In this episode of Functional Medicine Research, I interview Dr. Bruce Hoffman, who’s a board certified physician and he has a fellowship in Anti-Aging as well as a Master’s degree in Clinical Nutrition. He is also a certified functional medicine practitioner. Speaking with Dr. Hoffman was extremely educational, we spoke about mast cell activation syndrome and how exactly the condition is diagnosed. Dr. Hoffman covers how he first got interested in the disease and the progress that he’s made working with several other doctors working to understand the implications of mast cell activation syndrome. Dr. Hoffman explains how some conditions overlap and indicate mast cell activation syndrome; such as fatigue, brain fog, and even GERD. You should come away from this interview with a much better understanding of mast cell activation syndrome, how it’s diagnosed and what lab tests are beneficial in assisting in this diagnosis.
Below is a transcript of the interview on Mast Cell Activation Syndrome:
Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg. And I'm really looking forward to today's conversation with Dr. Bruce Hoffman. He's a board certified physician, and he has a Fellowship in Anti-Aging, as well as a Master's Degree in Clinical Nutrition. He's a certified functional medicine practitioner. And one of the really interesting things about him is that, in addition to his clinical training, he studied with many of the leading mind-body and spiritual healers of our time. So people like Deepak Chopra, Paul Lowe, Osho, Ramesh Balsekar, and one of my favorites, Jon Kabat-Zinn.
So, Dr. Hoffman, you shared the stage with Dr. Deepak Chopra, Dr. John Demartini. And he continues to spread his inspiring vision of healing and wellness with audiences and patients around the world. So Dr. Hoffman, welcome to the show.
Dr. Hoffman: Thanks very much, Nikolas. I'm glad to be here. Thank you.
Dr. Hedberg: Great. So I'm really looking forward to this discussion on mast cell activation syndrome. It's something I haven't seen a lot of in my practice. I have heard a number of lectures on this and read quite a bit about it. And it seems to be an area of your expertise. So why don't we jump right in and just talk about what mast cell activation is, and how is this condition diagnosed?
Dr. Hoffman: Sure. I first got interested in mast cell activation syndrome when I started to work with a cancer patient advocate by the name of Dr. Mark Renneker out of San Francisco. And he alerted me to the connection between cancer and mast cell activation syndrome, particularly in gynecological cancers. And then put me in touch with Dr. Lawrence Afrin, who leads one of the major sort of advocacy groups for mast cell activation syndrome as opposed to systemic mastocytosis, which I'll explain in a bit.
And so I've been for the last three to four years working with Dr. Lawrence Afrin's group and learning to understand the implications of mast cell activation syndrome in most of the patients that we see. Which are chronic multisystem, multisymptom patients who, as you know, have been everywhere and remain frustrated with the one disease, one drug paradigm that we learned at medical school. So, what I learned over time was how to separate between two specific conditions, one called systemic mastocytosis and the other called mast cell activation syndrome.
But before I begin with that, I'd like to say that mast cells are part of a...they're produced in our bone marrow, and they're part of our immune system. And they make up a very small percentage of it. And they act as defense structures against incoming invading pathogens. So anything that comes into our environment or into our biome, mast cells are often at the first line of defense. And they were actually discovered a long time ago, 1878, I believe, by Paul Ehrlich. And he called them mast cells because they were fat and puffy.
And the word mast in Greek means breast or the German means masticate. So, this is how the name mast cell got generated. Just for your North American readers, I say mast, and most people don't know what I'm saying. So it is mast in North America. People often don't know mast cells, what I'm saying.
So, these were originally discovered by Paul Ehrlich when he developed specific staining for them. And since then, they sort of lingered on in the literature. They were linked early on to cancer, but that sort of faded out of the picture and sort of just resuscitated by some Italian researchers who now are doing massive amounts of work on mast cell activation syndrome and cancers. And then it really sort of resurfaced in the 1990s and didn't really gather steam until about 2007, when two, you know, researchers and clinicians put together sort of a consensus statement on what constitutes mast cell activation syndrome.
There are two different schools of thought and they do tend to conflict with each other in terms of the diagnostic criteria. But basically, mast cells being part of the immune system, and regulating many of the incoming so-called antigens or toxins tend to be distributed in almost all tissues, but nowhere quite as much as on mucosal surfaces: so eyes, mouth, skin, GI tract, bladder, etc. They're also found in other tissues, you know, lungs and heart tissues, and brain, many mast cells activated in the brain.
And so when they get triggered, they do tend to release many, many mediators of inflammation. And it was estimated that there were over 200 mediators of inflammation that get released by these mast cells. But Dr. Afrin in a very recent post, as of last night, said that he's now changing his opinion that he believes there are over 1,000 mediators released by mast cells. All these inflammatory mediators like histamine, like proteases, prostaglandins, leukotrienes, all these inflammatory mediators that then set up this multisystem inflammatory response, which can confuse diagnosticians particularly if you have been trained in single organ, you know, specialties.
So that leads to the sort of difficulty with the diagnosis as people present with many different symptoms. And unless you have an understanding of mast cell activation syndrome, and a method of sort of sifting through the multiple systems they can present, you can often get very confused and misled. So the recent, you know, people speaking about mast cell activation syndrome is an attempt to bring some coherence to this somewhat disorganized field. And hence, establishing criteria for the diagnosis, lab tests, and then treatment protocols. So now it's coming into its own and I think you're gonna hear a lot about it in the years to come.
Dr. Hedberg: Mm-hmm, so we're talking about illnesses that may be so-called mystery illnesses, and multifactorial presentations like gut issues, skin, brain, and things like that. Can you just let everyone know some of the overlap that you see in various conditions in your practice that would specifically indicate mast cell activation syndrome?
Dr. Hoffman: Yeah. So mast cells, when they release the inflammatory mediators, can present locally or systemically. So a local condition would be something like hives, urticaria, or interstitial cystitis. Or it can be systemically like people can present with often cognitive symptoms. So they'll have fatigue and brain fog, and associated GI symptoms, like GERD. GERD is a potentially very big diagnostic category for mast cell activation syndrome or, you know, the irritable bowel syndrome. Even the autoimmune diseases of Crohn's disease and ulcerative colitis have been linked to mast cell activation syndrome.
Asthma is another one. Asthma, you know, if you analyze all the triggers of an asthma response, and you identify them, like, for instance, mold, allergy or mold inflammation, which are two different criteria, and you remove the trigger and downregulate the mast cell activation potential, I can't tell you how many cases of asthma have been absolutely shut down when you treat the mast cell activation. It's very rewarding. The same goes for GERD, the same goes for irritable bowel syndrome. The same goes for anxiety and cognitive decline. When you target the triggers and downregulate the mast cell activation, it's very rewarding to treat these patients, and they're very grateful. Angioedema, another, canker sores another one, there's many, many symptoms in all the organs that can present with this syndrome.
Afrin has written a chapter in a book. The book is called "Mast Cells," the editor is David Murray. The chapter is chapter...I think it's chapter 6, and it's called Presentation, Diagnosis and Management of Mast Cell Activation Syndrome. And at the back, he gives a long, long list of every organ that can be affected from ophthalmic, to lymphatic, to pulmonary, to cardiovascular, and just goes through all the systems, even fibromyalgia, even osteoporosis, headache, all the mood disorders, dysmenorrhea, endometriosis, many of the hematological conditions, the immunological conditions. There's a huge long list of different organ systems that can be affected that present as isolated diagnosis to specialists, but often they miss the overriding pathophysiological basis to the condition.
And our training as MDs makes us very aware of what is called systemic mastocytosis, which is when the mast cell from a clonal perspective within the bone marrow becomes amplified. There's actually a mutation of the KIT gene. And the mast cells become very high in numbers. So there's increased numbers of mast cells, which is systemic mastocytosis, which is very different from mast cell activation syndrome, which is an abnormal reaction of the mast cells, not an increased number.
So I can't tell you how many patients come back to me after having got the diagnosis of mast cell activation syndrome by myself with the criteria I use go to the specialties, go to the hematologist,
