman:

It’s fun, and it’s very pleasant for a time. And I’ve done it for a long time, but you still got to go down the chakras and work your way through them. Early developmental trauma.  All of that stuff. You’ve got to heal that stuff.

Mary Vallarta:

If anything, it’s sort of a way where someone could continue resisting actually looking at themselves, getting to know themselves by sitting with a guru, and not ever advancing to internal examination.

Dr. Bruce Hoffman:

Perfect, perfect example you just gave.  It really does, in many cases, exemplify and exaggerate, the very pathology that’s brought them to the guru in the first place, which is resistance and projection. By sitting in front of the guru they are refusing to face the very thing that they need to face, which is themselves and their defenses.

Mary Vallarta:

Yes. Fascinating. So aside from sitting or seeing your patients, one-on-one Dr. Hoffman, you also actually have online programs and courses that people can take. Can you tell us a bit about what those are?

Dr. Bruce Hoffman:

Well, it’s funny, I used to do weekend workshops and all sorts of things. Then I condensed it all into a Friday afternoon lecture, a one-hour lecture for my new patients. Then the one-hour lecture became seven hours. I felt sorry for my patients. So then I took that lecture and made it into a book. So that book and those videos are available.

Mary Vallarta:

Nice.

Dr. Bruce Hoffman:

Yeah. So if you want to learn Seven Stages to Health and Transformation, I have a video and I have a PowerPoint explanation of it all, but I no longer lecture to that degree. I’m going back and starting to do lectures on different topics like Alzheimer’s disease and Mast Cell Activation and mold exposure and various aspects of mind-body healing. Those are in development. Most of the time now I’m helping other practitioners. Guiding them through this new curriculum of Seven Stages to Health and Transformation where not only do they learn new skills, but they learn about themselves.

Dr. Bruce Hoffman:

They have to stay congruent, they have to be present in that experience. I forgot to mention as part of my explanation, I went off at a tangent, that patients who don’t have good relationships with their parents have low trust. If they have medical PTSD or trauma from the medical system, that gets projected on you as a healer because all medical systems are very patriarchal and you are a parental figure. So if you’re sitting in front of a patient and there’s no trust established, there’s nothing you can do. So you have to ask that question first. You know I’m trying to teach people, other practitioners, how to be present with patients before they get more tools in their toolbox and go into courses and learn things.

Mary Vallarta:

That is so important.

Dr. Bruce Hoffman:

How to develop trust with a patient. Sometimes you can’t, they’re too traumatized and you try your best, but it’s just not possible.

Mary Vallarta:

But that just shows the role that each person plays. The role that the practitioner plays and also the role that the patient plays. If either one of them is not invested, it’s not going to yield the highest potential outcome.

Dr. Bruce Hoffman:

It won’t. Some people are too traumatized with too much mental health illness that they just can’t do what it takes to show up in that experience. Then you just have to admit that it’s not going to work out. You have to learn who is sitting in front of you. Also, know yourself through your own Myers – Briggs typology, through your own Ayurvedic typology,  you have to know if you’re Vata, Pitta, Kapha. Is that patient Vata, Pitta, Kapha because the Vata patient is not going to do what the Kapha patient does. They are an entirely different person.

Mary Vallarta:

Yeah. And then honoring and accepting that type of person and not projecting another type of person in that chair.

Dr. Bruce Hoffman:

If I’m a Pitta practitioner in my hero archetype and I know everything, I’m going to tell you what to do. And the Vatta patient walks in and is very sort of inspired for like three days and then they lose interest. If you impose your value system and your Ayurvedic typology or dosha onto them, and you don’t resonate and know how to treat Vata patients, you will lose them and you’ll feel frustrated.  Like a Kapha patient, they always show up, they never do what you asked them to do, or they do very little, but they’re always very loyal.

Mary Vallarta:

Very loyal. And we’re talking about Kapha, Vatta, Pitta. Those are the different dosha constitutions, that we talk about in Ayurveda.

Dr. Bruce Hoffman:

Then the Pitta patient, if you’re not the best in the city, they’ll leave you and go find the best.

Mary Vallarta:

They are looking for the facts. They’re like the fact-finder.

Dr. Bruce Hoffman:

You’re not sharp enough and don’t have the best office and are always on time….

Mary Vallarta:

You gotta check all the boxes for the Pitta patients.

Dr. Bruce Hoffman:

But as a practitioner, you’ve got to know who’s coming in the door because you’ve got to adjust the way you interact with them.  Knowing your Myers-Briggs typology as well, thinking people are not the same as feeling people. You’ve got to know that.

Mary Vallarta:

That’s very true. It’s sort of like detective work that you have to do when you work with your patients. Well, Dr. Hoffman, I can talk to you for hours. There are so many different questions that I can keep asking you, but for the sake of this particular interview, I’d like to ask if there’s anything else, one thing that you can leave us with here today that you didn’t get a chance to cover.

Dr. Bruce Hoffman:

In regards to talking to well people? Or people with complex illnesses? Or could you give you more direction?

Mary Vallarta:

Yeah. Well, the title of the summit is Healing Your Chronic Illness and Taking Your Life Back, meaning taking control of your health, right? Being the person and seeing the power that you have to own your life, to own your health. And so what would be the last thing that you’d want to leave us with here today?

Dr. Bruce Hoffman:

I think what’s most important is that people have to understand that if they present with chronic ill health or chronic complex illness, they have to try and find a practitioner who has a broad range of experience with multiple tools in their toolbox. They can’t just do one stool test and hope to heal. That’s number one.

Number two, they have to become their own patient advocates. If they are not invested in advocacy, there is very little that you can do.

Number three, they can’t project all the will to heal on the practitioner. They have to take some of that responsibility themselves.

Number four, they have to raise health up as a value. If the health isn’t one of the first or second values, it will default to number four or five, wherever you have your highest value, you will have your most order. Wherever you  have your lowest value you will have your most chaos. If health truly isn’t your highest value, be honest with yourself. Then look at it and say in the future, I will make it my high-value but right now I want to keep working and eating poorly and making money because that’s where my highest value is. Not wrong or right.  Just be honest and truthful and know your value system.

Mary Vallarta:

Wow. That is a great way to end the discussion. I feel like you beautifully summarized our conversation and added new thoughts to it. So I appreciate that. I will go ahead and make sure that I link Dr. Hoffman’s website, where some of his writings and programs are, so you all can take a look. I’ll also include that in the post-summit email. Dr. Hoffman, you’re also on social media. So what is your handle where people can find you and possibly connect with you there?

Dr. Bruce Hoffman:

So Instagram. My staff said, “make sure you say this at the end”.

So Instagram is www.instagram.com/drbrucehoffman/

Facebook is www.facebook.com/TheHoffmanCentreforIntegrativeMedicine/

and then the website is www.hoffmancentre.com.

I also have a brain treatment center, www.braintreatmentcentreofalberta.com I think those are all the handles.

Mary Vallarta:

Yeah. I mean, there are more.  Do you have a Tik Tok? Do you have a Twitter?

Dr. Bruce Hoffman:

Yeah. Yeah. Yesterday my Twitter account was activated by an assistant. I have no clue.

Mary Vallarta:

There you go. Well, Dr. Hoffman is on Instagram, so you can catch him there. I think that everyone’s on Instagram. So find him on IG. You should see the links in the handles below. Look at his website. There are a lot of resources there where you can get started if you are interested in everything that we’ve talked about. As Dr. Hoffman said, be truthful to yourself and meet yourself where you are. Stop, resisting, and meet yourself where you are, because that is an integral part of starting and continuing the healing journey.

Dr. Bruce Hoffman:

Also, the outer aspects of healing often in complex illness have to be congruent with inner healing too. You can’t just take a potion or herb. It’s much more complex than that. You’ve got to take a full system approach. There is a lecture being posted on my website soon on YouTube, where I give a 1 ½ hour lecture on the Seven Stages of Healing which will summarize some of the things we’ve mentioned.

Mary Vallarta:

Ooh, yes. I’m gonna watch that for sure. Okay. Thank you so much for joining us today. Hope you got a lot out of this.  Dr. Hoffman, you are amazing. Thank you for speaking with me.

Dr. Bruce Hoffman:

Yeah. It was nice talking with you.

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.

Chronic Illness Begins with Environmental Toxins

Our bodies are in a constant state of flux – always in a give-and-take relationship with the outside world. That interchange never stops. The problem is the outside world has become increasingly filled with toxins.

Modern chronic disease was born out of this phenomenon. Sadly, allopathic medicine does not address environmental toxins or chronic disease. As more people fall victim to chronic illness, however, it’s incumbent on all of us to consider the impact the external environment can have on our internal bodies.

Exposure to Toxins

Exposure to toxins has become a risk for everyone. No one is exempt. More and more people are fighting chronic illnesses that go misdiagnosed – or even unrecognized as illness – because they don’t fall into the standard cache of diseases according to allopathic medicine. We are not merely biological machines, yet a mechanistic view of the body has led to a constricted view of illness and wellness.

Our present medical system is not equipped to assist patients in locating what’s causing their chronic disease. In my practice, it is not uncommon to see patients who have visited twenty or thirty physicians without receiving any clear answers. They feel deeply frustrated, even helpless.

Many are told that they have chronic fatigue syndrome, fibromyalgia, or depression, but they aren’t given any guidance on environmental toxins, detoxification, or treatment. Some are prescribed anti-depressants, which of course do nothing to address the underlying issue: chronic exposure to toxins, leading to chronic illness.

The reality is that, as our environment becomes more polluted and pesticide use more widespread, as we unwittingly come into contact with dangerous chemicals through cosmetics or food additives (some commonly used chemicals inhibit hormones that are critical to immune system functioning), and as our bodies become repositories for heavy metals like mercury (from dental fillings) or mold biotoxins (from water-damaged buildings), more and more people are suffering chronic diseases that leave them in a nearly constant state of exhaustion, mental fogginess, anxiety, and physical pain, among many other symptoms.

Maybe you feel this way, or know someone who does.

Homotoxins

A century ago, the German physician Dr. Hans Heinrich Reckeweg developed a working model of how disease originates in the body, showing that the entire manifestation of symptoms and disease is the interplay between two factors: toxins (which he called homotoxins) and the defenses of the body.

Homotoxins enter the body through the lungs, the gut, and the skin. They make a series of inroads until they reach the holy grail of the cell’s nucleus and mitochondria. The nucleus is where our DNA is stored and where we regenerate new cells—up to 60 billion per day.

There are defenses the body initiates to halt this progression. However, if those defenses are weak—as they are in people with modern chronic disease – the homotoxins keep marching on until they get to our DNA and mitochondria in a way that significantly alters the body’s normal replication of cells, resulting in degenerative diseases, and ultimately, cancer.

There is an overwhelming body of data linking environmental toxins to degenerative diseases like heart disease and diabetes, neurological diseases like Parkinson’s and Alzheimer’s, and cancer.

Disease does not just happen. It manifests when toxins enter our porous bodies and penetrate to our core. There is a causal chain that sets every chronic illness into motion—beginning with exposure to toxins. Understanding this chain is the first step toward healing.

New Patients

My new patients begin their path to wellness by filling out a toxicity questionnaire and undergoing an indoor home assessment and heavy metal testing. Once the clues have been culled and we know the toxicity of the patient’s body and environment, it’s time to turn our attention to detoxification and healing.

When patients are empowered to recognize their particular causal chain and are presented with treatment options that transcend the boundaries of allopathic medicine, they become awakened to the real possibility of healing.

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