Question from Travis comes in, “MAST cell activation syndrome. What is the general approach to managing or better understanding the underlying cause within Functional Medicine?”
Amy Nett: Mast cell activation syndrome can be caused by any number of things. I would probably still start with the gut. I would look at methylation as well, so B vitamin status, think about detoxification. We also sometimes think about mold-related illness or chronic inflammatory response syndrome. I think both Chris and I have sort of moved away from the most traditional approaches to chronic inflammatory response syndrome in terms of the full Shoemaker Protocol, for any of you who are familiar with them, CIRS, but sometimes they will use binders for potential mycotoxins whether it’s … even just chlorella sometimes, modified citrus pectin or clay, and then sometimes cholestyramine. Cholestyramine, or CSM, is the prescription. We use a compounded prescription medication that is recommended for mycotoxins or mold-related illness, and, again, from the work of Ritchie Shoemaker, but I found that to be a common cause of MAST cell activation syndrome.
Interestingly, I also had a patient whose inorganic mercury level was twice the upper limit of normal, and he had almost all the signs and symptoms of MAST cell activation syndrome. We did a lot of the MCAS testing on him, like tryptase levels, histamine levels, all these things, and they were actually normal, even though he really, again, he had all the signs and symptoms of MAST cell activation, and once we got his mercury levels down, that was actually all we needed to do. Again, I think MAST cell activation syndrome, just remember that there are so many different causes, and I don’t know that it necessarily points me in any one direction in terms of how to look for it.
I think I’m generally still doing a pretty comprehensive gut, B vitamin, what’s our detoxification capacity, are the mitochondria functioning well, looking on the organic acids test to get an idea of mitochondrial function, mold-related illness, heavy metals, probably some chronic infections as well. Again, I don’t really do tick-borne illness or tick-borne diseases, but I would imagine many of those chronic infections can certainly cause symptoms of MAST cell activation as well. As with most of your patients, just being a detective and trying to figure out what are the most likely sources, starting looking there and kind of figuring out where you need to go as tests come back normal, keep moving into the next one.