Gregory A. Plotnikoff, MD, MTS, FACP, IFMCP, is the founder and Medical Director at Minnesota Personalized Medicine, a micro-practice dedicated to serving patients suffering from mystery, complexity, and severity despite extensive medical evaluations. Dr. Plotnikoff brings to this work a broad background with board certification in Internal Medicine and Pediatrics, as well as advanced training in medical acupuncture, Kampo (traditional Japanese herbal medicine), hospital chaplaincy, and mind-body medicine. He is the recipient of multiple local and international awards for his work in cross-cultural and integrative medicine. These include early career distinguished achievement awards from both Carleton College and the University of Minnesota Medical School. Dr. Plotnikoff is the lead author in over 60 publications in the medical literature and 23 medical textbook chapters. His 2003 article on vitamin D deficiency and chronic pain is one of the most highly cited articles in the history of the Mayo Clinic Proceedings. He is the co-author with Mark Weisberg, PhD, of the book Trust Your Gut: Get Lasting Healing from IBS and Other Chronic Digestive Problems Without Drugs.
Kalea Wattles, ND:
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On this episode of Pathways to Well-Being, Dr. Greg Plotnikoff will explore a topic that’s been the subject of an increasing amount of research lately: mast cell activation. We’ll discuss how the functional medicine approach can help recognize when hyperactive mast cells may be contributing to a patient’s dysfunction and how we can begin to address this complex issue. Dr. Plotnikoff, we’re so excited to hear your perspective and how you’ve been working with patients. Welcome to the show.
Greg Plotnikoff, MD, MTS, FACP, IFMCP
Well, thank you. It’s great to be here. This is such an important topic for every IFM practitioner, so I’m looking forward to our conversation.
Well, I absolutely agree. And I thought to kick off our conversation on mast cells, we should do some exploration of their biological purpose. I feel like mast cells have been villainized a bit, and we have to understand that they do a purpose. Can you give us a primer on mast cells and how and when they are appropriately activated?
Oh my goodness, villainized is such a nice term because yes, they are actually friends or foes. And most of us in our education probably heard that they were about as boring as basophils. In fact, actually, they play a really important role in both innate and adaptive immunity and are behind multiple protective things on our behalf, ranging from anything from wound healing to the list goes on and on. And so allergies and our response to infections and more, they’re gonna be very pivotal for our host defense and clearly play a role in everything which is termed allergic. But, you know, the viruses, the fungi, the parasites, the molds, all these things are going to be in the realm of appropriate mast cell response.
Now, I like to think about mast cells as sentinels. They’re there on our borders with the outside world seeking to protect us. It’s like icebergs, saber-toothed tigers, smoke, they’re there to detect problems and to alert us. Every mast cell looks a little bit like a pepperoni pizza. And this is important, because mast cells have nothing to do with yachting or boating. It has to do with their misunderstanding, when first described in 1879. The person who first described these thought every pepperoni was a little bit of nourishment for other cells. And therefore, going to Greek or Latin for nursing nourishment, he called it a breast cell, a “mast” cell, like mastitis or mastectomy. But actually, within those pepperonis are over 200 key mediators ranging from things like amines like histamine—really important concept—proteases like tryptase and kinase, and cytokines like interleukins and tumor necrosis factor alpha; the chemokines and the eicosanoids, those leukotrienes and prostaglandins, and heparin and growth factors. The list goes on and on. There’s a lot they can do. And ideally, they’re there to protect us.
Well, I very much appreciate your use and skill in giving us these visualizations to help us conceptualize this really complex process.
Yes, so in trying to describe this to patients, it’s best to use metaphors, in my experience, so I talk simplistically. So I say, “Okay, alright, iceberg, okay. Right. Release the pepperonis.” And I tell people when the pepperonis are released, what we call degranulation, you have three things happen. One is gates open that are normally closed, fluid goes where it isn’t normally found. So like runny eyes, running nose, swelling, these are all mast cell–related concerns. Second thing is a call goes out, “Hey immune system, we need some help over here.” And that is literally—you’re inviting the immune system to the area when it arrives, activating it, rolling out the initial inflammatory response, which, of course, is a healing response.
The challenge is, though, it rolls out, and hey, we’ve been at this for a while, where’s the off switch, can’t find it. Okay, keep going. And that’s where it becomes a dysfunction and where people are inappropriately symptomatic and where some rebalancing is required. And that type of clinical state tends to be quite vexing for all practitioners, and certainly for every patient and their families and their friends and extended on out. But that’s where we get a chronic multi-organ, multisystem disease of abnormal activation, with inflammatory, allergic, and multiple other complications.
Thank you for giving us this contrast and comparing between a normal event that’s part of our immune functioning and then what we might call mast cell activation syndrome, which really describes this clinical state when these cells are being chronically triggered. Just to zone in on this a little bit further, can you describe to us how might mast cell activation becomes hyperactive? Why is that clinically problematic?
Well, it’s clinically problematic, when we think of the body perceiving that, rightly or wrongly, that there are a lot of saber-toothed tigers in the area, or icebergs, or forest fires, or whatever, that the threshold for activity may go down. And again, the body thinking that this is protective. And so when you think about triggering, it’s very important to think about triggering for this constellation of symptoms that can range from cutaneous flushing to chronic pain to brain fog to autonomic dysfunction to profound food and medication intolerances, things that get people labeled as whiners or all kinds of things, but these are the patients who need an IFM practitioner who’s going to be able to listen deeply, not presume that they’re crazy, despite this crazy range of symptoms, who can generate a hypothesis and then know the right test for assessing those hypotheses.
And recognizing that there are multiple triggers for mast cell activation that includes not just the classic understanding of IgE, whether IgG triggers, infections, toxins, an altered microbiome, a lot of environmental stimuli: heat, chemical, mold, barometric pressure, a variety of foods, alcohol, and this is a really important one, excipients in medications. Lactose is readily found and often not reported. And just like we get concerned about gluten, and medications for gluten for celiac patients and the like, there’s all kinds of things from polyethylene glycols to a long list of excipients that can drive things requiring people often to have to use compounded medications. And then there’s that final topic of stress: environmental, physical, emotional, spiritual, dietary stress, any one of those five forms of stress. There’s only one response: cortisol, and the higher the cortisol, the lower the threshold for mast cell reactivity. So imagine that you’ve got to have a variety of feed forward loops here taking place where the actual physical stress can set off emotional stress, can set off more physical stress, just kind of its feed forward loop. And so oftentimes these are patients that require practitioners like IFM practitioners who can think in multisystems, multidimensions at the same time and not just focus on a single pill as the answer for things.
As a clinician, I’ve often thought that this variety in the way that mast cell activation can manifest is a real clinical conundrum, because, as you mentioned, the symptoms present across a variety of body systems, and I’ve always felt that functional medicine is uniquely well suited to treat this type of patient, because it’s already part of our philosophy to look at all of those body systems, the functional medicine matrix, how that’s working together. And I think that’s the perfect lead in to my next question for you. How does the functional medicine understanding of the importance of mast cell hyperactivity in several different conditions differ from a more conventional definition of mast cell activation syndrome?
Okay, cool. This is a very important topic and question, and I’ll try to do my best job explaining this. First of all, there’s multiple things we need to consider. One is systemic mastocytosis and that people can present with, again, a wide variety of vexing symptoms, will often have a very high tryptase level, and often may have a variety of skin manifestations or other manifestations that will lead them to a hematologist and where maybe a bone marrow biopsy would be considered. And that’s where you’re looking for a greater than 25% mast cell clonal expansion, spindle cells under microscopy. And that’s a whole very different story. So once that one has considered that, rule that out, move on.
Then there’s another condition called hereditary alpha tryptasemia, HaT for short. And that is like systemic mastocytosis, we will have very high tryptase levels, but there is no evidence of clonal expansion. The mast cells aren’t spindled, they’re round. And this is due to a very specific genetic variation that leads to overproduction of alpha tryptase. And, but to people who have hereditary alpha tryptasemia, this can be autosomal dominant, can run in families, and until a 2016 article from researchers at NIH, these were people who are often, again, blaming the victim. Unfortunately, these are patients who were written off, but now, actually, we can say that these patients with very high tryptase levels have a wide variety of symptoms and need to be taken seriously, and that can be addressed by things that we’ll talk about a little bit later. Mast cell is for people who have these wide variety of symptoms, a big long list of challenges, maybe a big long list of doctors, a lot of frustration, and unfortunately, a lot of patients who have felt discounted or denigrated or dumped from the system, “Oh, you’re too complex” or “you’re a whiner” and stuff.
And this is where mast cell activation syndrome comes in, where, okay, is there an aberrant mast cell activation? Conventional allergists have asserted that the diagnosis for this comes from the measurement of tryptase within one to four hours after an event. Most often they would consider anaphylaxis an event. Anything less than anaphylaxis may not be considered an event. And the idea is that you have a baseline tryptase level and then a tryptase level which is 20% higher plus two and that meets the definition. But as every viewer right now understands, it’s like no one in the ER ever measures a tryptase, would ever consider that, it just never gets done. And this proposed definition really has very little clinical validation. And this is where patients then get stuck. “Oh your tryptase level is fine, you’re fine.” “No, I’m not.” And it’s this challenge of lack of clinical findings, lack of pathological findings, results in clinical abandonment. The patient’s a whiner.
But we know that IFM practitioners are very, very thoughtful, deeply caring, and recognize, and this is a key point, need to recognize that there is very limited data to substantiate the assertion that tryptase is the gold standard criteria for diagnosing MCAS. And I will stand by that. Absolutely. And the American Academy of Allergy and Immunology will vociferously disagree, but I think people can read the literature for themselves and see the flaws in the argument that this is a gold standard test. So the bottom line is that tryptase is a poor biomarker. And so many of the things that we hear, termed functional: functional GI, functional neurologic and stuff, really means idiopathic without abnormal measurements. And this is where IFM practitioners have a very important role to play. It’s just like, “Yes, we just haven’t asked the right questions. We haven’t got the right measurements.” And so my greatest hope is everyone watching this won’t consider at the start, patients are crazy even though the symptoms may be very vexing and bizarre, it can be really bizarre, but taking time to listen deeply, generate hypotheses, get measurements, can be really helpful, deeply helpful, for people.
Great. Well, I agree. The symptoms can be bizarre and frustrating. And I think that’s where we really underscore the importance of remaining curious and asking the right questions, and you mentioned some biomarkers. And I just wanted to revisit this for a moment, because as a primary care doctor, sometimes I am at a decision point where I have to choose whether to send my patient to a specialist or figure out what I can do in a primary care setting. For someone like me that’s doing primary care, what are some biomarkers that I might want to look for when determining if a patient has overactive mast cells? Is there something fairly simple that I can do just in my regular labs well covered by insurance?
Well, that is the great challenge. There are over 200 mediators released when mast cells degranulate. And only a few are measurable, and even fewer are specific for mast cells. And to complicate matters, they’re often very volatile, and so at room temperature, they can disappear within a few minutes. And so testing is really complex. Now, an ideal panel would include a plasma assessment of prostaglandin D2 and histamine. However, that requires a refrigerated centrifuge, and very few places can spend the thousands upon thousands of dollars to get a refrigerated centrifuge. So that may be just like, well, maybe that’s not gonna happen. Certainly, everyone can get a serum tryptase and should, and a chromogranin A. Those are easily done with a blood test.
More challenging are 24-hour urine collections, or maybe in spot collections for N-methylhistamine, leukotriene E4, and this is a great one where your lab will love you dearly, 2,3-Dinor-11beta-prostaglandin F2 alpha, perfect for Scrabble. But the challenge with these 24-hour urines is, we’re measuring very volatile things. So the collections need to be done in refrigerated containers kept in the refrigerator on—in an ice bath, brought to the lab on ice in some kind of container so that there’s been no room temperature or things, and then delivered to the person at the lab, the hospital lab, presuming that it’s their very first day and they don’t know how to handle these things. They cannot be left sitting around, they need to be frozen, separated and frozen and prepared for transport right away. It’s different from any other urine test. And because of the the stringent specimen and handling requirements, there can be a lot of false negatives, just because the hospital lab is gonna send to ARUP or Mayo or somewhere, and there may be a variety of intermediates in there. It’s just too many hands handling these things, making a lot of false negatives.
But in your clinic, I would say, please, you’re already doing this, but just know that, yes, ensuring a very good vitamin D level, ensuring a normal homocysteine level—critical for your patients with this. So a lot of times people will just say, “You know what, this is a $2,000 set of labs that can have a high risk of false negatives, we’ll just do the tryptase, chromogranin A” or, but if you have access to a refrigerated centrifuge, or a center where that can be done, those additional measurements could be really helpful.
Very helpful. Thank you for that. I have two just quick follow up questions. I have had patients come to me with a diagnosis of mast cell activation syndrome. They’ve been diagnosed by their GI doc who’s done an intestinal biopsy. I just wanted to get your thoughts on that. Is that something that you’re seeing often?
Okay, well that’s interesting, so thank goodness, you’re working with gastroenterologists who are actually measuring mast cells in their GI biopsies. That’s unfortunately rather rare in the United States. Yes, and there’s a debate over what is the number of what constitutes excessive mast cells. And also, there’s debate as to whether excessive mast cells are meaningful. But I’m sorry, I can’t remember the author’s name of a report that found that the mean number of mast cells per high-power field found in intestinal biopsies was 13. And the standard deviation meant that anything greater than 20 per high-power field was an increased amount. And there’s debate over kind of, well, if you have 40 per high-power field, or 60 per high-power field, or 80 per high-power field, is that clearly mast cell activation disorder? And that needs to be further evaluated, whether the numbers are definitive or not.
I think when people say we’re supportive, well, you have to remember also that there may be other factors which determine mast cell presence, and so I would say that that would be very important to mention but may not be definitive for mast cell activation. If you happen to be working with a gastroenterologist who is open to this, the request is an immunohistochemical stain for CD117. And that with reports on how many per high-power field for at least 10 fields, and that can be helpful. Under normal circumstances, that one would find low mast cells in the esophagus, and so that would only be part of the story. The other thing from a gastroenterology perspective is if you’ve got someone with quote “functional dyspepsia” and their endoscopy comes back boring, that there’s nothing seen, then you need to think mast cell. Or if there’s some kind of gastritis present without any known trigger for that, that you may need to consider mast cell activation as a driver of that as well.
I think this really speaks to what we teach in functional medicine also, which is really marrying any lab results to the clinical presentation. What is the patient experiencing? And so before we move on, I just want to ask one more follow up question. If someone doesn’t have access to all of this testing, whether they just don’t have a lab that will do it or the patient can’t afford the testing, but they clearly have symptoms of mast cell hyperactivity, is there a role or an appropriateness in treating them even without all of those lab results?
Yes, in fact, actually, and empiric treatment makes great sense. As long as you’ve ruled out other stuff, you’ve ruled out the zebras, so to speak, carcinoid and a variety of other things that everyone would consider, this big, long list of considerations, but if you’re really certain that this is kinda the way to go and that the flushing or other things are not due to pancreatic neuroendocrine tumors, like, then yes, absolutely, empiric treatment makes great sense. And first line treatment is H1 blockade and H2 blockade. And that can be done both by natural products as well as relatively inexpensive over the counter products. The challenge is many people who are highly highly reactive can end up maybe reactive to excipients found in over the counter products. Second caveat here is that Zyrtec doesn’t equal Claritin and doesn’t equal Allegra and doesn’t equal quercetin. Some people respond really well to one and not the others. And so it often makes sense to go the over the counter route. Well, actually, everyone needs as much as possible to go the over the counter route for cost. Then, if people tried three weeks on Zyrtec and three weeks on Claritin, three weeks on Allegra, and then report back which seems best, that can be helpful. I’ve been surprised by the unpredictability of a very favorable response to one of these medications.
I was going to ask, I tend to rely on pattern recognition, but it seems like pattern recognition isn’t so straightforward with this one, and it’s a little bit hard to predict responsiveness.
Yes, so that’s where the relationship that is so important and to be able to speak with confidence and clarity and commitment to the patient, to be with them, walk with them through these challenges, is so important. And we may have to, like, do trial and error because there really is no predictability and maybe there must be a better term than trial and error. Just trial and retrial. Maybe best.
There you go. Well, you mentioned a few pharmaceutical and nutraceutical options that we can choose from, but I also wanna talk about nutrition, which is really at the core of a functional medicine approach. I’m wondering if you have had any success with nutritional interventions, anti-inflammatory diets, elimination diets, low histamine diets; what kind of dietary changes are working well in your practice?
Well, in my experience, and having seen a lot of mast cell patients over the past six years, people may respond well to a low histamine diet. So that’s a first line thing and being aware. So a nice story to illustrate this, a woman came in one day she said, “I don’t know what’s going on. We’ve been married 30 years, we love each other dearly. But every time my husband cooks, I am miserable.” This big, long, long list of things. She said, “I don’t think he’s trying to poison me, but…” I said, “Well, what does your husband cook?” “Well, he doesn’t really cook, he heats up leftovers.” Oh, bing, bing, bing, bing, bing, and just, like, seriously, it’s just like eliminating leftovers as her meals made a profound difference. And we know no leftovers, particularly leftover meats and especially fish, are just going to be high in histamines. The older the foods, the higher the histamines. And there are a zillion different lists of high histamine foods, none of them agree. And so again, it’s just walking with people on food and symptom diaries and, like, listening to their experience, trusting the patient before any technology becomes very important, but a lot of people have expressed concerns, “Oh, I thought this kombucha and yogurt sauerkraut diet was really good for me.” Well, maybe not.
So, but after a low histamine diet, I’d also say it’s worth considering gluten-free or grain-free diet. Now one of the things is that people may not be gluten reactive. There are about 10 other reasons why going grain-free might be actually quite good. One of them is nickel. And so I ask people about the nickel test, that is, do you have problems wearing earrings? Do you have to be careful? Silver or gold? Can you wear costume jewelry? Well, turns out that that’s a great test for nickel reactivity. If costume jewelry drives one’s ear crazy, with swelling and redness and crustiness and pain and itching and whatever, then we have to consider then that foods high in nickel may cause that same reaction in the gut. Now, how significant can this be?
Well, so two years ago, I saw a woman who for nine years had these unusual rashes on her body. They would stay there for weeks and sometimes she would go months without leaving her house because she was so embarrassed with their being visible, she’d have to try covering up. In nine years, I kid you not, nine different dermatologists, at least a dozen biopsies, no answer. I said, “Oh, I see that you’re not wearing earrings.” Okay, we have a hypothesis. I said, okay, let’s go two weeks on a no-nickel diet, a minimal nickel diet. And I kid you not, in two weeks she’s coming back, “They’re gone. They’re gone. For the first time in nine years, they’re gone.” So it’s like, I take that to be very important. Now, of course, every IFM practitioner must know that you cannot be gluten-free and plant-based at the same time without paying deep attention to methionine levels. There is no methionine in a gluten-free, plant-based diet. Period. And you know how methionine is so important for methylation and for everything else. So one has to pay close attention to that if one is going to be gluten-free, grain-free on this.
The third option to work with people on is FODMAPs and that we know that there’s been one trial of a low-FODMAP diet and IBS-diarrhea patients that have shown a reduction in plasma histamine levels. Maybe important, maybe not. We know that a high-FODMAP diet results in visceral hypersensitivity and increased mast cell density in the colon. Important to know, but the challenge, of course, on a low-FODMAP diet is that it’s very hard to get the food intake that can support butyrate production in the gut, and so we won’t take low-FODMAP diets, we wanna be just aware of that they’re not meant for long-term care and that there may be other approaches to the same issue. I think the biggest one that we hear the most about is going to be the high histamine diets and just being aware what foods are very high in histamine, like chocolate and tomatoes and alcohols, and this is where we practitioners may be accidentally labeled Doc-zilla because, “Not my chocolate!” But in fact, that may be an issue.
And another thing I find really important is dose determines poison. So having a spinach salad with cheese and olive oil vinaigrette and strawberries, a glass of iced tea followed by a big fruit salad dessert, it’s just maybe too much, and so it doesn’t mean that people can never have some things again. It’s just really a matter of paying attention to total dosing. But we do know histamine in foods can activate mast cells in the gut, causing direct gut issues and systemic reactions. And we get this feed-forward loop. And this is a key concept. Mast cells degranulate and release histamine, histamine comes right around and reactivates the mast cell. So mast cells are long living, unlike a bee that once it’s stung, it’s out of the picture, a mast cell can keep on making the pepperonis and keep on releasing them. And we get this feed-forward loop going on. You know, this is where people get stuck in a detrimental, non-resolving, proinflammatory loop. And our mission is to break that. And that often requires going beyond diet and beyond nutraceuticals and including more classic pharmaceuticals.
Wow, so many clinical pearls for us to chew on there. And we’ve talked about the pharmaceuticals, nutraceuticals, dietary interventions. And I want to make sure that we check in on the mind-body-spirit connection that’s so important in functional medicine. It’s what we call the center of the matrix. And it’s really important that we align all of those pieces for optimal health. And I know that in your professional background, you’ve studied the impact of spiritual concerns in medical care. And I’m wondering, how might you incorporate this with a patient who presents with some mast cell hyperactivity? Are there mind-body therapies like meditation or yoga? I imagine some of those things might be really helpful to downregulate that inflammatory cascade that you’re describing.
Absolutely. And so many of our patients have experienced traumas, physical traumas, emotional traumas, sexual traumas, traumas in the medical system. And this can put people into a kind of, again, a detrimental, non-resolving, pro-inflammatory loop. And which, again, it’s this feed-forward system. So the key point is, and from people who have experienced abandonment, one, we need to actually affirm this commitment to be with people and not have them reexperience that kind of trauma, which is a really important part of it. Likewise, when people are coming to you for diagnosis, oftentimes, they may get a little bit sensitive if you’re saying, “Well, let’s talk about meditation.” And so one has to weave this in as part of an overall picture for things. And that’s where I talk, again, going to your pizza analogy, where there are many slices to make the pizza and just one slice is to consider the role that the unconscious plays in all of this.
And so, I guess I need to share with you a story about the unconscious and how powerful this can be. This is one I share with a lot of patients. A number of years ago, I did a large, randomized clinical trial on four herbs and a mushroom for menopausal hot flashes. You can imagine we were overwhelmed with people wanting to get into this study and enrolled 180 women and, you know, there was placebo, regular dose, high dose, of keishibukuryogan, a traditional Japanese herbal medicine, which is a leading prescription drug in Japan for menopausal hot flashes. At the end of the trial, we called women and said, “Would you like to know what you were on?” They all said, “Oh yes, yes.” I never forget the third woman I talked with. I said, “What do you think you were on?” She said, “Oh high dose, no question.” I said, “Oh, tell me about that.” She said, “Oh, for the first time in years, I wasn’t kicking my husband. I wasn’t throwing off the sheets. I wasn’t changing the pillow, changing my night gown, going to the bathroom, I slept great.” And then a couple weeks after finishing the trial, it all came back, and I said, “Oh cool. Well let’s open this envelope.” I, just wanting it to be a successful study, I’m just like, “Placebo.” And she was, like, mad at me, and then, “Oh, no, no.” You just need to get a mind-body connection. This is a gift, this is a skill that can be developed further. But I think what I wanted to share with you is the role of the unconscious. And that is, we can reframe things. We can do all the cognitive behavioral therapies, but it’s the unconscious that plays a very profound role. And in this case, we had irrefutable physiological changes when she was asleep.
So yes to yoga, yes to meditation. But I’m also very much in favor of these more shamanic approaches as well. Many people feel that they haven’t been heard. If the prescription, number one thing on the prescription is meditation or yoga, they can feel dismissed or discounted. They’re looking for a diagnosis and a cure. So it’s just part of the greater picture. The unconscious, though, the ways of accessing that have been very powerful, and things like the Gupta Program, Annie Hopper’s DNRS, polyvagal approaches. I found that these more shamanic approaches have been deeply powerful, and I have received, I think it’s three letters now from patients unsolicited. And it’s not like I get a lot of letters from patients, but unsolicited, and I rarely get letters. In fact, I’ve never gotten letters where people have used the word miraculous. But I think it’s three letters now where people use miraculous around DNRS. And so that’s an important part of things. You know, one woman said I was down to three foods, I was completely dysfunctional, blah, blah, blah, with this, now I’m now up to 28 foods. I have my family back, I have my job back, I have my life back. And we’ve gone full court press on the medical approaches, but it was the shamanic approaches where the great breakthroughs really came. So I see that as a very important part of the whole picture. And anything that will dial down cortisol, anything you can do to help people dial down the inner critic and dial up hope, dial up optimism, dial up perception that their future will be different than the present goes a long, long way to help people recover from these very vexing multi-organ, multisystem challenges.
It’s a really fascinating connection. And one observation I have just listening to you talk, it’s interesting how you said patients that have mast cell disorders tend to have some history of abandonment on their timeline, or that’s a common pattern that you see. And these are the same patients that come into my office and say, I’ve been through 10 different doctors, and, you know, we haven’t found a solution yet. And sometimes there’s a sense of abandonment from the medical field in general. And that’s an interesting connecting point I didn’t make until right now.
Oh, yes, yes, you play a very important role in having people rediscover a trust in humanity. And we are all professionals in the service of healing, ideally. And that’s why it’s so distressing and so saddening, so aggravating when we encounter people, the suffering that comes to my door here, it’s quite immense. But I tell people, “Why do I love my job? I love my job because good things happen.” When good things happen, I like to celebrate. In fact, over your shoulder there, there’s a special bowl I brought back from Japan. And when good things happen, we ring it, and so I want you to focus on what it would take to ring the bowl with you. And I have to admit that there’s barely a week that goes by where I don’t ring the bowl at least once. And it’s most deeply meaningful, it’s deeply meaningful when that happens, and just because we encounter a world of suffering, and it’s our role to be in the service of healing. And I think every one of you who’ve stayed this long in the broadcast is actually committed to that. And so I wish all of you the very best at bringing your full humanity in the service of healing.
Well, thank you so much. That was a beautiful way to close our episode. And I certainly feel like it’s been a good thing for me to share this time with you today. So thank you so much for bringing your clinical insights. It’s just been a pleasure to talk with you.
And thank you so much. It’s been great fun, and yes, I wish you and your patients well. Thank you.
Want to learn more about mast cell activation syndrome? Join IFM and the functional medicine community June 4th and 5th for AIC 2022, an online event at a special price. Visit aic.ifm.org for more information.
Below are links to some recent references provided by Dr. Plotnikoff regarding mast cell activation:
- Mast cell activation syndrome: a primer for the gastroenterologist.
Weinstock LB, Pace LA, Rezaie A, Afrin LB, Molderings GJ.Dig Dis Sci. 2021 Apr;66(4):965-982.
- Diagnosis of mast cell activation syndrome: a global “consensus-2”.
Afrin LB, Ackerley MB, Bluestein LS, et al.Diagnosis (Berl). 2020 Apr 22;8(2):137-152.
- Recent advances in our understanding of mast cell activation – or should it be mast cell mediator disorders?
Theoharides TC, Tsilioni I, Ren H.Expert Rev Clin Immunol. 2019 Jun;15(6):639-656.
- Long-COVID syndrome-associated brain fog and chemofog: luteolin to the rescue.
Theoharides TC, Cholevas C, Polyzoidis K, Politis A.Biofactors. 2021 Mar;47(2):232-241.
- Mast cells, mastocytosis, and related disorders.
Theoharides TC, Valent P, Akin C.N Engl J Med. 2015 Jul 9;373(2):163-72.