Episode 27: Dr. Kelly McCann, MD on MCAS, POTS, and Mold Toxicity
Show Summary:
Have you ever heard of mast cell activation syndrome and wondered if it is the missing puzzle piece for you? Or do you have mast cell activation syndrome and want to know what you can do about it?
Today we are diving into Mast cell activation syndrome, also known as MCAS, with Dr. Kelly McCann.
Dr. McCann has been in private practice in Costa Mesa, California since 2008. She is certified by the Institute of Functional Medicine and also Board Certified in Integrative Medicine by the American Board of Physician Specialties.
She lectures internationally on various topics, including mold and mycotoxin illness, lyme and chronic infections, mast cell activation and related conditions and environmental medicine.
Join us for a conversation today with Dr. McCann about MCAS, how it intersects with mold toxicity and POTS, and what you can do to support your health.
Timestamps:
0:00 - Introduction
3:38 - What is MCAS?
6:08 - MCAS and brain health
7:30 - How do you know it’s MCAS?
18:01 - MCAS & POTS
24:46 - MCAS & Mold Toxicity
31:54 - Low Histamine Diet & MCAS
35:35 - Gut health and MCAS
37:34 - How prevalent is mold toxicity?
39:38 - Cats carry bartonella
42:22 - Treatments for MCAS
51:00 - Dr. McCann’s morning routine
52:08 - Dr. McCann’s book recommendations
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Full Episode Transcript:
SPEAKERS: Dr. Andrew Wong, Dr. Kelly McCann
Welcome to the Capital Integrative Health podcast, a podcast dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of both disease and wellness. I am Dr. Andrew Wong, co-founder of Capital Integrative Health, an integrative practice committed to expanding access to holistic root cause medicine to the global community.
Dr. McCann:
Patients with muscle activation, they get worse with treatment, they can't tolerate the treatments, they get exacerbations of their symptoms when we start to try and give them binders and give them antioxidants like glutathione you know, even putting people on phosphatidylcholine when the standard treatments for mold illness don't work right away though I know we're dealing with mast cell activation.
Dr. Wong:
Have you ever heard of mast cell activation syndrome and wondered if it is the missing puzzle piece for you and your health or do you have muscle activation syndrome and want to know what you can do about it? This is a very complicated topic but today, we're diving into mast cell activation syndrome also known as MCAS with one of the nation's experts on mast cell activation, Dr. Kelly McCann. I am Dr. Andrew Wong, co-founder of Capital Integrative Health. This is a podcast dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of both disease and wellness. Dr. McCann has been in private practice in Costa Mesa, California since 2008. She is certified by the Institute for Functional Medicine and also board certified in Integrative Medicine by the American Board of Physician Specialties. Dr. McCann also lectures internationally on various topics including mold and mycotoxin illness, lyme and other chronic infections, mast cell activation syndrome and related conditions and environmental medicine and personally she is one of my most favorite mentors. Join us for a conversation today with Dr. McCann about MCAS, how it intersects with mold toxicity and POTS, which is also known as paroxysmal orthostatic tachycardia syndrome, and what you can do to support your health. Thank you so much, Dr. McCann for coming on to our podcast. We're so honored and delighted to have you here.
Dr. McCann:
Thank you, Dr. Wong. I’m very happy to be here.
Dr. Wong:
So, also you know, just on a personal note, Dr. McCann's been a mentor of mine for a while, really a lot of what I've learned in Integrative Functional Medicine I’ve learned from Kelly so I really want to thank you for that.
Dr. McCann:
You're welcome, my pleasure.
Dr. Wong:
And you know, as you see in your clinic as well, we have a lot of patients, a lot of people in the community even that aren't in our clinic that have a lot of complex chronic illnesses you know, health challenges of course. We know that you know, the puzzle pieces of people's health is kind of like it's not a checkerboard, right? It's not where we could say a two-dimensional puzzle. It's more like a rubik's cube, you know, In some ways.
Dr. McCann:
Absolutely. And I was never very good at rubik's cubes but fortunately, the human body seems to be a little bit easier for me to put together than a rubik's cube.
Dr. Wong:
Exactly. I mean there are people that are very talented with rubik's cubes. There's actually a Netflix series called ‘Cubed’ where these world champions can do rubik’s cubes in like five to six seconds actually which is amazing. They tend to be good at Math and like they tend to be very much you know. into that. But today, we want to talk about one piece of the puzzle, of the rubik's cube which is mast cell activation syndrome and we'd like to talk about mast cells first what they are, what MCAS is and then we'll kind of go from there and maybe explore other parts of that rubik's cube and how that's kind of related to the other parts.
Dr. McCann:
Sure. It's one of my favorite topics so I’m happy to talk about it. So, mast cells are part of our immune system and it turns out that they are actually derived from some of our red blood cells so it's a hematopoietic stem cell line that then goes to the myeloid stem cell line which also is where we get our platelets our red blood cells and then many of our white blood cells with the exception of the lymphocytes and those mast cells are actually pretty small in number but very very important for our immune system defenses. They tend to grow up in the bone marrow and then move to the areas of interface between ourselves and the outside world so they live at the border of our mucous membranes , in our upper respiratory tract, in our lungs, they line our entire gastrointestinal system, they also tend to be in our brain and then on our skin. And so, because they are lining the areas of entry point for our body, it's their job to be constantly surveilling for foreign invaders and so what happens with MCAS is that these immune system cells get dysfunctional, they get hyper responsive, they start to perceive threats where there may not be any even though there may have been an initial threat that was a true threat like a an infection or a toxin. Now, they've gotten triggered and they are reacting to all sorts of things and as a result, causing a lot of symptoms in patients.
Dr. Wong:
So, there's a lot that we can go into with that.
Dr. McCann:
Yes, certainly.
Dr. Wong:
I think the first thing that came to my mind when you were talking about the different organs where the mast cells concentrate you know, the gut, the lungs, the sinuses. When you said brain, I kind of paused because I was like “Wow!”, you know, brain's an internal organ, why would that be a mast cell site? Is it basically because that's another entry point with the blood-brain barrier and things like that or?
Dr. McCann:
You know what, I haven't actually looked at that specifically to figure out if they're there because of protecting the blood-brain barrier but we do know that when patients have mast cell activation symptoms, they get a lot of neurological and cognitive symptoms too so some of the the symptoms can be depression, anxiety, mood changes, irritability anger, headaches and I was just looking at a paper where it does tend to be that there's this relationship between the gut and the brain with regard to mast cells too so you've got a lot of mast cells in the gastrointestinal tract and then the GI tract is communicating back and forth by the vagus nerve to the central nervous system and so there's crosstalk there too but that's a good question. I'll have to investigate why we have a lot of mast cells or some mast cells in our brains.
Dr. Wong:
Thank you and just the symptoms you listed and we know that a lot of symptoms with mast cells with you know, anxiety, depression and then on the other end gut issues. How do people know like listeners out there if they have these type of symptoms, if it's something else that's causing the anxiety, depression, the irritable bowel you know, etc., etc., or if it's related to mast cell?
Dr. McCann:
It's a good question and it is hard. I mean I think this is part of the science, of the art of Medicine, you know? There are two different consensus in terms of diagnostic criteria. There is what on my side we call the ‘consensus one’, diagnostic criteria for mast cell activation and typically, these are going to be the more conventional allergists and they recognize anaphylaxis and some of the allergy type symptoms as symptomatology related to mast cells but then, they have this very strange, what I perceive to be very strange, diagnostic criteria where they only look at tryptase and they say if tryptase is 20% plus two nanograms per milliliter greater during a flare than at a normal time frame, that is the criteria so their criteria is very rigid and then you know patients have to respond to appropriate treatments so that's consensus one. That was originally delineated by an allergist named ‘Valent’ and his cohort of folks in 2010. Soon after that, Dr. Lawrence Afrin and his colleagues put out a different statement which we've now decided to call ‘consensus 2’ and it has a lot broader diagnostic criteria which means that patients who are suffering from these unusual symptoms are much more likely to be able to get a diagnosis and to have appropriate treatment from practitioners who understand that mast cell activation can be a very broad spectrum of symptoms and may or may not even have biochemical evidence in labs because the truth is mast cells produce these chemicals we call mediators. There are hundreds, if not thousands, of mediators that are produced by mast cells and in commercial labs, what we have available now, we can test for maybe six or seven maybe eight of these markers so the likelihood that somebody could have mast cell activation with lots of symptoms and still get a biochemical lab value that is positive, no it's not a hundred percent.
Dr. Wong:
Would you say that mast cell diagnosis is kind of like finding a needle in a haystack but then not even realizing there might be six or seven different haystacks, we're looking at like one haystack, you know?
Dr. McCann:
Yeah, absolutely. It is complicated so you know, in order to get back to your question, “How does a patient know that they might have mass activation?”, it is you know, probably the easiest way to say it is it's inflammation that might be in multiple systems of the body and typical symptoms could be things like fatigue, allergy symptoms, irritable bowel symptoms, people can get palpitations, chest pain, they can get neurological symptoms like we talked about with the anxiety, depression, migraines, etc., they can have shortness of breath and lung symptoms, asthma symptoms but also again, think about inflammation in other parts of the body so interstitial cystitis which is bladder irritation, any sort of fibromyalgia type symptoms, joint pain, headaches and then for women they can have menstrual irregularities, heavy periods, painful periods and then autonomic nervous system dysfunction so the autonomic nervous system which is as you know part of the nervous system that enables us to breathe and our hearts to pump and our gastrointestinal system to do its job without us having to think about it. That system is often impacted either by mast cell activation or as its own separate entity which we can talk about.
Dr. Wong:
Wow, wow. That's a whole other that. Rubik's cube just opened up a new rabbit hole. Oh well, let's let's dive into a couple of small rabbit holes. I think there won't be too deep. We can still get out of them here but-
Dr. McCann:
Okay.
Dr. Wong:
So, one thing is you know, in terms of mast cells and you've explained really beautifully here you know what they are, how they work in the system you know, what symptoms might be you know, sort of diagnostic based on criteria two or consensus two like you said. A, how common is it for people to have there been studies on consensus two mast cell activation but also if we think about it from an integrative functional naturopathic perspective, right, in terms of root cause you know, and chronic disease often being caused by inflammation and we know that inflammation usually doesn't silo in one organ, right? It always kind of spread you know, brain, gut, hormone system, different tissues in the body. Wouldn't all chronic inflammation in a way be potentially influenced by muscle activation?
Dr. McCann:
Potentially. I mean it does get a little confusing but I think that one of the things that I will say is it does appear that about 17 of the general population has mass cell activation.
Dr. Wong:
You said 17?
Dr. McCann:
17%.
Dr. Wong:
That is a huge number.
Dr. McCann:
Exactly. That is a huge number of people and the history is really really important so many of these people who develop mast cell activation will be allergic to kind of kids. They might have food sensitivities and food allergies, they might have environmental allergies as kids and typically, if you listen to the story and take the time or for you know, those patients who are listening, think about your own history and you may see that there's periods of waxing and waning and increased exacerbations of symptoms over the years so you know, I was an allergic kid, I had you know runny nose and allergies and stuff
like that in my teenage years and it wasn't until later that the mold exposure and the lyme disease and all those things started manifesting in gastrointestinal issues and hives and things like that so you know, if I look at my own life I can see the progression from being I would never would have been diagnosed with mast cell activation as a teenager but you know now, in my late 40s early 50s I have a lot more symptoms and so I think that that's part of it too is that there's this stepwise progression that happens mostly because our mast cells are getting triggered by a variety of different things like chronic infections, like mold exposure, like environmental toxicants which is their job and we don't know all the genetics. In fact, mast cell activation seems to be more related with kit genes that have what are called somatic mutations so we're not all born with mast cell activation. I think the genes take hits over time that start to change the functionality of those mast cells, getting them to be more and more hyper responsive so.
Dr. Wong:
Yeah. I kind of when you were saying that I was imagining if someone was like hitting my shoulder, right? Right like this you know, and the first few times it was just like a little annoying but then after a while it's like oh my shoulder's starting to hurt and it starts to throb and you know, that kind of thing.
Dr. McCann:
Yeah. I think it works something like that.
Dr. Wong:
Something like you know, the masT cells are getting more sensitized over time. Do you feel like as a population, are we getting more sensitized in general by the global hits of not only infections but you know global toxicity and all these different things, the pesticides all that?
Dr. McCann:
Absolutely. I think unfortunately, our health is going to continue to be challenged because of so many environmental exposures that we have whether that's glyphosate or you know other pesticides et cetera, et cetera. That's a whole topic.
Dr. Wong:
That's a whole other topic, yes. So, there's a lot of connections so we might want to explore the rubik's cube a little bit and then I think towards the end, we may want to talk about you know, as mast cells we know that you know, mast cells are needed for a defense system needed for the immune system to sound that red alert on, hey let's rev up that immune system, let's let's defend and protect you know, our bodies but then you know, there's that balance point it sounds like is what you're saying, Dr. McCann. You know, there's a point at which they need to be revved up but not too much, you know, so that it causes things like autoimmunity or POTS or you know, these type of things or you know, one of the contributors to POTS maybe.
Dr. McCann:
Yeah.
Dr. Wong:
So, I guess let's talk about some of the connections first and then we'll go into later how to maybe desensitize those mast cells or kind of calm them down, have them take a little bit of a chill pill if you will.
Dr. McCann:
Yeah, exactly.
Dr. Wong:
So, let's talk about some of I know your favorite topics. What are the connections between mast cell activation syndrome and POTS, what is POTS, and I think that you know, we can talk about that first.
Dr. McCann:
Sure. So, POTS stands for postural orthostatic tachycardic syndrome. That's why we call it POTS because that's quite a mouthful and essentially what that means is when somebody goes from lying to standing, their heart rate increases in an abnormal way. You know, we really shouldn't have a big jump in our heart rate but with patients who have this POT syndrome, their heart rates can jump 30 or 40 beats. The younger they are, the more you have to have the 40 beat per minute increase, so that's the clinical definition of POTS. Now, POTS is only one of a variety of different kinds of dysautonomic conditions. Another fairly common one is orthostatic hypotension where the blood pressure drops, systolics 20 beats or diastolic 10 beats, 10 points when a person goes from lying to standing up but the POTS tends to be much more common with muscle activation. I did a quick literature search and preparation and there was one study in allergy and asthma just last year where they did a chart review of like 200 different charts looking at patients who had POTS and Ehlers-Danlos Syndrome which is something else we can talk about but 31% of those patients who had the diagnosis of POTS and EDS also had symptoms consistent with mast cell activation and at least one biochemical marker so there is some overlap there. There was another allergist probably consensus, one author who wrote an article that completely denied the relationship. Of course, we're going to get lots of varying opinions in the medical literature but then, there was another one that came out in 2021, the journal of American Heart Association actually where 42 of the patients with POTS had mast cell activation symptoms so you know, somewhere between 30 and 40 overlap which is pretty huge. Some of the other studies that looked more like 60 percent overlap so again, in the consensus 2 community, we start to talk about these conditions as absolutely being related. In fact, we have a name for them called ‘pentad patients’ or even you know, pentad plus patients where they have mast cell activation, dysautonomia, Ehlers-Danlos hypermobility syndrome, autoimmune conditions and then often gastroparesis too and then you can throw in chronic lyme, chronic mold, SIBO symptoms and these patients are the patients that are walking through our doors.
Dr. Wong:
Yes, yeah so thank you for that tour de force of all the genetic associations there. I wanted to just take a little bit of a sidebar since we're both trained in the traditional medicine at first and then integrative functional and you know I think in traditional medicine, we aren't really taught to think beyond silos you know I mean that's just one of those challenges that we see with why isn't traditional medicine as good or effective as we would like to you know, when we use that hat, right, at really dealing with chronic issues because it wasn't really that we got that training in that type of medicine when we need to connect the dots which you need to I think in complex chronic illness.
Dr. McCann:
Absolutely, we need to connect the dots and you know, I don't recall of course, my lenses were different then but you know, in the late 90s early 2000s, patients didn't look like this, they weren't that complicated, not in general. You know, if somebody had an autoimmune condition then you know you would see the autoimmune condition but they didn't tend to have all of these other symptoms. I mean even in the beginning of my practice in the early 2000s, I don't recall the level of severity that patients have these days. I don't know if that's your-
Dr. Wong:
Well, I kind of feel like the sea level rise, right? We're not gonna know until it floods all the coastal towns, you know? I mean yeah, I agree. I don't know because I think everything changes sometimes slowly or imperceptibly and then it's like oh why are we seeing so many people but we do feel like we're seeing sicker patients now it seems. Yeah, for sure I think just from treating people over the years but then the other thing is you know, all the lab companies are revising the ranges of health downward to fit an average. In other words you know, testosterone or you know, it's like it's normal but was it normal 20 years ago 30 years ago it was low so you know, who's to say you know, rangers are being revised downward in order to fit normality even though that's not healthy.
Dr. McCann:
Right, yes.
Dr. Wong:
This is another piece so I think if we're all feeling terrible and have multi-complex chronic illness or at least chronic inflammation but we're all looking at each other saying hey how are you feeling, right? If I go down the hall and say “Hey, Kelly”, you know, “How are you feeling?”, “I'm feeling great. I'm feeling fine”, because that's socially acceptable, right? That's what we say to each other when we're talking on a superficial level but if we're all kind of feeling that way and that's the baseline and all of our friends and family are like that then then that's normal but it's not necessarily healthy.
Dr. McCann:
Yeah.
Dr. Wong:
So, I think our goal posts may have changed too and it's good to probably remember where we were so we can maybe get back to that if possible so.
Dr. McCann:
Yeah, that's very true.
Dr. Wong:
Yes. So, let's talk about another big topic. I think we're almost covering multiple things here but let's talk about mold and mast cell. What is that connection like does mold trigger mast cell, does mast cell then trigger more susceptibility to mold? What's that relationship?
Dr. McCann:
So absolutely, I’ve seen again and again and again mold trigger mast cell activation which makes sense because that's what the mast cells are designed to do. They're designed to perceive a threat and mold and in particular, mold toxins cause all sorts of havoc, increase oxidative stress in the body and you can have many many symptoms from mold and mycotoxin exposures alone that don't necessarily have to be muscle activation but I think the difference would be you know, the patients who just have mold exposure tend to be able to tolerate the treatments whereas patients with mast cell activation they get worse with treatment, they can't tolerate the treatments, they get exacerbations of their symptoms when we start to try and give them binders and give them antioxidants like glutathione you know, even putting people on phosphatidylcholine when the standard treatments for mold illness don't work right away, then I know we're dealing with mast cell activation. Now, does mast cell activation make subsequent mold exposures worse? Sure, absolutely. I mean these people get highly sensitized to the mold and so, there's a lot of things that I do in my practice to really try and reduce that reactivity using different kinds of immunotherapy. For example, we can do immunotherapy to different molds, we do immunotherapy like low-dose allergy therapy to foods and environmental things. I haven't worked much with low-dose immunotherapy like LDI via Ty Vincent but that may be a possibility for some of these mast cell patients, too.
Dr. Wong:
Yeah. I definitely want to get into that as well. Always more to learn, right?
Dr. McCann:
Always more to learn.
Dr. Wong:
Yes. And you know, I think for mold, I mean this is something that I just want to point out as a primary care you know, clinic and also just in general when you listen to this you know, who's listening to us out there, this is not something that most doctors, most practitioners are going to really be even thinking about. Is that correct?
Dr. McCann:
Yes, absolutely. Many of our conventional colleagues probably think I'm a little kooky because you know, I talk about mold and how sick it makes people but the truth is that it is out there and it is causing people to be sick and the proof is in getting people better so I you know, identify that mold is an issue, get them out of the moldy house, put them on a regimen and when they get their lives back and they get their brains back, well there's the answer so at a certain level, it doesn't matter to me if the conventional doctors don't believe me in the beginning but I think it's important for your listeners to understand that this is not something we were taught as you know, medical doctors, we didn't talk about mold. In medical school residency, it wasn't part of our training and so this is something that really only functional docs who have gone the extra step really know anything about.
Dr. Wong:
It kind of reminds me of those movies where there's like a town and it's on the outpost and there's like high walls and stuff. There's probably like a lot of stuff outside and so, you don't you don't want to go outside that wall because who knows what will happen you know, kind of thing so I think for us that have kind of been in both worlds and I think it just really goes back to like you said, the patient results, right? We see that patient, there's no clock behind them, you know? Their symptoms are real, their improvement is real, and I think that's where even with functional medicine, the limitations of testing is because sometimes it detects it but sometimes the patient is their best lab test. you know?
Dr. McCann:
Absolutely, yeah. I mean lab tests are not perfect. I tell this story of a husband and a wife whom I had as patients. The wife was very sick, had chronic lyme, lots of symptoms, neurological symptoms, depression. Occasionally, she would get a foot drop, chronic diarrhea. etc., etc., and she swore to me over and over again, “No. I don't have mold. I don't have mold. No, we don't have mold”, until the hot water heater in the apartment was leaking and it rotted through and literally the hot water heater fell through into their kitchen and there was black mold stachybotrys everywhere. It just covered all of their belongings and I had the husband do the Real Time Lab Mycotoxin test and his test showed five to ten times higher in the three mycotoxins that they were testing at the time, five to ten times higher than the upper limit of normal so huge huge exposure and the wife's test showed nothing.
Dr. Wong:
Wow. She was so sick she couldn't mobilize any of that.
Dr. McCann:
Oh, yeah.
Dr. Wong:
Yeah, right. Despite the same exact exposure as her husband and so in some cases like with that one, the patient the person who is the sickest may not even be able to mobilize those mold toxins to get a test that's going to help us and help the patient so sometimes I have to have the partner do a test too or somebody else who's living in the house to try and identify that mold is the issue.
Dr. McCann:
So now, same with heavy metals too it sounds like. Heavy metals, probably chronic infections, we're really trying to find a needle in multiple haystacks but the needle is moving too, you know, the needle is trying to not be found in a way.
Dr. Wong:
Yes, yes. So, with detox, particularly with metals, if they're incredibly toxic, they don't mobilize those metals and you have a mistaken impression that they don't have them when they might. Yeah, very common. So, let's get into some of the possible treatments, you know, someone's out there, they're itching all the time you know, chronic urticaria, they might have all the something you just named, joint pain, chronic pain elsewhere, fatigue you know, brain fog, gut issues, allergies, multiple food sensitivities, sinus issues, you know? How do they get relief from this? Where do they start with you know, with mast cell?
Dr. McCann:
Sure, good question. So, some people can get benefit from avoiding certain kinds of foods and so, some foods are very high in histamine or will trigger a histamine response and so, simply by changing the diet, avoiding things like avocados and eggplants actually, green beans, any sort of packaged food, processed food, lots of additives, leftovers even can trigger histamine responses in people and so, there are a whole bunch of low histamine diets out there. I think beth O'Hara does a great job on Mast Cell 360 with her low histamine diet recommendations so I do recommend checking out her website and then, patients really need to start keeping a journal because even if they eat a low histamine diet or may or may not be reactive to all those histamine foods and vice versa so that's really an important place to start and then there are some supplements that they can try. Some of my favorites include quercetin and quercetin is a massive stabilizing supplement. It's available all over and it's generally very safe and it will help with a little bit of COVID too so why not. The doses range from like 250 milligrams you know, upwards of a thousand milligrams four times a day so there's a lot of flexibility in the dose for quercetin. There are some enzymes that help break down histamine such as DAO enzymes so again, going back to the diet and the food. Some people don't make enough DAO enzymes to break down the histamine in the foods so they can take DAO enzymes before their meals to help with metabolism of histamine while they're eating. Let's see so, those are some of the the ones that I would suggest that are supplements.
Dr. Wong:
Yes. Thank you, thank you. Well, I think first of all, we should say that you know, it would be great if we could come up with the avocado that was low histamine.
Dr. McCann:
Yes, seriously. Yeah.
Dr. Wong:
I think that would be seriously important for everyone. And then, the other thing is that we know that histamine, right, can be a neurotransmitter. It's not a binary thing, you know, how we always like inflammation let's just kind of just let it
Dr. McCann:
Get rid of it all.
Dr. Wong:
Just get rid of all and then you know, we don't have any immune system so, histamine is good for us in some ways, right, some of it?
Dr. McCann:
Sure, of course. Just like mast cells are really important for our immune system. They're our defense. It's the aberrant or you know, hypersensitive mast cells that are a problem and it's the overabundance of histamine that's a problem and so, a normal histamine level in blood should be less than one. I have patients with histamine levels like 2, 5, 25. 25 level of histamine, that person is really, that's a lot of histamine.
Dr. Wong:
That's a lot of histamines, yeah.
Dr. McCann:
Yeah.
Dr. Wong:
Now, let's talk about root causes so we talked about I think before that you know, most of the immune system is in your gut, right, It's in the gut. How does gut health affect mast cells, mast cell activation?
Dr. McCann:
Well, I mean it depends so somebody can have leaky gut and irritable bowel and SIBO and they don't have mast cell but it can be a component as we're talking about in these you know, genetically susceptible, we don't understand the genes yet of a person who has a lot of reactivity so I find some of the biggest drivers of mast cell activation are really two things predominantly- mold exposure and the infection bartonella, maybe even more so than lyme. And those things including lyme disease impact the gut tremendously. It can cause disruption in the gut barrier, it can cause disruption in the gut microbiome, you can get an overabundance of yeast and candida, you can get colonization with other funguses when you're mold exposed and so, those things can exacerbate symptoms of mast cell activation.
Dr. Wong:
So, thank you. We're talking about overall prevalence of mold toxicity, I mean it sounds like it's hard to know if some people are testing and they're excreting that same urine or something but then other people are just too toxic and they're just holding onto and they can't really excrete it. How many people do you think have some degree of clinically significant mold toxicity just overall in the general population, just kind of walking around into the grocery store if you're just seeing a group of you know 100 people at Trader Joe's or something, how many people have mold issues do you think and bartonella same thing?
Dr. McCann:
That's a good question. I actually haven't looked that up to see what that looks like but I will say you know, roughly 60 percent of all of the buildings in the US have some form of water damage and that's not just homes that's you know, schools, office buildings churches, synagogues, etc., so we are being exposed. In Southern California where I practice, there's a lot of mold here not because it's a particularly wet place but because the construction is not well done. They throw up a building overnight and don't need to pay attention because we don't have inclement weather so there could be a pinhole leak in the piping, there’s just shoddy construction that's going to set that building up to have water damage and then water damage leads to mold growth because we build with particle board and you know, we build with wood that is fuel for the mold, the mold grows and then we get sick. Now, not everybody who lives in a moldy building will be sick. We do know from Ritchie Shoemaker's work that there are some people who are more susceptible to mycotoxin illness than others but I don't find it that useful to test the genes for mold sensitivity. Of course, in my practice, my practice is cute. I'm sure yours is too. You know, many people in my practice, I don't know, 70 people in my practice are mold exposed and then in terms of bartonella, gosh, I think some of the statistics are like eighty percent or more of all domestic cats in the US have bartonella. It's very very high.
Are you a cat person or a dog person or none of the above?
Dr. McCann:
I’m actually both.
Dr. Wong:
Okay.
Dr. McCann:
I have a dog. I did have a cat. My cat actually did have bartonella and my husband unbeknownst to us played aggressively with her and contracted bartonella.
Dr. Wong:
With the cat you said or the dog?
Dr. McCann:
With the cat.
Dr. Wong:
With the cat, okay. But then, the dogs carry lyme too so that's
Dr. McCann:
Yeah but I don't know. It's a lot easier to get scratched by a cat than get bit by a dog. Right?
Dr. Wong:
Yeah, yeah. I didn't know it was 80%, that's a lot of cats actually.
Dr. McCann:
It's a tremendous amount of cats. Maybe that was the feral cat. Anyway, we need to look that data point up but I do remember having a conversation with the premier veterinarian who writes about bartonella in the US and it's a very high percentage. Now, most cats are not symptomatic. My cat was not symptomatic but it doesn't mean that that infection can't be transmitted and then of course, bartonella can be transmitted many other different ways from ticks and fleas and other sorts of insects so bartonella is probably far more common than lyme disease and gets a lot less press.
Dr. Wong:
I feel like these are all stealth conditions or at least from a conventional point of view, they're stealth meaning we can't really diagnose them if we're doing that more than a conventional way because we're not even thinking about it, you know?
Dr. McCann:
Exactly and the commercial labs are not very good.
Dr. Wong:
Right.
Dr. McCann:
There are 20 some odd species of bartonella in that we're aware of at this point and most labs just check for Bartonella henselae and using things like IGeneX testing. I find a ton of other kinds bartonella- quintana, vinsonii, elizabethae, and then some just no name. There's galaxy labs which is another way to identify bartonella infections but it's more difficult in many cases to identify bartonella than lyme disease.
Dr. Wong:
Yeah. Just to get back to the mast cells, how do you think people can desensitize the mast cells work on that assuming you know we're trying to go on a a little bit of a hunt on you know, what's going on with root cause you know, triggering or perpetuating or mediating this? What are some of the other lifestyle factors that have been really helpful that you've seen in your practice, let’s say?
Dr. McCann:
Sure. Honestly, I use a lot of over-the-counter antihistamines and it's a great place to start because they're inexpensive, they're very safe for patients so there are five second generation over-the-counter antihistamines and usually what I encourage my patients to do is try them all because they may find that one works great for them and others don't work well at all so Claritin, Zyrtec, Allegra, Xyzal and then I'm not sure if this is available over the counter yet but clarinets which is a form of claritin is the second generation ones and then you know, simple benadryl. Sometimes Benadryl can really work for patients to calm down those reactions. It is often sedating so they may not be able to take it during the day but can take it at nighttime and then the H2 blockers so things like Pepcid or Tagamet, Axid. Those can be really helpful particularly if they have gastrointestinal symptoms and mast cells. Now, these are not acid blockers in the sense like a proton pump inhibitor so I make sure the patients understand that and usually, they're worried especially if they have SIBO, “I don't want to suppress my acid”. It's blocking histamine in the gastrointestinal system from getting to the histamine receptors so it shouldn't impact the acid levels in the stomach at all or compromise GI function so those are great places to start for things that patients can do on their own. There are other supplements that can be helpful too but it's probably best to try and find a practitioner to start working with.
Dr. Wong:
Thank you and since you're a fairly experienced practitioner yourself, Dr. McCann, love if you could share a patient's success story. You know, a lot of times people are coming in and they might need a model or at least a little bit of beacon of hope you know, someone else that has gone through this journey of you know, mast cell activation, chronic conditions and probably not feeling listened to or heard or you know, even if it's not like not diagnosed, it's hard to diagnose sometimes but even just being dismissed you know, we've had a doctor come on recently, Dr. Zingman I don't know if you know Dr. Zingman but she's a musculoskeletal specialist that was going through ortho residency and she ended up getting diagnosed with the EDS but only after going through 10 to 15 doctors with herself as an MD herself being called a hypochondriac so that was a journey for her and think just to give people hope here, what have you found in terms of you know, people getting better and maybe sharing some of that with us, with our listeners?
Dr. McCann:
Sure . So, I have a lot of patients who have gotten to the point where they're able to manage their symptoms either through diet. I couldn't think of a specific one off the top of my head but I have a couple of vignettes I can share so I had one woman who probably had chronic diarrhea for 20 years you know, and she was in her 70s and we've been working on all sorts of things over the years and I kept trying to help her with her diarrhea you know, give her lots of probiotics, give her antifungals, we did a parasite treatment for her, I thought maybe it was bile acid diarrhea so I put her on like bile acid medications and then it dawned on me, “Maybe you have mast cell activation”, and I put her on two Zyrtec a day and that actually helped. And she was going you know, six, seven, eight times a day kind of watery stool this poor woman.
Dr. Wong:
That's a lot.
Dr. McCann:
That's a lot so twice a day seemed to help a little bit, solidified it a little bit. Three zyrtec three times a day was like the charm. She normalized to you know, two or three bowel movements a day. She was so happy. It was pretty impressive.
Dr. Wong:
That's amazing. What made you think of mast cell in that situation for her?
Dr. McCann:
Because I knew that she had some mold exposure and you know, I had just recently learned about mast cell activation. I tried everything else poorly like wait oh I know what it is.
Dr. Wong:
And sometimes it's about perseverance you know, sometimes it's about working with someone you know, whether whoever's listening out there you know, thinking about your own finding a practitioner out there because really sometimes, it's about turning over their stones you know, sometimes just like playing a piano piece, you have to get all the measures wrong before you play it correctly, you know? So.
Dr. McCann:
Absolutely and the same goes through with like trial and error of different supplements and medications that might work for a mast cell patient. Unfortunately, we don't yet know at this time what's going to work for somebody so it really is a trial and error. You know, personally I like Zyrtec. I have other patients who prefer Claritin and do great with Allegra or Xyzol. It really is a matter of just trial and error. Let's see, I have another patient that I can share as well. Again, an older woman you know, and she had lyme and parasites and she had a lot of hives. She would get these like terrible rashes and and we figured out the lyme and the parasite stuff and and you know, for her it was the right combination of all of the medications and the supplements so she's on Cromolyn you know, 200 milligrams two or three times a day, she's on Ketotifen which is another pharmaceutical from mast cell activation, she's got her Zyrtec on board and her quercetin on board and she's on low-dose naltrexone as well and as long as she does all of those things consistently you know, she's much much better. She also had diarrhea and the diarrhea gets better when she pays attention to her diet and so you know, for some people, it really is a management issue and then for some people, they can actually really get things under control and then back off on their medications and their supplements and I have absolutely seen that particularly when we're able to identify the trigger. For example, if it is mold and they get out of the moldy building and we do the mold treatment, those mast cells can really calm down substantially.
Dr. Wong:
I’ve seen that too but I think just like most of these things if it's taken a long time to get there it takes a little bit of time for the body to heal so I think that's really important as patience is really required in spades I think with these type of issues.
Dr. McCann:
Yeah. I'm doing serial mold test ,mycotoxin testing with people and it's taking 18 months, two years kind of at a minimum to really start to see those mycotoxins go up first as we're mobilizing things and then come back down again so it is a journey, it's a marathon, not a sprint.
Dr. Wong:
Yes. Well, thank you so much for this journey here today Kelly. Really appreciate you being on and sharing expertise about mast cell and also some of the patient stories you know, some of the struggles of you know, others can you know, hopefully be of service to those that are listening and hopefully they're feeling better as well but we'd like to also ask you some fun questions, too.
Dr. McCann:
Yeah.
Dr. Wong:
Because we always ask our guests to. If you wouldn't mind sharing your morning routine you know, we always know that you know getting a good start to the day is really great for your health and kind of gets you off on the right foot so what's Kelly's morning routine?
Dr. McCann:
My morning routine, so I get up usually around 6, 6:15. I sit in meditation probably only for about 10 minutes. I don’t have a whole lot of time in the morning and then I walk my dog. I have a Beagle-Golden mix. He's getting up there in age but we go for our walk and I'm actually learning Spanish so I do Duolingo while I'm walking my dog.
Dr. Wong:
Nice.
Dr. McCann:
I've been doing Duolingo for set almost 700 days straight now.
Dr. Wong:
How is that? How's that there?
Dr. McCann:
You know, it works. It works. It’s fun.
Dr. Wong:
Yeah. We have someone in the office doing that, too. Yeah. Definitely want to learn as well. We know that lifelong learning is not only good for the the brain you know, of course you know, keeps our minds active. Hopefully it prevents dementia and these type of things, right? But also, I think it can really give us hope and you know, give us some new perspective you know, other people writing or talking on podcasts or different things. What book or podcast are you enjoying the most right now and and why?
Dr. McCann:
Let's see. So, when the new ‘Dune’ movie came out, I admit I’m a sci-fi like.
Dr. Wong:
Oh, nice. Yeah.
Dr. McCann:
So yeah, I'm reading the Dune series. I'm on book five right now.
Dr. Wong:
Okay.
Dr. McCann:
Which takes place like thousands of years in the future after the original I had no idea. That's pretty cool. It's definitely a different read and it enables me not to think about Medicine for a few minutes in the day which is important.
Dr. Wong:
Yeah.
Dr. McCann:
Although, I will say probably my favorite book that I've listened to recently is called ‘The Golem and the Jinni’, Jinni is spelled j-i-n-n-i, fabulous tale set in like the 1930s, 40s in New York City about this golem which is a creature made of clay looks like a woman and a jinni and their relationship and it was awesome. It was a great book.
Dr. Wong:
I should check it out.
Dr. McCann:
Totally recommended.
Dr. Wong:
Yeah.
Dr. McCann:
And if you can listen to it, it's even better because the person who read the story was just phenomenal so highly recommend it.
Dr. Wong:
Thank you, thank you. And then, how can listeners learn more about you and work with you?
Dr. McCann:
Okay. My website and my practice is called ‘The Spring Center’ so you can google www.thespringcenter.com. I am not accepting new patients right now but will be probably in the next couple of weeks so if somebody is interested please keep an eye on the website. I do see patients all over the country so it is possible to do telemedicine with me and then other things that I have on in store I will be hosting a health mean summit in the end of august, beginning of september on mast cell activation and I will be interviewing probably 40 experts in the field of mast cell activation and I'm really hoping to also include POTS and EDS and kind of look at the whole picture of these pentad patients that we've been talking about so look into that. I'm very excited. It should be phenomenal.
Dr. Wong:
Yeah. I don't think there's been a summit on mast cell. Has there?
Dr. McCann:
No. There has not.
Dr. Wong:
Until this year. This is exciting.
Dr. McCann:
Yeah.
Dr. Wong:
Well, we'll definitely be excited to listen to that and yeah. Thank you so much, Dr. McCann for coming on today and for our listeners, thank you so much and please leave some messages in our chat box if you have any questions for Dr. McCann or just any kind of comments about this episode you know, I think this has been really helpful we have so many people with mast cell, so many people with symptoms of mast cell probably that are not even knowing that that's often what it is so thank you so much.
Dr. McCann:
You're welcome. Thank you, Andrew. I really appreciate spending the time with you.
Dr. Wong:
Thank you for taking the time to listen to us today. If you enjoyed this conversation, please take a moment to leave us a review. It helps our podcast to reach more listeners. Don't forget to subscribe so you don't miss our next episodes and conversations and thank you so much again for being with us.