Integration of Complex Systems into a Structured and Staged Diagnostic and Treatment Approach

Integration of Complex Systems into a Structured and Staged Diagnostic and Treatment Approach

Good morning everybody.

I’m the last speaker of the conference, and I’m going to try and tie up some of the concepts we’ve learned into a comprehensive diagnostic and treatment protocol specific to the theme of the conference One People, One Planet, One Health.  I want to provide some idea of how I approach patients with complex issues and attempt to make sense, if you will, of some of the complexities and some of the multiple incoming bits of data and information that we often are asked to sort through.

So, this is a very common scenario. The patient presents at your office having seen many people, having tried many things, having researched, having been on the internet, and is up-to-date with all the latest treatments and then asks a few things that you may or may not be familiar with. You are left wanting to know or thinking, how do I approach this patient, and what systems of inquiry do I use, what diagnostic protocols can I think of? How do you proceed to make sense of this? It’s very challenging.

Where do we begin? The amount of misinformation out there is huge, patient advocacy is welcomed, but often misdirected. There’s often lots of single point causation. People think it’s Lyme or mold or mast cell activation syndrome. It’s often all those things and much more. It’s very difficult to penetrate and get into a patient’s system of inquiry without sometimes ruffling feathers or offending people’s points of view.  It is sometimes a minefield, not always but sometimes. Sometimes it’s very pleasurable and it fills you with hope and it sort of makes you realign with why you started to do this work in the first place. Other times, it’s very challenging. The question that arises often is – is the functional medicine integrated model adequate, does it leave things out? What else can be considered? What other considerations can we bring into account when we’re dealing with complex patients? And I hope to go over some of those today by presenting this data.

By way of background, I was talking to Werner Vosloo, a member of the ISEAI board one day about complex patients and had approached him and he said, well didn’t you just present it and show us what you do. So that is the basis of this presentation.  Just a little bit by way of background because it would make sense at the end, why I chose to introduce some biographical information about how I arrived at this system.

I had a rather complex childhood, but I was fortunate when as a teenager. I was sent to boarding school and had this high school teacher by the name of Roger. He introduced me to many things, including the philosophical system of Vedanta and a particular subset of Vedanta called Advaita. The relevance of this will be made clear a bit later. He also introduced me to the writings and work of Carl Jung, whose book, Memory, Dreams, and Reflections was a seminal piece of work in my early exposure to philosophical systems.

Carl Jung was the first person to draw out the cartography of the psyche as told through his autobiographical narrative, which is a very fascinating read. He was also the first person to really say that the psyche, the inner world of people, has an objective reality. Although it’s subtle and unseen, there are aspects to it that can be used and taken to be somewhat fixed and relied upon as a roadmap when you’re working with people’s unconscious material. He also said, along with many others, that the desire to be whole, or what he called” individuated”, or to be integrated, to be healed if you will, to know yourself. In the East, they call it enlightened, Maslow called it self-actualized. He said that this was an evolutionary urge. Everybody desires to be the best they can be in the most integrated way.

This is evolutionary. So patients, although they may present with sickness and disease, there may be another directive that they are asking. The question is, as medical practitioners, is this our responsibility?  Where do we enter into these complex systems and what are our responsibilities? I’ll address these a bit later. So, he (Jung) said that the urge to be whole, to be healed is evolutionary.  Advaita, within this Hindu system or the Vedantic system, is often translated as non-duality.  A more apt translation is non-secondness, meaning that there is no other reality other than what they call Brahman in Hindu terms.  That the reality as we see it through the five senses is not ultimately, at its deepest core, constituted by bits and pieces, by parts. That is, everything that’s always changing in the universe, all these changing things have no existence of their own, but they are all appearances of what they call The One, Brahman, the Unmanifest Field. This is not that different from what the great quantum theorists of the last 150 years have said. They’ve all said that behind this vast appearance of matter, is this unified field of information and intelligence, which they call a quantum field or light if you will, which is infinite, eternal, and never changes. It’s not subject to space-time and present moment awareness.

Advaita says that there is nothing to be made whole, as Jung said, because you already are whole, you just don’t know it. You don’t just wake up to that reality. It’s a philosophical concept which we’ll address and come back to. Now, ironically, the title of this conference is One People, One Planet, One Health, the very essence of Advaita. One mind, one manifestation, everything is connected with everything else.

Another bit of biographical data, which I introduce in order to elaborate on why I use the system. When I was younger, I had two major experiences of what they call satori in Zen Buddhism or Christ consciousness in Christianity, Fana in Sufism, Samadhi in yoga whereby you directly experience this reality. When you directly experience this oneness, it’s a very peculiar experience. It’s not psychotic. You are very much in your body, but you really do see this unified field that underlies all matter. You really do see that past, present, and future are continuous. You really have no fear because you understand yourself to not be your ego squeezed into the confines of a body through space-time. You just experience this expanded state of awareness. Literally, everything does appear to glow with a certain light. Quantum theorists will tell us that matter is nothing other than light squeezed down into matter. That’s the basis of quantum theory.

So when you have these awakenings and these experiences, which many people have had through near-death experiences and precognitive dreams and synchronicities etc., you definitely do experience that oneness that underlies all appearances of matter.  It really is a different state of consciousness, but it actually, you resonate with it and believe it and know it to be true.

After high school, I found myself in medical school and became a family physician in Saskatchewan,Canada and then started to be curious as to what other methods of healing and methods of inquiry could help patients when they presented to the office with symptoms.

I was then exposed to a video by Larry Dossey, who you all may know, and he incorporated aspects of Eastern and Western medicine into his approach. This approach evoked in me a memory of my childhood exposures to Eastern thought, and then launched a massive search for whatever it was that could assist patients to live at their maximum potential, not just treat symptoms, but to live more fully. So, using my allopathic training as a basis, I then, like many of you, became curious and started to study beyond that allopathic model.  I studied TCM and acupuncture. I spent years with Deepak Chopra and David Simon studying Ayurvedic medicine. Went to India and did an Ayurvedic internship in Poona. Did IFM training and A4M training, spent years with and still do, listen and study with some of the great leaders in biological medicine, Dr. Dietrich Klinghardt, many others in the field.  I’ve studied with Lawrence Afrin and Shoemaker like many of you, Dr Horowitz in the Lyme world, William Walsh in the mental health field.

But I was ultimately provoked into thinking about integral theories by the works of Ken Wilber and his so-called integral theory of everything. He combines all these areas of thought, and philosophical systems into one unified system. It’s theoretical, but not practical. So, what I did was make practical these theoretical systems. This is the seven-level model that I’m proposing today.

The title of the conference is One Health. One Health is a big movement of trying to integrate different aspects of our reality, including animal health, human health, and environmental health.  Even though Advaita and the One Health concept have different epistemological origins, one is more of a different state of consciousness whereas the other is more linear in space/time. They both embrace an attempt to unify different aspects of separateness.

This unification of systems is not new. We know from antiquity that many of the old traditional systems of medicine, which were not alternative, they were the traditional systems, were very integrative. They weren’t like traditional medicine as we know it now. Allopathic medicine is the new kid on the block. More integrative systems have always been there. We know from the ancient temples of Asclepius, which were scattered around Greece and Turkey, that people would travel very long distances to go to these temples. They would spend time in the outer sanctums getting all the purification rituals. These are the outer therapies.  They also had to travel long distances.  It has been shown that if people go through some sort of hardship to get to a healing center, there’s a much greater prognosis. This has been replicated with studies with cancer patients showing the further they travel, the better the outcomes.

So, people had to give up something to get something. They had to have intent. They have to mobilize themselves.  This is something we know.  When we’ve tried treating patients, if there’s no true intent, if they don’t mobilize the inner resources to get what they need and want, if they stay passive, it’s very difficult to treat people. We call that “projection of will” or “high resistance”, if you will, in psychological terms, but when patients present in that mode and you start working harder than the patient, you all know this, it becomes very difficult to help them. And so, the practitioners at ancient temples knew this, that people would travel long distances to come to these temples. They would go to the outer sanctums where they are getting the outer treatments, much like today, where you get your pills and potions. They go through purification, rites, and rituals, which is similar to the nutrition and detoxification protocols of more integrative practices today.

Then they would be shifted or moved into the inner sanctum where the abaton was, where the dream sanctuary was, where they were required to have some inner experience, some inner signal from the unconscious that they were on a healing sort of path. After that was over, they would go outside the inner sanctum and move into the theaters or amphitheatres where great Greek tragedies and plays were enacted.  These were to show people that these dramas of health, healing, and transformation were archetypal.  Players would re-enact the great human dramas of evolution in life and show people the archetypal description of how life unfolds. So, these traditional integral systems have always been around.

Larry Dossey, through his book Reinventing Medicine showed that modern medicine has started to embrace more integral concepts, as we all know.

He called Era One medicine, physical medicine – existing from 1850 to the present day.  Actually, through Paracelsus, we know that the application of outer remedies has been around somewhat for 500 years or so.  But our true allopathic paradigm exists from about 1850 to now. Then Era 2 medicine, when mind/body medicine systems were integrated. Then Era 3, what he calls “non-local” medicine where spiritual practices and spiritual insights were added to the paradigm and somewhat integrated into therapies that exist to this day.

At a recent Lyme conference, an ILADS conference, there was a presenter who showed that there are many research systems now trying to integrate a lot of these different, disparate aspects of reality into a sort of a research mode or research vehicle so they can try and look at different systems as to how they interrelate and what the additive effect of different systems are. So, there’s lots of research going on in integration.

But, all of you know, when we approach patients with our old allopathic mindset or what we call Era 1 Medicine, well, the reason you are at the ISEAI conference is that we know that the system has its limits, but it also has its great virtues. These are just some of the reasons why we’ve moved beyond that model alone. We know about all the research articles that have shed some doubt on some of the previous findings and how editors of journals are highly compromised and how research often hides the negative data and promotes the positive data. We also know that you can’t really treat patients just through physical interventions. We can’t treat people as machines. We do. Sometimes very effectively.  But when you’re treating complex patients, you can’t separate consciousness, environment, culture, emotions, and the sort of inner core workings of the patient as they relate to their society and their culture and the world at large. You just can’t isolate it.

Then the allopathic model, as we all know, limits treatment to drugs and surgery. We’ve got to expand our model. Majid Ali coined the phrase N squared, D squared medicine. Meaning name of disease, name of drug. This is what we spend a lot of time doing in allopathic medicine. The other aspect that is interesting is that when you name a disease it often limits the involvement of the patient. It often tends to shut down further inquiry and that in itself can be problematic.  When a patient has lupus, for instance, it just brings together a whole mental minefield. “Oh, I have lupus, what now?” It shuts down further inquiry into the antecedents, mediators, and triggers in the functional medicine world. It also isolates the inner reality of the patient from the outer disease. The inner healer, the inner intent sometimes just goes down, goes quiet. They simply focus on the diagnosis.  I have lupus now let’s deal with lupus.” I think this is a great tragedy, which I will explain a bit later.

Why? It separates cause and effect. Patients present with say Mast Cell Activation Syndrome and yes, they identify some triggers and they go on all the mast cell blockers, but it doesn’t really take into account building biology and EMFs and other things that may be playing a role.

Then one of the great tragedies and often experienced with that is when the disease or symptom cluster can’t be named, it is dismissed as all in your head. This is a great tragedy. More and more practitioners are being made aware of this great tragedy. When allopathy runs out of diagnostic options, very often these simplistic interpretations get placed on the patient.  Instead of the provider saying I don’t know, what other methods of inquiry should we open up? Who should we refer to in order to get more insight into this case? As we all know, allopathy has a tendency to be quite arrogant in terms of its understanding of mechanistic disease. If it can’t be explained through Newtonian mechanisms, it often is said to not exist, and we all know this not to always be true.

I was listening to a talk by Dr. Klinghardt and he brought forward this insight, which I thought was fabulous. He said when he was exposed to his early medical training, he was primarily exposed to the regulatory forces in health and healing. His teachers told him that there were three classes of medicine: regulation, substitution, or suppressive. Suppressive, or what we know as antibiotics, et cetera. Substitution is when something is deficient, you give something to replace it.  Regulation is the idea that the body is a self-regulating system. You just have to find ways to assist the patient in self-regulation or to optimize function. We know that the mind, through intent, has a tremendous capacity to self-regulate as well. So, I thought this was worthwhile introducing.

The other thing about our model is that it ignores different stages and states of consciousness. It just treats mechanistic, Newtonian models of space and time. The body as a machine that’s broken down and needs fixing.  This doesn’t really take into account the different stages of people’s lives and different states and stages of consciousness, and what can be called diseases of the soul.

That’s a broad concept, but sometimes the patient needs another input other than what we have in our arsenal.  Like Prozac or Abilify or something like that, then they have a true crisis of the soul, a spiritual crisis if you will. An integral physician, a person who practices a more complete model, becomes aware of these dimensions of being in consciousness.  They will be able to determine through their own internal sort of system of knowing, which one it is and whether to prescribe Prozac or meditation or send them to a spiritual crisis therapist, et cetera.

Another aspect that I find quite challenging is this patient/doctor relationship. You know, we all go to med school, naturopathic school, a chiropractic college, and we accumulate this huge body of knowledge. In the first half of life, when we are accumulating all this knowledge, there is this tendency to occupy what can be called the hero archetype.

It is this all-knowing archetype that we  assume that we know more than what the patient knows. The patient is seen as an object, a closed materialistic system, unknowing and sick. It ignores very often when the doctor is in the hero archetype, the part of the patient that is not sick, the healthy aspects of the patient, their value systems, their choices, their intent, and the fact that they have the capacity to demand quite a significant healing response within themselves. When the doctor is the hero archetype, the patient assumes the “sick” role and becomes passive.  Often, they sort of learn this passive role in order to survive this one-sided relationship. How often have you heard our patients say, “I tried to tell him, I wanted to ask him questions and I was just shut down and I had five minutes and they walked out the room.”

This is very common. We’ve all experienced it and it’s ubiquitous in our field. But the thing that’s really interesting is that the doctor in the hero archetype remains blind to their own vulnerability and their own cycle of woundedness if you will. So being a doctor as a hero is one archetype. 

The doctor as a healer is a very different archetype. The wounded healer, if you will. I don’t really like that word, but it’s just the doctor being vulnerable.  They see both sides, the sick and the healthy parts, and they stay related to both within themselves and the patient. They don’t just see organs, hormones, neurotransmitters, and psychopathology.  Not just a body of overactive muscles and neurotransmitters. Not a soulless body, but the whole being of the patient. Now the healer archetype is embodied more by who the doctor is than what they know.

And we have to stay humble to that and stay related to those two archetypes. Who are we? What do we know and how do we stay related to the patient? So, there’s just a diagram explaining the difference.

This brings me to the point that the inner world of the physician becomes paramount. How much inner work has the physician done on himself to know what he knows or doesn’t know. How much does the physician actually embody that outer symbol? The caduceus, if you look at the symbol of the caduceus,   the caduceus is actually the staff of Hermes, the Greek version of the Egyptian God. He is the God with a man’s body and the head of a bird.

He was worshiped as the creator of the arts and sciences and music and medicine. Greek legend has it that one day Hermes was walking along and saw two snakes that were fighting and he took his staff and he struck it down between the two snakes. They curled themselves around this staff, forever in contention, but held in mutuality of power by the staff.  This was written by Robertson Davies. Now the symbol of modern medicine is the staff of Hermes separating these two opposing forces, not letting one outshine the other or align to win the battle and the struggle for supremacy. These two opposing forces are wisdom and knowledge.  The caduceus is a reminder that medical practitioners must maintain a balance between the two. Knowledge is what we learn in our toolkit, all that we learned from the outside. We bring many years of training to bear on the diagnosis.

Wisdom is what comes from within. Where the doctor looks not at the disease, but at the bearer of the disease, the person who’s sitting in front of you. That is what creates a link, or unites the healer and the patient. This exercise makes him the true physician, a true healer, or what Robertson Davies called a true child of Hermes. The book is called The Merry Heart – How a doctor can also be a humanist. It’s the wisdom that tells a physician how to relate to the patient and to make them a partner in their own evolution and cure. Both of these sources of wisdom must be accessed, not only by healthcare providers but also by the patient. The patient themselves must apply as much external knowledge as they possibly can if they’re not too ill.

It’s from as many different sources as they can. While also being cognizant of the fact that not all healing is about applying an external remedy, an inner journey is required.

Then another issue about the loss of competence in our model is that it emphasizes this disease-based model. We are asked to treat one small link in a sometimes thoroughly diseased chain of events. We patch people up and send them back into the same environment. The model has very few directives for wellness, let alone directives for living at one’s maximum potential across all spectrums of the body, mind, spirit axis.

This has been known for a long time, 2012, New England Journal of Medicine quote “We must teach aspiring physicians about system science. We should emphasize homeostasis and health, rather than only disease and diagnosis.” We’ve paid lip service to this, but it’s really not organized into any roadmap or system of approach.  IFM and functional medicine do a very good job, but is there more?

Then we come to the question, how do we even define health? We understand that human beings are these assemblages of molecules. But we know as humanists that they contain much more and we’ve kind of just reduced them to materialistic bodies. So, what does health mean in a multidimensional being?  Interesting question.  Can I be healthy if I’m spiritually malnourished?

If a white supremacist’s blood work comes back normal, is he healthy? How many levels should a physician actually treat? Is this even our task? As a physician, we can compartmentalize and treat one area, but as a human being, we face a painful dilemma. We just can’t do that. We know the patient comes in with complexity.  The more I become a doctor treating one little piece, the less I become a humanist, aware of all the interconnections. Traditional medicine, as we know, treats the illness. Integrative medicine has more of a patient systems approach but a more complete model includes the physician’s own role in terms of wisdom and knowledge, both internal and external ways of knowing as they relate to this complex human being. The Hippocratic Oath is “First, do no harm”, but remember there are two ways to harm. Errors of commission, but also errors of omission. By what we know, but also by what we don’t know.

So, what do we do practically in the office when we know everything is connected to everything else? What do we do when we know all illness is embedded in larger network systems and chains of pathology? How can we approach people from this perspective?

The first possibility is viewing suffering, physical or emotional, as unwanted. We suppress it and we treat it and we say illnesses have no causation, they just fall out of the sky and we get a diagnostic code and we go and find a remedy. We subscribe to the consensual reality of our culture that just perpetuates this cycle. This is symptom treatment and has nothing to do with healing. You’ve all heard that the original definition of a quack is someone who treats symptoms.  This is true. This is from antiquity. So that’s one possibility.

The second possibility is working with patients who began to look at physical symptoms as a larger inquiry.  Symptoms, as teleological, more as entry points into something that they need to transform. I have observed this over years of working with patients. Yes, you may present with a diagnosis, but are these symptoms pointing to something deeper in the patient’s complexity that’s asking to be made conscious, is it giving voice to silence in a system? I can quite categorically state in many cases, yes, a cold is sometimes just a cold, nothing further is required. Or pneumonia is pneumonia, but very often symptoms are teleological. They point towards something that needs to be made conscious and worked with.

I remember a patient recently just last week presented with multiple sclerosis (MS). She had a very difficult relationship with her father, her whole life. She was never seen by her father. Her father was a very famous coach in the national sport in Canada. He spent all his time working with his team and was never at home. This patient was extremely, extremely bitter, and angry about this relationship. She felt she was never seen and never fully taken into the father’s confidentialities and mentored and parented by the father as she should have been. This was part of her whole life. This is where it becomes interesting. She presented with MS. So, we asked a little bit more as to when the MS appeared? And she gave me the exact date. Then I asked her, and where was your father at the time? She suddenly just broke down in tears. She said you know what? I developed MS the day after my father was fired from the team.

It was immediately apparent to her that she’d been ignored and neglected her whole life by her father. The day after her father no longer had the obligation to leave home and be out of the home most of the time. He was fired, he was now at home. She showed the symptomatology of MS the day after he was fired. She connected the two. She said, finally, he saw me and started to take care of me. One day, 24 hours. That is a symptom that I think is teleological. I don’t know what else to call it.

Patients who fall under the second possibility often start to ask much deeper questions and use symptoms as allies. They ask themselves questions. We all have these patients, and they are a delight to work with if their reasoning is rational. Sometimes we get people who, as we know, don’t have the capacity to integrate knowledge in a way that is coherently helpful to them. That becomes problematic. But many people are excellent self-advocates and have deep intuitions as to meaning and purposes as to the possible teleology of symptoms. They use a much more conscious approach and they recognize patterns and they approach their healing, not just with physical interventions, but with a much wider array.

Then you get the third possibility, that others seek a state of health motivated by aspiration or something more than just an absence of symptoms, but a positive state of wellbeing. As much as they’ve learned about illness, they now look at what it is to be healthy and well. This includes a sense of inner self-regulation. Competence, self-competence, not hubris or arrogance, but they just know themselves. They have a core self that is self-regulated. They really are called from above. They are inspired.  They have a sense of meaning and purpose. They know why they get up every day and they know they have a destiny to fulfill. They are inspired from within. They are also aware of parts of themselves, this part of themselves they don’t want to own, shadow, and how they project that shadow onto others. They also know that the ultimate desire is to know themselves as much as they are capable of.

They stay in their core, without too many emotional fluctuations. They see crises as blessings. They are inspired by a mission and vision bigger than themselves to which they stay aligned. These patients are delightful to work with, as we all can attest.

Alastair Cunningham, in his book, Bringing Spirituality into Your Healing Journey said the qualities of cancer survivors that best predict spontaneous remissions are those who are open to change. Those who have a commitment to daily practices, have a deep sense of themselves, and have achieved a level of autonomy integration and inner authority, as opposed to those who have what has been turned into type C patients. Type C patients, as we know, are less able to summon the strength within themselves. They suppress emotions and tend to have “projection of will,”where their desire to be healed is all placed in your hands.  They tend to defer their own needs to the needs of others. They don’t tend to practice a healthy balance of narcissism and altruism. Everything is about the other.

Then is the fourth possibility. Those who seek a level of health that is fundamentally and radically different. These are the people who have what we call an expanded level of consciousness. Self-transformation rather than self-regulation. This viewpoint embraces all the previous perspectives and approaches to health while simultaneously transcending them in the creation of a fundamentally new vision. Here people start to identify themselves with an aspect of themselves that is not only their bodies, their emotions, and their mind. If you think about it for a moment, our bodies change, our emotions come and go, our mental field changes, but to whom are those changes taking place? The answer is you, the deepest sense of who you are.

That is a sort of subjective experience which you can align with. They define themselves by attention to an inner, more spiritual process, rather than something outside of itself. They become attuned and surrendered to something, to an intelligence that’s greater than their own ego. They know that their ego is not the center of the universe. The evidence for ourselves not being at the center of the universe against the backdrop of infinity is rather overwhelming. People who surrender to that awareness know that they are just one small cog in a very large wheel and against the backdrop of infinity. They don’t take themselves too seriously, but they stay aligned to what they are called to do in this incarnation.  But they surrender to something bigger than themselves. That’s why the ancient Greek temples often had open roofs. Peoplewere open to something, some intelligence that is more than just themselves. This is very similar to what happens when I had that satori experience, you stay open to something bigger than yourself. What happens is when that comes through, fear completely disappears. It really does. You just have no fear of death, because you really know that we are not our bodies, emotions, or thoughts. You just know that to be true. This is the deepest possibility of a transformed individual, from illness to illumination. Hence the nature of my talk.  Very often, when we have these awakenings and satori, they are fleeting. My first one lasted a few hours and the second one lasted a few days. So, you have this awareness and then you come back into your body and space-time, and the duality of being in the emotional body, but you still carry that awareness in you, that there is this possibility beyond your ego-based experience.

All the great wisdom traditions teach that is the true state of who you are. That’s the essence of Advaita. That’s the essence of many of these inner esoteric traditions of spiritual practice.

This can be felt and experienced and be part of your healing journey. So, we move then from the relative purpose of medicine to the ultimate purpose and possibility of healing when we start to incorporate this deeper aspect, this sort of shifting consciousness if you will.

So, a more complete roadmap doesn’t look at treatments but looks at how all these approaches can be applied. The doctor, the patient, the individual, the collective unconscious, the unconscious states, and stages of consciousness, sickness, and wellness. The healer and the patient have that roadmap. They are aware there’ll be multiple risk factors at all layers and all levels. There will be many different diagnostic and therapeutic options at all layers and all levels.

As I mentioned, I use Ken Wilber’s integral medicine model, but it’s not practical. It’s theoretical. Ken Wilber incorporated many paradigms into his system of human inquiry. All the ancient sciences, physics, chemistry systems, theories. It is a system of individual outer and inner reality and collective outer and inner realities. He calls it the Integral Theory of Everything.

One of his statements in the forward to the book, Consciousness and Healing, which I recommend everybody read, says “In the black bag will not be just 20 pills, two scalpels, and an orthopedic hammer, but all layers, all quadrants, all states and all stages of consciousness. The crucial ingredient isn’t all the ingredients, but the holder of the bag. The integrally informed practitioner opened to their entire spectrum of consciousness who can acknowledge what is occurring in all levels internally, as well as externally. Who have an expanded map – from dust to deity, from dirt to divinity, and from agony to ecstasy. Only then the treatment.” I think it’s a wonderful insight into what’s possible. How to practically apply that in insurance-based medicine, in a short appointment, well that is another thing.  That’s the logistics of how to practice in this model.

So, is there some way to practice medicine that surrenders not one ounce of the rigorously scientific, empirical, and clinical dimensions that are the cornerstone of any modern scientific system of healthcare, but also make room for other dimensions of being in the world that if ignored, subtract from one’s humanity and effectiveness as a physician? This was the great question that arose in my evolution as a doctor/physician. I was likely to be exposed to many great thinkers and read many books and visit many clinics and ashrams and so forth.

The origination of the model, I’m now going to teach you and show you just briefly. It was based on original Vedantic awareness.  When you look at the literature, they talk about these layers and levels of the human experience, and they step them down. They call them Koshas. It’s an Ayurvedic or Vedantic map of the human experience. At the time I was studying Ayurveda, I happened to meet Dr. Klinghardt, who has his Five Levels of Healing. I looked at his five levels and I looked at the Koshas, the bodies that I was learning and studying with Ayurveda, and I created a few more divisions. With Dr. Klinghardt’s permission, I created subdivisions of the five and made them seven. He allowed me to use his map, but I took the level one and made it it’s own.  Stage One, or the environment. Then in Stage Four, I separated the mind, the intellect, and created another subsection called emotion. You’ll see why in a moment. I separated them out into seven instead of five.

This model, if you look at it. Stage One.  When you are sitting in front of a patient and you’re trying to look at them through a certain lens of how you’re going to appreciate what they’re presenting with, this is the lens I use. I can’t think any other way now.  I think of what stage is being asked to be interpreted and covered. Stage One is all about the external body, the environment. Stage Two is all about physical, biochemical, and structural. Stage Three is all about energy, the autonomic nervous system. Stage Four is about emotion. Stage Five is about intellect, ego, and defenses. Stage Six is about the unknown aspects, the hidden aspects of our reality, which is called, for want of a better word, soul. I like the word authentic self as opposed to the persona, and then the family systems that we inherit, and then there’s a sort of archetypal, mythical dimension underneath that too.

Then Stage Seven is this expanded state of consciousness, the so-called unified field, or the Grand Organized Design, (G.O.D.)which is this nature of reality behind our space, time, physical existence. Now Ayurveda recognizes that health is more than just the absence of diseases. They call it a vibrant state in which your mind, your body, and environment are intimately connected and functioning in a healthy, nurturing, and supportive way. It’s a harmonious relationship between all these levels, the mind, the body, and the environment at the highest level of joy.  The mind is clear and creative, the body’s healthy, vibrant, and strong, the air is clean and fresh, the food is nourishing and clean and relationships are loving, communicative, and nourishing. Well, this is an idealism. We know that. But it’s an idealism that can be entertained when you’re working through space-time reality.

This is the model we all bring to our rooms when we see patients. At the highest level of healing, none of that matters because at our deepest sense of who we are, we are beyond all of that. That is what you do invoke when you have this awakening into another level, at Stage Seven, if you will. So, at the deepest level of Stage Seven, none of that will matter because that’s not who you are. So that’s the roadmap.

 On the screen, I know this is going to make you annoyed because I put everything into this map, but you can’t read it because it is too small.  There is no way to make this map readable on a computer screen, but I’m going to break it down. So here are the Seven Stages to Health and Transformation.  At the bottom, I’ve acknowledged the contribution of Dr. Klinghardt who has five levels and I’ve incorporated some of his concepts as well. But as I said, I’ve expanded them and added many, many other dimensions. So, I’m going to break them down and you’ll be able to read the breakdowns for each level.

So, here’s a patient in his fifties presenting with marital conflict, alcohol abuse, and depression. You’ve got to think of this patient through the seven-level model.

Stage One – environment. He’s got mercury toxicity, organophosphate exposures, biotoxins, root canal issues, tick bite history, et cetera, et cetera, everything to do with the environment.

Stage Two – looking through the functional medicine lens, everything we know, the genetics, the food sensitivities, the permeability, the Mast Cell, it’s all there and we do our appropriate workup. We find out that he’s in the cell danger response, his mitochondria were low, et cetera, et cetera.

Stage Three – we look at his electromagnetic body if you will.  We see that he is exposed to computers all day, he has had head injuries, his NeuroQuant MRI shows certain things like asymmetry from a head injury, he’s got high thalamus and amygdala in his NeuroQuant at 99% percentile.  Knowing that this person probably has mast cell activation and the limbic looping through either PTSD or early childhood trauma.

Stage Four – here we have it.  Sexually abused as a child, beaten by dad as a child, dad was an alcoholic, brother died when he was 12. His own son died when he was 17. This is a highly traumatized individual. This is a very difficult case to work with because of the complexity and the defenses this person is going to bring to the interaction, especially in terms of trust.

Stage Fivev–one could say he has a narcissistic personality disorder, major depression. He has a personality disorder and a mood disorder.

Stage Six – from the family. There were all sorts of inherited trauma that was brought through. 

Stage Seven – he had no connection to anything other than his own suffering.

This patient is complex and difficult to treat. But if we have a roadmap, we can sort of orientate ourselves to each layer and each level and then work accordingly. Give ourselves a year to sort through a lot, if the patient has the ego strength to survive that level of complexity. We have to often modulate our own knowledge of this individual where their weaknesses and strengths lie and then adjust ourselves accordingly.

So, when patients like this walk in, we take the history, we look for the antecedents, mediators, and triggers. We create timelines, we posit a working hypothesis. We do all the tests and we jump into treatment. I’m just going to suggest before we take this approach, before you rush into treat these specific symptoms, clusters, or diagnoses across all layers and levels, step back and ask a couple of questions of ourselves.  When we go to look through this much larger lens there are certain things that I think we should bring to the dynamic in the room with the patient.

So here are the things that I sort of need to remind myself of many times a day, and sometimes forget when I’m in the doctor as hero archetype, which is not difficult to do. You get humbled.  You’ll often get patients who humble you.  You get challenged, and then you drop back into the awareness that yes, we can occupy doctor as hero but we also need to be doctor as patient.  We have to be aware of our own hubris and our humility when you are dealing with complex patients.  You will be pulled back and forth by so many dynamics that are being thrown at you.

Here are some of the things I think are important. Are you present, related, listening, resonant, embodied, and attuned?  This is Porges social engagement theory. Does your face reflect that you are listening to that patient? Is there trust established? Are these patients being seen by you? Were they ever seen by anybody? The patient I mentioned before, was never seen by his father, his brother died, he got lost. His mother was so traumatized. Then his own son died. Can you imagine the level of trust he has in outer parental or in external authority figures? Not much. You’ve got to be aware of the projection of these unresolved early developmental issues of patients.

The patient, as I mentioned, had so many unresolved complexes that he projected onto the exchange it was very difficult to negotiate in some of these complexities. How many layers and how many levels are needing your attention? Are symptoms Teleological? Do they point to something in the system as I mentioned before?

Then what stage of life are they in? The first half or second half? This is a very important question that comes up a lot.  If you look at the trajectory of life, the first half of life is very different from the second half of life. In the first half of life, you’ve got this developmental brain, you’ve got the so-called triune brain, the reptilian brain which is fight/flight, you’ve got the limbic brain which is emotional and then you’ve got the mammalian brain, the prefrontal cortex, which is the inhibitory brain.

If you look at the trajectory of patients, attachments, and needs in the first 10 years the child needs to be seen by the mother in particular, not so much the father although the father does play a role.  The child attunes to the gaze of the mother. The mother’s right prefrontal cortex tunes and attunes with the child’s right prefrontal cortex, and a sense of attachment and safety is created.   Sebern Fisher showed in her fabulous book about neurofeedback development that if the mother and the child attune in the first 10 years of life, and there are no breaks in the bond, that creates, in the child, right prefrontal cortex maturity, and they develop a sense of self. Now, if the mother’s present and it tunes with the child, because the child looks to the mother, attunes with the mother, feels safe, looks away, self soothes, self regulates then looks back to the mother.  This goes on for years. In a daughter, up to 30 years. In a son, later, up to 35 years. That child is always trying to attune to the parental expectation. Now, if the mother is present and the mother is attuned, the child feels safe. So, the first 10 years of life is all about fight/ flight and safety. If the child is safe in themselves, they then start to develop core strength and a stable sense of self, which they then take into the next 10 years, which is developing an identity and a sense of self with peer groups. Now, the father’s often responsible for tuning the child into the second half, the second decade of life when the limbic brain becomes attuned. If that child then gets exposed to bullying and ridicule, that limbic brain is highly traumatized and that’s when you get all these anxiety states and OCD states because there’s no self-regulation at that level of development.

Then in the third decade of life, you achieve a certain sense of autonomy. You’re starting to lay down your prefrontal cortex, your inhibitory brain, where you inhibit the fight/flight of the first 10 years. You inhibit the fears of the second decade, and you start to develop a sense of autonomy and independence, where you’re no longer looking for parental guidance. The parent is the external prefrontal cortex for 30 years. The child’s always looking for (external) self-regulation. But then as the child develops and leaves the father’s or mother’s house, they have their own prefrontal cortex to inhibit their fears and their emotional fluctuations, and their fight/flight responses. That’s a healthy developing ego. Patients in the first half of life are often taken up by these biological imperatives. They are very different. It’s the ego development of the child to develop a coherent sense of self. It’s very different from the second half of life, which we call more of a soul part of a person’s life. Whatever develops in the first half of life, particularly if there was high drama and trauma, the child will often develop what’s called a provisional sense of self, where they leave their authentic self behind. They make themselves adjust to cope and survive. That is what we call the provisional self, and that becomes the ego, the operational sense of self that takes them through life, which can be very highly developed. But the core instinctual self often gets left behind. It’s been my experience that in the second half of life symptoms will often bring a patient back to re-examine that part of themselves that they left behind in order to develop a provisional operational sense of self.

This happens all the time when I take histories and look at the teleological impact of symptoms. I think we need to, as practitioners, be aware that treating a patient in the first half of life, I’m talking about patients with complex mind-body type illnesses, not just bronchitis, but I’m talking about complex patients. Patients in the first half of life are called, driven by biological imperatives. You know, Freud talked about libidinous drives, Dr. Adler talked about power drives.  Jung was the only one to talk about the drives of the soul. Jung would not see a patient psychologically until the second half of life, because he said there was nobody home. He said that in the first half of life, you’re just driven to become something. So, you’ve got hormones at your disposal and there is no true consciousness to work with.

I’m not saying that younger people aren’t conscious, of course they are. But you are being driven to become something and succeed in life, it’s only in the second half of life when we are naturally drawn to become more aware of your true, authentic self, that we can really start to do more of the inner work because we’re not being driven to succeed in the outer world. This changed my practice when I started to look through that lens. I think it’s an important lens. We can’t ignore it.

So, this series of questions. What is the strength of that person? What ego strength? Are they fragile? Do they project their will? Are they highly resistant? These patients are different. You’ve got to be aware of them. How defended are they?

What unconscious dynamics are they wanting to be made conscious of? Are they ego defended or soul defended? There’s a difference, which I don’t have time to go into.  The soul defended people are far more traumatized.  Are they able to self-regulate or are they in their core or do they fragment into different ego states? Do they freeze or disassociate? Are there personality disorders?  Then asking other questions. What is the actual content of the internal dialogue? How polarized are they into black and white thinking? Is there a need for a new narrative, a new story that needs to be told? I often see complex patients and they often don’t heal unless they have a new image, a new story, a new internal dialogue, even sometimes an awakening that is physiologically experienced. Not cognitive, but a true awakening to a new reality.  That’s not a fragmented ego state or dissociative ego state. It’s truly a transcendent experience.

What is their capacity for self-advocacy? How well-informed is it? Is it rational? Is it magical? Wishful thinking? Are you, as a medical provider able to create salience and relevance? Do you educate your patients as to the complexity of their presentation? Or you just tell them what to do? There is a difference. We all know that education goes a long way in creating so-called compliance because there is salience, there is relevance. What are they asking of you? To treat disease, to make symptoms go away? Or are they asking to be assisted in their quest for full human flourishing? It’s important to know. What archetype do you occupy? Are you in your doctor as hero or doctor as healer mode? Do you stay in your core? Are you able to take no credit, take no blame, stay true to your own chief aim, vision, destiny? Are you able to keep loving what you do and not get too elated when people praise you or depressed when people damn you?

Doctors are subject to lots of projection, lots. A patient comes in the door and praises you.  I know to keep yourself in your core because the next one’s going to come and damn you. So, you just don’t oscillate between seeking praise and getting too upset when people go at you.  Which they do. On social media. On rate MD. You know, people can project all of the unresolved parental conflicts onto authority figures. Don’t forget we as MDs or naturopaths or chiropractors, carry a big potential for large parental projections onto us. These are unconscious projections by patients, that which they haven’t resolved with their parents. One of the great questions I always ask a patient is how are you related to your mother and father? If there is a complexity there or they’ve never seen their mother, never seen their father, that’s a different patient than one who’s been seen, loved, and nourished by patients. We know that through attachment theory and early trauma.

The last question is where do we enter into this complex system when patients present with this kind of complexity, where do we enter? What level?  Do we enter at the level of toxicology?  Do we enter at the level of the soul? Do we enter at the level of ego development? This is what we need to ask ourselves. Often when you sit enough in the field of a patient it becomes clear. It sort of unravels itself. It’s only through a phenomenological inquiry that the answers will emerge. You kind of walk in with a plan. You’ve got to stay related. You’ve got to look the patient in the eyes and you’ve got to listen and then see what emerges phenomenologically in the field as to where this system is asking to be unraveled or order created out of some chaos.

Here’s what we do. The first level is the Extended Body. You know, the river is my blood, the rainforest produces oxygen- is my lungs, the earth is my body. Every time we breathe in and out, we exchange tons of information with the environment. Just look at COVID. See how much gets exchanged through droplets, etcetera. Someone calculated with every breath we exchange 10 billion trillion atoms. That’s remarkable. Where were those atoms before I breathed them out? They were in my liver, my kidney, my spleen, my bones, my brain.  Deepak used to talk about the fact we are always in an involuntary organ transplantation program. COVID has brought us this awareness. It’s too close to home. It has been calculated, do the math, that by the time you leave a room, we walk out with at least a million atoms that came into the room with somebody else. We’re constantly exchanging our bodies with each other and with the environment at large. Everybody here has atoms that were once in the body of Jesus Christ or Mahatma Gandhi or Saddam Hussein or the lion in the Kalahari Desert or Donald Trump for that matter or the notorious RBG if you will. So, when you say “this is my body”, it’s somewhat of a delusion. It’s a limited perspective of who we are. So, the air we breathe, the food we eat, the water we drink is densely packed with a multitude of potentially carcinogenic and immune system depleting toxins. We know that. I mean, fabulous lectures this weekend on that from some of the world’s authorities.

The great teachings of Ayurveda say “I’m not in this world, the world is in me”. It’s not metaphysics, it’s science. We are continuously in exchange. We have a responsibility as well, to know that there is no “out there”.  Us and “out there” are one and the same. It is incumbent upon us in this field to be environmental activists. In the highest sense, we have a responsibility because we know this to be true. Every time we drive our car when we could be walking. Every time we throw away a bottle and we could be recycling. We should be and must be at the forefront of the environmental movement.  I do believe ISEAI is really carrying that mantle, of course. Mark Hyman’s new bookFood Fix was fabulous when he outlined how our food supply is in the hands of our 12 CEOs of big companies. Very sobering.  We have a need for this regenerative farming, et cetera. So that’s the Extended Body, the world outside of ourselves. I just put together this quick slide. These are some of the toxicology environmental labs that I use. Some of the treatments I’ve found helpful. We are all familiar with these, you know these, I just wrote this down for quick reference.   I originally had much more time to speak and I was going to go into more detail, but unfortunately, that can’t happen today.

The second level is the level of the Physical Body. We know that our body is nothing other than DNA wrapped in food with some structure. We know that macro and micronutrients influence this dramatically.  When we look at the physical body as such, there are certain things that really have emerged in my practices. At the core of this awareness, because this is where most people will enter. They enter into at Stage Two, the physical symptomatology and biochemistry. We do our allopathic history and functional medicine history. We do a complete functional medicine workup with all the tests we can. That stupid saying that we all are aware of, “you can’t manage what you can’t measure”, it’s so true.  Some practitioners are excellent at what’s called ART, autonomic response testing, and don’t test as much. I personally am more familiar and more skilled at test interpretation. I try and get as many tests as I possibly can so as to explore the cartography of what’s being presented. People often, and budgets are limited, of course, so you have to adjust accordingly, but if you can test it really helps you pull in all these disparate parts and create a more cohesive roadmap for helping patients. So the complete functional medicine workup, we’re all familiar with it. I do feel that the different diets, you need to know all of them. You need to know about fasting, mimicking, intermittent fasting. I personally find the paleo autoimmune low histamine diet to be the bedrock of trying to get people to downregulate the inflammatory issues they usually come up with.  You have to be familiar with the histamine diet, the oxalate diet, the SCD, the Ayurvedic diet.  A Vata person’s diet in Ayurveda is very different from a Pita person’s diet. You’ve got to know the different tastes and flavors that these different Ayurvedic doshas if you will, do better with.  I do think it’s important.

Mitochondrial medicine, the cell danger response, membrane medicine, Robert Naviaux’ s theory is unbelievable.  It changed the way our practice works. We are now able to do the labs that look at some of these markers. I do them on every patient, almost. Working with Dr. Afrin and Mast Cell patients, we now start talking about Pentad and recently Septads.  Pentad patients are patients with Ehlers-Danlos,   POTS and dysautonomia and auto-immunity with chronic infections and cranial, cervical instabilities. This is important. Many POTS patients go undiagnosed. You’ve got to take the blood pressures, lying and standing. You’ve got to ask about Ehlers-Danlos and do Beighton scores. These are very important, little bits and pieces I’ve picked up over time that I’ve put into my toolbox. Sleep and exercise medicine, we all know that. Peptides, exosomes, stem cells are new kids on the block, and there’s even more now. We’ve got psychedelics in there too. There’s so much going on, unbelievable. Ketamine, et cetera. Dentistry, you’ve got to know dentistry. You got to start learning about dentistry and how to read a two-dimensional panorex and maybe 3D cone-beam CT scan, but best to work with a biological dentist, you’ve got to know a lot. Lots about Nucca chiropractic, craniosacral vision therapy, and know your immune system basics.  It is very important to know how to down or up-regulate accordingly.

Then Stage Three is the Electromagnetic Body. We all have this layer of Prana according to Ayurveda, this level of energy and vitality. There’s a difference between a corpse and a human being.  With a human being, there is some intelligence flowing through which needs to be nourished and interacted with in every way. Just as we are metabolizing food, we metabolize with sight and touch and smell, et cetera.

We have to know some of these theories and some of these insights. These energy fields that come from the body that works in concert, and it’s been shown that they actually govern biological processes. We know from the work of Dr. Albert Popp that there’s a biofield around in the body. It’s coming from what they believe to be DNA. This whole concept of the aura is actually real. Local fields, meridians, regulate the flow of energy within the body.  These fields operate as a spectrum. They can include electrical, electric, magnetic, and subtle energies. These do correspond with a wide range of scientific data and field reports. I learned from Dr. Klinghardt from his work with Dr. Popp and others that our matter, our actual biochemical reactions are controlled by this energy component, which shapes matter. Apparently, there’s an electromagnetic sort of field that stands as a standing wave outside of your body. Where they intersect it actually is where the control of biochemical reactions occur. We know from Harold Burr in the nineties, he measured these electrical fields around an unfertilized, salamander egg, and found it was shaped like a mature salamander. He showed that often these electromagnetic patterns often undergo destruction before the physical body, before physical illness follows.  When we look at this electromagnetic field, we have to know about the brain. We have to know about the autonomic nervous system. We’ve got to know about NeuroQuant MRIs, heart rate variability.  The QEG work that we do here at the clinic is extremely important. I love to correlate NeuroQuant MRIs with QEEGs. You can often tell the biography of a patient just by looking at what’s showing up in the NeuroQuant MRI and what’s showing up in the QEEG. We also have to know about interference fields, scars, tonsillectomies, tissues that have damage to them, which can actually interfere with some of these fields. We have to know about man-made electromagnetic fields. This becomes part of our workup. Getting a building biologist to go into a home and measure electrical fields, magnetic fields, EMF’S, and dirty electricity.

We also have to know about the mind because the mind through the stress response or through intention can sort of change the electrical field.

Upregulation of the HPA access, for instance, can cause cortisol to cause a leaky gut, leaky brain, leaky mitochondria. So we have to know about stress responses, mental fields, and the downstream effects on the electromagnetic body. This is the so-called regulatory medicine that Dr. Klinghardt mentioned where we use interventions, homeopathy, acupuncture, all forms of regulatory medicine of which we learned, not through allopathic medicine, but through other studies. Sometimes with brain injury, we do need to do neurocognitive testing. I do quite a bit of this, particularly with traumatic brain injuries.

Now we switch from the outer world to the inner world. We start looking at the emotional fields of the body. And Candace Pert was the first to show that thoughts create our physiology through first electrical and then chemical signals on neural peptides.

Every time we think a thought it’s turned into a chemical.  The Ayurvedic saying is if you wanted to look at what your experiences were like in the past, look at your body now. There is a blueprint. If you want to know what your body’s going to look like in the future, look at your experiences now.  Traditional Chinese medicine teaches us that emotions are linked to specific organs. You know that a patient who’s been sexually abused, particularly females, often have a lot of pelvic symptomatology. Anger and the liver are very much linked. You’ll see this a lot. Also, grief. I had a woman who gave up a baby for adoption and she presented with asthma. She dealt with the adoption guilt and her asthma cleared. Nothing else. It’s just linking emotion to organs. This is a real thing. It’s not just speculative on the part of traditional Chinese medicine. Many studies have been done showing how emotions are linked to biochemistry. Anger has specific upregulation of inflammatory cytokines, laughter downregulation, et cetera, et cetera.

We know from this world of the emotional body we’ve got to start looking at early developmental traumas, the adverse childhood effects of trauma, and what effect they have on the body. We know that there’s an increased incidence of all sorts of diseases with adverse childhood experiences and early trauma. We’ve had to learn about trauma-based therapies, integrated body psychotherapy, somatic experiencing, family constellation work, early developmental trauma work. We use a wide array of therapeutics in this domain. We can’t ignore the level of complexity that dysregulated emotions bring into the interview.

Level Five is everything to do with the Intellectual Body or the so-called individual mind and ego development, the operational sense of the self. We have this individual ”I”, which is interrelated to bio-social networks. This is a very important part of how we interrelate.  Is the person’s ego-sense of self strongly developed? Is it fragile? Because it depends on how you interrelate with a person as to whether this is true.

Everybody has a value system. You need to know your patients’ value systems. Every person has different personality types. Every person has different constitutional types. I find it quite important to know about Ayurvedic types.  The Vata patient is very different from the Kapha patient who is very different from the Pitta patient as to how you interrelate with them. With Myers Briggs typology, a person who’s an introvert is very different from an extrovert. A person who is judging is very different from somebody who’s perceiving and so forth and so on. A feeling type is very different from a thinking type. It’s important when you start to work with patients to know some of these typologies in order to work with them accordingly.

So, the individual mind, which is located to the body, takes in information through the five senses, transforms that through the filters of values and core beliefs, morals, ethics, and culture, and then in the step-down transformer, the brain, transforms that into reality.  Also, the individual mind or ego takes in information, if you will, from above, from internal images that it has created and stories, we’ve told ourselves about early developmental experiences. Then we filter that through our personalities, our constitutional types, and provisional selves. Our ego states are usually provisional selves. Then we translate that into reality and thus physiology. Our conscious core beliefs about our ego selves mobilize biochemistry, causing neurons to fire together. We often have unconscious core beliefs, unconscious  complexes that come up from below, and then these then create our outer reality.

We have to know how to work with this intellectual body through different interventions. ISTDP is a form of psychotherapy that I respect and refer out to other people to use. ISTDP looks at the defenses of a patient. Patients are often presented with a cluster of symptomatologies, which are masking the inability to feel deeper emotion. For instance, anxiety. Anxiety is not an emotion. It’s a defense against feeling deeper emotions like shame, guilt, anger, rage. So, an ISTDP practitioner will ask patients certain questions and work with them in the transference and countertransference of the relationship to try and see how symptoms may be presenting based on defenses that are being crystallized, preventing them from uncovering what they really are trying to feel. I find ISTDP a fascinating and very deep form of therapy, but difficult to do. I use other methods, the Demartini method, and others.

So, individuals who have truly miraculous responses to healing in their physiology are the ones who have a shift in perception, in consciousness. They extract a new set of information from their perceptions. They change their beliefs about their perceptions and hence radically reorganize their downstream physiology as a consequence.

At the level of the soul, we have to know about the cartography of the soul. The objective reality of the soul that Jung talked about. We have the outer ego that orientates itself to space-time, and we have the deeper unconscious aspects of the shadow in the self. It’s only in midlife that often the soul body or the authentic self wants to emerge.  Very often in a therapeutic encounter, you’ve got to know the difference. Symptoms will often present themselves at this midlife stage, as I mentioned, in order for a person to transition from the first half to the second half. If they hold on too tight to the first half of life ego-based demands, they will often attract challenges in their physiology in order to draw attention to the fact that transition is needed. You know, in Greek mythology, the seat of the soul is on your knees. You will often see this. People who attract tragedies, will attract physical ill health, they’ll attract divorces, they’ll attract bankruptcies. They’ll be challenged, forced to change the trajectory of their life from the first half to the second half, because if they continue on the first half of life endeavors, as the hormones retreat, they will fail to recognize the calling of the soul to become more whole and more developed. We naturally evolve as we mature to integrate parts of ourselves that we left behind. Our provisional selves get made conscious and we start to integrate parts of ourselves that we previously were not aware of. We become more authentically ourselves. We start to deal with something called shadow projections, parts of ourselves that we don’t necessarily like. Those parts of ourselves that we don’t necessarily like, we often attract on the outside.  We have to deal with them until we learn to integrate them. We have 4,500 traits. Every trait serves a purpose. Until we can learn to integrate all traits, we’re not really able to be authentically ourselves.  That’s a methodology and that’s something we have to learn.

The other thing at the level of the soul is the family soul. We often inherit this.  We have to take a multi-generational history to determine neuro-psychiatric conditions. The experience of a parent before conceiving markedly influences both the structure and function and nervous system of subsequent generations. So, at level six, this is one of the most profound insights I’ve ever sort of experienced, what the ancestors bring to the table will often be expressed in the individual, but it has nothing to do with them. It is in their system.  They inherit epigenetically trauma in the system.

Sometimes when you start to see the dynamics and the entanglements of the family system, and the patient is made conscious through family constellation therapy, of these entanglements, and they get an entirely new insight into what preceded them, it entirely rewrites their story and their personal dialogue and their beliefs about themselves. They’re able to really let go of the narrative that they brought into the treatment room. This has been very profound. I used to do a workshop every year with Mark Wolynn who is one of the masters at this work. Whereby we would look at illness and inherited family trauma. Very often we could see how illnesses have their origin in inherited entanglements and family systems. I encourage all of you if you’re fascinated by this to not ignore inherited epigenetic family trauma.

Bert Hellinger was of course the great pioneer of this work. His work is immensely helpful and worth reading.

When a patient shifts their judgment, criticism, and projections, to understanding and see their parents, for instance, in a greater light, something profound happens. They may have hated their mother, but when they start to see how their mother got very little from her mother, something opens in them and they stop telling the same story. They see their mother with more compassion. So, when a parent or individual is placed in a much larger family system, a new image is created, and it absolutely changes downstream metabolites, it really does work that way. These trickle-down effects do go down into physicality and to biochemistry and a whole new healing potential is set in motion.

This summary slide sort of summarizes what I’ve said. When we work at all layers or levels from our family system, from our ancestors, we may inherit events. As well, when we are born, we inherit early childhood bonding experiences either positive and negative, which then influence our beliefs, our values, our internal dialogue. We have 60,000 thoughts a day. Most of them are the same as the day before. When those change, it creates a different downstream metabolism. Then our defenses, that then influences the content of our thoughts, which creates a specific image and a narrative, a so-called internal dialogue, which then alters the autonomic nervous system, peripheral and central nervous system, and the HPA axis immune system. In the brain that then transforms first into electrical signals, then chemical messages in the form of neuropeptides, neurohormones, that then interface with protein receptors in the nucleus of the cell mitochondria.  That is then encoded in specific genes to translate proteins that transform into enzymes, neuropeptides, immunoglobulins, hormones, connective tissue.  That then becomes you, that beat your heart, breathe your lungs, procreate your off-spring and heal.

Or, if you further increase your allostatic load, triggers from the environment, et cetera, creating further cell danger response or hyper-freeze in Porges dorsal vagal theory, that then creates more symptoms of diseases. So, in the middle of this, we’ve got to enter into the system and start to unpack and uncover what’s going on at all layers and all levels that could create either health, healing and a sense of living at one’s maximum potential. Or, further increase and down-regulate the cell danger response and the hyper freeze response and make things sicker and worse. We have to enter into this system and try to unravel what’s going on and what to do. This is the skill of a fully informed practitioner who has a bigger roadmap than just the functional medicine roadmap.

This is a patient who presented, for instance, just looking at the family systems issues.  She presented with all the symptoms that we know many people present with. She was Vata imbalanced. She had POTS, she had chronic pain. She had worked with everybody and still remained very symptomatic. She had an MSQ of 102.  The family story was that her dad was a drug addict. He used drugs, the parents weren’t happy, dad left when she was two and then died from drugs when she was 10. The story in the system was that dad was useless.  Was a drug addict. Killed himself, she seldom thought of him when she did it was very negative. She had a break in attachment with her mom because her mom was always busy with her father and took her eyes off the patient.

She was merged and identified with the deceased father. She could not love him overtly because he was terrible, that was the family myth. He was a no-good drug addict. So, she loved him covertly, but by becoming sick like him.  Children have a massive unconscious loyalty to their parents. No matter what the parents do. She would say to herself unconsciously, (this was not conscious), dad you didn’t live a full life, I won’t either.  I’ll suffer like you, so you won’t have to do it alone. This is the unconscious loyalty of the child to a parent. So, when this was uncovered in a history taking, she tuned in to the sensations of her body, she felt more cohesive. She was able to feel more integration. She felt the vibration, and this became her sense of self. This became a daily practice and she started to then visualize attachment to the mother appropriately and started to bring her father back into her life.

She placed a photo of her dad on her desk as an altar to him, inviting him in. She went to his grave. She visited his family.  Now remember she’s half her father. So, this half of herself which she’d cut off and ignored now, all of a sudden, came up alive and introduced energetically into her system, the part of herself that she had ignored and rejected and was in pain. She then did, level three or stage three work. She did emWave to develop coherence, saw a somatic experiencing practitioner. She developed a stable sense of self and developed the so-called “window of tolerance”. She said, you know, these insights have changed my life. I’m asking dad to guide me. She just started to develop a core self, an increased window of tolerance. Her symptoms calmed down; her POTS was under control. Of course, we did all the biological functional medicine, you know, salt and stockings and Florinef and everything we do at level two. But it was this insight that really had a trickle-down effect. After a certain period of time, her MSQ had come down to 30.

Level Seven – Spiritual Body.  About a hundred years ago, there was, as I said, this infusion of ancient souls.  They said things were not really physical. Behind this mask of molecules behind this facade of materialism, there’s this vast domain of energy and information.  We can relate to it.  It beats your heart, it breathes your lungs, it moves birds’ wings, it creates black holes and supernovas. This intelligence underlies all matter. It has no limits. Larry Dossey’s, his new book is called One Mind. It says that everything behind the appearances of separateness is this One Mind. It is connected in infinity in all directions.

And you can experience it directly through these Satori’s or awakenings or precognition as mentioned. It’s not located within my mind or my body. It is not limited to my brain or my body. It’s the umbrella to all individual minds. This is a level of transcendence that can be experienced. Once it is experienced, it’s the ultimate healing because there’s no fear of anything because you realize that is all there is. We manifest from that. Our separateness is somewhat an illusion of the five senses. This can’t be cognitively felt, it has to be transcendentally experienced.

In summary, in the Seven Stages to Health and Transformation, Stages 1-5: Conscious / Space-Time / Ego.  Stages 6-7: Unconscious / Systemic / Soul. Each level has its own order and its own laws, which need to be understood. The lower five levels belong to the personal realm, the conscious ego-self.  The sixth and seventh to the systemic and transpersonal realms, unconscious. The higher levels have an organizing influence on the lower level.  It is very important to realize that the lower level supplies the energy to the higher levels and creates boundaries for the individual to exist in. Resolution of issues at the higher levels, trickle down to the lower levels. This is so true. You can’t treat POTS and hope for family system trauma to be healed. But if you heal family system trauma, POTS may resolve.

This is very much a rule that I was taught by Dr. Klinghardt and which exists to this day. So, the Seven Stages to Health andTtransformation.  The purpose of an inclusive model is not to create a larger tool bag of treatment strategies, whether they’re allopathic or integrated. The purpose is not to add 10 minutes of prayer to radiation treatment, and believe we are filling a more holistic imperative. We don’t necessarily need more tools and hammers in our toolkit. The purpose is to create as large as possible a diagnostic and therapeutic roadmap that relates directly to the patient’s experience and request and ask, what is it about all the approaches that can be applied to healing? Where both the doctor and the patient, the individual, and the collective, both sickness and wellness are considered and included.

The crucial ingredient isn’t all the ingredients, but the holder of the bag. A transformation in the practitioner. The integrally informed practitioner who is open to the entire spectrum of consciousness. They can acknowledge what is occurring at all levels and all layers, internally as well as externally, as much as is possible. With both confidence and humility, be aware within themselves, of the doctor as hero, as well as the wounded healer, and be aware of projection of this and the patient’s complexes. And attempt to lower as much as possible errors of commission, as well as errors of omission.

“In the black bag there will not be one mechanic to one machine, one plumber to one broken faucet, but one human being to another.  Not just 20 pills, two scalpels, and an orthopedic hammer, but all layers, all quadrants, all states, and all stages of consciousness. They will have an expanded map from dust to deity, from dirt to divinity and from agony to ecstasy – only then the treatment”. That’s Ken Wilber. 

What is most obvious is that this does not happen without a profound inner shift in consciousness and a radical shift in the beliefs of the patient about what is humanly possible.

These beliefs are contained in the internal dialogue at Stage Five. This is accompanied by an entirely new narrative and image, replacing the one from the past and what is possible for the future.  Rewiring through new neurocircuitry a different set of downstream metabolic modulators.

I remember Debra, a dear patient who died from stage four breast cancer after seven years of treatment. She had achieved a profound sense of health and healing in all areas of her life at the moment of her death. She had experienced this shift in consciousness: One mind, and I believe she died fully healed.

This is completely possible. So, we moved from the relative purpose of medicine to relieve symptoms and to cure disease, to fix people, to eradicate tumors, to normalize blood tests, alleviate pain, create clear CT scans and prolong life. These are the culturally sanctioned notions of what physicians are supposed to do. We all asked to do this with the least amount of effort, expense, and sense of personal responsibility. This is compounded by the consensual reality that all illnesses are negative and should be eradicated. Illness is not being used as information for self-transformation.

We then move from the relative to the absolute purpose, to assist in healing the physical body so that people can live out their lives in a state of maximum potential, in the fulfillment of love and purpose, and feel the love, joy, wisdom, and compassion in their lives more fully.  We achieve this, not by medicating a symptom away, but by using it as a feedback mechanism. To let us know where we need to become more conscious, we lean into the sharp points of our lives, and we assist in creating a culture in which spirit and energy have equal priority over matter and the body. We assist in cleaning our connection to this infinite field. One Mind – to which we are all connected. If we fail and people die from physical diseases, there is no tragedy because we can die fully healed with an open heart and a state of present moment awareness with the realization that our true self, our One Mind is connected to something greater than our individual self. It’s non-local, it’s outside of space/time. It’s immortal, and eternal and therefore incapable of death.

 I apologize for going overtime. Thank you for your attention.

Mast Cell Activation Syndrome and Excipients

Mast Cell Activation Syndrome and Excipients

Mast cell activation syndrome (MCAS) is a complex disease that I’ve previously written about at length. It’s a multi-faceted condition that can often be frustrating and difficult to manage for both the patient and the provider.

Mast cells are immune cells that function to help your body get rid of what they deem to be harmful compounds. In the presence of a harmful substance, the mast cells release mediators such as histamine, leukotrienes and prostaglandins which help your body to expel the invader.

However, in certain individuals, mast cells can be oversensitive and release large amounts of mediators in response to certain triggers. These include heat, cold, sunlight, certain medications, and certain foods, among other things. These reactions can cause a cascade of symptoms of varying severity, up to and including anaphylactic shock.

Treatment for MCAS involves identification and strict avoidance of your triggers, along with medication therapy and lifestyle changes. Medications that may help with the management of MCAS include H1 and H2 histamine blockers.

However, sometimes these changes alone aren’t enough to help you completely manage your MCAS. You may also struggle to identify what triggers your MCAS reactions.

MCAS is considered ‘idiopathic’ when triggers can’t be identified. If you’re struggling with idiopathic MCAS, this article will be of interest to you.

Common drugs known to trigger MCAS

  • Vancomycin is an antibiotic often used in C. Difficile treatment, which is known to cause ‘Red Man Syndrome’.
  • Morphine and other opiates, with fentanyl and Dilaudid being the opiates that are the most easily tolerated.
  • Aspirin and non-steroidal anti-inflammatories (NSIADS), like Motrin and Advil, are only sometimes a problem as in certain people they can actually act as mast cell inhibitors.
  • Angiotensin converting enzyme inhibitors, known as ACE inhibitors, are drugs used to treat hypertension and can increase bradykinin levels, which in turn activates mast cells.
  • Beta-blockers are used to treat hypertension, anxiety and tachycardia and lower the threshold for mast cell activation, interfering with the efficacy of epinephrine if this is needed for anaphylaxis. A glucagon pen can be used as an alternative if beta-blockers are necessary to treat other conditions.
  • Some local anesthetics, such as benzocaine, procaine, tetracaine, and chloroprocaine, can trigger mast cell activation, although lidocaine is usually well tolerated.
  • Some muscle relaxants like atracurium and succinylcholine can act as triggers, but vecuronium and pancuronium are usually well tolerated.

One relatively recent development in the treatment and management of MCAS involves considering drug and supplement excipients or inactive ingredients, rather than the actual drug itself. Drug formulations vary significantly between brands and there’s mounting evidence to suggest that many people with MCAS may have reactions to certain excipients found in their medications and/or supplements. The same drug or supplement made by different manufactures with different dyes, excipients, or fillers may provoke very different reactions in patients with MCAS. The active drug itself may not be the issue, but the excipients, dyes, and fillers may be the culprit.

In this article, you’ll learn:

  • What excipients are
  • How they can trigger mast cell responses
  • Some of the most common harmful excipients
  • How to tell if you’re having a reaction to an excipient
  • How to identify and avoid excipients that may worsen your MCAS

What are excipients?

Excipients are inactive ingredients found in over-the-counter and prescription medications, as well as in vaccines. These ingredients play a number of different roles in the proper delivery of the active ingredient to the body and many of these roles are absolutely necessary to facilitate the efficacy of the drug. (1)

In fact, most drugs are made mostly of excipients and the active ingredients represent only a small percentage of the drug by weight.

According to Dr. Jill Schofield of the Center for Multisystem Disease, excipients “are supposed to be ‘inert’ and ‘safe,’ but they may cause problematic reactivity in MCAS patients, including anaphylaxis.” (2)

Unfortunately, many excipients pose a risk of reactivity in people with MCAS, so it’s important to fully consider the impact of not only the active ingredients of a drug, but also its inactive ingredients when starting a new medication.

Types of excipients

There are over a thousand known drug excipients and the list grows almost daily, as researchers continue to develop new drugs and drug delivery systems.

Here are some of the main categories of excipients and their role in medications, according to Dr. Schofield:

  • Lubricants: These prevent pills from sticking together in storage, examples being silica and magnesium stearate
  • Binders and fillers: These provide volume to pills and bind ingredients together. Binders and fillers include cellulose and polyethylene glycol.
  • Coatings: These protect pills from damage, make them easier to swallow, and may provide ‘time-release’ or ‘extended-release’ function, examples being shellac and gelatin.
  • Dyes: As you’d expect, these alter the color of medications. Dyes used include FD&C red #5 and FD&C blue #2.
  • Flavourings: These alter the taste of the drug to mask bad-tasting ingredients and improve acceptance of the medication, especially in the case of children. Flavouring examples include sucralose and xylitol.
  • Preservatives:Substances such ascitric acid and retinol palmitate improve the shelf life of medications.

This is just a small sampling of some commonly used excipients. Not only are there hundreds more individual excipients, there are also many more categories of excipients that play different roles in medications.

How can excipients affect MCAS?

Dr. Schofield describes people with MCAS as “canaries in the coal mine.” If you’re unfamiliar with this turn of phrase, it refers to the canaries that were carried by miners deep into mines when they worked. If there were toxic levels of gases present in the mine, the canary would die well before the miners, serving as warning that they needed to get out of the mine.

People with MCAS, like the canaries in the coal mine, are profoundly more sensitive to the chemicals they’re exposed to than other people. Unfortunately, this means that many people with MCAS experience reactivity to one or more drug excipients. These reactions can manifest in the following ways:

  • Fatigue
  • Malaise
  • Gastrointestinal upset, such as abdominal pain, nausea, vomiting, or diarrhea
  • Skin rashes
  • Itchy skin
  • Hives
  • Headache
  • Anxiety
  • Flushing
  • Anaphylaxis
  • Headaches
  • Insomnia

However, this isn’t a complete list of symptoms of excipient reactivity. MCAS is such a complex and individualized disease and symptoms can differ vastly from person to person.

If you’ve been diagnosed with MCAS and have removed your known triggers but are still experiencing symptoms, it may be time to investigate drug and supplement excipients and how they may be affecting you.

What are some of the common harmful excipients?

Some of the most common excipients that people with MCAS are reactive to include alcohol, dyes, and povidone. In fact, according to Dr. Schofield, dyes and alcohol are a great starting point for determining excipient reactivity in MCAS patients, primarily because so many people are reactive to them.

Povidone

Povidone is an extremely common excipient, used as an ingredient in hundreds of drugs. (3) It’s a polymer that’s added to drugs to help disperse the active ingredient evenly throughout a liquid or powder solution. It’s also used as a binder and to help drugs in pill form disintegrate properly. It’s water-soluble, so it’s commonly used in liquid drug solutions as well as in tablets or capsules.

It’s an ingredient in betadine, an antiseptic iodine solution that’s used to prep the skin before medical procedures. According to Lawrence B. Afrin, M.D., if you’ve previously been diagnosed with a betadine allergy, it’s highly likely that you’re actually sensitive to povidone. (4) You see, iodine is absolutely vital for proper body functioning so it’s illogical, and emerging research suggests it’s impossible, to be allergic to iodine (5). Because the only ingredients in iodine solutions like betadine are often water, iodine, and povidone, and it’s highly unlikely that you are allergic to water or iodine, this leaves povidone as the likely culprit.

Dyes

Dyes are ubiquitous in medications, a very common MCAS trigger, and unfortunately serve no purpose beyond an aesthetic one.

Although you may find that you’re only sensitive to one or two dyes, it’s often best to avoid all FD&C dyes when possible. Ferric oxide red and yellow may be better tolerated by people with MCAS, according to Dr. Schofield.

You should note that even white tablets may contain dyes, so you’ll need to check the ingredient list for confirmation.Many drugs have dye-free formulations or, in the case of drugs in capsule form, you can discard the capsule. This is often the only portion of the drug containing the dye and you can then simply take the powder inside.

Alcohol

According to Dr. Schofield, alcohols are an extremely common trigger. They’re commonly added to liquid medications, IV medications, or topical medications, which are applied directly to the skin.

Alcohol has some antiseptic qualities, which is why it’s used to disinfect the skin prior to medical procedures, along with being used as the active ingredient in most hand sanitizers. It’s also used as a solvent, to help suspend the active ingredient evenly throughout a drug, and as a preservative, to extend the shelf life of a drug.

Luckily, tablet or capsule forms of alcohol-containing liquid or IV medications are often alcohol-free. This makes them a potential alternative that wouldn’t cause reactivity.

Although these are some of the most common excipients that MCAS sufferers may react to, theoretically you could have a reaction to any of the hundreds of excipients that are used in medications today. This is why an understanding of how to identify an excipient reaction is of the utmost importance for people with MCAS that suspect they have excipient triggers.

Adhesives

Many adhesives are based in glycerin, which is corn-derived. If people react to corn, they may have problems with standard adhesives. Standard tegaderm adhesive wound dressings may be replaced with Opsite 3000 and the IV 3000 line of adhesive products.

Another product is DuoDerm Extra Thin CGF Dressing. If adhesives can’t be used and a patient needs an IV line, this can be wrapped with guaze, on top of which tape is then fastened. All IV bags should be DEHO free to reduce the risks of mast cells reactions

How to tell if you’re reacting to an excipient

There are several ways to tell if you’re reacting to an excipient in a drug, according to Dr. Schofield.


First and foremost, you should suspect excipient reactivity if you have an unexpected reaction to a drug that you previously tolerated well. In this case, some questions you can ask are:

  • Did you get this from a different pharmacy than usual?
  • Is this drug from a different manufacturer than the one that was well tolerated?
  • Was there a risk for environmental contamination when this drug was compounded?

Next, you should suspect an excipient reaction if you have different reactions to two different medications that are in the same class of drug. For example, loratadine and fexofenadine are two over-the-counter antihistamines that function in similar ways to help manage allergies. If you react differently to these drugs, it may be because one contains an excipient that you’re reacting to.

Additionally, if you experience side effects that aren’t typical for a drug, these side effects may actually be a result of reactivity to one of the excipients in that particular formulation of the drug.

You should also consider an excipient reaction if you react to a drug or supplement within the first few doses of taking a new pill. 

Finally, if you’ve been diagnosed with multiple drug allergies or intolerances, you should strongly suspect excipient reactivity. Particularly if you’ve been diagnosed with an iodine or betadine allergy, this is a strong indicator that you may actually be sensitive to povidone. This is an excipient that’s commonly added to iodine solutions along with a variety of other medications, including those as seemingly harmless as over-the-counter pain medications.

Identifying and avoiding harmful excipients

Identification of excipients to which you’re sensitive will require collaboration between you, your physician, and your pharmacist.

According to Dr. Schofield, once you’re able to identify an excipient that you react to, it should be added to your allergy list. However, you shouldn’t add the medication in which it was found to that list, as it’s likely you’re only sensitive to the specific excipient and not the medication itself.

Luckily, due to the availability of different brands and formulations of drugs, it’s often easier than you expect to find a formulation of your needed medication that doesn’t contain any of your excipient triggers.

However, you’ll need to thoroughly review the ingredient list of all medications you’re prescribed, or purchased over-the-counter, to see if they include any excipients that you’re sensitive to. Dr. Schofield recommends using DailyMed, a service of the U.S. National Library of Medicine that provides detailed information about medication ingredients, including excipients.

You may need to get creative in your avoidance of your excipient triggers. For example, if the tablet form of a medication contains an excipient you’re sensitive to, check to see if there’s a capsule, liquid, or IV form that would be okay for you.

As I already mentioned, if you’re sensitive to dyes, you can often just discard the capsule that contains the dye and still use the powder inside the capsule. You can sprinkle it on top of yogurt or mix it into a drink.

If you find that you’re profoundly sensitive to a certain excipient, you may need to have your medications especially compounded in a ‘clean room’ that poses minimal risk for cross-contamination with your triggers. Your local compounding pharmacist should be intimately involved with the challenges of MCAS and the potential risks of excipient reactivity. Sourcing of the pure powder ingredient in a medication may be necessary. Compounding pharmacies should be accredited with their parent organization, the Pharmacy Compounding Accreditation Board (PCAB).Established in 2007 by eight of the nation’s leading pharmacy organizations, PCAB offers the most comprehensive compliance solution in the industry. This includes the combining, mixing, or altering of drug ingredients to create a medication pursuant to a prescription order for an individually identified patient.

In Canada, most of the compounding pharmacies will use microcrystalline cellulose, known as Avicel, as a filler. This compound is derived from wood pulp and contains strings of glucose molecules strung together. It’s commonly used a texturizer, an anti-caking agent, a fat substitute, an emulsifier, an extender, and a bulking agent in food production.The most common form is used in vitamin supplements or tablets or as an alternative binder in compounding medications. Some people may also not tolerate gelatin capsules and are given vegicaps as a substitute. These are composed of hypromellose, short for hydroxypropyl mMethylcellulose (HPMC), a substance that’s prepared from cellulose, which is the main polysaccharide and constituent of wood and all plant structures.

Additionally, excipients aren’t only found in medications. If you’re sensitive to an excipient, you’ll also need to check foods, supplements, cleaning products, cosmetics, and body care products to see if they contain any of your excipient triggers.

Please reach out to me or my team if you need help managing your MCAS or identifying potential triggers or excipient reactivity. My team is extremely experienced with the management of MCAS, and we can help you formulate a plan to identify your potential triggers and remove them so that you can have some relief.

References:

  1. Abrantes CG, Duarte D, Reis CP. An Overview of Pharmaceutical Excipients: Safe or Not Safe? J Pharm Sci. 2016;105(7):2019‐2026. doi:10.1016/j.xphs.2016.03.019 Abstract: https://pubmed.ncbi.nlm.nih.gov/27262205/
  2. Schofield J. The Problem of Excipient Reactivity in MCAS Patients. Lecture from The Center for Multisystem Disease, n.d.
  3. National Center for Biotechnology Information. PubChem Database. Povidone, CID=131751496, https://pubchem.ncbi.nlm.nih.gov/compound/povidone (accessed on May 31, 2020)
  4. Afrin LB. Re: [MASTerMinds] Precautions for Oral Surgeons doing Wisdom tooth extractions in CCI patients? #cci #mcas #dental. Email communication from MASTerMinds listserv. 2020 May 8.
  5. Dewachter P, Mouton-Faivre C. Allergie aux médicaments et aliments iodés : la séquence allergénique n’est pas l’iode [Allergy to iodinated drugs and to foods rich in iodine: Iodine is not the allergenic determinant]. Presse Med. 2015;44(11):1136‐1145. doi:10.1016/j.lpm.2014.12.008

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.

Natural Treatments for Mast Cell Activation Syndrome

I have recently returned from a most stimulating conference/think tank with Dr. Afrin and 30 other leading clinicians on Mast Cell Activation Syndrome (MCAS) at Commonweal—a cancer retreat centre in northern California.

MCAS is a type of mast cell activation disorder (MCAD) characterised by an abnormal activation of mast cells resulting in chronic multisystem polymorbidity of a general inflammatory nature, with or without an allergic nature. Mast cells are white blood cells that are concentrated at the entrances to body tissues (ears, ears, nose throat, skin, genitalia, rectum), and when activated, they release over 200 signalling chemicals (e.g. histamine, prostaglandins, leukotrienes, cytokines and chemokines). These chemical mediators trigger inflammation in response to the invasion of foreign toxins, infections or chemicals, resulting in a range of chronic symptoms. With MCAS, this function becomes upregulated and chronic, occurring at inappropriate times in response to substances that are not necessary a threat. This can lead to widespread symptoms in many different body organs and systems.

Mast cells are located throughout your body in many different tissues, primarily including dermatological, gastrointestinal, neurological and respiratory tissues.  While we need mast cells to protect us from threats, they become a problem when they are overactive and hyper-responsive and will not ‘turn off’. Dr. Afrin, a leading mast cell researcher, believes that between 15 and 20% of the North American population may be affected  by MCAS. The symptoms of MCAS vary greatly. As a result, many people spend years, even decades, in search of a correct diagnosis, visiting many different subspecialists. What is more frustrating for patients is that many doctors are not familiar with the multiple ways in which MCAS may manifest.

MCAS is often found in individuals with hypermobility syndromes (Ehlers–Danlos syndrome), postural orthostatic hypotension (POTS) as well as chronic inflammatory response syndrome (CIRS) and tick-borne illnesses (Lyme disease and co-infections).

The most common symptoms of MCAS include:

  1. Feeling as though you have been sick forever
  2. Trouble with allergies and asthma
  3. Overreaction to insect bites, bee stings and chemical intolerances
  4. Facial and chest flushing
  5. Skin rashes that come and go, including hives and angioedema
  6. Itchiness and a burning feeling
  7. Brain fog and headaches
  8. Poor wound healing and easy bruising
  9. Waxing and waning of symptoms

The condition may be mild in some people and only exacerbate in response to a significant life stressor, which may be either physical or psychological in nature (divorce, bankruptcy, loss of job, travel, infection, death of a loved one, exposure to novel infections, occupying a water damaged building, exposure to cold or heat). In others, symptoms may develop from a young age and slowly become worse over time. People with MCAS are likely to experience a few of the most common symptoms. Because mast cells are located throughout the body, symptoms can affect the eyes, nose, ears, throat, skin, heart, blood, lungs, gastrointestinal tract and the nervous, endocrine and musculoskeletal systems.

The symptoms of MCAS are often confusing. For a long time, many people with MCAS have been told that their condition was psychosomatic or ‘in their head’. Fortunately, awareness of this frustrating and debilitating condition is spreading. Testing for MCAS is somewhat complex and confusing, as positive biomarkers may only be observed when a patient has a flare up. Incorrect collection of specimens may also lead to false negative testing. Many specimens need to be chilled with a refrigerated centrifuge, which is not available in every lab or doctors’ office.

If you need a comprehensive overview MCAS, I encourage you to read my article: Mast Cell Activation Syndrome and Histamine: When Your Immune System Runs Rampant.

The most common drugs that are prescribed for treating MCAS include:

  • Histamine 1 blockers – Hydroxyzine (Atarax), Doxepin (Silenor), Cyproheptadine (Periactin), Loratadine (Claritin), Fexofenadine (Allegra), Diphenhydramine (Benadryl), Ketotifen (Zaditen) and Cetirizine (Zyrtec, Reactine).
  • Histamine 2 blockers – Famotidine (Pepcid, Pepcid AC), Cimetidine (Tagamet, Tagamet HB) and Ranitidine (Zantac). Famotidine is chosen most often because it has fewer drug interactions than Tagamet.
  • Mast Cell Stabilisers – Cromolyn (Cromolyn Sodium, Gastrocom—oral form, Nasalcrom—nasal spray, Opticrom—eye drops, and there is a nebulised form and a cream can be made from a bottle of Nasalcrom and Eucerin or DMSO cream), Ketotifen (both a mast cell stabiliser and an H1 blocker) and Hydroxyurea (Hydrea).
  • Mast Cell Inhibitors – Montelukast (Singulair), Zafirlukast (Accolate) and Zileuton (Zyflo). Pentosan (Elmiron) is used in the genitourinary tract for perineal pain and interstitial cystitis.
  • Antibody neutralisers – Omalizumab (Xolair).
  • Tyrosine Kinase Inhibitor – Imatinib (Gleevac).
  • Stimulants – Mixed salts amphetamine (Adderall XR), Methylphenidate (Ritalin) and Ephedrine (Epipen provides an acute rescue injection when experiencing an anaphylactic episode).
  • Non-steroidal anti-inflammatory (NSAIDS) – Helpful in some, a trigger in others.  Aspirin is the most commonly used NSAID. COX 2 selective NSAIDs—Celecoxib (Celebrex)—are also used.
  • Low-dose Naltrexone (LDN) – Used in a step-up dosing at night.
  • Cannabinoids – Drobaninol downregulates neurons and mast cells via inhibitory cell-surface cannabinoid receptors (not available in Canada). CBD is more helpful than THC.
  • Benzodiazepenes – Addresses the inhibitory mast cell benzodiazepine receptors. Use short-acting varieties. Lorazepam (Ativan) and Clonazepam (Klonopin, Rivotril) are best when used three times daily. Valium and Midazolam are also sometimes used.
  • Selective Serotonin Reuptake Inhibitors – may occasionally be of benefit.
  • IV Immune Globulin (IVIG) – this treatment is sometimes used in MCAS.

While your doctor may prescribe you some of these drugs to help your symptoms, there are also several natural treatment options. A benefit of using natural treatments for MCAS is that you can take these on your own and they do not require a prescription. However, because most patients with MCAS present differently, it is a good idea to implement these with the guidance of a functional medical doctor who is experienced in MCAS.

Although there is a good possibility that you will eventually find the right therapeutic combination of treatments that will help alleviate many of your symptoms, the fact is that there are no specific biomarkers that will predict which therapy will be the most effective for your specific manifestation of this condition. Trial and error with both drug- and non-drug-based options is often the name of the game.

Also, if you opt for natural treatments for MCAS, always be sure to disclose everything you are taking to your doctor so he or she has a clear idea of what is going on. It is also important that you make only one change at a time when attempting different combinations of treatment options.

Advantages of Using Natural Treatments for Mast Cell Activation Syndrome

There are many advantages of using natural treatments for MCAS, including:

  1. Lower cost
  2. No need for a prescription
  3. MCAS patients are often sensitive to pharmaceuticals, particularly the excipients (bulking agents, binders, fillers, dyes) within the products. Patients will have to work closely with their compounding pharmacists to help identify a list of offending ingredients in drug formulations. If a patient has a strange reaction to medications (e.g. insomnia while using a typically sedating antihistamine), it is likely a flare up of mast cells in the CNS causing the problem and not the drug itself.
  4. Some drugs block DAO—an enzyme in the gut that breaks down histamine
  5. Many patients prefer natural treatments
  6. May have benefits beyond mast cell stabilisation

Disadvantages of Using Natural Treatments for Mast Cell Activation Syndrome

  1. Supplements are bioactive compounds that may have unacceptable effects
  2. They may interfere with known medications
  3. They still have to be processed through the same liver detoxification enzymes as pharmaceuticals and thus may have unacceptable side effects
  4. Supplements may also contain excipients that produce unacceptable side effects

Many of my patients find that these natural treatments are sufficient when it comes to treating their MCAS. For others, these natural treatments allow them to reduce the number or amount of drugs they need. When it comes to natural treatments for MCAS, the most effective work in the following ways:

  1. Stabilising mast cells
  2. Increasing histamine breakdown
  3. Reducing histamine levels
  4. Stabilising the immune system and reducing inflammation

With that in mind, here are some of the best natural treatments for MCAS according to the mechanisms they influence. These recommendations were presented at the think tank by Dr. Brian Bouch, a leading integrative medical doctor from California.

1. Stabilising Mast Cells

One of the best things you can do for MCAS is add natural treatments that stabilise your mast cells. Such therapies work by inhibiting the inflammatory mediators mast cells release and can be broken down into three groups (A, B, and C) based on how helpful and potent they are.

The “A” Team:

  1. Quercetin  – 2000 mg daily, dose divided
  2. Green tea (EGCG, L-Theanine) – 2 to 3 cups daily. Supplement with 500 mg (175 mg of ECGC) twice daily
  3. Curcumin (Meriva is a common brand name) – 1 to 4 g daily, dose divided
  4. Chamomile tea (Apigenin, luteolin) – 1 to 2 cups before bed
  5. Resveratrol – 20 mg twice daily
  6. Diamine oxidase enzymes (DAO) – 2 capsules with each meal
  7. Vitamin C – may need a non-citrus source such as rose hips – 1 to 3 g daily

The “B” Team:

  1. Luteolin – 100 mg twice daily
  2. Ginkgo biloba – 500 mg daily
  3. Silymarin – 500-1000 mg daily, doses divided
  4. Shea oil – 3 capsules daily
  5. Ellagic acid – 500 mg daily
  6. Pycnogenol – 500 to 1000 mg daily
  7. Magnolia/Honokiol – 200 to 250 mg twice daily
  8. Parthenolide (Feverfew) – 200 to 400 mg twice daily

The “C” Team:

  1. Fiestin – 100 mg twice daily
  2. Rutin – 200 mg daily
  3. Genistein (isoflavone)
  4. Mangostin (often taken as a juice) – 500 to 1000 mg daily
  5. Xanthium (dihydroleucodeine, also known as cocklebur) – 6 to 9 capsules daily
  6. Isatis (indoline) – 6 to 9 capsules daily

Here is some further information about select products that are used most often

Quercetin

  • Found naturally in stinging nettle, grapefruits, onions, apples, black tea, leafy green vegetables and beans
  • Downregulates the enzyme that converts the protein histidine to histamine—histidine decarboxylase
  • Inhibits the release of histamine, prostaglandins and leukotrienes— three of the most common inflammatory mediators found in MCAS
  • Decreases the production and release of inflammatory cytokines—the inflammatory mediators responsible for many of the symptoms of inflammation related to MCAS
  • Often used as a primary therapy—has been shown to be more effective than the pharmaceutical Cromolyn
  • Treats allergies, contact dermatitis, photosensitivity and inflammation
  • The dihydrate form has the best bioavailability
  • Dr. Theoharides, a top mast cell researcher, has produced a product called NeuroProtek, which contains quercetin, luteolin and rutin. At least 8 capsules must be taken daily for maximum effect.

Green Tea – EGCG

  • EGCG is the most common polyphenol found in green tea
  • Inhibits calcium influx into mast cells, thus preventing their degranulation
  • Inhibits mast cell production of inflammatory mediator leukotriene C4.
  • Has other benefits: improves brain function, improves dental health, lowers risk for cardiovascular disease, combats skin aging
  • Lowers risk for Alzheimer’s disease, Parkinson’s disease and diabetes mellitus

Curcumin 

  • Widely used in popular supplements for lowering inflammation
  • Best found in phospholipid forms such as Meriva
  • Has antiallergic activity—inhibits the degranulation of mast cells in a dose-dependent manner
  • Inhibits inflammatory molecules—interleukin-4 and tumour necrosis factor -?
  • Widely used in cancer and joint inflammation

Resveratrol

  • Found in grapes, berries and peanuts
  • Reduces the expression of inflammatory markers IL-6 and IL-8
  • Inhibits IgE allergy reactions

Vitamin C

  • Research has shown that when Vitamin C levels fall in the blood, histamine levels increase exponentially. When Vitamin C is reintroduced, histamine levels fall exponentially
  • There is very little evidence in the literature, however, to support its use as a natural antihistamine
  • It is frequently combined with quercetin in supplements—a popular supplement is Natural D-Hist by Ortho Molecular Products. Take 2 three times per day for maximum effect
  • Be careful of citrus-based Vitamin C and be aware that high does can cause diarrhoea. It is best to take smaller amounts more frequently
  • Slow-release formulations may be better

Silymarin

  • Silymarin, an extract of milk thistle, which has been shown to attenuate mast cell-mediated anaphylaxis-like reactions
  • It also prevents the release of proinflammatory cytokines such as tumour necrosis factor, interleukin 6 and nuclear factor–kappa B.
  • Also known to have hepatoprotective, anti-carcinogenic and anti-inflammatory effects. Widely used to protect against drug- and chemo-induced liver toxicity

Other supplements that have been used in MCAS:

  • Lipoic acid
  • N-acetylcysteine
  • Ashwagandha – an Ayurvedic remedy known as an adaptogenic herb that modulates the body’s response to stress. Withaferin A is a compound found in ashwagandha that has been shown to prevent mast cells from releasing histamine and other inflammatory mediators
  • Vitamin D – usually best at higher doses. Need to test blood levels

Important Caveat:

Both quercetin and green tea extracts may inhibit the COMT enzyme. If you have a COMT ++ enzyme (slow function) on your 23andme, be careful when using these two supplements. The COMT gene determines your ability to process catechols, oestrogen and the major neurotransmitters adrenaline, noradrenaline and dopamine. Your anxiety, insomnia and pain may increase due to further slowing down of the excretion of these excitatory chemicals plus the excitatory catechols, substances found in green and black tea, coffee, chocolate, green coffee-bean extracts and quercetin.

Other things to consider in MCAS patients:

  1. Ensure you have sufficient magnesium levels, as a deficiency has been shown to induce the emergence of mast cells, particularly in the liver. Magnesium also has hundreds of other important functions in a healthy body.
  2. Zinc is another mineral you should ensure you’re getting enough of because it is important in appropriate mast cell signalling.
  3. Stress reduction is also important in stabilising mast cells. When you’re stressed, your body releases corticotropin-releasing hormone (CRH), which is associated with the activation of skin mast cells. Incorporate meditation, yoga, breathing exercises and other stress-reducing techniques into your daily life.
  4. Maintaining a schedule is a great way to help stabilise your mast cells because they exhibit circadian rhythm patterns. Try to wake up and go to sleep at the same time each day. Also, avoid electronic screens before bed or wear a pair of blue-blocking glasses for better hormone regulation.

2. Increasing Histamine Breakdown

Diamine oxidase (DAO) stabilises mast cells, but more importantly, it is the predominant enzyme that breaks down histamine. To increase your DAO levels, you can take DAO enzymes. I recommend taking two capsules with each meal. You can also increase your DAO levels with high doses of vitamin C.

You should also avoid anything that blocks the release of DAO. First and foremost, this includes any form of alcohol. Histamine and alcohol metabolic pathways share common enzymes—aldehyde oxidase and aldehyde dehydrogenase. When you drink alcohol, histamine is released from your mast cells and DAO is simultaneously inhibited. This can cause a runaway chain reaction, which results in greater sensitivity to alcohol and worsening histamine intolerance. Aged cheese and wine together may induce a major mast cell activation.

3. Reducing Histamine Levels

To reduce histamine levels in your body, you should adopt a low histamine diet. Avoid the following:

  • Alcohol
  • Smoked and cured meat
  • Seafood
  • Pickled foods
  • Fermented foods
  • Leftovers
  • Canned fish or meat
  • Berries, especially strawberries
  • Nightshades, including tomatoes and potatoes
  • Preservatives
  • Vinegar

Try to eat foods as fresh as possible, and stick to anti-inflammatory foods. Adding rosemary oil to fish reduces histamine formation as the fish ages.

For a comprehensive resource on low-histamine foods, diets and recipes, I recommend my guide on the Low Histamine Diet as well as Healing Histamine.

4. Stabilising the Immune System and Reducing Inflammation

Calming the immune system and reducing inflammation is a critical part of any MCAS protocol. The recommendations above mainly help to stabilise the immune system and reduce inflammation, though there are a few other effective methods:

  1. Check and treat any underlying infections – These can contribute to a widespread inflammatory response in the body if left untreated. These may include H. pylori, Epstein Barr and herpes simplex.
  2. Correct gut dysbiosis – Correcting the balance of your gut microbiome has been shown to reduce inflammation and improve immune system health. Specifically, there are certain strains of probiotics that have been shown to help breakdown histamine, including:

Many patients will need to experiment with various therapeutic options at different doses until they find the right combination of medications that helps with their particular symptoms. If unusual side effects are experienced with known medications, remember that the excipients contained within the medications may be the problem, not the medications themselves.

While there is no cure for MCAS, there is a lot you can do to minimise the condition’s impact on your life. The good news is that most of the natural treatments for MCAS are recommendations for a healthier life that anyone would benefit from. To read more about living with MCAS, check out 12 Tips for Living With Mast Cell Activation Syndrome.

With a chronic illness such as MCAS, it is possible to live a full life—the treatment just requires a careful, comprehensive approach. If you believe you have MCAS or have already received a diagnosis and need a functional medical doctor who specialises in MCAS in Calgary, Alberta, you can request an appointment here or call 403-206-2333.

Resources:

https://hoffmancentre.com/2017/11/mast-cell-activation-syndrome-histamine-immune-system-runs-rampant/ https://www.ncbi.nlm.nih.gov/pubmed/22470478
https://www.ncbi.nlm.nih.gov/pubmed/24477254
https://www.ncbi.nlm.nih.gov/pubmed/28458279
https://www.ncbi.nlm.nih.gov/pubmed/9421440
https://www.nature.com/articles/srep39934
https://www.ncbi.nlm.nih.gov/pubmed/17490952
https://www.ncbi.nlm.nih.gov/pubmed/25095772
https://www.ncbi.nlm.nih.gov/pubmed/10344773
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315779/
https://www.ncbi.nlm.nih.gov/pubmed/12793960
https://www.ncbi.nlm.nih.gov/pubmed/21390145
https://hoffmancentre.com/2017/11/12-tips-living-mast-cell-activation-syndrome/

Is Your Histamine Intolerance Actually Mast Cell Activation Syndrome?

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

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

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

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

Histamine intolerance is a subset of MCAS

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

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

Conditions associated with MCAS

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

  • Chronic inflammatory response syndrome (CIRS)
  • Irritable bowel syndrome
  • Gut dysbiosis – the gut is rich in mast cells and home to over 70% of the immune system. Parasites, bacteria, fungi, and parasites can all trigger gut mast cells.
  • Obesity
  • Diabetes
  • Asthma and allergies
  • Autoimmune diseases (such as lupus, rheumatoid arthritis, and Hashimoto’s)
  • Candida overgrowth
  • Celiac disease
  • Parasite infections
  • Skin conditions such as eczema and psoriasis
  • Food intolerances and allergies
  • Gastroesophageal reflux (GERD)
  • Infertility and endometriosis
  • Postural orthostatic hypotension (POTS)

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

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

Resources:

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

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

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

12 Tips for Living With Mast Cell Activation Syndrome

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

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

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

1. Adopt a low histamine diet

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

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

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

3. Work on your gut health

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

4. Stabilize mast cell mediator release

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

5. Use H1 and H2 blockers every 12 hours

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

6. Block nighttime histamine release

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

7. Treat existing infections

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

8. Identify and remove toxins and allergens

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

9. Take helpful nutrients

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

10. Add supportive herbs

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

11. Get into a routine and stick to it

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

12. Reduce stress

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

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

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

How to Tell If You Have Mast Cell Activation Syndrome

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

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

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

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

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

Symptoms of MCAS

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

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

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

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

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

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

Lab work for MCAS

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

The most important tests are:

  • Histamine – plasma – Quest 36586 – must be chilled. Normal range – 28-51 ug/l.
  • N-Methylhistamine – 24-hour urine – must be chilled. Normal range – less than 200 mcg/g.
  • Prostaglandin D2 – plasma – must be immediately chilled and spun in a refrigerated centrifuge. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
  • Prostaglandin D2 (PGD2) – 24-hour urine – specimen collection must be chilled. Must be off NSAIDS (Motrin, Advil), aspirin, ASA, anything containing aspirin, for 5 days.
  • Chromogranin A – Quest 16379 – must be off proton pump inhibitors (PPIs) and H2 blockers (Pepcid and Zantac) for 5 days before tests, since they can falsely elevate chromogranin A.

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

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

Resources:

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

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

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

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

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

What is Mast Cell Activation Syndrome?

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

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

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

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

Any of these symptoms could indicate MCAS.

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

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

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

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

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

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

Detailed Symptoms of Mast Cell Activation Syndrome

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

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

 

Mast Cells The Bad

 

Histamine Intolerance & Mast Cell Activation

 

Most Common General Symptoms:

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

MCAS Symptoms by Organ System

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dental – Deteriorating teeth.

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

Illnesses Associated with MCAS

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

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

Here’s a relatively common situation:

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

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

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

Histamine Intolerance is a Subset of MCAS

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

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

Diagnosis of Mast Cell Activation Syndrome

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

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

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

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

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

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

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

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

10 Non-Food Triggers of Mast Cell Activation Syndrome

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

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

10 High Histamine Foods that Should be Avoided

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

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

Conditions Associated with Mast Cell Activation Syndrome

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

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

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

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

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

Ask Your Doctor for Lab Work

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

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

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

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

Further tests that may be of help:

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

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

Treatments for Lowering Histamine and Reducing MCAS Symptoms

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

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

If you want lasting relief for MCAS:

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

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

Here is how I approach treatment with my MCAS patients:

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

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

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

Resources

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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