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August 21, 2019

ADHD & the Gut: Are they linked & what is the link? Part 1: ADHD, in The Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

In this next article on the gut-brain axis, we address ADHD and the gut this week. Recent research has established a strong link between the gut and the brain. The gut-brain axis regulates brain function and behavior (Chunlong Mu, 2016).

The gut-brain axis plays a critical role in many neurological disorders. It affects neuropsychiatric disorders like anxiety, depression, schizophrenia, dementia and autism (Kim YK, 2018). It also affects neurodevelopmental disorders in children including ADHD, autism, learning disabilities, intellectual developmental disorder, motor disorders, and specific learning disorders (EPA, 2015).

In this article, we will explore the link between ADHD and the gut brain axis.

ADHD (attention-deficit/hyperactivity disorder) is a brain disorder marked by a pattern of inattention and/or hyperactivity-impulsivity that interferes with normal functioning or development (National Institute of Mental Health, 2019).

You may have heard the name ADD, or attention deficit disorder. This is an out-of-date term. It was previously used to describe people who have problems paying attention but aren’t hyperactive. Instead of using the term ADD, such a person is now said to have the type of ADHD called predominantly inattentive.

The term ADHD became official in May 2013, when the American Psychiatric Association established the diagnostic criteria for different mental health conditions in the ‘Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association, 2013).

Some facts about ADHD:

  • ADHD is one of the most widespread neurodevelopmental conditions (Ming X, 2018).
  • The Center for Disease Control and Prevention (CDC) reports that 11% of all children (1 million) in the U.S. aged 4-17 have been diagnosed with ADHD in 2016. This represents a 43% increase since 2003. (Centers for Disease Control and Prevention, 2018).
  • In 2015, the CDC said the total number of Americans, adults and children, with ADHD continues to rise from 7.8% in 2003 to 9.5% in 2007 and to 11% in 2011 (Centers for Disease Control and Prevention, 2018).
  • ADHD rates are growing. Figures from 2003 to 2015/ 2016 show increases of 43% in children and 41% in all Americans with ADHD (Centers for Disease Control and Prevention, 2018).
  • The causes of the disorder remain unclear (Ming X, 2018). We do have some ideas on causes and they will be discussed later in this article so please do read on for information on causes of ADHD.
  • Boys have a higher incidence of ADHD than girls. In 2015-2016, Children and Adults with ADHD (CHADD) reported that 14% of children with ADHD were boys vs. 6.3% who were girls (Children and Adults with Attention-Deficit/Hyperactivity Disorder, 2019).
  • Co-occurring conditions are quite common in children (2-17 years of age). 63.8% of children with ADHD had at least one co-occurring condition: (Children and Adults with Attention-Deficit/Hyperactivity Disorder, 2019)
    • 51.5% had behavioral problems
    • 32.7% had anxiety problems
    • 16.8% had depression
    • 13.7% had autism spectrum disorder
    • 1.2% had Tourette syndrome
    • 1% (of adolescents) had a substance abuse disorder

Common symptoms of ADHD are:

  • difficulty focusing and concentrating on tasks
  • being easily distracted
  • forgetting to complete tasks
  • interrupting people while they’re talking
  • having difficulty sitting still

The National Institute of Mental Health further characterizes ADHD into three types; Inattention, Hyperactivity and Impulsivity: (National Institute of Mental Health, 2019)

  • Inattention: being easily sidetracked from the task at hand, lacking persistence, difficulty sustaining focus/concentration
  • Hyperactivity: appearing to move constantly, including when it is not appropriate, excessively fidgeting, tapping or talking, extreme restlessness or wearing others out with constant activity
  • Impulsivity: acting in a rash manner without first thinking about one’s actions, a desire for immediate reward or inability to delay gratification, being socially intrusive and excessively interrupting others

It is clear that the incidence of ADHD is growing. Part of this increase can be potentially attributed to better diagnoses. But in Functional Medicine (FM) we always want to dig deeper to get to the root causes and to understand why ADHD is on the rise. So what is going on?

In ADHD, there is an underlying metabolic and functional disorder in the brain. There are abnormalities in the neurotransmitter (NT) system in the brain, triggered by an imbalance of the neurotransmitters dopamine and noradrenaline (All About ADHD). These two NTs play an important role in the transmission of stimuli in nerve cells. When these neurotransmitters are out of balance, faulty information processing will result in the affected areas of the brain (All About ADHD).

With ADHD, the parts of the brain that are responsible for control and coordinating information processing are particularly affected (All About ADHD). This negatively impacts a person’s ability to concentrate, as well as their perception and impulse control (All About ADHD).

Causes of ADHD:

No single risk factor explains ADHD. Both inherited and non-inherited factors contribute and their effects are interdependent. (Thapar A, 2013)

In conventional medicine, it is widely accepted that ADHD is an inherited condition, although the precise cause or causes remain unclear. Studies have shown that children with a parent diagnosed with ADHD have a greater than 50% chance of having ADHD (Ming X, 2018).

However, only a small number of genes have been reported to have any effect in predicting ADHD and that effect is relatively small (Ming X, 2018).

The more likely explanation is that ADHD is due to a combination of genetic and environmental epigenetic factors. These environmental risk factors and potential gene-environment interactions increase the risk for the disorder (Banerjee TD, 2007). Environmental factors can be ‘inherited’. Growing up in and living in the same household means people – whether children or parents – are sharing their environment and are likely to be experiencing the same environmental factors.

Environmental factors influencing and potentially increasing the risk of developing ADHD are: (Banerjee TD, 2007) and (Ming X, 2018):

  • food dyes and additives in the diet
  • lead contamination and exposure to other heavy metals
  • micronutrient and mineral deficiencies
  • cigarette and alcohol exposure
  • maternal smoking during pregnancy
  • low birth weight
  • perinatal stress
  • neurotransmitter disruption

It is estimated that between 10% and 40% of the difference in heredity may be due to environmental factors (Ming X, 2018). Yet these known environmental factors do not account for all of the difference in heritability (Ming X, 2018).

More recent research into causes has highlighted the role of the gut, and specifically the microbiome-gut-brain axis, in ADHD (Ming X, 2018) and (Cenit MC, 2017). Please see our recent article on anxiety and the gut-brain axis for a full explanation of the microbiome-gut-brain axis.

In ADHD, it has been found that:

  • Dysbiosis, or an altered gut microbiome, and specifically increased Bifidobacterium species of gut bacteria, exist in patients and may contribute to the clinical expression of ADHD (Ming X, 2018).
  • Dysbiosis is associated with gastrointestinal symptoms, such as constipation, diarrhea, abdominal pain, and flatulence. A number of studies have noted an increase in these gastrointestinal symptoms in neurodevelopmental disorders and specifically in ADHD (Ming X, 2018).
  • Dysbiosis can lead to gut inflammation, due to a large amount of pro-inflammatory microbes. This can cause increased intestinal permeability and inflammation, allowing microbes into circulation through a leaky gut, which may lead to low-grade systemic inflammation and immune dysregulation (Ming X, 2018).
  • This low-grade systemic inflammation may gradually damage the blood–brain barrier and possibly cause the neuroinflammation seen in ADHD (Ming X, 2018).
  • Diet influences ADHD symptoms by affecting the gut microbiome through its impact on brain functioning and behavior. One proposed mechanism for these effects of gut microbiota is through their ability to synthesize neurotransmitters (NTs) and their precursors (Aarts E, 2017). Precursors of the NTs involved in ADHD (dopamine, noradrenaline and serotonin) are produced by the gut microbiota. Their precursors are amino acids (phenylalanine, tyrosine and tryptophan) which may pass through the gut lining, enter into circulation, and cross the blood-brain barrier (Aarts E, 2017). Once in the brain, they could potentially influence NT production. As a result, differences in gut bacteria may impair brain function and behavior relevant to ADHD (Aarts E, 2017). In fact, a higher amount of the gut bacteria Bifidobacterium in babies has been associated with increased risk of developing ADHD in childhood (Aarts E, 2017).

In conventional medicine, treatment used for ADHD is medication, behavioral treatment and/or a combination of medication and behavioral treatment. The most commonly prescribed medication for ADHD is Ritalin. Ritalin is not a cure for ADHD but it can improve concentration, reduce impulsivity and promote calmness (NHS, 2018). It does have side effects such as an increase in blood pressure and heart rate, difficulty sleeping, loss of appetite, headaches and stomach aches (NHS, 2018).

One recent study has just come out with findings that Ritalin changes the brain structure in children with ADHD (Reneman D, 2019). These effects were not found in adults with ADHD in the same study. The scans of the children’s brains showed changes in their brain structure in a short period of 4 months on Ritalin (Reneman D, 2019). These differences were in the left hemisphere of the brain and involved the process of coating nerve fibers, such as nerve fiber density, size and myelination (Reneman D, 2019). Patients can be on Ritalin and other medications for years, despite there being little knowledge about its long-term effect on the brain.

In Functional Medicine, we like to dig deeper and look for the root cause(s). As there is no single cause of ADHD, in FM the approach we take is to look at all the factors found in research to be influencing ADHD.

We cannot change genetics but we can affect how genes express. We cannot change any prenatal events as mentioned above such as maternal stress, poor diet, smoking or alcohol use during pregnancy and/or a low birth weight.

We can, however, change and improve a number of health factors, which will improve the condition of ADHD. Please stay tuned for a list of these factors and specifically what you can do in the case of ADHD in next week’s article ‘ADHD & the Gut: Are they linked & what is the link? Part 2’ of ‘The Gut-Brain Axis Series’.

 

References:

Aarts E, E. T. (2017). Gut microbiome in ADHD and its relation to neural reward anticipation. PLOS One.

ADDitude. (2019, March 18). MTHFR: Another Piece of the ADHD-Genetics Puzzle. Retrieved August 14, 2019, from ADDitude: https://www.additudemag.com/mthfr-adhd-genetics-puzzle/

All About ADHD. (n.d.). Causes of ADHD. Retrieved July 30, 2019, from All About ADHD: https://www.adhd-information.com/adhd-causes.html

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM–5). American Psychiatric Association.

Banerjee TD, M. F. (2007). Environmental risk factors for attention‐deficit hyperactivity disorder. Acta Paediatrica.

Bowling A, S. J. (2017). Cybercycling Effects on Classroom Behavior in Children With Behavioral Health Disorders: An RCT. Pediatrics.

Cenit MC, N. I.-F. (2017). Gut microbiota and attention deficit hyperactivity disorder: new perspectives for a challenging condition. European Child & Adolescent Psychiatry, 1081–1092.

Centers for Disease Control and Prevention. (2018, September 21). Attention-Deficit / Hyperactivity Disorder (ADHD). Retrieved July 28, 2019, from www.cdc.gov: https://www.cdc.gov/ncbddd/adhd/data.html

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (2019). General Prevalence of ADHD. Children and Adults with Attention-Deficit/Hyperactivity Disorder.

Chou WJ, L. M. (2018). Dietary and nutrient status of children with attention-deficit/ hyperactivity disorder: a case-control study. Asia Pacific Journal of Clinical Nutrition, 1325 – 1331.

Chunlong Mu, Y. Y. (2016). Gut Microbiota: The Brain Peacekeeper. Frontiers in Microbiology.

EPA, U. S. (2015, October). America’s Children and the Environment. Neurodevelopmental Disorders | Health.

Hariprasad VR, A. R. (2013). Feasibility and efficacy of yoga as an add-on intervention in attention deficit-hyperactivity disorder: An exploratory study. Indian Journal of Psychiatry.

Hernandez-Reif M, F. T. (2000). Attention Deficit Hyperactivity Disorder: Benefits from Tai Chi. Journal of Bodywork and Movement Therapies.

Kim YK, S. C. (2018). The Microbiota-Gut-Brain Axis in Neuropsychiatric Disorders: Patho-physiological Mechanisms and Novel Treatments. Current Neuropharmacology.

Lee MJ, C. M. (2018). Heavy Metals’ Effect on Susceptibility to Attention-Deficit/Hyperactivity Disorder: Implication of Lead, Cadmium, and Antimony. International Journal of Environmental Research and Public Health.

Lissak. (2018). Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study. Environmental Research.

Ming X, C. N. (2018). A Gut Feeling: A Hypothesis of the Role of the Microbiome in Attention-Deficit/Hyperactivity Disorders. Sage Journals.

Mitchell JT, M. E. (2017). A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation. Journal of Attention Disorders.

National Institute of Mental Health. (2019). www.nimh.nih.gov. Retrieved July 28, 2019, from NIH National Institute of Mental Health: https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

NHS. (2018, May 30). Treatment ADHD. Retrieved August 14, 2019, from NHS: https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/treatment/#

Pelsser LM, B. J. (2009). ADHD as a (non) allergic hypersensitivity disorder: a hypothesis. Pediatric Allergy and Immunology.

Reneman D, B. C. (2019). White Matter by Diffusion MRI Following Methylphenidate Treatment: A Randomized Control Trial in Males with Attention-Deficit/Hyperactivity Disorder. Radiology.

Sharif MR, M. M. (2015). The Relationship between Serum Vitamin D Level and Attention Deficit Hyperactivity Disorder. Iranian Journal of Child Neurology.

Slykerman RF, C. C. (2019). Exposure to antibiotics in the first 24 months of life and neurocognitive outcomes at 11 years of age. Psychopharmacology.

Taylor AF, K. F. (2011). Could Exposure to Everyday Green Spaces Help Treat ADHD? Evidence from Children’s Play Settings. Applied Psychology.

Thapar A, C. M. (2013). What have we learnt about the causes of ADHD? Journal of Child Psychology and Psychiatry.

The Mayo Clinic. (2017, September 28). ADHD diet: Do food additives cause hyperactivity? Retrieved August 14, 2019, from The Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/adhd/expert-answers/adhd/faq-20058203

Wang LJ, Y. Y. (2019). Dietary Profiles, Nutritional Biochemistry Status, and Attention-Deficit/Hyperactivity Disorder: Path Analysis for a Case-Control Study. Journal of Clinical Medicine.

Ystrom E, G. K. (2017). Prenatal Exposure to Acetaminophen and Risk of ADHD. Pediatrics.

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August 7, 2019

Anxiety & the Gut: Are they linked & what is the link?

by Dr. Miles Nichols and Nicola Schuler, CNTP, MNT

A tremendous amount of recent research has established a link between the gut and the brain. There is a gut-brain axis, which regulates brain function and behavior (Chunlong Mu, 2016).

The gut-brain axis plays a critical role in neuropsychiatric disorders like anxiety, depression, schizophrenia, dementia and autism (Kim YK, 2018).

Anxiety has been shown to be deeply affected by the gut–brain axis. In this article, we will explore this connection in more detail and suggest ways to address anxiety using the latest research on the gut-brain link.

  • Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 + (1% of the population) every year (Anxiety and Depression Association of America Facts & Statistics).
  • Approximately one in four adults in the US will suffer from an anxiety disorder at some point in their lives. (Murrough JW, 2015)
  • Worldwide, 4 out of every 100 people suffer from an anxiety disorder, but North America appears to have a higher than average rate (8 in 100), while East Asia had the lowest rate (3 in 100). (Mulpeter, 2017)
  • Patients with anxiety disorders experience substantial physical and emotional discomfort and have elevated rates of substance use and medical illnesses. (Murrough JW, 2015)
  • Anxiety disorders are more common among women, who were nearly twice as likely to be affected as men. Other at-risk groups include adults under age 35, and people with chronic diseases such as cardiovascular disease, COPD, diabetes, and cancer. (Mulpeter, 2017)

Anxiety can be mild to debilitating. The main feature of anxiety disorders is excessive fear and anxiety and behavioral disturbances that occur as a result. Common anxiety signs and symptoms include (Mayo Clinic, Anxiety disorders):

  • Feeling nervous, restless or tense
  • Having a sense of impending danger, panic or doom
  • Having an increased heart rate
  • Breathing rapidly (hyperventilation)
  • Sweating
  • Trembling
  • Feeling weak or tired
  • Trouble concentrating or thinking about anything other than the present worry
  • Having trouble sleeping
  • Experiencing gastrointestinal (GI) problems
  • Having difficulty controlling worry
  • Having the urge to avoid things that trigger anxiety

How does the gut brain axis work in relation to anxiety?

The gut brain axis refers to biochemical signaling between the gut and the brain. Broadly defined, the gut–brain axis includes the nervous system, the immune system and the endocrine (or hormone) system.

The ‘microbiome–gut–brain axis’ explicitly includes the role of gut flora in the biochemical signaling events that take place between the GI tract and the brain. This is important because gut microbiota, i.e. bacteria in the gut, regulate neurophysiological behaviors through neural, endocrine and immune pathways (Collins, 2012).

  • Vagus nerve: Neurons are nerve cells which transmit nerve impulses and communicate with each other. Neurons are in the brain and the gut and they communicate with each other via the vagus nerve. The vagus nerve is a large nerve connecting the brain and the gut, sending signals in both directions, and is involved in control of mood, immune response, digestion, and heart rate (Breit S, 2018).  Breathing, meditation and yoga stimulate the vagus nerve and decrease mood and anxiety symptoms (Breit S, 2018).
  • HPA axis: The gut brain axis includes the HPA axis. The HPA axis is part of the endocrine (hormone) system and regulates stress and the stress hormones. Stress, especially chronic stress, affects and changes the microbiome (Liu L, 2018). Stress activates the HPA axis and increases cortisol (a stress hormone) levels leading to increases in anxiety levels and intestinal microbiota changes (Liu L, 2018). Thus the change in the microbiome affects mood. Conversely, the intestinal microbiota can also inhibit the increase of cortisol through the HPA axis to relieve anxiety and depression (Liu L, 2018). Therefore, the HPA axis plays a bi-directional role in the gut-brain axis.
  • Neurotransmitters or NT’s: Neurotransmitters are chemical messengers produced in the brain. They transmit signals from one neuron to another neuron, muscle cell, or gland cell. They control feelings and emotions. The neurotransmitter serotonin contributes to feelings of happiness (Anguelova M, 2003). Gamma-aminobutyric acid, or GABA, is another NT which helps control feelings of fear and anxiety (Mazzoli R, 2016). Neurotransmitters are also produced by gut cells and the trillions of microbes living there. For example, a large proportion of serotonin is produced in the gut (Anguelova M, 2003).
  • Short-chain fatty acids or SCFAs: The trillions of microbes that live in the gut also make other chemicals that affect how the brain works (Clarke G, 2014). Gut microbes produce short-chain fatty acids such as butyrate, propionate and acetate. They are related to regulating the immune system and their absence or reduced status in the gut can contribute to inflammation in the gut (Hirschberg S, 2019). In a study on anxiety, low levels of SCFA-producing bacteria were found in patients with anxiety as compared to healthy controls without anxiety (Jiang HY, 2018).
  • Immune system: The gut plays an important role in immunity. 70-80% of immune cells are located in the gut. Gut bacteria provides crucial signals for immune system function. The gut controls what enters the body and what does not. If there is intestinal permeability, or leaky gut, inflammation occurs. The immune system will over-react and this can lead to disorders associated with inflammation like depression, Alzheimer’s and autoimmunity. Chronic low-grade inflammation causes cytokines, inflammatory molecules, to be released into the blood, further affecting the immune system. Intestinal microbiota contain molecules that can cause inflammation. The indirect effects of intestinal microorganisms on the immune system can cause changes in the circulating levels of pro-inflammatory and anti-inflammatory cytokines, which in turn have direct impacts on brain function (Kim YK, 2018).

Anxiety & the Gut

Anxiety is a multi-factorial disorder prompted by certain environmental factors in genetically susceptible individuals (Cenit MC, 2017). There is an element of complex gene-environment interactions and gut microbiota changes that precede the onset of neuropsychiatric diseases such as anxiety (Cenit MC, 2017).

Risk factors include genetics, brain chemistry, personality, and life events. (Anxiety and Depression Association of America Facts & Statistics). Anxiety can be triggered by a difficult or traumatic event (i.e. an accident, divorce, death of a loved one), trauma, chronic stress and in many other situations.

While genetics play a role in the possibility of developing anxiety, there are people with the same genetics who develop anxiety and others who never experience anxiety as an issue. In this article we will focus on modifiable risk factors that you can take some action towards changing.

There is a clear link between the gut brain axis and anxiety. About 60% of anxiety and depression patients have disturbed gastrointestinal function, such as in irritable bowel syndrome (IBS) (Liu L, 2018).

Treatment to date for anxiety is often therapy, typically in conjunction with anti-anxiety or anti-depression medications such as SSRIs (selective serotonin reuptake inhibitors). In the case of generalized anxiety, treatment response rates for SSRIs of between 60 and 75% are generally reported in studies, compared to response rates of between 40–60% for placebo (Lach G, 2018). While these rates are not insignificant, the issue with using SSRIs is that they do not address the root causes of the anxiety.

It is more effective to identify and address the root cause or causes of anxiety and avoid taking medication for the rest of your life. Furthermore, these drugs can have unintentional side effects. Antidepressants are well known to have antimicrobial effects and can damage the health of the gut microbiome (Lach G, 2018). This will reshape not only brain biochemistry, but also the gut microbiota, and not for the better (Lach G, 2018). The negative implications of antidepressants on gut health may result in intensifying anxiety over the long term, in a vicious cycle.

Furthermore, anxiety has various causes. If the root cause or causes are not addressed, treatment success rates over time are low (Kim YK, 2018). Emerging evidence of the interactions among the brain, gut, and microbiome can help those suffering from anxiety and the mechanisms underlying these complex interactions (Kim YK, 2018).

Gut health is critically important in cases of anxiety.  Before we address specific solutions to anxiety, let’s take a look at what can negatively impact the health of the gut microbiome (Mu C, 2016):

  • Diet
    • Sugar & excess refined carbohydrates
    • GMOs
    • Highly processed foods
    • Lack of fiber
    • Excess caffeine
    • Excess alcohol
  • Genetic make-up of the individual
  • Inflammation, particularly if in the gut
  • GI issues like dysbiosis (an unbalanced gut flora), leaky gut and many others
  • Antibiotics, SSRIs for depression or anxiety, NSAIDs and other medications
  • Circadian rhythm dysregulation
  • Stress – physical or emotional
  • Environmental toxins – mold, chemicals & others
  • Habits – news/ media, electronic use, lack of sleep, addictions, etc.
  • Abusive relationships, excessively stressful job, and history of trauma that has not been adequately processed/ resolved

Solutions:  What can you do?

Fix your gut: Like many other conditions we have written about in our blog, it is necessary to work on gut healing when addressing anxiety.

Inflammation in the gut is a key factor in neuropsychiatric conditions like anxiety. We’ve mentioned leaky gut but there can be other sources of gut inflammation.

Dysbiosis (an imbalance of good and bad bacteria in the gut), bacterial overgrowth like SIBO (small intestinal bacterial overgrowth), yeast overgrowth like Candida, a shortage of SCFAs, histamine intolerance, parasites, IBS, and other gut issues can all cause gut inflammation.

We recommend working with a functional medicine practitioner to identify any GI issues, infections or overgrowths when addressing anxiety.

Additionally, it can be helpful to work with an expert on issues like rebalancing neurotransmitter levels, increasing SCFAs in your gut, stimulating vagus nerve function, rebalancing an imbalanced HPA axis or stress response, and ensuring that your overall gut function is optimal.

Diet: Certain foods are particularly helpful for the gut-brain axis.

Some of the most important ones are:

  • Omega-3 fats: These are good fats found in wild salmon, sardines, anchovies, mackerel and herring as well as in high quantities in the brain. Studies in humans and animals show that Omega-3 fats can increase good bacteria in the gut and reduce risk of brain disorders (Robertson RC, 2017), (RJT Mocking, 2016).
  • Probiotic-rich fermented foods: Yogurt, kefir, sauerkraut, natto, kimchi and kvass all contain healthy microbes that are beneficial to gut health.  One study found that fermentation enhances the specific nutrient and phytochemical content of foods, which is associated with mental health (Selhub EM, 2014). In addition, the microbes (Lactobacillus and Bifidobacteria species) associated with fermented foods may also influence brain health via direct and indirect pathways (Selhub EM, 2014).
  • Prebiotic foods:  Prebiotics have been reported to improve inflammation and to alleviate psychological distress (Kim YK, 2018).  These foods contain non-digestible fibers that promote the growth of beneficial gut microbiota such as Lactobacillus and Bifidobacterium, benefiting the microbial-gut-brain axis (Kim YK, 2018). Prebiotic foods include lentils, apple cider vinegar, dandelion greens, raw garlic, raw or very lightly cooked onion, leeks, raw asparagus, green bananas, green plantains, potatoes that have been cooked then cooled 24 hours (served cold or at room temperature, as is common in potato salad), apples and others.
  • Polyphenol-rich foods: Clove, berries, raw cocoa, green tea, olive oil and coffee all contain polyphenols, which are plant chemicals that are digested by gut bacteria. Polyphenols increase healthy bacteria in the gut and can improve neuro-inflammation, inflammation in the brain, commonly found with depression and anxiety (Matarazzo I, 2018). These foods have been reported to promote cognitive function (Filosa S, 2018). One of our favorite polyphenol-rich foods we recommend to patients is pomegranate juice. While we normally don’t recommend fruit juices due to sugar content, research on pomegranate has shown such a high concentration of polyphenols that it tends to favorably impact blood sugar, likely due to its beneficial effects on the gut (here’s a link to an article we did on pomegranate).
  • Tryptophan-rich foods: Tryptophan is an amino acid that is converted into the neurotransmitter serotonin. Serotonin regulates mood, anxiety, stress, aggression, feeding, cognition and sexual behavior (Olivier B, 2015). Low serotonin is thought to be associated with anxiety (Olivier B, 2015). By increasing tryptophan through diet, the gut is better nourished to make serotonin. Foods that are high in tryptophan include turkey, eggs and cheese.

 Probiotics

Probiotics are live microorganisms that stimulate the growth of gut bacteria and enhance gut health.  Studies on probiotics have shown that low-grade inflammation is reduced, gut permeability is restored, and the composition of the gut microbiome changes (Kim YK, 2018). Probiotics modulate the processing of information that is strongly linked to anxiety and depression and influence the stress response. (K Schmidt, 2014).

Multiple studies have looked at specific strains of probiotics and found the following:

  • Lactobacillus casei Shirota – Improved mood in those who initially had poor mood, Better long-term memory (Kim YK, 2018)
  • L. helveticus, B. longum – Improvement of anxiety and depression symptoms (Kim YK, 2018)
  • L. acidophilus, L. casei, L. rhamnosus, L. bulgaricus, B. lactis, B. breve, B. longum, S. thermophiles – Improvement of anxiety and depression symptoms (Kim YK, 2018)
  • B. bifidum, B. lactis, L. acidophilus, L. brevis, L. casei,  L. salivarius, Lactococcus lactis – Improvement of self-reported mood and sadness (Kim YK, 2018)
  • L. casei Shirota – Decreased anxiety symptoms (Kim YK, 2018)
  • Lactobacillus rhamnosus – Reduced stress-induced anxiety- and depression-like behaviors in mice, Decreased levels of stress-induced hormones and changed levels of the NT GABA throughout the brain (Sharon G, 2016)
  • Lactobacillus rhamnosus and Lactobacillus helveticus – Reduced anxiety-like behaviors in mice in another study (Sharon G, 2016)
  • Bacteroides fragilis – Corrected anxiety-like and repetitive behaviors in mice, Partially restored an impaired microbiome, Restored intestinal barrier function (Sharon G, 2016)

Prebiotics

  • Prebiotics increase the level of Bifidobacterium, a healthy gut bacteria in the intestinal tract, benefitting the microbial-gut-brain axis (Kim YK, 2018)
  • The effect of prebiotics and increased Bifidobacterium can increase levels of Lactobacillus, Bacteroide and Bifidobacterium, other probiotic strains, in the gut (Kim YK, 2018)
  • Prebiotics increase the production of SCFAs as a result of the healthier gut flora profile (Kim YK, 2018)
  • In both animal and human studies, prebiotics have improved inflammation and reduced psychological distress (Kim YK, 2018)
  • One study showed prebiotics reduced stress and its effects, which positively impacts the microbiome (Kim YK, 2018)

Fecal Microbiota Transplantation (FMT)

FMT is the transplant of healthy human feces to a patient with severe gut dysbiosis, in order to regulate the intestinal microbiota of the patient. When the normal gut microbiota are destroyed, for example by excessive antibiotic treatment or other negative substances like GMO foods, it can be challenging to recover a normal healthy bacterial flora. FMT can be extremely helpful in these situations (Kim YK, 2018).

FMT can be an effective treatment for IBS. IBS showed a remission rate of 36-89% after FMT treatment (Kim YK, 2018). Recently, the first FMT trial in a neuropsychiatric area took place. In this eight-week clinical trial to evaluate the impact of FMT on GI and psychiatric symptoms, both GI and psychiatric symptoms were significantly reduced and Improvements were measured to have lasted eight weeks after treatment (Kim YK, 2018).

Many factors can affect anxiety and mood. Some may be a relatively simple and quick fix that you can do on your own like diet changes, while others may be more complex like FMT. Some other approaches to consider with anxiety include:

  • Balance blood sugar – Living on the blood sugar rollercoaster with excessive swings in blood sugar create and/or worsen mood issues like anxiety and depression.
  • Reduce caffeine consumption – Caffeine is a stimulant and can make you feel on edge or anxious. This is especially true for people who are slow metabolizers of caffeine.
  • Identify food sensitivities and allergies and eliminate those foods – Common allergenic foods like gluten, dairy, soy and corn can contribute to symptoms.
  • Address a potential magnesium deficiency – Research has shown that magnesium can help decrease anxiety in magnesium–deficient people (Boyle NB, 2017).
  • Reduce, where possible, and manage stress levels
  • Practice mindfulness and meditate daily
  • Work with an expert to process any past traumas
  • Deep diaphragmatic breathing – Breathing exercises can help to stimulate the vagus nerve and slow both heart rate and blood pressure.

If you or someone you know is suffering from anxiety, get in touch with our clinic today. Book a free 15-min discovery call to see how we can help you with your symptoms. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

References:

Anguelova M, B. C. (2003). A systematic review of association studies investigating genes coding for serotonin receptors and the serotonin transporter: I. Affective disorders. Mol Psychiatry.

Anxiety and Depression Association of America Facts & Statistics. (n.d.). Retrieved July 9, 2019, from Facts & Statistics: https://adaa.org/about-adaa/press-room/facts-statistics

Boyle NB, L. C. (2017). The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review. Nutrients.

Breit S, K. A. (2018). Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Front Psychiatry.

Cenit MC, S. Y.-F. (2017). Influence of gut microbiota on neuropsychiatric disorders. World J Gastroenterol.

Chunlong Mu, Y. Y. (2016). Gut Microbiota: The Brain Peacekeeper. Frontiers in Microbiology.

Clarke G, S. R. (2014). Minireview: Gut Microbiota: The Neglected Endocrine Organ. Mol Endocrinol.

Collins, S. M. (2012). The interplay between the intestinal microbiota and the brain. Nat. Rev. Microbiol. 10.

Filosa S, D. M. (2018). Polyphenols-gut microbiota interplay and brain neuromodulation. Neural Regen Res.

Hirschberg S, G. B. (2019). Implications of Diet and The Gut Microbiome in Neuroinflammatory and Neurodegenerative Diseases. Int J Mol Sci.

Jiang HY, Z. X. (2018). Altered gut microbiota profile in patients with generalized anxiety disorder. J Psychiatr Res. .

K Schmidt, P. C. (2014). Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers. Psychopharmacology (Berl).

Kim YK, S. C. (2018). The Microbiota-Gut-Brain Axis in Neuropsychiatric Disorders: Patho-physiological Mechanisms and Novel Treatments. Current Neuropharmacology.

Lach G, S. H. (2018). Anxiety, Depression, and the Microbiome: A Role for Gut Peptides. Neurotherapeutics.

Liu L, Z. G. (2018). Gut–Brain Axis and Mood Disorder. Front Psychiatry.

Matarazzo I, T. E. (2018). Psychobiome Feeding Mind: Polyphenolics in Depression and Anxiety. Curr Top Med Chem.

Mayo Clinic, Anxiety disorders. (n.d.). Retrieved July 9, 2019, from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

Mazzoli R, P. E. (2016). The Neuro-endocrinological Role of Microbial Glutamate and GABA Signaling. Front Microbiol.

Mu C, Y. Y. (2016). Gut Microbiota: The Brain Peacekeeper. Front. Microbiol.

Mulpeter, K. (2017, January 31). These Groups Are Most at Risk for Anxiety Disorders. Retrieved July 9, 2019, from Health: https://www.health.com/anxiety/anxiety-disorders-women

Murrough JW, Y. S. (2015). Emerging Drugs for the Treatment of Anxiety. Expert Opin Emerg Drugs.

Olivier B, O. (2015). Serotonin: a never-ending story. Eur J Pharmacol.

RJT Mocking, I. H. (2016). Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry.

Robertson RC, S. O. (2017). Omega-3 polyunsaturated fatty acids critically regulate behaviour and gut microbiota development in adolescence and adulthood. Brain Behav Immun. .

Selhub EM, L. A. (2014). Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry. J Physiol Anthropol.

Sharon G, S. T. (2016). The Central Nervous System and the Gut Microbiome. Cell.

 

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July 29, 2019

Mast Cell Activation Syndrome: What is it and could it be affecting your health? Part 2

by Dr. Miles Nichols and Nicola Schuler, CNTP, MNT

Mast Cell Activation Syndrome: Part 2

Last week, we published Part 1 on Mast Cell Activation Syndrome, in which we discussed what it is, symptoms and diagnostic criteria, including a quiz on MCAS. In this week’s article, MCAS Part 2, we cover causes, triggers, treatment and most importantly, what you can do about MCAS.

As a review, Mast Cell Activation Syndrome or MCAS is a collection of symptoms resulting from mast cells or MCs which have been inappropriately activated (Afrin, 2013).  When MCs become overactive, they can cause serious problems in the body.

For a fuller explanation, please refer back to MCAS: Part 1. Also please take our quiz on MCAS if you suspect it may be affecting you.

Cause:

The cause of MCAS is not known. There is certainly a genetic component to the syndrome but this is currently not fully understood (Afrin, 2013). In our clinical observation, those with mold illness and Lyme disease tend to have a very high incidence of MCAS also. Gut imbalances, overgrowths, and infections are also part of the root in many cases.

Triggers:

It is helpful to look to triggers of MCAS while also addressing causes.

Potential Mast Cell Triggers:  (Symptoms And Triggers Of Mast Cell Activation, 2019)

  • Heat, cold or sudden temperature or weather changes
  • Stress: emotional or physical, including pain
  • Allergies, which can be both IgE-mediated or non–IgE-mediated triggers such as:
  • Environmental allergy to pollution, pollen, pet dander, etc.
  • Chemical allergy to chemical odors, perfumes, scents, industrial chemicals or dyes
  • Allergy to a particular food or beverage including alcohol
  • Exercise
  • Fatigue
  • Medications (opioids, NSAIDs, antibiotics and some local anesthetics)
  • Venoms (bee, wasp, mixed vespids, spiders, fire ants, jelly fish, snakes, biting insects, flies, mosquitos and fleas, etc.)
  • Infections
    • Viral
    • Bacterial
    • Fungal
  • Sunlight

In addition to these better known triggers listed above, lesser known triggers could be:

Heavy metals toxicity:

Heavy metals like aluminum and mercury have been shown to destabilize mast cells. In fact, these metals are used in vaccines in order to elicit a heightened inflammatory immune response. Lead, cadmium, and bismuth have also been found to activate mast cells and cause mast cell mediator release (S. Bent, 1992).

Gut health:

If you have been following us and our blog articles for any length of time, you will know that often we come back to gut health as a cause, trigger or contributing factor in most conditions. MCAS is no different.

Various gut infections, issues or dysbiosis in the gut can contribute to MCAS. Specifically, parasites, bacterial and/or viral infections, or bacterial and/or fungal overgrowths in the gut can activate mast cells (R. Saluja, 2012). Parasitic worms, also known as helminths, can over stimulate mast cells (Lee TD, 1986). The fungus Candida albicans can lead to an over stimulation or reaction in mast cells (José Pedro Lopes, 2015). Gut dysbiosis may cause mast cell disorders as the interactions between different strains of gut bacteria and MCs are quite complex (Afrin LB, 2015).

CIRS:

CIRS or Chronic Inflammatory Response Syndrome occurs as a result of exposure to mold. It results from a particular genetic susceptibility to mold which causes a reduced ability to clear mycotoxins (mold toxins) from the body. This syndrome can lead to a constant activation of mast cells or MCAS (Kritas SK, 2018).

Is there a Treatment for MCAS?:

Therapies for MCAS generally aim to control and improve the condition by inhibiting overactive mediator production and release, by blocking released mediators, and/or managing the consequences of excessive mediators (Afrin, 2013). Many therapies are available. Of course we recommend working with a skilled functional medicine office that has experience with MCAS, gut issues, Lyme, and mold.

There is currently no way to predict which set of therapies will best control an individual person’s condition. A systematic, trial-and-error approach usually succeeds in finding significant relief from symptoms. Comprehensive functional lab tests looking for root causes are very important.

Lifespan for most MCAS patients appears normal, but quality of life can be mildly to severely impaired if no correct diagnosis and effective treatment is given (Afrin, 2013).

What can you do about MCAS?: In order to fully get to the root cause(s) of MCAS, it is essential to look at these steps in great detail:

  • Identify and treat any infections – GI or others
  • Gut healing
  • Heavy metals detox
  • Identify toxins and allergens, then avoid or treat
  • Screen for CIRS (mold illness) and Lyme + co-infections – treat if present

Other helpful ways to address MCAS are:

Diet: To help manage MCAS and your symptoms, you can go on a Low Histamine Diet. We have recently written an article on histamine intolerance with the full details of a low histamine diet so please see here for details. Histamine is one of the many mediators released by mast cells. By lowering histamine, you will lower this mediator and the potential mast cell activation. You may need to experiment a little to see exactly which foods trigger your reactions. Low histamine is a great place to start then you can track foods and symptoms to tailor the diet more individually.

Supplements: It can also be useful to use supplements to increase DAO production and lower histamine. We included some details on these in our article on histamine intolerance. These include vitamin C and quercetin which help to reduce histamine load. You can also take a DAO supplement like DAO Hist-Digest, which we have formulated for our patients. DAO supplements are designed to increase diamine oxidase (DAO) enzyme, an enzyme that helps break down histamine in the gut. Pre-cursors to DAO can also help and include B6 (in P5P form), copper and B2. Co-factors for DAO production also include B12, iron and vitamin C.

Avoid certain medications: There are medications that decrease DAO activity; anti-arrythmics, some antibiotics, some painkillers, antidepressants, some psychiatric meds, antihistamines, antihypertensives, antimalarials, bronchodilators, diuretics, mucolytics, muscle relaxants and antiseptics. These are best avoided as DAO is required to break down histamine. It is best to also avoid medications that liberate, and therefore increase, histamine. These include some painkillers, antiflogistics, antibiotics, anti-hypotensives, antihypertensives, antitussives, cytostatics, diuretics, iodine-containing contrast mediums, local anaesthetics, muscle relaxants and narcotics. Certain medications inactivate B6, which is necessary to produce DAO. These include antihypertensives, antibiotics and hormonal contraception drugs containing estrogen.

Probiotics impact histamine levels: Some probiotics increase histamine levels (Lactobacillus Casei, Lactobacillus Delbrueckii, Lactobacillus Bulgaricus) so are best avoided with MCAS. Other probiotic strains decrease histamine. They can degrade histamine and are preferable to use in the case of histamine intolerance: Lactobacillus Plantarum, Lactobacillus Rhamnosus, Bifidobacter species and possibly soil based organisms like bacillus subtilis. Please see our article on histamine intolerance.

Mast cell stabilizers can help. There are a vast number of natural mast cell stabilizers:

  • Various flavonoids including quercetin (capers, apples), EGCG (green tea) and silymarin (milk thistle) (Walsh, 2013)
  • Coumarins including ellagic acid (strawberries, raspberries, blackberries, cherries) (Walsh, 2013)
  • Phenols including resveratrol (grapes) and curcumin (turmeric) (Walsh, 2013)
  • Terpenoids including menthol, the cannabinoids (cannabis), ginkgolide and bilobalide (Ginkgo biloba), and the curcuminoids (turmeric, mustard seed) (Walsh, 2013)
  • The amino acid theanine (green tea, mushrooms) (Walsh, 2013)

H1 and H2 blockers: H1 and H2 blockers are over the counter antihistamines.  They can be helpful for many people in minimizing symptoms. However, they do not get to the root causes and in some cases can exacerbate MCAS over the long-run. We may use them on a case-by-case basis in our clinic, if we think they will help a patient.

Reduce and manage stress: Stress causes the body to release a number of hormones. One in particular, CRH, Corticotropin-Releasing Hormone, can activate mast cells and cause them to release their mediators. This can make someone more vulnerable to allergic and autoimmune conditions (Elenkov IJ, 1999).

Sweat out toxins: Toxins such as the heavy metals arsenic, cadmium, lead, and mercury (Sears ME, 2012), phthalates (found in many cosmetic and personal care products) (Genuis SJ, 2012) and Bisphenol A (BPA) (found in plastic food and drink containers) (Genuis SJ B. S., 2012) can all destabilize mast cells and potentially trigger MCAS. Making sure that you sweat is one way for these toxins to leave the body. Going to the sauna to sweat and exercising regularly to induce sweating are ways in which you can mobilize toxins and increase toxic outflow from your body.

Sleep /Manage circadian rhythm: Mast cell activity and mediator-release follows the circadian rhythm of the body. It will increase if the sleep wake cycle is disturbed. For this reason, focus on getting regular high-quality sleep and practice good sleep hygiene in order to keep mast cell activity to a minimum (Pia Christ, 2018).

Others issues like excessive estrogen and low methylation can contribute to high histamine levels. These are best addressed with the help of an experienced functional medicine practitioner.

 

If you suffer from MCAS, allergies or simply have undiagnosed symptoms, then get in touch with us today. We can help to identify whether or not you have MCAS and more importantly, help you get to the root causes and work towards minimizing symptoms. Book a discovery call today with someone from our staff. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

 

References:

Become Mold Illness Free. (2019). Retrieved 6 25, 2019, from Mold Illness Made Simple: https://www.moldillnessmadesimple.com/

Chris Kresser. (2019, 5 28). Retrieved 6 26, 2019, from https://chriskresser.com: https://chriskresser.com/could-your-histamine-intolerance-really-be-mast-cell-activation-disorder/

Mast Cell Activation Syndrme Variants. (2019). Retrieved 6 25, 2019, from The Mastocytosis Society Mast Cell Diseases: https://tmsforacure.org/overview/mast-cell-activation-syndrome-variants/

Overview & Diagnosis. (2019). Retrieved 6 25, 2019, from The Mastocytosis Society Mast Cell Diseases: https://tmsforacure.org/overview/

Symptoms And Triggers Of Mast Cell Activation. (2019). Retrieved 6 25, 2019, from The Mastocytosis Society Mast Cell Diseases: https://tmsforacure.org/symptoms/symptoms-and-triggers-of-mast-cell-activation/

Afrin LB, K. A. (2015). Mast Cell Activation Disease and Microbiotic Interactions. Clinical Therapeutics, 941-53.

Afrin, L. B. (2013). Presentation, diagnosis, and management of mast cell activation syndrome. In L. B. Afrin, Mast Cells: Phenotypic Features, Biological Functions and Role in Immunity (pp. 155-232). Nova Science Publishers, Inc.

Akin C, V. P. (2010). Mast cell activation syndrome: Proposed diagnostic criteria. The Journal of Allergy and Clinical Immunology, 1099-104.

Akin, C. (2017). Mast cell activation syndromes. The Journal of Allergy and Clinical Immunology.

Anand P, S. B. (2012). Mast cells: an expanding pathophysiological role from allergy to other disorders. Naunyn-Schmiedeberg’s Archives of Pharmacology, 657-70.

Elenkov IJ, W. E. (1999). Stress, corticotropin-releasing hormone, glucocorticoids, and the immune/inflammatory response: acute and chronic effects. The Annals of the New York Academy of Sciences.

EZ da Silva, M. J. (2014). Mast cell function: a new vision of an old cell. Journal of Histochemistry and Cytochemistry, 698–738.

Genuis SJ, B. S. (2012). Human elimination of phthalate compounds: blood, urine, and sweat (BUS) study. Scientific World Journal.

Genuis SJ, B. S. (2012). Human excretion of bisphenol A: blood, urine, and sweat (BUS) study. International Journal of Environmental Research and Public Health.

Gerhard J Molderings, S. B. (2011). Mast cell activation disease: a concise practical guide for diagnostic workup and therapeutic options. Journal of Hematology & Oncology, 10.

José Pedro Lopes, M. S. (2015). Opportunistic pathogen Candida albicans elicits a temporal response in primary human mast cells. Scientific Reports.

Kritas SK, G. C. (2018). Impact of mold on mast cell-cytokine immune response. Journal of Biological Regulators & Homeostatic Agents, 763-768.

Lee TD, S. M. (1986). Mast cell responses to helminth infection. Parasitology Today, 186-91.

Lichtenberger, D. F. (2015, April 11). DukeHeartCenter/3-mcas-frank-lichtenberger. Retrieved 6 25, 2019, from www.slideshare.net: https://www.slideshare.net/DukeHeartCenter/3-mcas-frank-lichtenberger

Pia Christ, A. S. (2018). The Circadian Clock Drives Mast Cell Functions in Allergic Reactions. Frontiers in Immunology.

  1. Saluja, M. M. (2012). Role and Relevance of Mast Cells in Fungal Infections. Frontiers in Immunology, 146.
  2. Bent, C. G. (1992). The effects of heavy metal ions (Cd2+, Hg2+, Pb2+, Bi3+) on histamine release from human adenoidal and cutaneous mast cells. Inflammation Research, C321–C324.

Sears ME, K. K. (2012). Arsenic, cadmium, lead, and mercury in sweat: a systematic review. International Journal of Environmental Research and Public Health.

Tae Chul Moon, A. D. (2014). Mast Cell Mediators: Their Differential Release and the Secretory Pathways Involved. Frontiers in Immunology, 569.

Valent, P. (2013). Mast cell activation syndromes: definition and classification. European Journal of Allergy and Clinical Immunology, 417-424.

Walsh, D. F. (2013). Twenty‐first century mast cell stabilizers. British Journal of Pharmacolgy.

 

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July 18, 2019

Mast Cell Activation Syndrome:  What is it and could it be affecting your health? Part 1

by Dr. Miles Nichols and Nicola Schuler, CNTP, MNT

Mast Cell Activation Syndrome: Part 1

This is Part 1 of our 2-part series on Mast Cell Activation Syndrome. In Part 1, we will discuss what is Mast Cell Activation Syndrome, symptoms and diagnostic criteria. Next week in Part 2, stay tuned for information on causes, triggers, treatment and most importantly, what you can do about MCAS.

Introduction:

Mast Cell Activation Syndrome or MCAS is a collection of symptoms resulting from mast cells or MCs which have been inappropriately activated (Afrin, 2013).  When MCs become overactive, they can cause serious problems in the body.

MCAS and its symptoms can present as chronic and persistent or recurring periodically (Afrin, 2013). It usually appears relatively early in life via unknown mechanisms. It is possible that an interaction of environmental factors with inherited risk factors is the cause (Afrin, 2013).

It initially appears often in childhood or adolescence but symptoms are non-specific. Often all of MCAS’s symptoms are non-specific, which can lead to decades of mysterious illness and incorrect diagnoses before a correct diagnosis of MCAs is determined (Afrin, 2013).

Mast cell activation syndrome is different from mastocytosis. In mastocytosis, there is an excessive growth or amount of mast cells. Mastocytosis can also occur when the mast cells produced have some sort of genetic defect (Gerhard J Molderings, 2011). Mastocytosis is very rare and not usually triggered by an irritant (Gerhard J Molderings, 2011).

In MCAS, due to some type of trigger (we will discuss possible triggers in Part 2 next week), mast cells become overactive in some people, leading to the development of mast cell activation syndrome (Valent, 2013). Mast cell activation causes chronic inflammation that causes mild to life-threatening symptoms (Valent, 2013).

Symptoms:  The chart below gives a detailed overview of all of the symptoms of MCAS (Lichtenberger, 2015).

MCAS‐related symptoms may be mild, moderate, severe, or even life‐threatening  (Valent, 2013). The severity of MCAS depends on a number of different factors, including genetic susceptibility, the number of mast cells involved, which chemicals are released in the reaction, the type of allergen, the presence of a specific IgE allergy and the possible presence of certain comorbidities (i.e.: one or more additional conditions co-occurring with the primary condition of MCAS) (Valent, 2013).

MCAS was first recognized in 1991 and not identified as a condition until 2007 (Afrin, 2013). Diagnostic criteria were not in place until 2010 (Akin C, 2010).

So what is it?

Definition: Mast cells are white blood cells in the immune system. Mast cells are involved in various important functions such as certain immune system processes like inflammation, defense against pathogens and allergic reactions (EZ da Silva, 2014). They are also involved in the formation of new blood cells, wound healing, the development of immune tolerance, and the maintenance of blood-brain barrier function (EZ da Silva, 2014).

As part of the immune system, mast cells produce inflammatory histamine, cytokines and other chemicals.  These chemicals that they release are referred to as ‘mediators’. There are over 200 different types of mediators that they release, including histamine, tryptase, prostaglandins, leukotrienes and others (Tae Chul Moon, 2014). Cytokines can be positive or problematic, but are generally thought to be pro-inflammatory overall and we see this evidenced by MCAS significantly involving inflammation.

MCAS occurs if something goes wrong with the mast cells. In MCAS, a normal amount of mast cells are present but they are over-activated out of proportion to the perceived threat, causing them to release excessive amounts of mediators (Gerhard J Molderings, 2011).

Mast cell activation commonly happens in the case of an allergy. The allergic reaction begins when the allergen interacts with IgE antibody complexes which are on the surface of sensitized mast cells (Walsh, 2013). This causes a series of downstream signaling events within the mast cell. This process leads to the release of chemical mediators such as histamine from mast cells as well as the production of cytokines and chemokines, which are inflammatory molecules of the immune system. The actions of these mediators as well as other immune cells are responsible for the effects of an IgE‐mediated allergic reaction (Walsh, 2013). Mast cells are central to both the development and maintenance of allergic diseases.

MCAS can occur as an indirect result of another disease or condition and be unrelated to an allergy. An IgE-type allergy can be a cause of secondary MCAS, but other diseases can cause secondary MCAS also (Mast Cell Activation Syndrme Variants, 2019).

It used to be thought that histamine was the primary mediator released by mast cells. But we now know that there are hundreds of mediators involved. Due to the vast number of possible mediators and the large diversity of both direct and indirect, local and remote effects caused by these mediators released by MCs, MCAS can present itself quite differently in different people (Akin, 2017).  Thus the symptoms of MCAS can vary by person, based on which mediators are released by the overactive mast cells:

Possible Effects of Some Mast Cell Mediators (Symptoms And Triggers Of Mast Cell Activation, 2019)

MEDIATOR POSSIBLE EFFECTS
Histamine Flushing, itching, diarrhea, hypotension
Leukotrienes Shortness of breath
Prostaglandins Flushing, bone pain, brain fog, cramping
Tryptase Osteoporosis, skin lesions
Interleukins Fatigue, weight loss, enlarged lymph nodes
Heparin Osteoporosis, problems with clotting/bleeding
Tumor Necrosis Factor-α Fatigue, headaches, body aches

This list is not exhaustive and is just to serve as an example. Mast cells secrete many different types of mediators responsible for numerous symptoms (Symptoms And Triggers Of Mast Cell Activation, 2019). Furthermore, mast cells are found in all human tissue in the body, so MCAS can potentially have an effect within every organ system of the body (Gerhard J Molderings, 2011). It has been found to be associated with conditions such as obesity, diabetes, skin conditions, irritable bowel syndrome (IBS), depression, autoimmune conditions and possibly others (Anand P, 2012).

In fact, some clinicians are beginning to think that histamine intolerance issues could be MCAS, which would make it a more common condition as histamine intolerance is seen more frequently than MCAS is (Chris Kresser, 2019).

Diagnosis:

There are three criteria to officially diagnose MCAS:

  1. the symptoms recur in separate episodes or are chronic
  2. tryptase, one of the possible mast cell mediators, is measured as elevated during and after an episode and
  3. symptoms decrease in a ‘complete and major’ response to medications that inhibit histamine and other mediators (Overview & Diagnosis, 2019).

Testing:

There is no definitive test for MCAS but there are a number of biomarkers that can aid in coming to a diagnosis. The markers below can be useful in confirming a diagnosis of MCAS and in tracking the progress of treatment (Become Mold Illness Free., 2019). Most of these biomarkers are mediators released by mast cells:

  • DAO
  • Histamine
  • Ratio between DAO and Histamine
  • Tryptase
  • Chromogranin A
  • Prostaglandin F2 alpha
  • Prostaglandin D2
  • Heparin
  • N-methylhistamine

In addition to these diagnostic criteria and tests, there is a questionnaire to recognize symptoms of mast cell activation disease in a standardized manner (Afrin LB M. G., 2014).

We will continue next week with Part 2 of Mast Cell Activation Syndrome, when we will discuss causes, triggers, treatment and most importantly, what you can do about MCAS. Please be sure to read MCAS Part 2.

 

References:

Become Mold Illness Free. (2019). Retrieved 6 25, 2019, from Mold Illness Made Simple: https://www.moldillnessmadesimple.com/

Chris Kresser. (2019, 5 28). Retrieved 6 26, 2019, from https://chriskresser.com: https://chriskresser.com/could-your-histamine-intolerance-really-be-mast-cell-activation-disorder/

Mast Cell Activation Syndrme Variants. (2019). Retrieved 6 25, 2019, from The Mastocytosis Society Mast Cell Diseases: https://tmsforacure.org/overview/mast-cell-activation-syndrome-variants/

Overview & Diagnosis. (2019). Retrieved 6 25, 2019, from The Mastocytosis Society Mast Cell Diseases: https://tmsforacure.org/overview/

Symptoms And Triggers Of Mast Cell Activation. (2019). Retrieved 6 25, 2019, from The Mastocytosis Society Mast Cell Diseases: https://tmsforacure.org/symptoms/symptoms-and-triggers-of-mast-cell-activation/

Afrin LB, K. A. (2015). Mast Cell Activation Disease and Microbiotic Interactions. Clinical Therapeutics, 941-53.

Afrin, L. B. (2013). Presentation, diagnosis, and management of mast cell activation syndrome. In L. B. Afrin, Mast Cells: Phenotypic Features, Biological Functions and Role in Immunity (pp. 155-232). Nova Science Publishers, Inc.

Akin C, V. P. (2010). Mast cell activation syndrome: Proposed diagnostic criteria. The Journal of Allergy and Clinical Immunology, 1099-104.

Akin, C. (2017). Mast cell activation syndromes. The Journal of Allergy and Clinical Immunology.

Anand P, S. B. (2012). Mast cells: an expanding pathophysiological role from allergy to other disorders. Naunyn-Schmiedeberg’s Archives of Pharmacology, 657-70.

Elenkov IJ, W. E. (1999). Stress, corticotropin-releasing hormone, glucocorticoids, and the immune/inflammatory response: acute and chronic effects. The Annals of the New York Academy of Sciences.

EZ da Silva, M. J. (2014). Mast cell function: a new vision of an old cell. Journal of Histochemistry and Cytochemistry, 698–738.

Genuis SJ, B. S. (2012). Human elimination of phthalate compounds: blood, urine, and sweat (BUS) study. Scientific World Journal.

Genuis SJ, B. S. (2012). Human excretion of bisphenol A: blood, urine, and sweat (BUS) study. International Journal of Environmental Research and Public Health.

Gerhard J Molderings, S. B. (2011). Mast cell activation disease: a concise practical guide for diagnostic workup and therapeutic options. Journal of Hematology & Oncology, 10.

José Pedro Lopes, M. S. (2015). Opportunistic pathogen Candida albicans elicits a temporal response in primary human mast cells. Scientific Reports.

Kritas SK, G. C. (2018). Impact of mold on mast cell-cytokine immune response. Journal of Biological Regulators & Homeostatic Agents, 763-768.

Lee TD, S. M. (1986). Mast cell responses to helminth infection. Parasitology Today, 186-91.

Lichtenberger, D. F. (2015, April 11). DukeHeartCenter/3-mcas-frank-lichtenberger. Retrieved 6 25, 2019, from www.slideshare.net: https://www.slideshare.net/DukeHeartCenter/3-mcas-frank-lichtenberger

Pia Christ, A. S. (2018). The Circadian Clock Drives Mast Cell Functions in Allergic Reactions. Frontiers in Immunology.

R. Saluja, M. M. (2012). Role and Relevance of Mast Cells in Fungal Infections. Frontiers in Immunology, 146.

S. Bent, C. G. (1992). The effects of heavy metal ions (Cd2+, Hg2+, Pb2+, Bi3+) on histamine release from human adenoidal and cutaneous mast cells. Inflammation Research, C321–C324.

Sears ME, K. K. (2012). Arsenic, cadmium, lead, and mercury in sweat: a systematic review. International Journal of Environmental Research and Public Health.

Tae Chul Moon, A. D. (2014). Mast Cell Mediators: Their Differential Release and the Secretory Pathways Involved. Frontiers in Immunology, 569.

Valent, P. (2013). Mast cell activation syndromes: definition and classification. European Journal of Allergy and Clinical Immunology, 417-424.

Walsh, D. F. (2013). Twenty‐first century mast cell stabilizers. British Journal of Pharmacolgy.

 

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July 4, 2019

HISTAMINE INTOLERANCE

by Dr. Miles Nichols and Nicola Schuler, CNTP, MNT

 

What is histamine?

Histamine is a chemical that is found in foods and is made in the body (1). Histamine is released from mast cells, within the immune system, when an allergen is detected by the body (1).

Histamine is also is produced in the body from the amino acid histidine, which is a type of protein (1). Histamine occurs in food as a by-product of the fermentation of histidine. It is a chemical which is produced by bacteria during fermentation, storage or decay.

Histamine plays an important role in the immune system. It causes an immediate inflammatory response. It serves as a warning to the immune system, telling the body about any potential attackers. Histamine causes blood vessels to swell, or dilate, so that white blood cells can quickly find and attack the infection or problem.

Histamine plays other roles in the body as well. As a neurotransmitter, it communicates important messages to and from the brain and spinal cord (1). These messages are related to arousal and attention. This partly explains why OTC anti-histamines that cross the blood-brain barrier, such as diphenhydramine or Benadryl, act as sedatives (1).

Histamine is also involved in stimulating the parietal cells, found in the stomach, to secrete stomach acid, which is critical for breaking down food in the stomach and for good digestion (2). Too much histamine can be one cause of excessive secretion of stomach acid. This can lead to acid reflux / heartburn (GERD).

Histamine Intolerance is an increased sensitivity to histamine and/or an excessive build-up of histamine in the body.

An excessive amount of histamine is suspected to result from various sources:

  • Allergic response(s)
  • Eating large quantities of histamine-containing foods or beverages
  • Consumption of foods or other substances that cause histamine to be released
  • Impaired ability for enzymes in the body to break it down (3)

The enzymes that can break down histamine are diamine oxidase (DAO) and histamine N-methyl transferase (HNMT) (3).

There are two primary categories of issues:

  1. An increased amount of histamine in the body
  2. Decreased activity of the enzymes that break down histamine and remove it from the body

In addition to these categories, approximately 1% of the population experience adverse reactions to what is considered a “normal” level of histamine in food (3). This typically presents more often in people who are middle-aged (3). High levels of histamine can make a person feel unwell but the majority of people tolerate the amounts found in a regular diet without any issues.

A histamine reaction is the body’s natural immune response, but if histamine is not broken down properly, it can lead to histamine intolerance (HI). This is why OTC medications like Claritin can help with an allergic histamine reaction. Claritin is an anti-histamine which blocks and decreases histamine’s action.

What are the symptoms of excess histamine?

The onset and severity of histamine intolerance symptoms can vary greatly between individuals, but common complaints are (3):

  • Flushing
  • Migraines and headaches
  • Respiratory problems including: asthma, nasal congestion, sneezing, difficulty breathing
  • Skin conditions like: itching, rashes, dermatitis, hives or eczema, swelling
  • Gastrointestinal problems such as: nausea, reflux, vomiting, abdominal pain/cramps, diarrhea
  • Dizziness, low blood pressure, and irregular heartbeat
  • Difficulty falling & staying asleep
  • Anxiety
  • Abnormal menstrual cycle
  • Fatigue
  • Joint pain

 How is it diagnosed?

Diagnosis of histamine intolerance has been based on low serum levels of DAO (the enzyme responsible for breaking down histamine), the presence of gastrointestinal disorders and the improvement of symptoms with a low histamine diet (4). Some additional blood markers like whole blood histamine and a few others can also point to histamine issues.

What are the causes of high histamine?

Intolerance to histamine is primarily thought to be caused by previous or current gastrointestinal problems (such as SIBO or small intestinal bacterial overgrowth, dysbiosis, leaky gut, inflammation of the gut), toxic burden, and/or genetics.

There is evidence that dysbiosis, or an alteration of the gut microbiome, is related to the incidence of all food intolerances, and especially to histamine intolerance (5). Dysbiosis is an imbalance in the types and amounts of bacteria in the gut. It means there are too many pathogenic or bad bacteria and too few good or health-promoting bacteria in the gut microbiome. It is very often associated with disease.

One study analyzed the microbiome of people with histamine intolerance (5). They found increased amounts of certain pathogenic bacteria like Proteobacteria, and a reduced level of good bacteria such as Bifidobacteriaceae / Bifidobacterium (5). This imbalance and lower bacterial diversity can both point to dysbiosis, or a problematic balance of bacteria in the gut. Additionally, this study found an impaired intestinal barrier, or leaky gut, in this patient group (5).

Histamine has a negative effect on gut permeability. Dysbiosis in histamine intolerant patients may contribute to mucosal inflammation of the gut (5). This in turn could favor the development of a leaky gut as well as the reduction of intestinal DAO leading to elevated histamine levels and symptoms in sensitive people (5).

Mast Cell Activation Syndrome (MCAS)

Toxic burden can also be a cause of mast cell activation syndrome (MCAS). Mast cells are cells that produce histamine. When mast cells are activated, they produce and release a high level of histamine, in addition to other chemicals. MCAS is a condition where there seems to be overly active mast cells and high histamine levels. This creates an inflammatory response and contributes to very similar symptoms as histamine intolerance.

As mentioned, gut dysbiosis and gut conditions like small intestinal bacterial overgrowth (SIBO) can be a cause of histamine issues (including MCAS). There are also common issues where toxins accumulate and that also seems to be correlated with higher levels of MCAS. Not all of the causes of MCAS are known.

About 1 in 4 people have a genetic predisposition in which there is a change in the HLA-DR gene. This gene is involved with the immune system’s ability to identify certain kinds of toxins and to eliminate them from the body effectively. In people with this genetic predisposition, there is an increased potential for these toxins to bioaccumulate and cause inflammation. In many cases mold toxins, or mycotoxins, are one of the toxins that are not appropriately identified.

This is a significant issue, given that about 1 in 2 American homes have been shown to have water damage and may have high levels of mold toxins. Because only 1 in 4 people have the gene, not everyone in the home will become ill. This makes mold toxin illness a common issue that is often underdiagnosed.

Although the reason why there is a link between MCAS and mold toxin illness remains unknown, many clinicians who treat mold issues see a high correlation between these two conditions.

Our blog post next week will focus on MCAS so be sure to look out for that article and read further on MCAS.

Enzymes involved in decreasing histamine

The main histamine enzyme in the gut is diamine oxidase (DAO), while other areas like the skin, spinal cord, lungs and other organs rely on an enzyme called histamine N-methyltransferase (HNMT) (5). Though both enzymes play an important role in histamine break down, DAO is the main enzyme responsible for breaking down ingested histamine. Any deficiency in DAO will likely result in symptoms of histamine intolerance (5).

The causes of high histamine (3, 5)

  • Allergies (IgE reactions)
  • Bacterial overgrowth (SIBO)
  • Leaky gut (intestinal permeability)
  • GI bleeding
  • Dysbiosis
  • Gut inflammation
  • Mold toxin illness
  • Fermented alcohol like wine, champagne, and beer and histamine-rich foods
  • Diamine oxidase (DAO) deficiency

Causes of low DAO (6)

  • GI disorders such as gluten intolerance, celiac disease, leaky gut, SIBO, inflammatory bowel disease
  • Inflammation from Crohn’s, ulcerative colitis, and inflammatory bowel disease
  • DAO-blocking foods: alcohol, energy drinks, and black, mate and green teas
  • Nutrient deficiencies for co-factors of DAO (vitamin B6, vitamin C, copper, vitamin B12, and iron)
  • Genetic mutations that lead to a reduced DAO enzyme activity (common in people of Asian-descent)
  • Medications that block DAO or prevent its production including: Non-steroidal anti-inflammatory drugs (ibuprofen, aspirin), Antidepressants (Cymbalta, Effexor, Prozac, Zoloft), Immune modulators (Humira, Enbrel, Plaquenil), Antiarrhythmics (propanolol, metaprolol, Cardizem, Norvasc), Antihistamines (Allegra, Zyrtec, Benadryl) and Histamine (H2) blockers (Tagamet, Pepcid, Zantac)

Although histamine blockers, a class of acid-reducing drugs, seem like they would help prevent histamine intolerance, these medications can actually deplete DAO levels in the body.

Treatment

Symptoms either improve or disappear with a low histamine diet (4). One study found a significant increase in serum DAO levels in patients with strict and even occasional compliance to a low histamine diet (4). The study authors concluded that a low histamine diet not only improves symptoms in HI, but also leads to an increase in serum DAO which correlates with the degree of diet compliance (4).

It is also critical to work on gut health to alleviate histamine intolerance. We know that dysbiosis and other GI issues are often present with histamine intolerance (3, 5, 6). Eradicating any gut infections, overgrowths or inflammation will be vital for rebalancing the gut and ensuring a healthy balance of gut flora.

The Basics of the Low Histamine Diet

Eat freshly cooked and prepared real food! Packaged and processed food can have high histamine levels. Eating fresh food is important because histamine levels increase the longer food is not refrigerated. Histamine levels can also increase in left-over or fermented food.

Unfortunately, the histamine content of different foods can vary quite substantially depending on the maturity of the food, storage time, and processing (7). So histamine levels can differ considerably within the same food product. For example, the histamine content in Emmental cheese varies from <0.1 to 2000 mg/kg and in smoked mackerel from <0.1 to 1788 mg/kg (7). These variations make it difficult to estimate the histamine content of individual meals. However, it is entirely possible to decrease histamine load by concentrating on low histamine foods and avoiding foods high in histamine (like cheese and fish) or foods that block DAO activity.

Low Histamine Foods to Eat:

  • Freshly cooked grass fed, wild, organic meat or poultry: red meat, steak, ham, chicken and turkey
  • Freshly caught wild fish
  • Cooked pastured eggs
  • Gluten-free grains: rice, quinoa, corn, millet, amaranth, teff
  • Pure peanut butter (although peanut butter can be contaminated with a mold toxin called aflatoxin)
  • Legumes (except soybeans & red beans)
  • Fresh fruits: mango, pear, watermelon, apple, kiwi, cantaloupe, grapes
  • All fresh vegetables (except tomatoes, spinach, avocado, and eggplant)
  • Dairy substitutes: coconut milk, rice milk, hemp milk
  • Cooking oils: olive oil, coconut oil
  • Leafy herbs
  • Herbal teas
  • Decaffeinated coffee
  • Honey & maple syrup

 

Some tips to keep in mind for food preparation:

  • Try to cook most of your own meals to avoid histamine
  • Avoid or limit eating canned foods and ready meals
  • Avoid heavily processed or junk foods: food dyes/artificial colors can be big triggers
  • Keep the kitchen clean
  • Refrigerate vigilantly as histamine forms on food as it spoils

 

Foods to Avoid:

To reduce histamine from food, avoid:

  • Foods high in histamine
  • Foods that release histamine
  • Foods that suppress DAO

Unfortunately, some research says certain foods are high in histamine and other research disagrees in some cases. Some foods are consistent across research studies. For this reason, we focus on the foods that are consistent across research studies. You may find that our list does not mention foods that other lists or research say is high in histamine. However, if one research study says a food is high in histamine and another says it is low, we have eliminated that food in order not to recommend avoiding things unnecessarily. It is important to have a varied healthy diet with few food restrictions, especially when we are not sure about whether those foods have high levels of histamine or not.

Histamine-Rich Foods (3):

  • Yeast or anything that contains it: alcohol, bread, pastries, and baked goods
  • Fermented foods: sauerkraut, vinegar, soy sauce, kefir, yogurt, kombucha, etc.
  • Vinegar-containing foods: pickles, mayonnaise, olives
  • Cured deli meats: bacon, salami, pepperoni, luncheon meats and hot dogs
  • Soured foods: sour cream, sour milk, buttermilk, soured bread, etc.
  • Dried fruit: apricots, prunes, dates, figs, raisins
  • Some citrus fruits: lemon and mandarin
  • Some other fruit: pineapple, banana, and avocado
  • Aged hard or semi-hard cheese including goat cheese (soft fresh cheese is okay)
  • Nuts: all nuts, especially walnuts, cashews
  • Smoked fish or canned anchovies
  • Bone broth
  • Certain spices: curry, mustard seed / mustard, and soy sauce

Histamine-Releasing Foods:

  • Alcohol
  • Banana
  • Nuts
  • Pineapple
  • Shellfish
  • Many artificial preservatives and dye

 

DAO-Blocking Foods (6):

  • Alcohol

In addition to alcohol releasing histamine and inhibiting DAO, there is also enzyme competition as some enzymes that can break down histamine are also involved in breaking down alcohol. The body may have to choose one of the two and this can further exacerbate histamine issues.

 

Probiotics and histamine: Probiotics impact histamine levels. Some increase histamine levels and others decrease histamine.

These probiotics can produce histamine – consider avoiding with histamine intolerance:

  • Lactobacillus Casei
  • Lactobacillus Delbrueckii
  • Lactobacillus Bulgaricus

These probiotics can degrade histamine and are preferable to use in the case of histamine intolerance:

  • Lactobacillus Plantarum
  • Lactobacillus Rhamnosus
  • Bifidobacter species
  • Possibly soil based organisms like bacillus subtilis
  • Some report benefit from Saccharomyces Boulardii

 

How to manage histamine intolerance:

  • In order to manage histamine intolerance, it is useful to follow a low histamine diet for 3 months. Avoid foods that either release histamine or block the action of DAO.
  • It can be helpful to take a DAO supplement.
  • Experiment with supplements that are pre-cursors to endogenous DAO production: vitamin B6 (in P-5-P form), copper and B2 (7). In addition, vitamin C can help to degrade excess histamine (7). Vitamin B12 may also help in some cases (we prefer methylcobalamin form of B12).
  • Some herbs like nettles and nutrients like quercetin can also help.
  • Healing the gut is an important step. This involves addressing SIBO and other potential gut infections or issues (parasites, celiac, inflammation, dysbiosis or others), as well as healing leaky gut.
  • Then re-introduce histamine foods, one food every 3 days, and observe reactions very carefully to see what can be tolerated without symptoms. Once symptoms are better under control and the overall histamine load is lower, it may be possible to tolerate some histamine foods, in a few months’ time.

 

There are many other factors involved with histamine intolerance and MCAS. For example, methylation is one issue that we did not discuss in this article, but low methylation can be associated with increased histamine. If you feel that you have several of the symptoms mentioned in this article, we recommend seeking guidance from a practitioner experienced with histamine intolerance and/or MCAS.

Please get in touch with us to help you manage and improve your histamine intolerance. We consult with clients world-wide. Use this link to get in touch: https://livinglovecommunity.com/book-15-min-discovery-call/

 

References:

  1. Purves D, Augustine GJ, Fitzpatrick D, et al. 2001. Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates; 2001. The Biogenic Amines. https://www.ncbi.nlm.nih.gov/books/NBK11035/
  2. University of Washington. Regulation of Acid Secretion. https://courses.washington.edu/conj/bess/acid/acidreg.html. Accessed June 17, 2019.
  3. Kohn 2014. Is There a Diet for Histamine Intolerance? J Acad Nutr Diet. 114: 1860.
  4. Lackner S, Malcher V, Enko D, Mangge H, et al. 2018. Histamine-reduced diet and increase of serum diamine oxidase correlating to diet complance in histamine intolerance. Eur J Clin Nutr. 73, 102–104.
  5. Schink M, Konturek PC, Tietz E, et al. 2018. Microbial Patterns Patients with Histamine Intolerance. J Physiol Pharmacol. 69, 4, 579-593. DOI: 10.26402/jpp.2018.4.09.
  6. MTHFR Support Australia. 2018. DAO Deficiency and Histamine: The Unlikely Connection. https://mthfrsupport.com.au/2016/09/dao-deficiency-and-histamine-the-unlikely-connection/. Accessed June 17, 2019.
  7. Reese I, Ballmer-Weber B, Beyer K et al. 2017. German Guideline for the Management of Adverse Reactions to Ingested Histamine. Allergo J Intl. 26: 72. doi.org/10.1007/s40629-017-0011-5.
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June 25, 2019

What is the Difference between Near and Far Infrared Light Therapies?

by Dr. Miles Nichols and Nicola Schuler, CNTP, MNT

Infrared radiation (IR), or infrared light, is a type of energy that’s invisible to the human eye but that can be felt as heat (1). IR is a type of electromagnetic radiation.

Electromagnetic radiation is a continuum of frequencies produced when atoms absorb and then release energy (1). From highest to lowest frequency, electromagnetic radiation includes gamma-rays, X-rays, ultraviolet radiation, visible light, infrared radiation, microwaves and radio waves (1). Together, these types of radiation make up the electromagnetic spectrum.

Within the electromagnetic spectrum, infrared waves occur at frequencies above those of microwaves and just below those of red visible light. Waves of infrared radiation are longer than those of visible light.

You might be thinking that radiation sounds bad for the body especially when you hear that microwaves are next on the spectrum.

However, there are two types of radiation:

  1. Ionizing – can damage DNA (genes)
  2. Non-ionizing – tends not to damage DNA

Infrared radiation is a non-ionizing form of radiation, which does not damage DNA (2). Ionizing radiation exposure can damage DNA. Ionizing forms are far ultraviolet radiation and x-rays.

Infrared radiation can be categorized into three groups according to wavelength, namely near infrared (NIR, 0.8–1.5 µm), middle infrared (MIR, 1.5–5.6 µm), and far infrared (FIR, 5.6–1000 µm) (3).

Infrared energy explains the concept of thermal imaging. Some infrared energy can be seen as heat. Some objects are so hot they emit visible light, such as fire (2). Other objects, such as humans, are not as hot and only emit infrared waves (2).

The human eye cannot see these infrared waves but instruments that can sense infrared energy, like night-vision goggles or infrared cameras, allow us to see the infrared waves emitting from humans and animals (2).

Everything in the universe emits some level of IR radiation (1). The two most obvious sources are the sun and fire. All living organisms benefit from the natural electromagnetic radiation of the sun.

Thermal radiation (or infrared) is a band of energy that has been used effectively for millennia to treat and ease certain maladies and discomforts (4). Heated saunas are one of the oldest methods of delivering radiation in a controlled environment and within a convenient treatment time (4).

What is Far InfraRed:

Far InfraRed Radiation or FIR relates to the longer wavelengths of radiation in the infrared spectrum, between 5.6 and 1000 micrometers (3). FIR wavelength cannot be perceived by the eyes, but its heat penetrates up to 1.5 inches (almost 4 cm) beneath the skin (4). FIR has been found to stimulate cells and tissue and is considered a promising treatment method for certain medical conditions (4).

There are new techniques for delivering FIR radiation to the human body. In fact, you may have heard of a far-infrared sauna. If not, you can Google the term and find lots of information and products.

Specialty lamps and saunas, delivering pure FIR radiation (eliminating completely the near and mid infrared bands), have become safe, effective, and widely used for the therapeutic benefits of FIR (4).

Clothing made with fibers containing FIR emitting ceramic nanoparticles, which is woven into the fabric, is being used to generate FIR radiation, and attain health benefits from its effects (4).

Benefits of FIR:

There are multiple medical applications of FIR that can improve health and reduce or even treat disease:

  • Reduces pain and inflammation (4)
  • Promotes cell repair post exposure to FIR (4)
  • Enhances circulation in the skin (4)
  • Protects against oxidative stress (4)
  • Enhances weight loss (4)
  • Stimulates cell proliferation, increases tissue regeneration (4)
  • FIR sauna therapy has been used to improve cardiac and vascular function and reduce oxidative stress in patients with chronic heart failure (5).
  • FIR saunas have a beneficial effect on quality of life in patients with type II diabetes. Physical health, general health, stress and fatigue all improved in the treatment group receiving FIR (6).
  • A study of patients with rheumatoid arthritis and ankylosing spondylitis showed a reduction in pain, stiffness, and fatigue during far infrared sauna therapy (8).
  • FIR has the effect of reducing the proliferation of some cancer cell lines (4). This suggests that FIR radiation may be used as an effective medical treatment for some cancer cells (4).
  • FIR therapy reduced symptoms of exercise-induced muscle damage in highly-trained athletes after a trail running race (8).
  • Modulates sleep: one study used a blanket containing FIR emitting ceramic discs and reported improved quality of sleep in the study subjects (9).
  • Gloves have been made out of FIR emitting fabrics and these gloves can be used to treat arthritis of the hands and Raynaud’s syndrome (10).
  • FIR therapy is effective in relieving pain in patients with chronic pain, chronic fatigue syndrome and fibromyalgia (3).
  • FIR benefitted patients who experienced persistent and progressively increasing phantom limb pain after amputation (3).
  • FIR stimulation alleviated depression in patients with insomnia by increasing serotonin (3).
  • FIR can reduce the pain of wounds after standard medical wound treatments. Wounds exposed to FIR had lower healing times (11).

Risks:

FIR is generally quite safe compared to other medical interventions. However, there are risks of infrared radiation exposure to the skin and the eyes. A potential concern is an increase in photo-aging (skin aging due to light) (12).

Infrared radiation can also harm tattooed skin and cause skin inflammation (13). The lens of the eye is very sensitive to infrared radiation and long-term exposure can contribute to cataract formation (14).

How to access FIR:

There are three main ways to benefit from FIR radiation:

  • FIR saunas
  • FIR ray devices
  • FIR emitting ceramics and fabrics (4)

FIR saunas are quite popular and there are many brands of FIR saunas that can be purchased for home use. In addition to saunas, there are also FIR lamps and clothing that can be purchased. For recommendations on a far-infrared sauna, call our office at 720-722-1143 or use our contact page.

What is Near Infrared:

Near Infrared Radiation or NIR relates to the shorter wavelengths of radiation in the infrared spectrum; NIR, 0.8–1.5 µm (3). NIR is used in the therapy called Photobiomodulation or PBM. We have just written an extensive article on Photobiomodulation, which you can find here.  It is a form of light therapy that uses near-infrared light over the brain, inside the nasal cavity, or over injuries or wounds (15).

The light is used to heal, improve tissue repair in wounds, bones and tendons, reduce pain and inflammation and restore and stimulate multiple physiological processes which repair damage caused by injury or disease (15). The healing occurs wherever the beam is applied. The light stimulates the cell’s natural healing and pain relief processes.

Benefits:

Photobiomodulation is used for a huge variety of health issues as it has a significant anti-inflammatory effect. (Again, please refer to our article on PBM for the full details)

  • The key applications of PBM for the future are in the areas of inflammation and autoimmunity (16).
  • Cognitive performance or brain injury (16)
  • Wound healing (16)
  • Arthritis (16)
  • Muscle healing (16)
  • Inflammatory Pain (16)
  • Lung inflammation and asthma (16)
  • Abdominal fat, obesity and type 2 diabetes (16)
  • Cancer (17)
  • Achilles tendinopathy (16)
  • Thyroiditis (16)
  • Psoriasis (16)
  • Hair loss (16)
  • Cognitive performance, memory and mood (18)
  • Cosmetic and aesthetic improvements (18)

Risks:

There are no known risks or side effects associated with PBM.

How to Find out More:

If you live in Colorado or are willing to travel to the Greater Denver Area, please book a discovery call with our clinic to find out more about PBM therapy. You can also call or text “PBM Therapy” or “FIR Sauna” to 720-722-1143. Click here to book a complimentary 15-minute discovery call now.

Which Type of Infrared Radiation – NIR or FIR – is Recommended to be Better for Health?

Based on multiple factors, we recommend NIR therapy over FIR therapy if you have to choose one. However in many cases we may suggest both!

This is because the sun emits 37% of its total energy in the near infrared range, and 3% in the far infrared range (19). Humans are biologically designed to use near infrared light, more so than far infrared light (19). It is now understood that the human body is partially photosynthetic and that we need sun light and near infrared for optimal health (19).

Near infrared is received at the cellular level in a way that far infrared is not. As we discussed in our article on PBM, the effect of near infrared on the cells of the body is an increase in cellular energy production that can then be used to repair and rejuvenate at the cellular level. Far infrared does not have the same cellular effect on the mitochondria of the cells (19). Thus, Near Infrared can provide greater rejuvenating effects over FIR.

Near Infrared as a wavelength has deeper tissue penetration. NASA has measured tissue penetration as deep as 23cm with near infrared (19), whilst FIR penetrates to only 4cm into the skin (4).

Thus, we recommend Photobiomodulation therapy (using Near Infrared Radiation) in most cases as an effective means to treating specific conditions and improving health versus using Far Infrared therapy. That being said, there can be enormous value to the detoxification from sweating that can be stimulated through FIR sauna therapy. This is very beneficial in many cases, but can also be achieved with standard saunas and does not require FIR technology in the sauna. For those purchasing a sauna, we do recommend the FIR technology to add some extra benefit.

 

References:

  1. Live Science. 2019. What is Infrared? https://www.livescience.com/50260-infrared-radiation.html. Accessed June 11, 2019.
  2. NASA Science. 2019. Tour of the Electromagnetic Spectrum. https://science.nasa.gov/ems/07_infraredwaves. Accessed June 11, 2019.
  1. Shui S, Wang X, Chiang JY, Zheng L. 2015. Far infrared therapy for cardiovascular, autoimmune and other chronic health problems: A systematic review. Exp Biol Med. v.240(10); 2015 Oct.
  1. Vatansever F, Hamblin 2012. Far infrared radiation (FIR): Its biological effects and medical applications. Photonics Lasers Med. doi: 10.1515/plm-2012-0034.
  2. Fujita S, Ikeda Y, Miyata M, Shinsato T, Kubozono T, Kuwahata S, Hamada N, Miyauchi T, Yamaguchi T, Torii H, Hamasaki S, Tei C. Effect of Waon therapy on oxidative stress in chronic heart failure. Circ J. 2011;75(2):348–56.
  3. Beever R. The effects of repeated thermal therapy on quality of life in patients with type II diabetes mellitus. J Altern Complement Med. 2010;16(6):677–81.
  4. Oosterveld FG, Rasker JJ, Floors M, Landkroon R, van Rennes B, Zwijnenberg J, van de Laar MA, Koel GJ. Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis. A pilot study showing good tolerance, short-term improvement of pain and stiffness, and a trend towards long-term beneficial effects. Clin Rheumatol. 2009;28(1):29–34.
  5. Hausswirth C, Louis J, Bieuzen F, Pournot H, Fournier J, Filliard JR, Brisswalter J. Effects of whole-body cryotherapy vs. far-infrared vs. passive modalities on recovery from exercise-induced muscle damage in highly-trained runners. PLoS One. 2011;6(12):e27749.
  6. Inoué S, Kabaya M. Biological activities caused by far-infrared radiation. Int J Biometeorol. 1989;33(3):145–50.
  7. Ko GD, Berbrayer D. Effect of ceramic-impregnated “thermoflow” gloves on patients with Raynaud’s syndrome: randomized, placebo-controlled study. Altern Med Rev. 2002;7(4):328–35.
  8. Lin YH, Li TS. 2017. The Application of far Infrared in the Treatment of Wound Healing: A Short-Evidence Based Analysis. J Evid Based Complementary Altern Med.2017 Jan;22(1):186-188.
  9. Holzer AM, Athar M, Elmets CA. 2010. The other end of the rainbow: infrared and skin. J Invest Dermatol.2010 Jun;130(6):1496-9. doi: 10.1038/jid.2010.79.
  10. Chiang C, Romero L. 2009. Cutaneous lymphoid hyperplasia (pseudolymphoma) in a tattoo after far infrared light. Dermatol Surg.2009 Sep;35(9):1434-8. doi: 10.1111/j.1524-4725.2009.01254.x.
  11. Aly EM, Mohamed ES. 2011. Effect of infrared radiation on the lens. Indian J Ophthalmol.2011 Mar-Apr;59(2):97-101. doi: 10.4103/0301-4738.77010.
  12. Joovv. 2019. Photobiomodulation and Cancer: What is the Truth? www.//joovv.com/blogs/joovv-blog/photobiomodulation-cancer-truth. Accessed May 28 2019.
  13. Hamblin MR. 2017. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophysics, 2017, 4(3):337-361. doi: 3934/biophy.2017.3.337.
  14. Hamblin MR, Nelson ST, Strahan JR. 2018. Photobiomodulation and Cancer: What is the Truth? Photomed Laser Surg.2018 May;36(5):241-245. doi: 10.1089/pho.2017.4401.
  15. Hamblin MR, de Sousa MVP, Agrawal T. 2017. Handbook of Low Level Laser Therapy. Singapore: Pan Stanford Publishing.
  16. Lifestyle Integration. Near Vs. Far Infrared Benefits. https://www.lifestyleintegration.com.au/learning-centre/articles/119-near-versus-far-infrared-benefits.html. Accessed June 11, 2019.
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June 6, 2019

Photobiomodulation and Near Infrared Light Therapy

by Dr. Miles Nichols and Nicola Schuler, CNTP, MNT

What is it?

Photobiomodulation (or PBM) is a form of light therapy that uses red or near-infrared light or a low-level laser over the brain, inside the nasal cavity, or over injuries or wounds (1). The light is used to heal, improve tissue repair in wounds, bones and tendons, reduce pain and inflammation and restore and stimulate multiple physiological processes which repair damage caused by injury or disease (1). The healing occurs wherever the beam is applied. The light stimulates the cell’s natural healing and pain relief processes.

Originally PBM was called “low level laser therapy or LLLT”. It has also been called red light therapy (RLT), low level light therapy (LLLT), soft laser therapy, cold laser therapy, bio stimulation and photonic stimulation. Actual lasers are not required because LEDs or light emitting diodes work equally well (2).

For much of the time since its discovery approximately 50 years ago, the mechanism of action or how PBM worked was not really known (2). It is now understood how PBM works on the cellular level.

How does PBM work?

PBM works by producing a biochemical effect in cells that strengthens the mitochondria (2). The primary site of light absorption in cells has been identified as the mitochondria and PBM works by increasing the mitochondria’s potential (3).

All cells in the body have mitochondria. Mitochondria are commonly called the powerhouses of the cells as they provide most of the energy of the cell. They produce ATP (adenosine triphosphate), which is the chemical responsible for energy release within cells which promote cellular and physiological functions including injury repair and pain relief.

When a cell is damaged through injury or trauma, the mitochondria’s efficiency is impaired. As a result, less ATP will be produced. The reduction in ATP will decrease the cells’ healing time dramatically.

When exposed to infra-red light/low level laser at the right frequency and intervals, the mitochondria will be stimulated to immediately begin to increase the production of ATP (2). By increasing the function of the mitochondria using PBM, a cell can make more ATP (2). With more energy, cells can function more efficiently, rejuvenate themselves and repair damage.

How can it be used?

Photobiomodulation is used for a huge variety of health issues.

Cognitive performance or brain injury: PBM is being used to treat traumatic brain injury, stroke, neurodegenerative diseases (Parkinson’s, Alzheimer’s and dementia) and psychiatric disorders (4). PBM has anti-inflammatory effects on the brain which can help with brain injuries (4).

Wound healing: PBM has been used on both acute wounds and chronic non-healing wounds such as diabetic ulcers (4).  What has been found is faster healing and reduced inflammation (4).

Arthritis: Arthritis involves significant inflammation of the arthritic joint. Sometimes this inflammation is systemic as well. Studies have found that swelling and inflammation is reduced with PBM (4). Both osteoarthritic and rheumatoid arthritis have been ‘successfully treated with PBM’ (4).

Muscles: PBM can work well on muscles; it helps to heal muscle injuries and reduce muscle soreness and pain after excessive exercise (4). Unsurprisingly, PBM has many applications in sports. Light delivered to muscles before exercise and after exercise can increase sports performance in athletes (5). Studies have found that PBM can increase muscle mass gained after training, and decrease inflammation and oxidative stress in muscles (5). PBM increases the amount of work and power that can be produced by muscles and can increase the speed of recovery after exercise. This is very helpful in the intense training regimens of top athletes. PBM can also be used for enhancement of performance in amateur and recreational athletes.

Inflammatory Pain: PBM can reduce inflammatory pain and decrease pro-inflammatory markers, chemicals produced at the site of pain and inflammation (4). In fact, PBM is perhaps most relevant in cases of inflammation and inflammatory disorders (4).

Lung inflammation and asthma: PBM has been found to reduce acute lung inflammation and lung edema (4). Another study concluded that in asthma, the reduced lung inflammation and the beneficial effects on lung airways of PBM seem to be a result of increased anti-inflammatory chemicals and less mucous in the airways (6).

Abdominal fat, obesity and type 2 diabetes: The use of PBM to fight one of the biggest health problems of the modern age; obesity, excess fat deposits and type 2 diabetes; is also starting to take off (2). A study on mice found that PBM reduced inflammation in abdominal fat and significantly reduced blood sugar (4).

Cancer: PBM has been found to be effective in reducing the side effects of cancer treatment therapy (7). For example, oral mucositis is a common side effect of cancer treatments, particularly chemotherapy and radiation (7). It is when the mucosal lining of the mouth begins to break down, which can lead to ulcers in the mouth. It results in several problems, including pain, an inability to eat causing poor nutrition, and increased risk of infection due to open sores in the mucus area of the mouth. PBM helps to reduce this issue as well as other complications with cancer treatment (8). An important concern was whether the use of PBM for relief of side effects might encourage the growth of malignant cells and cancerous tumors, given its healing and strengthening effect on cells in general (8). Research has shown that this is not the case and that light can directly damage the tumor, enhance other cancer therapies and stimulate the patient’s immune system (7). There are some clinical trials showing increased survival in cancer patients who received PBM therapy (7).

PBM has been shown in studies to improve Achilles tendinopathy (less pain and reduced inflammation) and thyroiditis (overall improved thyroid function, a reduction in autoimmune antibodies to thyroid and reduced inflammation of the thyroid) (4).

Psoriasis, a chronic autoimmune disease of the skin, is greatly improved with PBM because of its anti-inflammatory effects (4).

Hair loss: PBM is successful in treating the various types of hair loss; alopecia areata, male pattern baldness and chemotherapy induced alopecia (4). Stimulation of hair regrowth is now well established (2).

PBM can also improve cognitive performance, memory and mood (2). It is expected that further research in this area will be emerging soon.

PBM is also useful for cosmetic and aesthetic improvements (2). Improvement of fine lines and wrinkles in the face is growing in popularity, as some people seek aesthetic improvements (2).

Improved understanding of how PBM works at a molecular and cellular level provide the rationale for its use for multiple diseases. The key applications of PBM for the future are in the areas of inflammation and autoimmunity (4).

There is also much promise for its application in brain health, given its ability to reduce neuroinflammation (4). 

The chronic diseases of our times, which are on the rise, are frequently tied to inflammation. Thus type 2 diabetes, obesity, Alzheimer’s, cancer and heart disease can all potentially benefit from the anti-inflammatory effects of PBM.

The benefits of PBM are quite clear: It has a significant anti-inflammatory effect (4). The exact cellular signaling pathways responsible for this anti-inflammatory action are not yet completely understood (4). But it is becoming clear that both local and systemic mechanisms are at work. The reduction of edema, and reductions in markers of oxidative stress and pro-inflammatory cytokines are well known. However there is also a systemic effect when light is delivered to the body that can positively benefit distant tissues and organs (4).

Because of the mitochondrial benefits, PBM can also be used preventively for those interested in longevity and long-term wellness. Those who are looking to optimize their cognitive performance, people who want to be at the top of their game, are also using PBM to boost their brain.

What are the Risks of PBM?

PBM has an almost complete lack of reported adverse effects (4). It is non-invasive. It does not require anesthesia. It is painless. It can be a sound approach for patients who have become disillusioned with conventional medical and pharmaceutical approaches to a range of chronic conditions, with their accompanying unpleasant side-effects.

How much Time is required?

More than one treatment is required to see results, in almost all cases. Treatment times can be quite short at 8-20 minutes (9). After an initial set of treatments, a schedule for maintenance therapy can be established. The frequency and length of treatments required would depend on the condition or illness being treated and its severity (9). Sessions can be anywhere from daily to weekly (often a take-home unit is used in conjunction with in-office treatmnets for ease of frequent use).

What is the Cost?

Clinics are offering PBM therapy for a variety of prices. It appears to be available in some clinics for around 100$ per session (9), whereas another clinic charges 4000$ for 20 sessions (10).

A New Kind of PBM with Great Promise

Innovations in technology have led to the production of intranasal PBM units. These use specific frequencies of light that pulsate inside of the nasal cavity. This produces a direct path to the dorsal area in the brain. This can offer significant stimulation of important parts of the brain. This therapy is being used with great success for many of the cognitive-related functions of PBM.

This therapy may be a great complimentary treatment option for those with cognitive decline and people who simply want to boost brain health or prevent cognitive issues.

How to Find out More

If you live in Colorado or are willing to travel to the Greater Denver Area, please book a discovery call with our clinic to find out more about PBM therapy. You can also call or text “PBM Therapy” to 720-722-1143. Click here to book a complimentary 15-minute discovery call now.

References:

  1. Joov. 2019. Photobiomodulation and Cancer: What is the Truth? www.//joovv.com/blogs/joovv-blog/photobiomodulation-cancer-truth. Accessed May 28 2019.
  2. Hamblin MR, de Sousa MVP, Agrawal T. 2017. Handbook of Low Level Laser Therapy. Singapore: Pan Stanford Publishing.
  3. Hamblin MR. 2018. Mechanisms and Mitochondrial Redox Signaling in Photobiomodulation. Photochem Photobiol.2018 Mar;94(2):199-212. doi: 10.1111/php.12864.
  4. Hamblin MR. 2017. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophysics, 2017, 4(3):337-361. doi: 3934/biophy.2017.3.337.
  5. Ferraresi C, Huang YY, Hamblin MR. 2016. Photobiomodulation in human muscle tissue: an advantage in sports performance?. J Biophotonics.2016 Dec;9(11-12):1273-1299. doi: 10.1002/jbio.201600176.
  6. Rigonato-Oliveira N, Brito A, Vitoretti L, et al. 2017. Effect of low-level laser therapy on chronic lung inflammation in experimental model of asthma: A comparative study of doses. Lasers Surg Med49: 36.
  7. Hamblin MR, Nelson ST, Strahan JR. 2018. Photobiomodulation and Cancer: What is the Truth? Photomed Laser Surg.2018 May;36(5):241-245. doi: 10.1089/pho.2017.4401.
  8. de Pauli Paglioni M, Araújo ALD, Arboleda LPA, et al. Tumor safety and side effects of photobiomodulation therapy used for prevention and management of cancer treatment toxicities. A systematic review. Oral Oncol.2019 Jun;93:21-28. doi: 10.1016/j.oraloncology.2019.04.004.
  9. NovoTHOR. 2019. Photobiomodulation Therapy. https://www.connectedptw.com/novothor. Accessed June 4, 2019.
  10. Westword. 2017. Can lasers Heal Brain Injuries? Two Colorado Docs Shine a Light. https://www.westword.com/news/colorado-doctors-using-lasers-as-a-weapon-against-tbi-other-brain-injuries-9223729. Accessed June 4, 2019.

 

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May 29, 2019

Platelet Rich Plasma Therapy

by Dr. Miles Nichols and Nicola Schuler, CNTP, MNT

PRP or Platelet Rich Plasma Therapy is a relatively new therapy used to repair and regenerate tissue in the body (1). It was first used in 1987 to promote healing in dental, orthopedic and plastic surgery procedures (2). It has potential to treat both chronic and acute musculoskeletal injuries of the tendons ligaments and muscles (2).

In the United States, it is estimated that approximately 86,000 athletes are treated with PRP annually (3).  Famous elite athletes such as Tiger Woods and Rafael Nadal have used PRP therapy to repair injuries. A study in 2017 states that even though the popularity of PRP is rising, its true effectiveness has yet to be fully established (3).

What is PRP exactly?

PRP uses a preparation of the person’s own blood (4). A solution of PRP is prepared by first taking blood from the patient. The blood is then centrifuged to allow for the separation of the various components based on the relative density. This allows for separation and collection of the platelet-rich plasma and not the other components of blood (3). By concentrating and separating the portion of the blood that has more platelets, the resulting liquid is packed full of potential for repairing tissues.

The repair potential of platelets stem from growth factors that can stimulate repair processes in the body. This high concentration of platelets in the PRP preparation provides a meaningful concentration of essential growth factors not found in normal blood. PRP contains a platelets concentration that is 4 -5 times higher than normal blood (3).

The increased concentration of platelets means an increased number of growth factors such as platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β), vascular endothelial growth factor (VEGF), and epithelial growth factor (EGF) (3).

The purpose of PRP injections is to enhance the healing process since an increased number of platelets results in an increased number of secreted growth factors, thereby theoretically improving the healing process (3).

The PRP solution provides a stimulus to promote repair in tissues with low healing potential (4). It is the additional growth factors that increase cellular healing in the damaged tissue. The prepared PRP solution is then re-administered to the site of injury via an injection.

Applications & Effectiveness of PRP

PRP is used in many clinical situations such as orthopedics to treat musculoskeletal conditions, sports medicine, dentistry, dermatology, and other applications (1). The use and effectiveness of PRP in chronic diseases is controversial because patient outcomes only show partial improvements (1).

In the realm of orthopedics, some studies find that injecting PRP to the site of injury does not provide any significant benefit in clinical outcomes; however, many others report the opposite conclusion (3).

Thus far, the evidence appears to suggest that PRP may provide benefit in patients with knee osteoarthritis or elbow injuries. Other uses have either shown minor benefit or not shown benefit or there has been insufficient data to know whether PRP is helpful (3).

Because of the mechanisms of increased growth factors, many athletes and progressive clients are choosing to experiment with PRP in joints and for cosmetic applications. Because PRP is minimally invasive when compared with conventional alternatives like surgery, its popularity is increasing.

For these reasons, PRP therapy is being used in many different types of musculoskeletal applications despite the fact that carefully controlled studies for these different applications do not exist (2). The success of PRP in one type of injury may not translate to other injuries but the hope and expectation is that it will.

  • One study from January 2019 found that PRP appeared to be safe and effective in reducing back pain. It admitted that although the clinical evidence of tissue repair of disc-related back pain by PRP treatment is currently lacking, there is a great possibility that the application of PRP has the potential to lead to a feasible therapy for the treatment of degenerative disc diseases (5).
  • Another study from Feb 2019 looked at the application of PRP therapy in osteoarthritis and concluded that clinical effectiveness of PRPfor knee osteoarthritis treatment is still under debate (6).
  • PRP injections into worn out or partially torn tendons in tennis elbow has been effective for the majority of patients (2).

Anecdotal and clinical evidence suggests that, at best, PRP therapy does work and, at worst, has no effect. PRP is an alternative to the other options; cortisone injection, surgery, or no treatment except pain medications or physical therapy (2). In many cases, the potential benefits outweigh the risks (2).

How Long is the Recovery from PRP?

Most people can resume their normal activities soon after having a PRP injection. Recovery time may take a few weeks depending on the precise injury and circumstances, location of the injection and age of the patient. It may take up to 3- 6 months to see the full benefits of PRP, as the cells at the injection site require time to regenerate and heal the tissue involved.

What is the Investment?

The investment for PRP injections vary depending on where the injection is administered, the skill level of the practitioner administering the injection, and how many injections are recommended. One study found an average of approximately $840.00 USD for a single PRP injection (3). Currently, PRP therapy is not covered by medical insurance. This may change with time and more research studies on PRP and its effectiveness. Often a series of 3-6 injections is recommended for certain issues. For individuals facing the alternatives of either surgery, chronic debilitating pain, or the inability to perform in a sport, the investment is often well worth the potential for benefit (hence 86,000 US athletes opting for PRP injection every year) (3).

Are there Side Effects?

Complications of PRP injection are extremely rare. Because PRP is derived from the patient’s own blood, it would be extremely unlikely to have an allergy or immune reaction (2). Side effects of PRP should be minimal; such as irritation, pain, or bleeding related to the injection site. The main risks include local infection (< 1% chance) and pain at the site of injection (2). Nerve injuries or tissue damage at the injection site are possible, but this would be more likely to result from the skill of the doctor than from the PRP therapy.

How to Find out More

If you live in Colorado or are willing to travel to the Greater Denver Area, please book a discovery call with our clinic to find out more about PRP injections. You can also call or text “PRP Info” to 720-722-1143.

 

References

  1. Andia I, Abate M. 2018. Platelet-rich plasma: combinational treatment modalities for musculoskeletal conditions. Front of Med. April 2018, (12):139-152.
  2. Stanford School of Medicine, Stanford University medical Centre Dept. of Radiology. Platelet Rich Plasma (Prep) Injection – Information and Instructions for Patients. file:///C:/Users/New%20Owner/Downloads/petctscan-pdf-prpbeaulieuletter.pdf. Accessed May 20, 2019.
  3. Hussain N, Joha H, Bhandari 2017. An evidence-based evaluation on the use of platelet rich plasma in orthopedics – a review of the literature. SICOT J. 2017; 3: 57. doi: 10.1051/sicotj/2017036
  4. Wu PI, Diaz R, Borg-Stein J. 2016. Platelet-Rich Plasma. Phys Med Rehabil Clin N Am. Nov 2016. Doi: 10.1016/j.pmr.2016.06.002.
  5. Akeda K, Yamada J, Linn ET, Sudo A, Masuda K. 2019. Platelet-rich plasma in the management of low back pain: a critical review. Jour. Of Pain Res. 2019:12 pp. 753-767. Doi: 10.2147/JPR.S153085
  6. Gato-Calvo L, Magalhaes J, Ruiz-Romero C, Blanco FJ, Burguera EF. 2019. Platelet-rich plasma in osteoarthritis treatment : a review of current evidence. Ther Adv Chronic Dis.2019 Feb 19;10:2040622319825567. doi: 10.1177/2040622319825567.

 

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May 20, 2019

Food Allergies, Sensitivities and Intolerances

by Dr. Miles Nichols and Nicola Schuler, CNTP, MNT

More than 20% of the population in industrialized countries suffers from food intolerance or food allergy (1).

The terms ‘allergy’,’ sensitivity’ and ‘intolerance’ to certain foods are used frequently. What is the difference between these different types of reactions? More importantly, what can you do to manage symptoms, or better yet, resolve the problem?

Food allergies are increasing:

  • Approximately 1 in 13 children and 1 in 25 adults in the US suffer from a life-threatening foosibod allergy (2)
  • From 1997 to 2011 there was a 50% increase in food allergies in American children (3)
  • In the United States, food allergies affect 8% of children (4)
  • A study done in 2013 found that the overall economic cost of food allergy was estimated at $24.8 billion annually ($4184 p.a. per child) (2)

 

Food Allergies

A food allergy is when the immune system believes a particular food to be pathogenic or dangerous and creates an IgE (immunoglobulin E) antibody to that food. The antibody will bind to that food (the irritant or antigen) which signals to the immune system that this ‘dangerous’ substance must be removed. Immune cells called macrophages then destroy the substance. During this process, histamine and other chemicals are created which can cause an allergic reaction.

Symptoms vary and can include: digestive problems, tingling or itchy mouth, hives, itching, eczema, swollen airways and difficulty breathing. Severe reactions can be life-threatening.  Symptoms can appear immediately or take a few hours to appear.

Common food allergens are: eggs, dairy products, nuts, soy, wheat/gluten, and shellfish. People can have allergies to other foods not on this list.

Food Intolerances or Sensitivities

A food intolerance is thought to be caused by a specific gut issue like an enzyme deficiency (i.e. lactase to digest lactose found in dairy products), difficulty processing a certain chemical (i.e. caffeine), poor absorption or other issue that impairs proper digestion of the particular food (1). With a food intolerance, antibodies are created in an IgG (immunoglobulin G) or IgA (immunoglobulin A) reaction. These reactions are thought to be more related to gut permeability (i.e. leaky gut) than to a true allergy (5). Food intolerances are thought to be more common than food allergies and can occur with any food, food additive or preservative.

Symptoms vary and can include: rashes, skin issues, asthma, GI symptoms like cramps, constipation, diarrhea and neurological symptoms such as migraines. Symptoms can take hours or days to appear which makes identifying the issue a challenge.  They are typically not life-threatening. They can be addressed, though, and addressing them can reduce inflammation in the gut and improve overall gut health.

A food sensitivity is another term for a food intolerance.

Gut Health

As you may have picked up from our previous blog articles, many conditions link back to the health of the gut. This is the case with food allergies and even more so, with food intolerances.

Both allergies and intolerances create inflammation. With a food allergy, it can push the immune system into overdrive or overreaction to a certain food which creates inflammation. A food intolerance creates inflammation in the gut.

As we mentioned in the last blog post on seasonal allergies, 70-80% of the immune cells is located in the gut so we need a well-functioning gut for optimal health. There is a risk with both food allergies and intolerances to potentially develop an autoimmune (AI) condition in the future, if they are not adequately addressed.

So What Can You Do?

Unfortunately a food allergy is usually an allergy for life so strict avoidance of the allergenic food is necessary to avoid symptoms, particularly if the allergy is severe. There are, however, things you can do to support your immune system and gut health which may help to mitigate symptoms. A food intolerance can potentially be reversed with diet changes and gut healing.

Work on Your GUT: Work to eradicate any GI infections or overgrowths that you might have. Work with a qualified functional medicine practitioner to test for these. This would involve a stool test like a GI-MAP or CDSA with Parasitology to check for dysbiosis, parasites, yeast, etc. and a 3-hour lactulose breath test to check for Small Intestine Bacterial Overgrowth or SIBO (For information about SIBO, read this article). Once you and your practitioner have eradicated any issues identified in testing, then follow a good gut healing program implementing some of the tips we recommend below:

Diet:

  • Eat a whole foods-based, non-inflammatory diet. Focus on organic whole foods like vegetables, fruits and organic animal products.
  • Legumes, nuts, and seeds are fine if tolerated.
  • Cruciferous vegetables have compounds that can be specifically helpful for T-Regulatory cells in the immune system. Eating 3-5 cups (measured before cooking) of cruciferous veggies daily can be helpful. When having cooked crucifers like broccoli, it is helpful to have a small amount of raw crucifer like daikon radish, mustard, or arugula for some myrosinase enzyme that can help produce sulforafane, a helpful compound that can improve detoxification and reduce oxidative stress.
  • Some full-fat grass-fed dairy can be healthy if tolerated. However, if you do not know if you might have a sensitivity to dairy, it might be helpful to remove dairy for 30 days and then re-introduce it with one normal portion per day for 3 days. Some people react to lactose (a sugar in dairy that gets reduced in the fermentation process so fermented dairy has less than non-fermented dairy). Others react to casein (a protein in dairy).
  • Be sure to eat fermented foods like sauerkraut, kimchi, kefir, miso, and yogurt. Fermented foods contain live probiotics. Also eat prebiotic foods which feed the good gut bacteria and strengthen gut health. Prebiotic foods are lentils, potatoes that have been cooked then cooled at least 24 hours (eaten cool or at room temp but not re-heated), green plantains, onions, garlic, leeks, apples, green banana, asparagus.
  • Bone broth contains glycine, gelatin and glutamine which are all very healing to the gut lining.
  • Avoid as much as possible: alcohol, processed / junk / fast foods, GMO’s and excessive refined sugars as these are all damaging to gut health.
  • Reduce sugars and grains in your diet as these are inflammatory and can lead to poor gut health.
  • Reduce inflammatory omega 6 fats (vegetable oils) and increase anti-inflammatory omega 3 fats (fatty fish like wild salmon, sardines, anchovies, mackerel) to reduce gut inflammation.

Supplements:

  • Vitamin D is important for immune system health. Studies have shown beneficial effects of vitamin D on immune function, particularly in the context of autoimmunity (6). You can test your vitamin D levels with a functional medicine practitioner. An optimal level is in the 35-60 range. Parathyroid hormone (PTH) between 15-30 is a further sign that vitamin D is sufficient. If PTH is >30, typically either Vitamin D or Calcium is sub-optimal.
  • Vitamin A is important for T-Regulatory cell function / production. T-reg cells have Vitamin A and D receptors on them (see the seasonal allergies article for more details). Taking cod liver oil (1 tsp per day) or eating about 4-6 oz liver per week can provide a good dose of pre-formed Vitamin A.
  • Probiotics help to populate the gut with good beneficial bacteria. It can be helpful to take a daily probiotic supplement in addition to adding fermented foods to your diet. There are three classes of probiotics that can be helpful. One class often contains various lactobacillus and bifidobacterium. Another class is actually a healthful yeast called saccharomyces boulardii. The third class are soil-based or spore-based organisms usually containing bacillus species like bacillus subtilis and/or bacillus coagulans. Try each of these three probiotics, one at a time for 2 weeks to see if you notice benefit. If you do notice benefit, keep that one in and go to the next one. You can take one, two, or all three groups at the same time if beneficial.
  • Stomach acid is necessary to break down foods and for good digestion. In experiments done over 70 years ago, the effects of stomach acidity on food allergen uptake were studied. It was found that increased stomach acidity and the presence of other food in the gut decreased absorption of the offending allergenic food, while decreased stomach acidity, such as from H2-blockers and proton pump inhibitors, and ingestion of alcohol, increased absorption of the allergenic food (7). Ensuring that your stomach acid is sufficient will help then with both food intolerances and food allergies. You can take HCL betaine and bitter herbs. It is best to work with an experienced practitioner in determining the right levels of HCL for you. Do not use HCL if you have an ulcer.
  • Digestive enzymes can help break down proteins, carbs, and fats. Breaking proteins down helps reduce the immune system trigger from a food because the more undigested the protein, the more potential it has to trigger the immune system. The more broken down the protein is, towards the amino-acid building blocks of the protein, the less likely it is to trigger the immune system. Taking digestive enzymes with every meal may help in cases of food sensitivities.
  • Quercetin has anti-allergic properties that stimulate the immune system, inhibit histamine release and reduce inflammatory immune cells. Based on a study in rats with peanut allergies, quercetin was found to reduce the histamine reaction and to suppress the IgE responses against peanut proteins (8). The study concluded that quercetin can be used to defend against IgE-mediated food allergies (8).
  • Glutathione is a powerful antioxidant and can also help support t-cells. Taking 200-1000 mg per day may be helpful.

If you suffer from known food allergies or intolerances, or simply have undiagnosed symptoms, then get in touch with us today. We can help to identify your food allergies or intolerances and more importantly, help you to get to the root causes and work towards minimizing symptoms. Book a discovery call today where someone from our staff can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

 

References:

  1. Zopf Y, Hahn EG, , Raithel M, Baenkler H-W, Silbermann A. 2009. The Differential Diagnosis of Food Intolerance. Dtsch Arztebl Int. 2009 May; 106(21): 359–370. doi: 3238/arztebl.2009.0359.
  2. Gupta R, Holdford D,Bilaver L et al. 2013. The Economic Impact of Childhood Food Allergy in the United States. JAMA Pediatr. 2013;167(11):1026-1031. doi:10.1001/jamapediatrics.2013.2376.
  3. Jackson KD, Howie LD, Akinbami LJ. 2013. Trends in allergic conditions among children: United States, 1997-2011. NCHS Data Brief.2013 May;(121):1-8.
  4. Gupta RS, Springston EE, Warrier MR,  et al.  The prevalence, severity, and distribution of childhood food allergy in the United States [published online June 20, 2011].  Pediatrics. doi:10.1542/peds.2011-0204.
  5. Shakoor Z, AlFaifi A, AlAmro B, AlTawil LN, AlOhaly RY. 2016. Prevalence of IgG-mediated food intolerance among patients with allergic symptoms. Ann Saudi Med. 2016 Nov-Dec;36(6):386-390.
  6. Prietl B, Treiber G, PieberTR, Amrein K. 2013. Vitamin D and Immune Function. Nutrients 2013, 5(7), 2502-2521; https://doi.org/10.3390/nu5072502.
  7. Sampson HA. 2016. Food allergy: past, present and future. Allerg. Intl. October 2016Volume 65, Issue 4, Pages 363–369. DOI: https://doi.org/10.1016/j.alit.2016.08.006.
  8. Mlcek J, Jurikova T, Skrovankova S, Sochor J. 2016. Quercetin and Its Anti-Allergic Immune Response. Molecules. 2016 May; 21(5): 623. doi: 3390/molecules21050623.
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May 16, 2019

Seasonal Allergy Relief

by Dr. Miles Nichols and Nicola Schuler, CNTP, MNT

Seasonal allergies (also called allergic rhinitis), hay fever, or any other type of allergy can be deeply uncomfortable. Symptoms usually feel like the first signs of a cold; sneezing, runny nose, red, watery, puffy or itchy eyes, itchy nose, nasal irritability and congestion, itchy throat, hoarseness, shortness of breath or wheezing, coughing, skin rash and/or itchy ears. With hay fever, symptoms usually appear when a person encounters an allergen, such as pollen, dust or mold.

Allergies are increasingly common. From 1988 to 2006, the prevalence of self-reported physician-diagnosed seasonal pollen allergy (or hay fever) increased from 8.8% to 11.3% (1). Asthma prevalence in the US population in 2005–2006 was estimated to be 14.1% (1).  Allergic rhinitis, commonly known as seasonal allergies or hay fever, has been associated with a lack of sleep, reduced productivity at work or school, emotional distress, and embarrassment (2).

Over the counter (OTC) non-prescription medications exist, with mixed results in terms of effectiveness. Current medications for allergies can have undesirable side effects such as dry mouth, drowsiness and sleeplessness (2), which may affect quality of life. It is far from ideal to be reliant on these OTC medications. Getting to the root cause of seasonal allergies and addressing that is preferable for many.

Seasonal allergy is typically triggered by airborne allergens: pollens, animal dander, dust mites or mold.

Causes of seasonal allergies:

Modern hygiene has been blamed for the increasing prevalence of allergies. The increasing incidence is thought to be related to a reduced microbial exposure (3). Children who have fewer exposures to allergens in early life, such as those in small families, are more likely to develop seasonal pollen allergy or eczema (1). Children in households with at least 2 dogs or cats are 70% less likely to test positive for allergies (1). In Europe and other modern societies, risk for allergy and asthma are lower for children on farms (1). Asthma prevalence increases with migration from a less to a more highly industrialized country (1).

Allergies are an immune system reaction to an allergen. The immune system reacts to a foreign substance such as pollen or pet dander, and creates antibodies which tag the foreign substance as if it is a harmful pathogen, even though it isn’t. When confronted with the allergen, the antibodies produced by the immune system will react and release certain substances such as histamine that will cause inflammation and allergy symptoms.

Inflammation is part of the allergic reaction. Histamine is stored in white blood cells of the immune system (in basophils and mast cells) and is a significant contributor to allergy symptoms, particularly in allergic rhinitis or seasonal allergies (4). Increases in both plasma and tissue levels of histamine have been observed in allergic reactions in the skin, nose and lungs (4).

Given that 70-80% of the immune system is based in the gut, allergies are, like many other conditions, closely related to gut health. This is one of the big root causes of allergies.

Gut issues that may be at the root of allergies include:

  • Intestinal permeability (aka ‘leaky gut’)
  • Small Intestine Bacterial Overgrowth (SIBO)
  • Yeast overgrowth (like candida as one example)
  • Dysbiosis (excessive bad bacteria that have been linked with immune issues and autoimmunity)
  • Other gut infections like parasites, worms, or certain viruses

These gut issues can be problematic for the immune system and lead to the development of allergies. Gut function should be addressed when treating allergies and a good functional medicine doctor will screen for and treat gut issues for those with allergies as a complaint.

Multiple studies show that the health of the gut microbiota influences allergy reactions:

  • One study states that altered gutmicrobiota is associated with several diseases, including allergic diseases (5)
  • Another study found that American adults with allergies, especially to seasonal pollen, have low diversity in gut bacteria and an imbalance in the types of gut bacteria strains (1). This is indicative of a gut that is not optimally healthy. The source of the dysbiosis is unknown but the authors of the study suspect that Caesarean births may play a role in the cause of the dysbiosis (1).
  • A study looked at people with a confirmed allergy to birch and gave them a probiotic combination of the strains acidophilusand B. lactis Bl-04 during peak birch allergy season (3). The results showed that the probiotics positively influenced markers of respiratory allergy, and showed a reduction in reported nasal symptoms (3).
  • One study found changes in the production of inflammatory immune cells were observed in patients treated with probiotics. These data show that probiotic supplements modulate immune responses in allergic rhinitis and have the potential to improve the severity of symptoms (6).
  • Quality of life for seasonal allergy sufferers improved when given a combination probiotic (Lactobacillus gasseriKS-13, Bifidobacterium bifidumG9-1, and  longum MM-2) for 8 weeks at a dose of 3 billion colony-forming units (or CFUs) during spring allergy season (2). The study subjects were healthy individuals with self-reported seasonal allergies (2).

In addition to addressing the root causes of allergies (typically related to the gut and immune system), there are other interventions beyond OTC medications that can help reduce symptoms, often with fewer side effects. We will first cover solutions that get to the root cause of allergies, and then look at remedies to help with acute symptoms during allergy season.

Solutions – getting to the root: What can you do to reduce or eliminate your seasonal allergies for good?

  • Probiotics: Clearly there are multiple studies that show how probiotics can help prevent and alleviate seasonal allergy symptoms (2, 3, 5, 6). Probiotics boost the immune system and help to populate the gut with good bacteria. There are various strains that show up in research; most of them are strains of lactobacillus and/or bifidobacterium. A professional-grade multi-strain lacto/bifido blend probiotic of at least 15 billion CFU (preferably 25-100 billion for a time when working on a root causes of allergies) can be helpful. You can order professional grade probiotics here (we like Ortho Biotic 100 if you want to try a product with 100 billion CFU that is also multi-strain)
  • Heal the gut: The health of the gut microbiome is now known to be associated with good health. Poor gut health is linked to so many conditions and diseases. Again, given that 70-80% of the immune system resides in the gut, this makes perfect sense. Find out if you have any gut infections or overgrowths (SIBO, parasites, candida, dysbiosis, leaky gut or others). A SIBO lactulose breath test (be sure it is 3 hour and measures hydrogen and methane) together with a stool test like the GI-MAP or a CDSA with Parasitology will help to rule out many gut conditions as well as show what strains of bacteria and how many are in your gut. Once armed with this information, you can implement targeted therapeutic approaches to improve your gut health. Working on gut health will improve your reaction to seasonal allergies. To work with a functional medicine doctor and get comprehensive testing for gut health, click here to book a free 15-minute discovery call to answer any questions and give you the opportunity to schedule with one of the functional medicine doctors in our clinic. We consult with clients world-wide.
  • Nutrients for T-Regulatory Cell activation: T-Regulatory cells are involved in calming overactive immune responses by producing regulatory cytokines. Cytokines are usually inflammatory molecules, but certain cytokines like IL-10 can help prevent immune cells from attacking your own body (autoimmunity) or reacting to food or environmental triggers. These cells have receptors for Vitamin D and Vitamin A right on the cells themselves. A nutrient in cruciferous vegetables can also help T-reg cell production.
    • Getting enough sunlight on unprotected skin (skin without sunscreen, but not enough sun to burn or even turn pink) for at least 5 days per week between 11am – 3pm can optimize vitamin D production for most people. For fair skinned individuals, this can be as little as 15 minutes 5 days per week.
    • Eating at least 4oz of liver per week or taking 1 tsp Cod Liver Oil per day provides a good amount of pre-formed vitamin A. The nutrient in carrots is actually called beta-carotene and needs to be converted in the liver to retinol. Retinol is vitamin A. Some people have poor conversion of beta-carotene to retinol so we recommend getting some pre-formed retinol through diet.
    • Eat about 3-5 cups (measure before cooking) of cruciferous vegetables (broccoli, kale, Brussels sprouts, cauliflower, bok choy, etc.). You can cook the cruciferous vegetables, as this makes them easier to digest. It can help to get more nutrients like sulforafane from cooked cruciferous vegetables like broccoli if you have a small amount raw crucifer like daikon radish, mustard, or arugula in the same meal. These provide the myrosinase enzyme that helps your body extract sulforafane. You do not have to have the raw crucifer in the same bite as the cooked cruciferous veggies, just in the same meal.
    • Short chain fatty acids can also help produce T-reg cells. These are made by gut bacteria (yes, back to the gut again). The gut bacteria convert fiber into these short chain fatty acids and so having some prebiotic fibers by eating things like lentils, potatoes that have been cooked then cooled 24 hours (eat them cool or room temp to keep the starch resistant so it will feed the bacteria), green bananas, green plantains, onions that are raw or partly cooked but still crunchy, leeks, and dandelion greens.
    • Glutathione can also support T-cells. Taking between 200-1000mg per day may be helpful.
  • Keep a diary. In order to identify what causes or worsens your allergic symptoms, track your activities and what you eat, when symptoms occur, and what seems to help. This may help you identify triggers for your allergies. Reducing exposure to allergens when possible can prevent symptoms.

Supplements that are useful in lessening allergy symptoms are:

  • Quercetin: Quercetin is a flavonoid found in onions, broccoli, apples, some herbs, tea and wine. Use caution with wine and alcohol though as it can worsen histamine and allergies. Quercetin is a strong antioxidant and has anti-inflammatory and anti-allergic properties. It inhibits histamine and other inflammatory immune cells, which cause allergy symptoms (7). It is effective in the treatment of hay fever (7).
  • Nettle: Nettle, or stinging nettle, is a plant that has medicinal properties. It is anti-inflammatory. It specifically has been found to reduce inflammatory events that cause allergy symptoms (8). It inhibits histamine, certain enzymes involved in inflammation and other inflammatory substances that cause hay fever symptoms (8).
  • Bromelain: Bromelain is an enzyme found in pineapples. It is also available as a supplement. It is anti-inflammatory and anti-allergic. In one study, it prevented allergic sensitization (9).It has an inhibitory mechanism on allergic responses and can help in the treatment of allergies and asthma (9).
  • Vitamin C: Vitamin C is an antioxidant which helps in the reduction of oxidative stress and inflammation. This can be beneficial in people with allergic diseases (10). This study observed that the use of high-dose vitamin C in daily practice in the treatment of allergic diseases reduces allergy-related symptoms (10). Furthermore, it was found that patients with allergic diseases had a vitamin C deficiency (10). Another study found that Vitamin C prevents the secretion of histamine by white blood cells and increase its detoxification (11). Histamine levels were found to increase exponentially as ascorbic acid levels in the plasma decreased (11).
  • N-acetylcysteine or NAC: NAC is an anti-inflammatory substance that can also break up and help to dissolve mucous (11). It reduces the thickness of mucous which helps it to be expelled from the body and from nasal passages (11).
  • Histamine supplements often combine many of these together for relief from symptoms of allergies. We like Hista-Eze by Designs for Health as a good option. You can purchase this at our online store here.

What diet should you follow to better manage allergy symptoms?

Research looking into what diet should be followed to avoid or reduce allergic diseases has found that a healthy diet rich in antioxidants and omega-3 fatty acids consumed by the mother during pregnancy and by the child during childhood may significantly decrease the prevalence and incidence of allergic diseases (asthma, allergic rhinitis, atopic dermatitis) even in children with a hereditary predisposition (12).

We recommend a gut-friendly, anti-inflammatory diet like the Mediterranean diet, which includes:

  • Unprocessed, whole foods
  • Lots of vegetables and fruit, which provide antioxidants and contribute to a healthy gut
  • Focus especially on brightly colored fruits and vegetables (for antioxidants) as well as cruciferous vegetables (for compounds like sulforafane)
  • Fish contains omega 3 fats which have an anti-inflammatory effect (1-2 pounds of cold-water fatty fish per week or some high-quality cod liver oil to get pre-formed Vitamin A + EPA and DHA from fish oil, especially if you aren’t eating a lot of fish and/or liver)
  • Unprocessed meats
  • Extra virgin olive oil
  • Raw nuts and seeds, legumes, garlic and onion are other beneficial foods in the Mediterranean diet

Avoid:

  • Sugar/ processed foods/ fast food/ soda and other sugary drinks
  • Gluten can damage the lining of the gut and can contribute to gut issues like leaky gut. Minimizing or avoiding gluten is helpful in many cases of people suffering with allergies.
  • Dairy foods as dairy products can increase mucous production. If you tolerate dairy (no digestive or skin symptoms that you know of) then having full-fat grass-fed dairy is fine when you are not having an excess of mucous.
  • Conventional meat can contain inflammatory fats that will contribute to inflammation. Organic, pastured grass-fed meats are preferred.
  • Alcohol can contain and promote the release of histamine, especially wine and champagne. All alcohol can also worsen many gut conditions. Avoiding alcohol can help reduce allergies.
  • Any foods which you know you are sensitive to as these will increase inflammation as well

Specific foods that can help with allergies:

  • Local Raw Honey: Eating raw honey made locally can help reduce allergies and symptoms. The honey contains beneficial bacteria and trace amounts of local pollen, which, when introduced in small amounts, can sensitize the immune system so that it can better tolerate the local pollens. A study using birch pollen honey found a 60% reduction in symptoms in allergic people who ate local birch pollen honey during the birch pollen season (13). You can also buy local bee pollen and have 1tsp per day for several months to help build tolerance to local allergens.
  • Fermented Foods: Fermented foods support good gut health. They contain probiotics and can help to rebalance and maintain healthy gut flora. This includes foods like sauerkraut, kefir, kombucha, yogurt and kimchi. However, fermented foods also contain histamine. If you are already overburdened by histamine from active allergies, such as during allergy season, you may want to avoid fermented foods and take probiotic supplements instead. Fermented foods when not in allergy season, if you tolerate them without histamine reaction, can be a great aid for improving gut health.
  • Ginger: A study on mice with allergic rhinitis found that ginger in the diet decreased the severity of sneezing and nasal rubbing in the mice (14). The anti-inflammatory effects of ginger can help to prevent and improve allergy symptoms (14). Making tea from or juicing fresh ginger and drinking regularly can help. Mix with a small amount of raw local honey and some lemon for a great-tasting, allergy-fighting drink.

Other helpful tips to minimize allergy symptoms:

  • Avoid known triggers: If you are allergic to pollen, stay inside with windows and doors closed when the pollen count is high. If you are allergic to dust mites, dust and vacuum and wash bedding often. You can also get an air filter for your home. A high-quality filter works much better than cheap options due to filtering finer particulate and moving more air. We recommend IQAir. You can use our affiliate code to get 5% off: IQ50470
  • Try nasal irrigation:Allergy symptoms improve with regular nasal irrigation, using a neti pot and a saline solution (or filtered water with a small amount of sea salt) (15). Nasal irrigation rinses out the sinuses with a salt and water solution.  It helps to flush out thickened mucus and irritants from the nose. One study found that it improved nasal symptoms by 28%, led to quicker mucous clearance from the nose by 31%, caused a 62% reduction in allergy medicine use and improved quality of life by 28% (15).
  • Household airborne allergy symptoms.Reduce your exposure to dust mites or pet dander by frequently washing bedding and stuffed toys in hot water, maintaining low humidity, regularly using a vacuum with a fine filter such as a high-efficiency particulate air (HEPA) filter and replacing carpeting with hard flooring.

 

References:

  1. Hua X, Goedert JJ, Pu A, Yu G, Shi J. 2015. Allergy associations with the adult fecal microbiota: Analysis of the American Gut Project. 2015 Nov 27;3:172-179. doi: 10.1016/j.ebiom.2015.11.038.
  2. Dennis-Wall JC, Culpepper T, Nieves C Jr, Rowe CC, Burns AM, Rusch CT, Federico A, Ukhanova M, Waugh S, Mai V, Christman MC, Langkamp-Henken B. 2017. Probiotics (Lactobacillus gasseri KS-13, Bifidobacterium bifidum G9-1, and Bifidobacterium longum MM-2) improve rhinoconjunctivitis-specific quality of life in individuals with seasonal allergies: a double-blind, placebo-controlled, randomized trial. Am J Clin Nutr. 2017 Mar;105(3):758-767. doi: 10.3945/ajcn.116.140012.
  3. Ouwehand AC, Nermes M, Collado MC, Rautonen N, Salminen S, Isolauri E. 2009. Specific probiotics alleviate allergic rhinitis during the birch pollen season. World J Gastroenterol. 2009 Jul 14;15(26):3261-8.
  4. White MV. 1990. The role of histamine in allergic diseases. J Allergy Clin Immunol. 1990 Oct;86(4 Pt 2):599-605.
  5. Harata G, Kumar H, He F, Miyazawa K, Yoda K, Kawase M, Kubota A, Hiramatsu M, Rautava S, Salminen S. 2017. Probiotics modulate gut microbiota and health status in Japanese cedar pollinosis patients during the pollen season. Eur J Nutr. 2017 Oct;56(7):2245-2253. doi: 10.1007/s00394-016-1264-3.
  6. Ivory K, Chambers SJ, Pin C, Prieto E, Arqués JL, Nicoletti C. 2008. Oral delivery of Lactobacillus casei Shirota modifies allergen-induced immune responses in allergic rhinitis. Clin Exp Allergy. 2008 Aug;38(8):1282-9. doi: 10.1111/j.1365-2222.2008.03025.x.
  7. Mlcek J, Jurikova T, Skrovankova S, Sochor J. 2016. Quercetin and Its Anti-Allergic Immune Response. Molecules. 2016 May 12;21(5). pii: E623. doi: 10.3390/molecules21050623.
  8. Roschek B Jr, Fink RC, McMichael M, Alberte RS. 2009. Nettle extract (Urtica dioica) affects key receptors and enzymes associated with allergic rhinitis. Phytother Res. 2009 Jul;23(7):920-6. doi: 10.1002/ptr.2763.
  9. Secor ER,Szczepanek SM, Castater CA, Adami AJ, Matson AP, Rafti ET, Guernsey L, Natarajan P, McNamara JT, Schramm CM, Thrall RS, Silbartt LK. 2013. Bromelain Inhibits Allergic Sensitization and Murine Asthma via Modulation of Dendritic Cells. Evid Based Complement Alternat Med. 2013; 2013: 702196. doi: 1155/2013/702196.
  10. Vollbracht C, Raithel M, Krick B, et al. 2018. Intravenous vitamin C in the treatment of allergies: an interim subgroup analysis of a long-term observational study. J of Intl Med Res. June 27, 2018. org/10.1177/0300060518777044
  11. Thornhill SM, Kelly AM. 2000. Natural Treatment of Perennial Allergic Rhinitis. Altern. Med. Review. Volume 5, Number 5.
  12. Saadeh D, Salameh P, Baldi I, Raherison C. 2013. Diet and Allergic Diseases among Population Aged 0 to 18 Years: Myth or Reality?. Nutrients. 2013 Sep; 5(9): 3399–3423. doi: 10.3390/nu5093399
  13. Saarinen K, Jantunen J, Haahtela T. 2011. Birch Pollen Honey for Birch Pollen Allergy – A Randomized Controlled Pilot Study. Int Arch Allergy Immunol 2011;155:160–166. doi:0.1159/000319821.
  14. Kawamoto Y, Ueno Y, Nakahashi E, Obayashi M, Sugihara K, Qiao S, Iida M, Kumasaka MY, Yajima I, Goto Y, Ohgami N, Kato M, Takeda K. 2016. Prevention of allergic rhinitis by ginger and the molecular basis of immunosuppression by 6-gingerol through T cell inactivation. J Nutr Biochem. 2016 Jan;27:112-22. doi: 10.1016/j.jnutbio.2015.08.025.
  15. Hermelingmeier KE, Weber RK, Hellmich M, Heubach CP, Mösges R. 2012. Nasal irrigation as an adjunctive treatment in allergic rhinitis: A systematic review and meta-analysis. Am J Rhinol Allergy. 2012 Sep-Oct; 26(5): e119–e125. doi: 2500/ajra.2012.26.3787.
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