Category: Interviews

  • What teeth say about your gut health

    What teeth say about your gut health

    Dachshund dog with a toothbrush on a light background, not isolated

    When dental hygiene doesn’t prevent bleeding gums and cavities, it’s time to look to histamine, mast cells and the wondrous world of bacteria living in the mouth. Dentist and author Dr. Steven Lin shares the tell tale signs of mouth flora imbalance, and how histamine and mast cells may contribute to gingivitis, dental erosion, and bleeding gums.

    You can listen to the interview using the player below, or read the transcript just underneath.

    photo of dentist dr steven lin

    Yasmina :

    Today, I’m interviewing Dr. Steven Lin, a dentist with a focus on nutrition. He’s been published on platforms such as TEDx, the Sydney Morning Herald, the British Dental Journal, the Huffington Post, and About.com. He’s currently writing his own publication, The Dental Diet, which will be released by Hay House in the United States, the UK, Australia, and Germany in January 2018. Dr. Lin’s CPD-accredited practitioner-training course, Nutrition and the Dental Practice, is educating a new wave of dentists to incorporate preventive dietary principles into oral health care. His own platform, DrStevenLin.com, has a rapidly growing audience of over 100,000 followers. In addition to being an amazing dentist, researcher, writer, just all-around human being, Steven is a friend of mine, and I’m really excited to have him here today and to talk about something that is of great interest to our growing community, which is our dental health.

    Now, I was really excited to talk to Dr. Lin about this a few months ago, where I mentioned that one of my odd symptoms, back in the day when I was having really bad ones … In my heyday, I was having upwards of 55 of them. I mentioned that bleeding gums were a huge problem for me, something that really freaked me out at the time, and he said that there is actually a mast-cell/histamine link. That’s what we’re going to be focusing on today, dental health and histamine and mast cells. Dr. Lin, thank you very much for joining us here today.

    Dr. Lin:

    It’s great to be here, Yasmina. It’s been a while since we talked, but I’ve been thinking about this a lot. I’ve actually been doing a lot of reading and also working with some patients, talking about some of the links between gingivitis and mast cell over-reactivity in the body, so I’m really excited to talk to you about it today.

    Yasmina :

    What do bleeding gums have to do with mast cells and histamine generally in your experience and in your research? Because you are a fabulous researcher and there is a plethora of amazing information on your website.

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    Dr. Lin:

    When we start to think of the mouth as an immune bacteria interface, just like our gut, then we start to see that bleeding gums might be a way that our relationship with microbes is a little bit out of whack. When we start to think of our oral cavity and our mouth, really it’s the home of many, many bacteria, over 600 species, thousands and thousands and thousands of different types of bugs, then we really should be trying to harbor the overall health of this ecology of the mouth instead of just trying to remove harmful bugs. Because if we think of disease as just being the invasion or infection of harmful bacteria, that’s a really small part of the story. With many dental diseases, we actually see that the invasion of the bad bacteria is the last bit of the story. Bleeding gums is actually part of the steps on the road to when we form gum disease.

    Just to go over gum disease, it’s a chronic inflammation process. It happens over many, many years, progresses at different paces in different people. That’s obviously because of many different factors, but what eventually happens is that your gums themselves erode, the bone that holds your teeth in jaw erodes because of the chronic infection, and your teeth get loose and they fall out. Now, I’ve seen patients where I’ve had to remove all of their teeth by their late thirties, early forties, so this is a big problem. What we’re really speaking to here is that in the mouth, we can really start to see potential imbalances that are occurring right through the body. The connection to histamine and inflammation is a really interesting one. That’s obviously the one that we started to talk about all those few months ago.

    Yasmina:

    I brush my teeth. What am I looking for? Is it a stream of blood? Do I notice blood on my toothbrush? Is it just a little bit of a tint when I spit into the basin, or is it when you’re eating something maybe a little hard, like an apple that rubs against the gums? What are the first signs of this?

    Dr. Lin:

    Probably you’ll find it on either your floss or the brush after you brush. It’ll be a little bit of red when you spit out into the basin. That’s usually first signs. Then, as things start to get a bit worse, we start to get a stream. Your gums become more and more inflamed, and the arterial flow of blood increases. That’s when you start to see streams of blood. Then, once you’re at the point where there’s streams of blood, your gingivitis is a long way along in the process. If you see a tint of blood when you’re brushing or on your toothbrush, that’s really the first sign. If you’re eating and you see blood, that’s pretty severe gingivitis. Any sign where you visibly see blood is a pretty sure signal that you’ve got at least mild to moderate gingivitis.

    Yasmina :

    This gingivitis, in your research and the current research of what we know, is there one particular cause? If you have a cause, is flossing and doing all these kind of things actually doing anything for you, or do you need to address the root cause?

    Dr. Lin:

    That’s the interesting thing. You probably saw The New York Times that came out earlier in 2016 where they actually went through the scientific research and they showed that flossing didn’t have a clinical or scientifically-backed benefit against gingivitis. That’s actually because there are many things happening in the mouth. While clinically, I see patients … Once we fix up their oral hygiene, it is a factor. It does help, yes, but is it the only factor? No. The real way that we can get control of our gingivitis is via understanding the oral microbiome. That’s where we see that the bugs that live inside your mouth actually perform beneficial procedures in the body. They’re actually managing your oral environment. Probiotic bacteria actually perform chemical and competitive behaviors that prevent bad bacteria from growing.

    Gingivitis is where your immune system is detecting bad bacteria and it’s sending blood and immune cells to get rid of it. What happens is there’s too much inflammation. We have an over-reactive immune system, and that’s where we get this chronic…

    Yasmina :

    That’s where the histamine comes in.

    Dr. Lin:

    Exactly. In gingivitis, what they show, even in the first stages of bleeding gums, is that we have an increase in histamine. What they show is that histamine and mast cells participate in the gingivitis-to-gum-disease process the whole time, but they don’t know exactly what cause or whether they’re actually causing the progression to gum disease. Some gingivitis, for instance, won’t progress to gum disease. Now, they don’t know exactly where the mast cells are directly contributing to this, but what they do know is that in both situations, mast cells are present and active.

    What some of the good research is showing is that gum disease is actually a loss of organization of the immune system in the mouth. When you have an organized immune system, our immune reaction is normal. It’s tolerant. It gets rid of pathogens efficiently. Once we have an imbalance, his is where mast cells come in, because mast cells are just releasing histamine quite blindly. That’s where things go wrong. When we have an intolerant, chaotic immune system, that’s where we get gum disease. That’s where we have this progression from bleeding gums, which is the first sign, onto gum disease.

    Yasmina :

    Just to explain to my readers a tiny bit, because some aren’t really familiar with the whole mast-cell thing, I’m just going to explain a bit. Basically, in our body, people are kind of familiar nowadays with the concept of histamine being in foods. If you have a problem with too much histamine, it might be because you’re told you have too little of the histamine-degrading enzymes like DAO. You might have a genetic polymorphism for HNMT, another histamine-degrading enzyme, so we’re told to avoid histamine-containing foods.

    What is not often explained to people who are diagnosed on a nutritionist level is that histamine is also found in the body in mast cells, that’s M-A-S-T cells, which are a key component of the immune system. Basically, within these mast cells live histamine and dozens of other inflammatory agents like prostaglandin, interleukin, leukotrienes, and when mast cells are disturbed in some way, or released in response to allergies or to infection or whatever, they break open in a process called degranulation, and this releases histamine and other inflammation into the body.

    Now, some people have mast cells that are unstable and are leaking when they’re not supposed to be. Other people, there is a cause, such as, for example, gingivitis, which I am quite sure that I had for many years. I was scared to go to the dentist because I knew I was reactive to anesthetics and I was just really scared to go. A lot of people with histamine issues have problems with anesthetics, but there are certain types that you can use. I was not going, and that’s when the whole bleeding-gum thing started.

    As Dr. Lin is explaining, when the gingivitis occurs, the mast cells that are present in the body, and they’re all over the body, go to the area where the infection or any kind of bacteria imbalance is happening to try and help. Think of the mast cells in this case as an ambulance. They get to the scene of whatever’s going on, the infection, and they degranulate, and of these inflammatory elements that’s released, histamine is the first responder. It goes to the area, it creates the inflammation, and allows the other bits to get in there and begin the healing process.

    It seems for some people that the mast cells can exacerbate the situation, because people with mast-cell issues, the inflammation just continues giving and giving and giving and giving either after the issue is resolved or, in the case of gingivitis, it might just be chronic. The issue itself is not resolving, so the mast cells just keep leaking and leaking and leaking and leaking, and it turns into a chronic, inflammatory condition. There was a link, isn’t there, between heart attacks and gingivitis?

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    Dr. Lin:

    Yeah. Gum disease, exactly. They’ve linked that people who have gingivitis have a much higher risk of heart disease. They’re really still trying to knot out exactly what causes that link, but the immune-system regulation really seems to play a part in that. What you described there, which you described really well, by the way, I see that a lot in patients, where we have these bleeding gums and there’s actually no real explanation for it. They brush well. They floss well. Their diet doesn’t terribly explain why their gums would bleed. It’s actually a sign that their mast cells and their histamine response is over-responsive. It’s interesting. For people who, for instance, react to foods that contain histamine, bleeding gums may be a sign that their immune system is also potentially a little bit too over-reactive, and perhaps that they’ve got some kind of immune and inflammation problem. A lot of people do now.

    Yasmina :

    Very interesting. How do we resolve gingivitis? Let’s say, what are the steps that we can take? My first question, actually … Well, this ties into that question, but is there such a thing as a probiotic that you just swish around your mouth, or is it more about diet?

    Dr. Lin:

    There’s actually a fair bit of research backing oral probiotics for gingivitis. Lactobacillus bug’s good for their bacterium, because what they do is they’re the defense factors. Your probiotic bacterium in the mouth will defend against and they’ll stop the harmful bacteria from building up that causes the inflammation in the first place.

    An oral probiotic, I recommend that, especially if there are persistent bleeding gums and gingivitis, as a starting point. Dietary behavior in the long term really is the gold standard in terms of how are we going to get our mouth, but also our gut and that relationship between bacteria and the immune system, back working properly. The oral probiotic area really is quite interesting. You can have them sometimes in a yogurt, or in a powdered satchel, you can get probiotics in. Some are in a mouth rinse.

    Yasmina :

    Oh, a mouth rinse. Okay, that’s interesting. I suppose you could just make your own, really. Could you make your own? Could you mix it with a little bit of water, or into juice or something, and just swish it around? Would that work? Because I know a lot of my readers have sensitivities to commercially prepared liquids.

    Dr. Lin:

    Yeah, completely. This goes back to the long-term solution. The best probiotic is always going to be fermented foods. If they tolerate dairy, you get a lot of the Lactobacillus species from that. Otherwise, a coconut kefir would be quite good, cheeses, or kombucha, or sometimes even something like an apple-cider vinegar.

    Yasmina :

    Ooh, interesting. That’s a great one.

    Dr. Lin:

    Yeah. It’s simple as well. Always diluted down, because it is acidic, but it’s a by product of a fermentation process, so it’s got quite interesting benefits. There’s quite good research showing that it decreases even insulin insensitivity in Type II diabetics. It all starts in the mouth. The benefits are all over the body. Not just in the gut, but also the mouth.

    Yasmina :

    Absolutely. Let me just ask you quickly. Those little brushes that … I don’t know how to describe them. They’re like toothpicks, but they have a little brush on the end. Are those too much for people with sensitive bleeding gums? Should they wait, or is that more effective? Does it do anything?

    Dr. Lin:

    Generally, I find, yeah. I think you’re talking about the picks that look like little toilet brushes?

    Yasmina :

    Yes! Exactly.

    Dr. Lin:

    Yeah. Good way to put it, right? They work great, actually, because the big problem with flossing is that people find it hard to get in there, so if you get a small one, it’s not going to be too traumatic on your gums and you can actually get to the places where it’s inflamed. That can really help to help clear out … Because you get plaque build up. If it stays there, and this pathogenic plaque isn’t removed, then that can really take things onto gum disease. Yeah, that can really help. Oral hygiene does play a part in the whole factor. That’s right.

    Yasmina :

    What would be your top foods? Because my readers, most of them don’t do well with fermented foods. I know some of us can do them in small quantities, but are there any other types of foods that help build that great bacteria that we need that will then affect our oral health?

    Dr. Lin:

    Yeah. Really, what your oral and gut bacteria need is fiber. Plenty of vegetables, prebiotic, like …

    Yasmina :

    Chicory?

    Dr. Lin:

    Asparagus, leeks. Yeah! Chicory, exactly. Artichokes. That’s really going to feed the beneficial bacteria in the mouth. That’s what they require. I’d really think about cutting down on the simple sugars, any kind of white flour, any kind of added sugar, because that will feed the harmful guys.

    Yasmina :

    What about fruit sugar? Let’s say whole fruits?

    Dr. Lin:

    That comes with sugar. Look, as a dentist, this is my bugbear because I see so many problems with sugar, but whole fruit with the fiber included is beneficial. I usually try tell people to limit it, just because there is a high sugar quantity compared to other foods, but exactly, eating an apple a day, or banana’s got prebiotic fibers as well, so that’s great.

    Yasmina :

    Exactly. Inulin, right?

    Dr. Lin:

    Yeah. Inulin’s great.

    Yasmina :

    To put it all into a nutshell, you’re brushing your teeth, you notice there’s some blood. What steps should we be taking to address the matter? If you could give me your checklist of one, two, three, four, five, in order that they should be done and in order of importance.

    Dr. Lin:

    Sure. First of all, I would be checking your own oral-hygiene regimen, so brushing twice a day and flossing. That’s a good start. Most people, they don’t perform their oral hygiene properly. That’s always a good start, and sometimes that can get you back on track. Now, if your gums are bleeding, you should also go and see a dentist, get a diagnosis, because it can be a sign of more serious problems. Number two is to go to get a check from your dentist.

    Yasmina :

    Very important.

    Dr. Lin:

    Yeah, exactly, but number three really is start to think about how your gums are a sign of wider inflammation and potentially histamine-release from mast cells in your body. You really should start to be thinking about how to rebalance your oral environment. I would think about an oral probiotic as a way to perhaps get things rebalanced. Then from there, four and five really is to put more fiber into your diet. Plenty of fruits and vegetables, prebiotic fibers like the bananas, like the artichokes, leeks. Then, really, if you do tolerate them, I know some of your listeners won’t be able to, fermented foods in the long term, that’s the most diverse and richest probiotic-

    Yasmina :

    The Holy Grail of food.

    Dr. Lin:

    The Holy Grail! Yeah. The Holy Grail of our microbiome.

    Yasmina :

    Okay. That’s wonderful. Any other steps you would recommend?

    Dr. Lin:

    It’s really monitoring. Your mouth really is a sign of what’s happening in your body. If your gums are bleeding, try and think about what other systemic conditions that you might have that are indicating. Perhaps you’ve got something wrong in your gut. If you have food allergies, or you have skin rashes or asthma or irritable bowel syndrome, that’s your body telling you in two distinct places that things are off balance, so I would really be taking bleeding gums as a message that there’s too much inflammation in your body. I would take going through those steps really to try and calm everything down in the long term.

    Yasmina :

    Okay. Something that you had said to me: tooth decay is not an infection.

    Dr. Lin:

    Yeah, exactly.

    Yasmina :

    A lot of people will be surprised to hear that.

    Dr. Lin:

    Yeah. It’s the same thing. We’ve talked about how gum disease is a lack of or an imbalance in the wrong bacteria. Tooth decay is the same thing. It’s a different process, though. Bacteria in your mouth actually manage the minerals, so from your saliva, and they actually require the minerals themselves to build the plaque. They do this because they need to survive. The mouth’s a hard place to survive. What happens is that when we feed our oral bacteria with too many simple sugars, the bad guys grow, they release too much acid, and eventually they take minerals from the teeth, because a low pH strips the calcium from our saliva, and eventually the bacteria have no choice but to take minerals from our teeth. We force our oral bacteria into causing a hole in our teeth, which is pretty amazing.

    Yasmina :

    Absolutely. Wow. That’s amazing. I’m so glad we had this conversation a while back, because it was really something that was bothering me and I couldn’t work it out. Eventually, I got over my fear of anesthesia and the dentist, and I started going regularly again, and it just completely disappeared. Obviously, I was making other changes at the time, my diet, definitely started focusing on the prebiotic foods because I wasn’t able to tolerate the probiotics, but suddenly, it all came together and I stopped having the problem, but I had never really resolved it in my mind how they were linked. Yeah, it’s absolutely fascinating.

    Thank you very much for speaking with me here today. Just to remind everybody, you have finished writing your book. You’ve finished writing a book that is going to be published by Hay House in the US, the UK, Australia, and Germany in January 2018. I am pre-ordering my copy as soon as that option becomes available. You can follow Dr. Steven Lin on Facebook, Instagram, Twitter, and LinkedIn, @DrSteven, that’s S-T-E-V-E-N L-I-N. Dr. Steven Lin. You’ll find his website here.

    Dr. Lin:

    Absolute pleasure, Yasmina. It was such great talking about this.

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  • Healing histamine: cognitive hypnotherapy course

    Healing histamine: cognitive hypnotherapy course

    Human head and a wrench

    This course will relaunch. Sign up to my mailing list to know when it does.

    My research into neural re-training convinced me that beliefs I was holding onto regarding my ability to heal, past negative food outcomes and exposure to stress were torpedoing my progress. Finding no practical approach to the problem, I tried cognitive hypnotherapy. It’s essentially a way of hacking into your belief system and re-wiring the brain for health. This four week course, created by my friend and cognitive hypnotherapist Hazel Gale, features the same techniques we’ve employed to further my recovery.

    Science backs hypnotherapy’s effect on histamine (read all about it in this post) but we’re not claiming this course will heal any condition. I do believe, and have experienced first hand, that these techniques will help open us up to the possibility of healing.

    In 4 weeks you’ll learn how to:

    Master your stress response*
    Re-wire your brain for health and happiness
    Let go of negative dietary beliefs
    Accept healing is truly possible

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    This course comprises:

    PDF materials
    Downloadable audio
    Personalised attention from Hazel and myself in a private Facebook Group
    Purchase this course today and you’ll receive an email directing you to the first week’s course materials and an invitation to join the Facebook group. Every seven days you’ll get a new email with that week’s link.

    Ready to open up a whole new healing mindset?

    Here’s an interview with Hazel on how cognitive hypnotherapy works.

    *Stress is a known mast cell and histamine trigger.

    Yasmina: I’m here today with Hazel Gale, cognitive hypnotherapist, my cognitive hypnotherapist. It’s a really interesting field, which has only appeared, to my knowledge, in the last couple of years, and I can say that I have been using it with great success for about 6 months now, I think it was. How long has it been, Hazel, since I’ve started working with you?

    Hazel: Yes, not that long. Maybe a little longer, but yeah, not far off that.

    Yasmina: Okay, well, whatever it is it’s been working really well. I’m really excited to be interviewing you here today for my readers, and also to talk about this great course that you have I have come up with together. Well, you, really, with a little bit of help from me. I think it’s going to do a lot of good for a lot of people. Can you please, Hazel, explain a little bit about what cognitive hypnotherapy is and how you tend to apply it and in what situations you apply it.

    Hazel: Sure. Okay, so, basically cognitive hypnotherapy is an amalgamation of other styles. It’s a little like cherry picking from many different therapy styles and finding the ones which seem to be most appropriate for the individual client in the particular moment that you’re talking to them. So we’re completely against anything that happens with a protocol or set procedure, or anything which labels people with a particular problem and says, “Because you have anxiety or depression or whatever it is, you will be treated in this way.” So it becomes a really fluid way of working. The main areas that we work within are – there is influence from traditional hypnotherapy, of course – but actually it’s quite different from traditional hypnotherapy. We’re grounded in a lot more technical and rational sort of stuff which comes from NLP, positive psychology and there are elements of psychotherapy in there, and Gestalt therapy, all of which comes together in this package, which means that you can move between the styles in any given session.

    The things that people see a cognitive hypnotherapist are really quite diverse. You could be seeing somebody for really emotional stuff like anxiety or confidence issues, or you could be seeing people for quite physiological presenting issues, which you recognize have an emotional connection, which I believe we’ll be talking a little bit about later on. It’s very diverse, the amount of things that you will see in a regular week of practice. Personally I specialize in working with people who have confidence and self-esteem issues, and particularly those who are struggling with performance stuff and chronic fatigue, because I have both suffered from chronic fatigue badly in the past and have overcome it with cognitive hypnotherapy, and I did that through being a full time athlete, so I’m well aware of the pressures that one can put themselves under by being in a performance job.

    Yasmina: What I found interesting about our sessions together and continue to find interesting about our sessions together is I have tried hypnosis in the past. I tried a session once with somebody and I’ve been doing self hypnosis on and off for many years, which I thought would be really great, because the book that I used helped you come up with your own script, you being the best person to really get into your brain and fish it all out. What I loved about working with you was I felt that the process of getting at the root of what was going on was much easier, because you really got in there and you asked the really important questions that made me think really hard about the genesis of the issue that I am dealing with. We spend a really long time talking about it before we actually get to the hypnosis part.

    Hazel: Yeah, I think that’s one of the main differences between cognitive hypnotherapy and the more traditional stuff. Which is not to put down any of the traditional hypnotherapy at all, because it absolutely can be brilliant for people. It’s just not the way we tend to work. In cognitive hypnotherapy, rather than thinking of the trance state, or hypnosis, as this spacial state which one gets put in by a therapist in order to fix their problem. Instead we look at trance state as something that we get in an out of every day, and that being positive and negative versions of it. A positive trance state, for example, would be being completely in love with somebody and absolutely absorbed in what they’re saying, or watching a great film, or being in flow state in sport.

    The negative trance state would be being hijacked by a negative emotion like anxiety. If you imagine a spider phobia, then the fear that comes on upon seeing a spider is a negative trance state. In many ways it’s the way that I see my job, rather than being to hypnotize people in order to fix them, it’s actually about looking into the thought processes behind the negative trance states in order to disrupt those processes, which is more about de-hypnotizing them out of the problem state than putting them into some special state which fixes it. And so you need to know exactly what the brain is doing in those moments, when it sees a spider and produces the anxiety. A lot of the time that will be to do with memories and things that have been experienced in the past, logged as dangerous and therefor anything that looks remotely similar to them in the present moment triggers an emotion, so that anything with a phobic pattern will work like that.

    There’s many other ways to work out what equations, basically, the brain is running and how to interrupt them so that you get these little pockets of awareness where you would usually just be going off on a negative spiral. Those pockets will act as windows of opportunity if you like, and are essential, because they don’t just mean that people can get better, they mean that people can get better in a way that feels that they’re in control of their own progress, which is enormously empowering, and also means that when they learn these processes they can apply in them to other areas in their life on their own, without having to go and see a hypnotherapist for another session for each time something goes wrong.

    Yasmina: Absolutely. I mean, something I found very interesting over the last couple of years is the greatest strides I’ve made in healing is by understanding the negative feedback loop that exists in my brain. I honestly believe that many of us were sick at some point, or continue to be sick in some way, but that our brain has sensitized us to becoming fearful of food, in this example, or certain triggers, because in the past when we were very sick we had a very, very bad reaction, but that is not necessarily the reality of today, and it’s not necessarily the fact that we need to have this incredible response.

    It’s partially, at least for some of us, dealing with mast cell and histamine issues. It’s the immune system misidentifying or exaggerating a response to otherwise harmless foods and situations. This is where a lot of the new brain retraining programs have come into play, the Gupta Programme, the DNRS, which I found very interesting but wholly impractical to put into practice on a daily basis. That’s why I love the work that we have done together. After that one hour that we spent together, it’s 15 minutes a day to rewire the brain for that new, I hesitate to use the word because it sounds really new agy, but paradigm. Just really quickly, I just want to tell people a little bit about some of the research that we’ve found.

    Sadness can intensify your histamine reactions, and that was discovered through hypnotizing people to be sad or be happy or be mad. Hypnosis can decrease the size of skin histamines reactions, so the wheel or the hive. Hypnotherapy for migraine lowers tryptase and histamine levels, tryptase being one of the mast cell mediators released along with histamine with mast cells. It’s involved along with allergies and also anaphylactic shock. Hypnosis and visualization can prevent mast cell de-granulation, thereby preventing the mast cells from dumping histamine and other inflammatory molecules into the body. These studies are linked to in my blog post, so you can check that out for yourself.

    Hazel, how does the process work for somebody like me. Can you explain a little bit about how you address what’s going on with people who are dealing with mast cell issues and histamine. We do understand you are not a doctor and I always say, “I’m not a doctor.” We’re not treating an actual condition. What we’re doing is we’re trying to reframe the way that the brain approaches a situation.

    Hazel: Absolutely. It should never be viewed as a cure. That’s not to say that you can’t have dramatic effects from it, but it’s not about physically curing the problem as such, although the results can be so diverse that you don’t know whether people could go completely into a place where the problem isn’t actually a physiological issue anymore. Nobody really knows exactly how that comes about through the psychological means of treating it. It’s possible.

    Yasmina: Hazel, for my listeners, it would be great if you could outline what happens in a typical session. I’ve booked an appointment with you, if I’m in London I can come to your office and have the session with you in person. Otherwise we do it by Skype. So what can we expect in a session.

    Hazel: The first thing that we need to do would be to talk about the problem and to work out what it is that your brain is connection to the issue. One of the things we really want to look out for are strong emotional feelings, especially ones with that are quite self referencing. Negative personal beliefs like, “I’m not good enough”, “I’m not lovable”. These sound dramatic, but the thing is that when somebody is suffering with debilitating physiological condition, it could be that one of those types of negative beliefs feed off it. So just part of the unconscious mind believing that has stimulated these ailments in the first place.

    It could just be that when they have an illness those emotions are chucked up and made more painful by the symptoms themselves, so that when they’re having a bout of illness it causes them to feel particularly negative about themselves. It’s those negative feelings that we’ll trace. If there is something in their past which is causing them to be particularly sensitized to that issue then that might be addressed. Or there may be any number of other processes that we might use to help them get in touch with and understand the root of those emotions and how their brain organizes them, and then to find ways to divert them and create these windows of opportunity where they can have a different choice. To develop a more conscious understanding of their behavior at that point, which could change the way the body manifests the problem.

    Yasmina: One particular session really sticks out in my mind, and that’s when I asked you for some help with my sleep. Now, my insomnia has improved tremendously over the years, but histamine does keep you awake. It messes with the circadian rhythm and it can make you feel quite tense and anxious at bedtime when the inflammation of all that you’ve eaten throughout the day catches up with you. You took me through this process whereby we discovered that I had some serious childhood fears that were working with the histamine and creating this negative feedback loop where I was actually scared to go to sleep.

    Once we identified that problem you gave me a method on this 15 minute hypnotherapy audio that you gave me, to deal with that fear and to slowly desensitize myself to that fear and just let it go. It was tremendously successful. I used it for a couple of weeks and I just started falling asleep without even trying. It was just absolutely insane because I’ve never been able to do that. Now I haven’t used the audio for, I don’t know, maybe a month or two, and I started having some problems sleeping again because I’ve been hyper dosing with vitamin B12, which is problematic for a lot of us, because my body needed it. I started having problems sleeping again and so I did the audio, and, bang, within two nights I was sleeping normally again. It was great.

    Hazel: That’s fantastic. The thing about the audios, what they do, if you have a session what they do is condense hours worth of conversations and associations made into 15 minutes. Even the ones that we’re going to be putting out in this process, what they do is they cause you, in a relaxed state, to make new associations with things that were once tricky. With the sleep type of issue, what we have done is we’ve created and imagery, with you you have imagery but it wouldn’t necessarily be the visual imagery with everybody. It might be a certain sound, it might be a certain feeling, but connecting positive associations to the old negative triggers like sleep or like a type of food which causes people a certain amount of fear. All sort of other areas could be dealt with in this way. It’s just repeating. That positive association teaches your brain to think about it in a different way.

    Yasmina: Absolutely. Just another quick example, when I failed my driving test the first time and I called you in a panic the next morning and I said, “I think I’m going to fail again and it’s a problem because I really need to pass this thing.” We did this great session where you had me visualize doing my yoga, which is where I feel completely in control and just very at peace with myself in a handstand or a headstand or whatever, and that positive association, I still think of it now. You’ve given me something great to work with, which is when I’m facing a situation that I think is just overwhelming, I just visualize myself in a headstand or doing an impossible back bend or balancing on one hand, and I think, yeah, I can deal with this.

    Hazel: Excellent. Yeah, you have this go-to symbolism for your own personal resources. The fact that we all have everything within us that we need to overcome our problem. This is particularly pertinent with things like histamine issue, because they are the body producing a reaction that is not necessarily needing to make. It’s all coming from inside. The body does know how to do what it needs to do, it just that it’s not necessarily doing it right at the time. If we’re working on the principle that we already have everything within us that we need to overcome the problem, and then it’s just about unlocking those things and organizing it in your mind in a way that means you can access it and use it, either consciously or just unconsciously and you can start to feel better without really necessarily knowing why.

    Yasmina: Absolutely. Why don’t you tell us a little bit about this course that you and I, but mostly you, have put together, because I really wanted to shout with happiness at the amazing progress that I have made since I’ve been working with you. I spoke with you and you very kindly offered a way so that could make it more cost effective for people. Tell us a little about the course and how it was put together and what people can expect on it.

    Hazel: What we wanted to do was really break it down in to easy stages. We’ve gone with a four week course. With each week there are easy assignments and a recording to listen to. The first thing that you are doing week one is just about relaxation, but learning how to relax. I’m not just talking about imagining sitting on a beach and breathing. It’s about really getting in touch with that your body feels like when it relaxes and then anchoring it. Anchoring is an NLP term, which basically means positive associations. You can create some kind of anchor, usually connected to a physical movement, like pinching your thumb and forefinger together would be an easy one.

    In the recording you’re guided into a relaxed state and then you create this physical anchor. The more times you repeat that the stronger the association becomes. It gets to the point where you can really depend on using, just in the same way you could use the image of yourself in the headstand, to access the state of calm control. This will allow you to create either a visual or a trigger word or physical movement that can bring you quickly back into a relaxed state, which is essential for any kind of healing work because your body must be in a place of psychological rest before this healing functions of the body can actually work, can actually do their job. So that’s week one.

    Week two we move into more specific healing suggestion work. There’s a new recording for week two, which is about coming up with metaphorical imagery, your own personal metaphoric imagery. Nothing is imposed on anybody, which you develop in order to tackle your issues. If you had one particular symptom the first time you do this course you might focus on that. You might come back to the recording which, of course, you can keep, six months later when you have a different symptom and then apply it to that and come up with different imagery.

    The third week stays with the guided imagery but it works specifically on the histamine stuff. We’ve got suggestions which have been designed to boost levels of DAO and HNMT, which help you break down the histamine in the system in a way which is really targeted for these problems. Again, you’ll be coming up with imagery. All of this imagery will be stuff that you can use throughout the say just to bring to mind in a matter of seconds the work that you’ve been doing the previous night by listening to the recordings so it becomes a part of your day, it becomes a part of your life.

    Yasmina: I have a question about the DAO, HNNT thing. I mean, we’re not actually saying that we’re boosting the levels. My understanding is we’re offering the brain a way to resolve what’s going on with us in a way that’s logical, but it’s not necessarily that we’re telling the body to produce more. Could you elaborate a little bit on that? Am I right?

    Hazel: Yeah. I mean, again, it’s all done through suggestions and symbolism, so it’ll be different for every person. But it’s about coming up with images that encourage your body, usually in quite a metaphorical way, to heal itself. Now, we can do this under the assumption that your body knows what needs to happen more than we do. It’s not that we’re giving you a drug for boosting a particular hormone. It’s not as obvious, it’s not as basic. It’s much more complex. It’s trusting the unconscious mind would hopefully do that for you.

    Yasmina: There’s a great book if people want to read a little bit more about this. Dr. Lissa Rankin, that’s Lissa with two s’s, Mind Over Medicine, and also Dr. David Hamilton, How Your Mind Can Heal Your Body, and Bruce Lipton’s, was it Bruce Lipton? The Biology of Belief. I’ll have to check on that, but I’m pretty sure that’s the title. Okay, and so week four?

    Hazel: Week four joins everything together where week four, there’s really no specific recording for week four. The idea is that you go back and you use all three of the recordings from before, because obviously you’re going to be going through this process through the entire, so you don’t want to let go of them even though you have their important points. You pick one according to how you feel each day and you use this program to create some positive habits and explore the things that you can do personally to improve your condition. It might be that there are practical measures that you can take. It might be that using some of the cognitive processes to overcome the negative emotions is going to be one of the most effective things for you. What I really want people to have a sense of agency in all of this, because that’s the most empowering way to be able to get better. It’s not about lying back and hoping everything gets fixed. It’s about being at the heart of it yourself.

    One of the things I encourage people to do in week four, and actually I would encourage them to do it for a few weeks after, is a technique called Three Gifts, which was originally designed as a part of the positive psychology approach. What this asks you to do is every day, at a certain point in the evening, you look back on your day and you write down three positive things that happened to you in that day. It’s enormously powerful. Actually, it’s been shown to be more powerful than antidepressants over a twenty-one day period for people with quite severe depression. What it does is it causes the brain to anticipate this task of writing down three things at the end of the day, especially if that’s relatively difficult for people, of course with depression it would be. Then it goes about looking for things to be able to put in this category of “positive” through the day. Of course what they end up doing is creating more positive things, find more positive things, so that after just a few days of doing this your mind is trained to see the brighter side of things. It sounds extremely simple, but it’s enormously effective for changing your perspective on life.

    Yasmina: It absolutely is, yeah. Hazel, I wanted to get your personal story, because it’s interesting, and I had told you this before, I had actually tried to book in with another hypnotherapist who I had seen mentioned in a newspaper article by chance on day when I was sitting on the tube, and I called his office and he was booked out while I was in London, but his secretary said that you are the person that this very well know hypnotherapist, you are the person who gives him his hypnotherapy and that I should definitely go see you. I checked out your website and your story really hit home for me because I saw that you had been through something really similar and I knew immediately that you would understand what I was going through. Please tell everybody a little bit about how you came to this and what your experience was.

    Hazel: For the last 10 years I was competing as a, first off, a kick boxer and then a boxer, which is obviously a very demanding sport. It’s got a fear factor that not necessarily every other sport will have. On top of that it’s something where your diet is enormously important because you have to make weight for competitions. It’s really, really stressful in many, many ways. I was over training. I pushed myself into a state of chronic fatigue by just over doing it and ignoring the signals from my body in the way that I’m sure that many people that are listening to this are going to sympathize with. It got to the point where I was really struggling with my training. Actually, instead of thinking, “Well, now I have to stop,” that was when I pushed myself even harder. Feel like I was lagging on my training so I should go for runs in the middle of the night. I just wore myself down into a complete state, really.

    Then I went to see all these medical doctors who weren’t able to help much. I exhausted Western medicinal options. Went to see a lot of different Eastern medicine practitioners. I made big changes to my nutritional program. All those things helped a little bit, but nothing really, really managed to shift it, and I was getting quite desperate. In the end the person who managed to make the big change for me was when I went to see Trevor Silvester, who’s the person who taught me aCognitive Hypnotherapy. We did a timeline regression process looking into the emotions that were attached to my illness. My illness made me feel disconnected, it made me feel like I couldn’t be the best of myself which made me feel like I wasn’t a good enough person for other people. I felt like I needed to get approval from other people by means of getting big titles and things like that. This was the way that I made myself feel attractive and worthwhile as a human being. So this illness was making that feel like it was taken away from me, which was the root to all of it.

    When we did – for me it was a reframe – it all went back to a really young sports day and my little brain made some silly conclusions about needing to win in order to be lovable with my dad, who was often away in those days. He happened to be at this one. It all came down to this really simple 5 minute interaction between my father and I when I was younger, and re-framing that, again I can’t say concretely with proof that this was the thing that made me better, but I know in my heart that it was. This was the point around doing this time that everything started to shift. Yeah, re-framing that, and then working with my recordings and opening my mind up to the connection between my body and my emotions solved everything. When it was that effected, I absolutely had to study in it, because I needed to get this out to other people, particularly sports people at that time.

    Yasmina: Wow. That’s wonderful. I’m so glad you decided to pursue this, because your helping me and a bunch of other people. I know a lot of people that I have talked to about you have scheduled sessions with you and, of course, you are available for private sessions at hazelgale.co.uk. That’s . co . uk. The link will be in the post accompanying this audio.

    The course is going to be structured in a way that I will be there answer questions on the weekly offerings, so there will be interaction on the site itself and also the supplemental Facebook group with Hazel and I answering questions. It is going to be hands on. It’s not like we are signing you up to a course and that’s it. You are going to have the opportunity to talk to us, to talk to other people on the course, if you wish, or you can sign up anonymously so you don’t have to share your name with anybody.

    Thanks so much for joining us here today, Hazel. That’s hazelgale, G-A-L-E, hazelgale.co.uk.

    CLICK HERE FOR A FOUR WEEK HISTAMINE RESET WITH MEAL PLANNERS, STRESS RELIEF STRATEGIES & MORE

     

  • The mold-histamine link

    The mold-histamine link

    mushrooms in the basket

    According to Dr. Ritchie Shoemaker, a leading biotoxin researcher with a medical degree from Duke University, Chronic Inflammatory Response Syndrome (CIRS), is the result of chronic inflammation produced by exposure to biotoxins (toxins produced from living organisms) that come from mold (mycotoxins), tick-borne infections like Babesia, dinoflagellates, blue-green algae, some reef fish, and the brown recluse spider. The most common trigger of CIRS is usually the combination of mycotoxins, bacteria, VOCs, chemicals, and other damaging pathogens found within water damaged buildings [1].

    Dr. Theoharides at Tufts, who has published nearly 400 peer reviewed papers and is in the top 5% of most quoted authors in pharmacological and immunological journals, has long spoken of the link between mold exposure and mast cell activation [2]. Activation of mast cells would release histamine, along with other inflammatory molecules into the blood stream.

    Today I’m interviewing Dana Howell, a patient who has healed herself from mold exposure and subsequent mast cell activation, through her research and with the help of Joe Cohen at Self Hacked. Joe is the person I called on to read my 23 and Me results. I wanted an unbiased view of what was going on and he certainly delivered.

    Yasmina:

    Dana, please tell us a bit about CIRS.

    Dana:

    24% of the population is genetically susceptible to getting very sick from biotoxins. This can be determined by a very simple HLA-DR blood test. Dr. Shoemaker, leading expert in CIRS, explains that for these genetically susceptible individuals, biotoxins can’t be “tagged” by the body, and so the body then responds the only way it can: with fierce inflammation. But animals have also become very sick in water damaged buildings, so it’s not 100% necessarily, that the genetically susceptible that are at risk; though they are much more prone to developing chronic issues.

    You’ll find recipes full of foods with antihistamine and anti-inflammatory properties my books Anti-Recipes and The Anti-Cookbook

    CLICK HERE TO CREATE YOUR OWN PERSONALISED HEALING HISTAMINE PLAN. 

    Yasmina: Please tell us a bit about the symptoms and your personal experience with mold exposure. Dana:  The average CIRS patient will have about 22 symptoms. The risk of these patients sounding like hypochondriacs is compounded when all traditional lab work returns ‘normal.’ I was one of the lucky genetically predisposed who became sick almost overnight in a very moldy home in Vietnam. It started with drowsiness and itchy skin. From there things went downhill fast. I was standing up talking one morning when I suddenly fainted. I came to with my Vietnamese host mother hovering above me in panic, rubbing tea tree oil on my face. I immediately removed myself from the mold home in Vietnam, but symptoms became more severe as the already absorbed biotoxins continued to recirculate throughout my bloodstream. I thought I was getting better when I suddenly began to get panic attacks (I was never an anxious individual, it was more of a “poison attack”), leading to sunlight sensitivity, extreme sound sensitivity, visual snow, loss of feeling of my left leg, confusion, brain fog, breathing problems, stabbing migraines, GERD, neuropathy, POTS symptoms, seeing make believe images in my peripheral, dizziness, and the worst…a case of 24/7 Depersonalization/Derealization (hallucinations, feeling as if you are on some kind of drug: patterns moving, seeing trails etc.). It’s no wonder LSD came from the grain fungus ergot, eventually triggering the Salem witch trials! All these years later mold is still creating problems, and patients are still being demonized and told it’s all in their head. Yasmina: I’m sorry but I have to butt in quickly: one of my really bizarre symptoms was LSD-like trippiness after eating certain foods. Cashews, vanilla, mushrooms picked freshly from a field in Beirut when I was covering the war spring to mind. Carpet patterns would literally start moving around. My bedroom in Spain growing up was in the basement. It was covered in mold. I still remember the smell. My mother was also a huge advocate of leaving food in the fridge for weeks and totally ignoring the sell-by dates. I still remember her scraping green mold off bread before handing it to me, saying: “Don’t be silly! Where do you think penicillin comes from?!”. 
    Dana:
    My early lab work was normal. At the time I was in Vietnam, I exchanged a bar of chocolate and $20 for an MRI (apparently a huge win for them, a steal for me!). Everything again..normal. I ended up seeing doctors all over the US, but only left with diagnosis of “possible MS,” shoulder shrugs, or scripts for SSRIs. Finally I was able to get the right testing, including a NeuroQuant of my MRI, a computer program used to scan properly run MRIs for brain injury, typically used for early detection of brain atrophy in dementia and Alzheimer’s Disease. My results showed swollen cortical gray matter, an exceptionally swollen forebrain (needed for organization, making plans, controlling emotions), and a shrunken caudate (the dopamine-rich part of the brain). My TGF Beta-1 and C4a levels were exceptionally high, indicating severe chronic inflammation. This inflammation activated mast cells and increased blood histamine levels, making my brain even foggier and symptoms that much worse. Thankfully, I was able to gain a lot of my health back through my own research, and through the work of very knowledgeable mold, lyme and out of the box practitioners and thinkers like Dr. Shoemaker and Dr. Marinkovich. Joe Cohen really helped tip things over the edge for me, and made me that much better. I am so beyond grateful! Yasmina: So, let’s say someone suspects they’ve been exposed to mold, what are their next steps? Dana:  If someone has list of about 20-30 symptoms, they really should get their mold biomarker tests, at least including the VCS test (visual contrast sensitivity-most all people with mold issues can’t distinguish certain shades of gray due to lack of oxygen and blood flow to the optic nerves), VIP levels, and inflammatory markers TGF Beta-1, MMP-9, C4a, C3a. Inflammatory markers like MMP-9 are important because they can test if a person is having a lack of ability to regulate inflammation in face of persistent stimulation, but with lack of finding certain antibodies. Dr. Shoemaker found that it’s a great marker for showing a whole series of cytokines instead of testing for certain individual cytokines like TNF-alpha, which only tests the TNF-alpha circulating in the blood, not what’s being bound in the cell or the cell next to it (in other words..the real results could be much higher!!). If you can later, through your treatment (as some of these tests can be expensive), you should test your MSH, HLA-DR genes, ADH/Osmolality, ACLA IgA/IgG/IgM, AGA IgA/IgG (this one’s not completely necessary in my opinion), VEGF, ACTH/Cortisol and Leptin. There is a lot of current research in progress related to mold illness in general, and in addition to the Shoemaker protocol. You must work through a pyramid of steps to resolve the inflammatory cascade. Yasmina:  Beyond testing, what can we do? Dana: The first step is removing yourself from your mold exposure and creating a safe environment to heal. Testing your home to make sure it has a safe HERTSMI-2 or ERMI scoring is recommended. The next step includes taking binders like Cholestyramine (CSM). Dr. Shoemaker discovered the effectiveness of this this cholesterol lowering drug for CIRS by chance, realizing it worked for binding a wide range of different negatively-charged molecules and toxins due to its positively charged molecules. This helps to bind biotoxins, halting their recirculation and helping to lower inflammatory markers. Some of the next steps focus on increasing MSH, correcting chronic hypoxia and lack of blood flow, and increasing VIP (vasoactive intestinal polypeptide) in order to regulate cytokine and inflammatory response from re-exposure. This protocol alone has an extremely effective track record. In my experience, this protocol has been very helpful, in addition to adding other diet and lifestyle changes (and a few other therapies) to further the healing process that much more. I’ll never forget my first hospital visit, looking down through the window at the cars below, swirling in circles like little ants. My brain didn’t comprehend any of it. I struggled to remember my brother’s name, to make sense of the chronic hallucinations. Absolute madness. I’m happy to say though, for anyone who is questioning if they will get better, there is a method to the madness. CIRS is a real documented illness, and there’s a way out. I’m so happy to be helping others find it. Yasmina: Dana, thanks so much for taking the time to share your story with us.

    You’ll find recipes full of foods with antihistamine and anti-inflammatory properties my books Anti-Recipes and The Anti-Cookbook

    CLICK HERE TO CREATE YOUR OWN PERSONALISED HEALING HISTAMINE PLAN. 

    ——————-REFERENCES——————–

    [1] http://www.survivingmold.com/about/ritchie-shoemaker-m-d

    [2] http://www.chronicpainpartners.com/free-webinar-mast-cell-disorders-by-dr-theoharis-theoharides-june-2-2015/

  • Interview: Dr. Georgia Ede on Histamine, Anxiety and Depression

    Interview: Dr. Georgia Ede on Histamine, Anxiety and Depression

    dr georgia ede

    My interview with Harvard trained psychiatrist Dr. Georgia Ede covers a subject dear to my heart: the role of diet and histamine in depression, anxiety and much more. Having been misdiagnosed for decades with anxiety, depression, bipolar, cyclothemia, borderline personality, schizophrenic episodes, amongst others, I have experienced first hand how diet can cause or alleviate their symptoms.

    Many, if not all, the women with mast cell activation/histamine intolerance I interact with share they have been told their symptoms are psychosomatic. Though I absolutely acknowledge there is a mind body connection and that retraining the brain will help us heal, being labelled a hypochondriac is incredibly counter productive. In my own case it caused me to dig deep into my illness, triggering ever increasing reactions and depression as I struggled to externalise the symptoms I felt so that someone, anyone, would believe I was actually sick. This led to increasing anxiety and depression symptoms as I grew more and more frustrated in the effort to be taken seriously.

    You’ll find recipes full of foods with antihistamine and anti-inflammatory properties my books Anti-Recipes and The Anti-Cookbook

    CLICK HERE TO CREATE YOUR OWN PERSONALISED HEALING HISTAMINE PLAN. 

    In our interview we discuss:

    The role of diet in psychiatric disorders

    How histamine causes symptoms of or mimics anxiety

    Histamine as a neurotransmitter

    The inflammation-depression link

    Psychiatric medications contraindicated in histamine disorders

    Psychiatric medications that may help alleviate histamine symptoms

    Steps to take if you believe histamine is the root/contributing cause of your psychiatric symptoms

    Dr. Ede was kind enough to share that that Ann Childers, a child and adult psychiatrist practicing in Oregon. She also belongs to the Physicians and Ancestral Health group and has a website about food and mood. 

    You can read more about the role of mast cells and histamine in depression and anxiety here.

    You can listen to the interview or read the the transcript below.

    Yasmina:     

    Joining me here today is Dr. Georgia Ede. She’s a Harvard trained psychiatrist who’s been working in the field of college mental health for the past 10 years, first at Harvard University Health Service, and now at Smith College in Western Massachusetts. In 2012, she founded diagnosisdiet.com, which is dedicated to exploring the scientific connection between food and all aspects of mental and physical health. Dr. Ede has a personal interest in histamine intolerance. You’ll find a comprehensive article about it on her website.

    She’s a founding member of Physician’s and Ancestral Health, a group of doctors that promotes the application of evolutiotary dietary principles to the treatment of human health conditiosn. At their national meeting in January, she gave a presentation entitled, Histamine Intolerance: Why Freshness Matters, the video of which will soon be posted on her website.

    So, Dr. Ede, thanks very much for joining us here today. It’s a real pleasure to have you.

    Dr. Georgia Ede:     

    Thank you so much for the invitation.

    Yasmina:

    I’d love to hear a little bit about your work as a psychiatrist generally.

    Dr. Georgia Ede:    

    When I first finished my residency in the late ’90s, I worked in private practice as well as in clinic settings working with people of all different ages, seniors all the way down to 16, 17 years old. My practice was very varied. I mostly prescribed medications and conducted psychotherapy sessions. But I didn’t have any interest at all in, or very little in nutrition and mental health. So, the first five years or so of my practice, was very conventional practice. But then my focus changed because I developed, in my early 40s, a variety of symptoms that were very troubling to me, and that doctors couldn’t help me with. Using a series of trial-and-error experiments I figured out that by changing my diet I was able to remove all of these symptoms.

    For example, I had symptoms of fibromyalgia and chronic fatigue and migraines and all kinds of other annoying things were happening for me. By changing my diet they all went away. So I became fascinated by nutrition and its impact on physical and mental health. In particular, my mood improved, and my concentration improved, and my energy. I was really surprised by that. So I changed my focus of my practice and I started doing nutrition consults both in private practice as well as at the Harvard Student Health Service, where I started working a number of years ago.

     So I would offer a combination of medication, services, as well as nutrition consultation, because I began studying, very intensely, the connection between food and mental and physical health. That’s what I’ve been doing now for many years. Now I’m at Smith College and I offer nutrition consults there as well as traditional medication services, at Smith.

    Yasmina:  

    That’s wonderful. That’s really great to hear. It’s been a personal quest of mine over the last few years, after some really negative experiences trying to go through psychiatry and psychotherapy myself, I eventually found the right way of doing it. I found a practitioner that I could work with, but I wish that I had met you. It would have saved me decades, literally decades, of my life.

    I would love to know a little but about the diet that you employed with yourself and what kind of dietary recommendation … Not necissarily dietary recommendations, but what do you see in the diet of people who you consult with that to you are warning signals or something that would contribute to their mood, for example?

    Dr. Georgia Ede:  

    It’s a big question. Let’s say that most people that I see who have mood problems, unfortunately, do not want to change their diet. Ill have, for example, students come into my office with a 32 ounce, florescent pink soft drinks or things like this. And they’ll be drinking that while they’re talking to me and complaining that they can’t concentrate or that they can’t sleep, or that their mood is imbalanced. It’s very difficult, especially with college students, to motivate them to change their diet because they’re young and they feel invincible. And they haven’t yet come down with a lot of health problems that can occur when diet is out of balance.

    Primarily, my main message is, to eat real food, to eat fresh food, to eat foods that are recognizable as food. That alone takes care of the lion’s share of what people are struggling with, but it’s so different from how most people eat, as you know. So that’s part one.

    Part two of the question that you were asking me is what do I eat. I don’t know if I’d necessarily go by me because I have a lot of food sensitivities. Histamine intolerance is just one part of what I discovered, or was true for me. My diet is very restricted due to my unique food sensitivities. I wouldn’t necessarily recommend the diet that I’m eating for everybody. It’s much stricter than it probably needs to be for most people. I eat for what works for my body, and everybody is so different, as you know. What I eat is mostly, I’d say, 80 – 90% fresh meat and chicken and fish, animals essentially. And then I supplement that with certain vegetables and low-carbohydrate fruits that I can tolerate, which aren’t very many, but I do have trouble with certain vegetables. Which was a surprise for me to discover. So, in any case, my diet is a mostly meat diet, and then supplemented with certain fruits and vegetables.

    (Yasmina: my diet is very different: 70-80% vegetables and fruit. I was down to five “safe” foods when I realised things needed to change and now eat mostly what I want histamine-wise). 

    Yasmina:        

    Are there any interesting studies that you can share on the topic of how food affects mood?

    Dr. Georgia Ede: 

    Yes. When I looked into this, because I noticed what a big difference my diet had made in my own mood and concentration energy … I think what I was surprised to find, there’s actually not that much good scientific information about food and mental health. It’s really a field that’s in its infancy. People are just staring to think about it. The exception being ADHD, which has been studied for decades.

    People have suspected that … Parents have suspected that what they fed their children was making a difference in their behavior. And they, in my opinion, were absolutely right. But then when the researchers went to look for a connection, for example, between sugar and attention, they didn’t find the connection they thought they might find. In my opinion, this was because they didn’t do the studies properly. They only removed sugar. They didn’t remove all the things that turn instantly into sugar, like white flour.

    Those studies were very flawed, but there were some fascinating studies about ADHD and food in children, almost all of them done in Europe 20, 30 years ago. Numerous studies where they would simplify a child’s diet, a child who had ADHD, and in some cases, their behavior was so dis dis-regulated that they were even hospitalized for their hyperactivity. They found that if they simplify the child’s diet, even for a couple of weeks, down to eight or nine simple foods, that, in the majority of cases, children with ADHD no longer met criteria for ADHD or their symptoms were markedly improved. That’s pretty amazing. It’s hard to say exactly what changes were the ones that were responsible for the improvement. But clearly, there’s a strong connection between behavior and attention and food if all you have to do is change the diet for a couple of weeks and you see such remarkable improvement.

    Yasmina:      

    That is pretty amazing. I’ve actually just remembered that there is a study that I blogged somewhere, also conducted in Europe, that found a correlation between children who had low levels of the HNMT histamine-degrading enzyme. It found that children with ADHD that were exposed to, I think it was food coloring, who did not lack the HNMT enzyme, reacted less strongly than the ones who were lacking in that enzyme. Food dye, of course, is a mast cell trigger.

    Read my post with the study here.

    I don’t know how many of my readers are familiar with them, at the moment. Mast cells are a part of the white blood cell system. They house histamine prostaglandin, interleukins, and other inflammatory mediators, keeping them safe when not needed. Then the mast cells break open in a process called degranulation, releasing this inflammation into the body to deal with things like digestion, healing, and various other things.

    We know that stress and foods can both trigger mast cells into releasing histamine and other inflammation into the blood stream. In addition, histamine is found in the brain as a neurotransmitter and also in food. You’ve written about histamine’s effects on body and mood. It would be great if you could share your findings.

    Dr. Georgia Ede:     

    Yes. One of the interesting things to me, as somebody who has histamine intolerance myself, I notice that I don’t sleep as well. It’s harder for me to concentrate. I feel more anxious, and sometimes feel very tired if I eat foods that are high in histamine and other biogenic amines. If we eat excess hisamine, if we eat a food that’s high in histamine, that histamine can, if we don’t have enough of the DAO enzyme that’s supposed to be the first line of defense in our gut, if we can’t break down that histamine, it does get into the blood stream. It’s not thought to cross the blood-brain barrier, but it’s so complicated. So, why would histamine have mood effects?

    There are two reasons why, as far as I can tell. One is that a lot of the physical symptoms of anxiety, you wouldn’t need to have any changes going on in brain chemistry, to have, for example a panic attack. A panic attack can occur completely in the body, and have nothing to do with the brain, because of the hormone adrenaline. That’s our fight or flight hormone, or panic hormone. That hormone is released when histamine is in excess. So, histamine can trigger adrenaline surges and adrenaline is the hormone that is responsible for panic symptoms. So that’s very interesting in and of itself.

    Histamine can trigger the release of all kinds of other things. As you remarked, this is really important, when mast cells get triggered, they can release all kinds of other inflammatory cytokins and other kinds of little chemicals that can stir the pot. One of them, this doesn’t come from mast cells but, estrogen is also trigger by histamine. So if you have too much histamine in your system, you will also, especially women, get a surge in estrogen. And estrogen does cross the blood-brain barrier. There are histamine receptors, and there are histamine-generating cells in the brain.

    So, if you have a surge in estrogen, the estrogen can cross into the brain and that can stimulate histamine release in the brain. And histamine is primarily … It has a variety of different functions but, two of the things that it’s very important in in the brain are brain arousal. It’s an exitatory neurotransmitter. It’s also key to memory and learning. A lot of people with histamine intolerance feel that they have brain fog, for example. And when they clean up their diet they feel much clearer. It’s very unclear what’s going on, but there are real biological connections that could explain why people feel the way they do.

    Yasmina:    

    That’s wonderful. I’m so glad you made the estrogen connection. It’s really a huge issue for many of us, and we never really look at it. I just want to add, absolutely, it’s really interesting that there are new studies coming out showing … There was a study in Finland where schizophrenics who were resistant to treatment with anti-psychotics experienced a remission in symptoms in being treated with H2-receptor antagonist, antihistamines working on the H2 receptor. I don’t know if you’ve seen that.

     Also, I came across some really interesting studies on how they think that it’s possible to treat drug resistant depression with anti-inflammatories or use them as an adjunct therapy to antidepressants. That’s really exciting news coming out in the last couple of years.

    Are you the only practitioner right now that you know of who is dealing with this? I know there is Judy Safir in Boston, who I’ve spoken with, who is aware of the histamine connection. But I know there’s a lot of people out there who need help dealing with, not only the effects of not being able to eat many foods and dealing with the symptoms, but a lot of us found that our initial symptoms were triggered by some sort of emotional upheaval or trauma – mentally, psychologically. We could really use some help. I’ve been working with somebody for a number of years and it’s made a huge difference in my life.

    Dr. Georgia Ede:   

    Yes. I know Judy Tsafrir. She’s fantastic. In fact, she’s the one, when I was at Harvard in eastern Massachusetts and living there, she was the one who wrote into my site and told me that I might have histamine intolerance. I was describing some of my symptoms as I was embarking on a ketogenic diet and I was actually feeling worse on the ketogenic diet than I had expected to. And it was because I had changed a lot of the types of food I was eating, especially when I was travelling. I was eating a lot more dried meats, and things like that because I couldn’t cook when I was on the road. So, she wrote in and said, “You probably have histamine intolerance.” That’s what got the whole thing going for me.

    Yasmina:     

    We know that a number of medication posses anti-histamine activity while others are contraindicated. Do you have some examples you can share and are there any, in particular, that could kill two birds with one stone, so to speak … Antidepressants or anti-anxiety meds that also work on histamine receptors?

    Dr. Georgia Ede:  

    Sure. There are some medicines that interfere with the enzyme that breaks down histamine, the DAO enzyme. Some of them are very commonly used, like the NSAIDs. We’ll call the NSAIDs, which are medicines like Advil, and Aleve. Those medicines can block the DAO enzyme and therefore can exaggerate, sort of exacerbate histamine symptoms. That’s one of the difficult things, as I’m sure you know, when you’re trying to diagnose somebody with histamine intolerance. One week they can do fine with a particular food, and the next week they don’t and they become really confused and so does their doctor about what’s going on. But it depends on what else is … How much of that food they ate … What other foods they ate that day … What medications they may have taken. Maybe they took Advil one week and not the next week. So, it becomes a difficult moving target.

    There are medicines which interfere with DAO. But then, as a psychiatrist, I think a lot about medications which block histamine receptors. Even though we don’t think of these medicines as anti-histamines … Anti-histamines we think of as Benadryl, and as Zertec and things like that. But, a lot of psychiatric medications do block the histamine receptor, at least partially. They include familiar antidepressents like Paxil or Paroxetine, and Remeron or Mirtazipine, and some anti-psychotics and mood stabilizers like Seroquel, which is also called quetiapine, Zyprexa, which is olanzapine, and Elavil, which is amitriptyline, an old-fashioned antidepressant.

    These medicines, their primary purpose is not to block histamine. In fact, histamine blockade is thought of as a nuisance by psychiatrists because if your medicine is blocking histamine it tends to make people very tired. But in any case, it can be useful if you’re having trouble sleeping. So, if you take a medicine that has one effect that you’re looking for, like anti-depression or anti-anxiety, but then it also blocks histamine, it can be very helpful for sleep.

    So medications in psychiatry are very complicated and they do a lot of different things. But for people who have histamine intolerance, taking a medicine that also blocks histamine can kind of be, as you said, killing two birds with one stone.

    Yasmina:   

    Indeed. That’s wonderful. I wanted to ask you, very quickly, if you could share with us what you think a person should do if they suspect that they have histamine-mediated depression symptoms or anxiety symptoms. What would your plan of attack be? Because I know a lot of people are lost out there.

    Dr. Georgia Ede:   

    Yes. It’s very hard to diagnose. There aren’t any very good tests. The best test, if you can find an allergist who will do this with you, is the histamine skin prick test. That’s the most sensitive test you can get. But, even then, it’s not as accurate as … I think the gold standard, in my opinion, is a low histamine diet, which is where you come in.

    A low histamine diet is really the way to find out whether or not you feel better when you lower your histamine load. You don’t have to do it for very long, as you know. Sometimes even just a couple of weeks will give you a lot of really good information about whether that’s part of what’s going on for you. I think eating whole foods, eating fresh foods, and paying attention … Keeping a food and symptom diary was absolutely key for me in terms of figuring out which foods bothered me and which ones didn’t. I think that’s absolutely step one.

    Then, if you notice a big change, it’ll give you a lot more control over how you feel from day to day. Even though I have histamine intolerance, I sometimes will eat something on purpose that I know is going to bother me. But at least I know that that’s going to happen. If I know that I need to feel absolutely on top of my game, then I eat a very, very clean diet. But nobody’s perfect. And it gives you information you can use to help you control how you feel.

    Yasmina:  

    Absolutely. I even used to do things like eat higher histamine foods when I needed to be awake for long periods of time.

    Dr. Georgia Ede:   

    That’s great. Great. That’s a perfect example.

    Yasmina:  

    Interestingly, I think one of the worst things I’ve ever done for myself was, I was on antidepressants that I had been described, incidentally I’ve taken all of the psych meds that you just mentioned, I was given Modafinil, Provigil, at one point, which is what airline pilots and fighter pilots take to stay awake for long periods of time. In recent years, in addition to its other waves of activity, they found that it works by boosting brain levels of histamine. So, wow.

    Dr. Georgia Ede:      

    That’s interesting. I did not know that. Yeah, Provigil is prescribed for alertness. That’s really interesting.

    Yasmina:      

    Yes. I was highly alert and much more than that for quite some time.

    Thank you so much for joining me here today. In closing I wanted to say that Carmine Pariante, I don’t know if I’ve pronounced that correctly, a psychiatrist and King’s College in London, was quoted in The Daily Mail of London recently as saying, “There may be a blood test within five to ten years that can measure inflammation in people with depression so that they can be treated accordingly.” Wouldn’t that be wonderful?

    Dr. Georgia Ede:     

    That would be wonderful. The connection between inflammation and depression is very strong. In fact, also between inflammation and schizophrenia, and bipolar disorder. It’s hard to know which direction that goes in because they’re associations. But eating a diet that’s anti-inflammatory … Which means, eating whole foods, and especially avoiding sugar, which is the most inflammatory substance you can put in your body, really makes a huge difference. Most chronic conditions are associated with inflammation you can’t see … The micro-inflammation … The cytokines … The high cytokine levels. It’d be great if we were able to target that more specifically with tests.

    Yasmina:    

    Absolutely. That’s what I tell people. The low-histamine diet is great, but generally, looking beyond might be even more beneficial. I tell people, there’s no point in eating a low-histamine diet that’s still full of garbage. It’s easy to do.

    Dr. Georgia Ede:  

    Exactly. I think they’re both very, very important. They reinforce each other.

    Yasmina:    

    Exactly. Toss in all the anti-inflammatory foods, all the whole foods, and, as I tell people, if it’s on a list and it works for you, or it doesn’t work for you, just go with what works for you.

    Dr. Georgia Ede:    

    Exactly. We’re each very different.

    Yasmina:  

    Absolutely. Well, thank you so much for joining me here today Dr. Georgia Ede. I highly recommend that every one of you listening to or reading this today, go check out her website, diagnosisdiet.com.

    Dr. Georgia Ede: 

    Thank you so much Yasmina. It’s been such a pleasure talking with you.

    Yasmina:                  Same here.

    You can read more about the role of mast cells and histamine in depression and anxiety here.

    You’ll find recipes full of foods with antihistamine and anti-inflammatory properties my books Anti-Recipes and The Anti-Cookbook

    CLICK HERE TO CREATE YOUR OWN PERSONALISED HEALING HISTAMINE PLAN. 

  • HARVARD NEUROSCIENTIST DR. MICHAEL VAN ELZAKKER: CHRONIC FATIGUE VAGUS NERVE LINK

    HARVARD NEUROSCIENTIST DR. MICHAEL VAN ELZAKKER: CHRONIC FATIGUE VAGUS NERVE LINK

    dr michael van elzakker

    In today’s interview Harvard and Tufts neuroscientist Dr. Michael Van ElZakker shares his fascinating new paper Chronic Fatigue from Vagus Nerve Infection: A Psychoneuroimmunological Hypothesis. His hypothesis proposes that an infection of the vagus nerve can cause greatly exaggerated chronic sickness responses like fatigue, pain and more. Our interview also touches on the mast cell link right at the end. 

    Click here to listen to the podcast or read the transcript below.

    You may also want to read my post on vagus nerve stimulation and my post on the vagus/mast cell link. 

    Yasmina:  

    Joining me today is Michael Van ElZakker, PhD, a neuroscientist affiliated at Massachusetts General Hospital, Harvard Medical School, and Tufts University. He has two primary research interests. The psychiatric condition Post Traumatic Stress Disorder, or PTSD, and the neuro-immune condition known as Chronic Fatigue Syndrome. Dr. Van ElZakker has authored a number of peer-reviewed studies, but one in particular has struck a chord in the immune dysfunction community. Chronic Fatigue from Vagus Nerve Infection: A Psychoneuroimmunological Hypothesis.

    Our discussion today revolves around this hypothesis, a very interesting one in which Chronic Fatigue Syndrome, or CFS, is proposed to be caused by an infection of the vagus nerve. Dr. Van ElZakker, thank you very much for joining me here today. Before we jump into our discussion, could you please tell our audience a little bit about your specialty of psychoneuroimmunology?

    Michael: 

    Sure. And thanks, Yasmina. It’s nice to meet you and I ppreciate you having me on. So psychoneuroimmunology is essentially a relatively new area of research. Western medicine is very good at breaking things down into components and reducing. And we look at cellular mechanisms and the mechanisms of even individual proteins and systems. And so historically, the nervous system and the immune system have been studied separately, and psychoneuroimmunology is a relatively new field in which it’s recognized now that the immune system can affect the nervous system in a way that affects behavior and experience. So that’s the psychoneuroimmunology, behavior, brain and immune system.

    Yasmina:    

    Indeed, there’s been some fascinating studies coming out recently about the link between inflammation and depression, for example, that have been absolutely fascinating to read. Can I just ask you to outline for our audience what are the main symptoms of Chronic Fatigue Syndrome?

    Michael:        

    Chronic Fatigue Syndrome, of course, is different than feeling chronically fatigued. Chronic Fatigue Syndrome is a neurological condition. It’s a disease that one of the main symptoms is a long-lasting, severe fatigue. Again, this is medical fatigue. It’s not the kind of fatigue that I have after a day at work where I need to just recharge for a few minutes and then I can go out. Medical fatigue is a lot more severe and debilitating and there’s a couple of other systems that tend to go along with Chronic Fatigue Syndrome, or CFS, like muscle pain, your sleep is not refreshing, a lot of people report having brain fog, trouble concentrating or remembering things. Sometimes people have headaches or sore throat or sore lymph nodes. And in general, the defining feature of Chronic Fatigue Syndrome is that after exertion, all of these symptoms get worse.

    Again, if I were to, untrained, run a marathon, I might have a really severe time recovering, but for someone with Chronic Fatigue Syndrome, that may be just walking around a shopping mall for the afternoon. And if it’s severe enough, for some people that’s even getting up and going to the bathroom and going back to bed.

    Yasmina:     

    Absolutely. I think many out there listening to this today have had that experience.

    Could you please tell us a little bit about the vagus nerve and its role in the body?

    Michael:    

    Yes. The vagus nerve is really a fascinating organ. It’s one of the cranial nerves and it’s a unique cranial nerve in that it innervates the trunk, the torso, the organs. It actually innervates all of the major trunk organs and it’s a bi-directional nerve. We call it a mixed nerve. It’s got fibers going from the brain to the organs, controlling them, and then it’s got fibers going from the organs to the brain, which is a way of letting the brain know what’s happening in the torso, in the body.

    The function of the vagus nerve has really come to light over the last 20 or so years. Essentially, when someone gets sick with anything, we all recognize that we have a pattern of symptoms. We have a low-grade fever, we feel tired, we can’t concentrate as well, we don’t feel like exercising or eating, and this is called the sickness response. It’s a broad response to any kind of pathogen. It turns out that the vagus nerve is really important for this process.

    And so, essentially, when molecules are released by innate immune cells, and there’s all different kinds of innate immune cells. White blood cells and mast cells included, glial cells, they release proinflammatory cytokines, which are a molecule that call other immune cells to the area of the infection or injury and they cause activation of these immune cells. They also change behavior and they make you feel really tired, unrested, you feel sore. But the interesting thing is that these cytokines don’t easily cross the blood/brain barrier. In other words, they don’t just flow through the blood and go right into the brain easily.

    How is it that say an infection in your lungs can cause you to have all these changes in your subjective experience, like feeling really exhausted and sore? Well, the vagus nerve is really important for that. The vagus nerve actually detects cytokines in the periphery and then sends a signal to the brain, essentially letting the brain know that the body is sick.

    There were some important studies done at the University of Colorado, for example, where I got my bachelor’s and master’s, where they would pick a rat and inject them with E. coli, say, some sort of a bacteria that would make the rat sick. And of course, the rat acts sick. It doesn’t run on a wheel, it doesn’t eat as much, it doesn’t socialize. That’s true unless you cut the vagus nerve, and then the rat acts normally. It’s essentially, its brain doesn’t know that its body is sick.

    That’s one of the really important functions of the vagus nerve, of which there are many, but that’s one of the important functions of the vagus nerve, the sensory vagus nerve that goes from the organs to the brain.

    Yasmina:      

    Okay, I’m going to come back to that in a minute because I want to ask you a question about that, but how is an infection of the vagus nerve … We understand now that the vagus nerve is kind of a messenger nerve, in essence. It’s sending the signal to the brain. What kind of bacterial or viral infections are predominantly linked to this kind of infection of the vagus nerve that you’ve been seeing?

    Michael:     

    I just want to make sure to clarify that this is a hypothesis and we’re working on proving it, we’re working on demonstrating that it’s accurate, or finding evidence. According to the hypothesis, there are a lot of pathogens that really like nerve tissue. That includes chicken pox, the herpes zoster virus, Epstein-Barr, HHV-6, some kinds of enterovirus, even the Lyme bacteria is a bacteria that really likes nerve tissue. I would say, not coincidentally, all of those are also pathogens that are linked to Chronic Fatigue Syndrome.

    The idea is that if the vagus nerve is this very sensitive detector of inflammatory markers, though it’s essentially an infection detector, right?

    Yasmina:  

    Mm-hmm (affirmative).

    Michael:        

    You can have a really small, localized infection, let’s say in the lungs, you’ve got a flu or something. The vagus nerve is very highly branched, so it’s got tiny little branches and tentacles all over your trunk and it’s able to pick up a tiny little signal of cytokines, which are produced. In general, they’re produced very locally. And that little infection is enough to change your subjective experience, to make you feel really tired and sore, give you brain fog and things like that.

    The hypothesis is essentially what would happen if one of these pathogens that really like to live in nerve tissue actually infected the thing that’s supposed to detect infection? The idea is that you get an exaggerated signal coming from the vagus nerve, where essentially the brain gets an erroneous signal that the body is extremely sick with viruses and bacteria, even though it’s really about the location of the infection and not the severity of it.

    Yasmina:  

    In your hypothesis, do you believe that you’ll find when you start the … What is it that you’ll be doing exactly to prove the hypothesis? What is it that you’re working on?

    Michael:           

    Right now, we’re doing a study where we’re using a combined MR and PET, so magnetic resonance like when an athlete gets injured, they have an MRI scan. It’s got very good spatial resolution. You can really see clear pictures inside the body and that is combined with PET, or positron emission tomography, in which a research participant or patient is injected with a substance that the machine can detect. What we’re looking for is increased cellular activity in the brain stem in a place called the nucleus of the solitary tract, which is where about 80 percent of these sensory vagus nerve fibers have their cell bodies.

    This is essentially the place where the vagus nerve enters the brain. The idea is that if we can see extra signal there, there’s more activity there in Chronic Fatigue Syndrome patients than there is in healthy people, that would be evidence that there’s an exaggerated signal coming from the vagus nerve into the brain.

    There’s a bunch of different ways that we can look for this and I can think of reasons why this particular method wouldn’t work, but we thought we would try this first because it’s sort of low-hanging fruit, and if it works, it might be useful in diagnosis down the road.

    Yasmina:           

    Do you think that you might find … Would you be able to see if there were previous infections? Is it possible, do you think, that the vagus nerve remains switched on in some way even though the infection has resolved?

    Michael:         

    Well, that’s very possible. One of the interesting things about these herpes viruses is that they go latent. All of us have herpes viruses in our body. More than 90 percent of human beings have more than one strain. Chicken pox, HSV-1, the simplex. We’re all walking around with these viruses in our bodies, but most of the time, they’re latent. People may have had the experience when they start to get a cold or a flu and they get a little cold sore on their tongue, that means when you’re immuno compromised, these herpes viruses can come back out of latency.

    One of the interesting things about these that comes from mouse research is that in a different cranial nerve, that’s actually also a neuroimmune nerve, just like the vagus nerve, it’s called the trigeminal nerve. When there are latent viruses in the trigeminal nerve, they continue to cause a low level cytokine response, even though the viruses are not active. Even though they’re in latency, they still cause a cytokine response.

    It could be the case that in Chronic Fatigue Syndrome, it’s usually triggered by a period of intense stress or a sort of otherwise normal cold or flu and then it never really resolves. What could happen is that if someone has a latent herpes virus embedded in their vagus nerve, or for that matter, trigeminal nerve, and it becomes reactivated, like a cold sore, right on that nerve, it can start causing this signal, which would be the initial experience of Chronic Fatigue Syndrome’s symptoms. But then it could even go back into latency and maintain that cytokine signaling that’s enough to cause ongoing symptoms.

    A lot of people notice that their symptoms can fluctuate, they might … Patients call them crashes. For some reason, they’ve had a bad crash. And it may be the case, again this is just a hypothesis, that that represents herpes viruses going in and out of latency, causing an increased cytokine response.

    So the answer is that if there’s a previous infection that has gone latent, we think that that would still cause exaggerated signaling in a nerve that detects cytokines.

    Yasmina:   

    Does your research indicate that this kind of infection is responsible for most cases of CFS? Or do you have any research on other causes?

    Michael:           

    We don’t have any direct evidence yet, but the hypothesis really is that any number of pathogens, as long as they cause an exaggerated signal, could cause this problem. For example, the Lyme bacteria is a bacteria that really likes to live in nerve tissue and if that were embedded in the vagus nerve or in one of the … The vagus nerve has these little clusters throughout the trunk called the ganglia, or paraganglia, and if a Lyme bacteria were embedded in one of those paraganglia, it could cause this ongoing signalling.

    The hypothesis really is … Part of, I think, the strength of the hypothesis is that it explains one of the real conundrums in Chronic Fatigue Syndrome, which is that there are a whole bunch of pathogens that are associated with Chronic Fatigue Syndrome, but there’s no pathogen that causes it every time. In other words, there’s plenty of evidence linking herpes viruses to Chronic Fatigue Syndrome. Increased antibodies in people with Chronic Fatigue Syndrome, a history of severe herpes virus infection predicts Chronic Fatigue Syndrome. However, it’s obviously not the case, since most of us have these viruses, that it always leads to Chronic Fatigue Syndrome.

    The hypothesis really is that it’s about the location more than the specific pathogen. This has to do with the fact that it’s an innate immune response that generally responds to all pathogens.

    Yasmina:       

    Let’s say people are dealing with a latent or a chronic viral infection that there’s really not much we can do about, such as these herpes viruses, is there any investigations that you’re aware of into a way we could possibly switch off that signal in the vagus nerve that’s unnecessary?

    Michael:         

    Yeah, sure. One of the, again that comes from mouse research, one of the interesting findings is that some antivirals can reduce the cytokine signaling even in latent viruses. There’s something about how antivirals work that can knock down the cytokine signaling. That’s one way to get at it.

    Another way to get at it is to just reduce the activation of these innate immune cells. Surrounding nerves and neurons are a type of cell called glial cells, G-L-I-A-L. The plural is glia, and there’s a bunch of different kinds. These are essentially neuroimmune cells. They’re kind of the immune cells of the nervous system. And just like other innate immune cells, like white blood cells, they detect pathogens, and when they do, they become activated. What happens is, if they were to detect a pathogen, they would activate and start producing all these substances that excite nerves. If they happen to be connected to the vagus nerve, they would excite that nerve.

    One way that we could get at it is with trying to reduce the glial activation, and I think that’s a reasonable avenue to pursue and research. There’s some evidence, there’s some preliminary studies that combination of antivirals and anti-inflammatories have been helpful. For example, in fibromyalgia, which I would argue is a similar process, just in a different type of nerve. There’s some research coming out of Alabama that shows, for example, that combining those two things can help.

    I think it’s one of those things that’s probably going to be A) really personalized because it matters what pathogen is at root. If one person, for example, has a herpes virus causing their problems, you’re going to use a specific type of drug. If another person has a Lyme bacteria, theoretically, it could even be caused by an injury, that activates glial cells as well. Then you’d want to attack the inflammation, the inflammatory process as well. Vagus nerve stimulation is a neurotherapeutic technique where you can actually give electrical stimulation directly to the vagus nerve and that causes an anti-inflammatory cytokine response in the body.

    I think these are all treatment options that are worth pursuing in research.

    Yasmina:           

    How would one, and now the tricky questions, how would one go about investigating whether a vagus nerve infection is responsible for their CFS?

    Michael:      

    Part of what my group is working on is to try and understand if we can even have a scan that allows us to see that. It’s a tough question. As of right now, the average medical center hospital is not going to be able to do that. They wouldn’t even know what to look for.

    I think at this point, the evidence that it’s a neurological condition with an immune component is pretty overwhelming. For example, there’s a really important study by a Japanese group that used a specific type of PET scan where they looked for a protein that’s produced by activated glia. The glia in the central nervous system, there’s a couple of different kinds, but one of them, when they become activated, produce a certain protein called the translocator protein. There’s a PET scan that can look for that, and this Japanese group found that individuals with Chronic Fatigue Syndrome had significantly increased levels of this translocator protein in their central nervous system.

    Now that means that there’s some sort of an inflammatory process happening. What we know is that when the vagus nerve detects cytokines in the body, it sends a signal to the brain, which then causes what we call a mirror response on the other side of the blood/brain barrier. Detection of cytokines in the blood of the periphery causes production of cytokines by these glial cells in the central nervous system. Part of that process is increasing this translocator protein.

    It may be the case that as we gather evidence and get down to the specifics of the neuroimmune basis of Chronic Fatigue Syndrome, we’ll be able to find specific types of scans and tests. That’s the hope, because patients struggle with doctors that are skeptical. Right now, there’s not really a commonly used objective test for Chronic Fatigue Syndrome. I would argue that it’s incorrect to say that there are no objective tests, but what we would like to see is a battery of tests that can really say, “Okay, this person actually has this condition.” Because right now, it’s basically people going to their doctor, describing their symptoms and then their doctor does a diagnosis of exclusion. They test for Lyme, they test for sleep apnea, they test for all these different, multiple sclerosis, all these different conditions that could be causing similar symptoms. If they don’t have these other diseases, they say, “Well, we’ll just call it Chronic Disease Syndrome.” Patients deal with a lot of skepticism from family members or from doctors who don’t follow the literature.

    Yasmina:     

    Indeed, they do. Okay. Basically, for treatment options, doctors or institutions to look to, “watch this space”, I guess.

    Michael:   

    Unfortunately, it’s tough for patients because there’s not really a lot of good treatment options right now. The standard is to get therapy that will help you cope, and of course, that’s not getting at root causes. Some people take, there’s this sort of a … In the UK, that’s taken a step further where there’s a powerful group of doctors there that really consider it to be a psychological condition, and so their version of therapy is to try to convince the patients that they’re not actually sick. It’s obviously really degrading and frustrating for patients.

    But in terms of treatment options, unfortunately, the best advice I could give is for really patients to talk amongst themselves and find open-minded, good doctors that are willing to follow the literature and try new options. If you’re seeing a doctor that considers it to be a psychological condition, then fire them and find someone else.

    Yasmina:        

    Excellent advice. In the meantime, is there anything you can advise, anything that people can do on their own or with their doctor, or is there any advice that you could give to any practitioners that might be listening? I know there’s quite a few doctors out there who read my blog, which is nice to hear.

    Michael:           

    Yeah, I think individual medicine is going to be important for Chronic Fatigue Syndrome. My personal opinion, and I think there’s an argument to be made against it, but my personal opinion is that it’s not the case that there’s some mystery virus out there that we just haven’t found yet and that’s going to explain every case of Chronic Fatigue Syndrome and we just have to find that one virus that’s really the magic bullet. I’m skeptical of that narrative. I think that it’s probably an autoinflammatory condition, as opposed to autoimmune condition, that can be triggered by any number of pathogens and might be maintained by a pathogen and might be maintained by ongoing inflammatory processes in people that are prone to that.

    For patients and clinicians, I would argue that they should think in personalized terms and look is there evidence in this particular patient for one particular pathogen? For example, a good friend of mine had really severe chicken pox later in life than usually happens, into her 20’s, a pretty severe case. That, to me, is some evidence that maybe it’s the zoster virus, maybe it’s the chicken pox virus that could be at the root of that person’s Chronic Fatigue Syndrome. You could do blood tests for antibodies to see if they’re elevated. There’s a really good research group out in Stanford that’s done some small clinical trials and found that elevated antibodies of certain virus strains predict patient response to specific antivirals. If there’s evidence that there’s an ongoing viral response in these patients, then there may be a specific antiviral that they should try.

    What I wouldn’t suggest is to just through antivirals at everyone who presents with these types of symptoms. I think there ought to be some evidence, because you don’t want to end up doing more harm than good. If someone’s got a herpes virus and they’re taking some sort of an antiretroviral or some drug that’s not really designed for that specific virus, they really could do more harm than good.

    Personalized medicine is key. Of course, there’s the standard advice of watch your activity levels, be wary, but these are the sorts of things that patients have figured out on their own. They already know. In general, just watch your activity level, be careful of those sorts of things, watch what you can handle, because post-exertion malaise is really tough.

    In general, there’s a tough tension between post-exertional malaise, which is increased symptoms after exertion, and deconditioning. I want to make clear that I don’t think deconditioning is the cause of this condition, but it’s not healthy and so-

    Yasmina:    

    Sorry, by deconditioning you mean?

    Michael:  

    Lack of activity can actually cause muscle atrophy. Every time someone exercises, their muscles actually produce cytokines. One of the things that happens is if someone has been on bed rest for a long period of time, the same amount of activity will cause an increased cytokine response, certain specific inflammatory cytokines.

    You want to try to find that balance of the level of activity that won’t completely wipe you out, but at the same time, try to not be at rest more than you need to be. If you can, don’t lie flat too often. This is for the very severe folks. If you can get someone to prop a couple of red bricks under the bed posts so that you’re tilted a little bit with your head up. What happens if you lie flat for a long period of time is that you’re blood pressure can start to drop, you’ll start to convert blood into urine, and POTS tachycardia, postural tachycardia is a concern among people with severe Chronic Fatigue Syndrome and so tilting themselves during bed rest can be something that helps a little bit with that. The sorts of things that help would be tight socks and leggings and things like that, to try and prevent blood from pooling in your legs when you sit up.

    Of course, these are not cures, but they’re changes that can help manage the symptoms and help prevent them from getting worse.

    Yasmina:        

    Okay, that’s great advice. Thank you very much.

    I know in my case, it was a very long journey coming back from my year of unintentional bed rest, but I had to start exercising five minutes at a time. There was a time when I couldn’t even walk up to two or three stairs without being winded and collapsing onto the sofa with the blood drained out of me. There’s actually an app I found recently that, I don’t know, it measures heart rate so it’s probably not relevant here, but it tells you whether your body is too exhausted to exercise again.

    Michael:    

    Hm. Interesting. Well, I don’t know anything about that specific app, but I will say that part of the vagus nerve, it innervates all of the trunk organs, and that includes the heart. When the vagus nerve that comes from the brain to the organs is called the motor vagus or the efferent vagus, and that actually does control heart rate and that’s one of the main ways that we can measure vagal tone is what’s called heart rate variability and it’s the difference in heart rate between breaths. That’s very much a vagus nerve thing, which I think is also part of the reason that I think that the vagus nerve is involved in this condition is because there’s all these autonomic symptoms.

    There’s a level of severity where you shouldn’t get up and walk three stairs. You really have to be careful and find that balance, but I guess just do what you can to find it.

    Yasmina:  

    Absolutely. And HRV, that’s what that app measures. That was, you reminded me, thank you.

    You can read my post on exercise induced fatigue where I mention the app here. 

    Michael:  

    Yep. Oh, yeah. That actually is one of the main measures of vagal tone.

    I would predict that folks with Chronic Fatigue Syndrome, and there’s evidence for this, are going to find a different heart rate variability than their healthy friends and relatives.

    Yasmina:    

    You mention the sickness response in your paper, what happens when the body goes through sickness and all of the different symptoms. Would that behavior, the symptoms of which are consistent with a typical mast cell activation event, is there … Basically, I guess, what I’m asking is do you see any link? You mentioned POTS. POTS and mast cell activation and EDS are kind of the trifecta that so many of us seem to come up with time and time again. I, myself, had very, very severe POTS symptoms for many years, which have only recently abated, but do you see any kind of link? Because we definitely have the CFS symptoms, but again, you said there are many different aspects to CFS.

    Michael:           

    Yes. One of the morphological, one of the structural factors about the vagus nerve sort of makes sense, which is that it particularly innervates areas of the body that come in contact with the outside world. The esophagus, the lining of the stomach, the lungs, all the areas where we breathe in or swallow pathogens. There’s another type of cell that really is found in those areas, and that’s mast cells.

    The crosstalk between the glial cells that surround the vagus nerve and mast cells is profound and it’s important. An activated mast cell actually produces several mediators that will activate the vagus nerve. Those include proinflammatory cytokines, all the interleukins, one through six, tumor necrosis factor alpha, which is another proinflammatory cytokine, prostaglandin, which is related to pain, muscle and joint pain, ATP and nitric oxide.There’s all these substances that are produced by mast cells that will activate other immune cells, other innate immune cells, including glial cells and will also directly activate the vagus nerve.

    These innate immune cells have a lot of cross-talk and it can become a snowball and that’s a new classification of disease that I’ve alluded to is autoinflammatory and that’s not the same thing as autoimmune, which is when your body attacks its own tissue. Autoinflammatory is when there’s an ongoing inflammatory process in the absence of evidence for a pathogen that would be causing it.

    There’s, I think, evidence that there can be a snowballing effect among immune cells that can grow out of control. There’s a lot of cross-talk.

    Yasmina:       

    Okay, so if I don’t have a virus triggering my vagus nerve, if I do just generally have a virus that is triggering my mast cells but not located in the nerves, that virus could still indirectly trigger the vagus nerve response?

    Michael:   

    Definitely. The vagus nerve detects a circulating of immune molecules and that doesn’t have to be produced directly by glial cells that surround the vagus nerve, it can be produced by white blood cells, mast cells.

    Let me give you a little background into the innate immune system so maybe it makes a little more sense.

    There’s two divisions to the immune system. There’s the acquired and the innate. The acquired is the antibodies, so it’s called acquired because we build it as we experience life. When we get sick with something, we make an antibody so the next time we get sick with it, we’ll be able to fight it off better. That’s the reason that kids get sick so easily.

    But then there’s the innate immune system, which is more evolutionarily ancient and it’s really evolved to handle anything. Instead of antibodies, which are very specific for an individual pathogen, the innate immune system is evolved to help us fight off pretty much anything we’d come in contact with. That’s parasites, viruses, bacteria, injury, and it’s got these general responses. Low grade fever, fatigue, muscle soreness. These are all things that prevent, for one thing, there are things that preserve energy so that we’re not out there running and dancing and procreating when we should be fighting off an infection. Like, for example, low grade fever, most of the pathogens that we come in contact with have evolved to really like 98.6 degrees for replication and so the brain says, “Well, if I can bump it up to 101, it’s going to be harder for those things to reproduce.

    Yasmina:      

    Ah.

    Michael:  

    Any time that we are sick with anything at all, we get this innate immune response. In Chronic Fatigue Syndrome, I would argue that it’s this innate immune response with the volume turned up to 11. It’s just extraordinarily severe. That’s part of the reason that I think the vagus nerve is directly involved. It’s evolved to detect a small amount of circulating immune molecules and if it’s directly bombarding the vagus nerve, the hypothesis is that it would really give an exaggerated signal.

    To come back to your question, it doesn’t really matter what type of innate immune cell finds a pathogen. They all have these things called PAMP detectors, so pathogen associated molecular patterns. Even mast cells have these receptors that basically look for things that look kind of like a virus or look kind of like a bacteria and they become activated when they discover something that seems sort of foreign. They start pumping out these immune modulators, which then are detected by the vagus nerve and cause a sickness response.

    It really doesn’t matter where or what type of cell, you’re going to get a vagus nerve response. But the difference between like, for example, if I were to catch the flu and my good friend with very severe Chronic Fatigue Syndrome, it’s just a whole different level of severity, which I think is why the vagus nerve might be directly involved.

    Yasmina:     

    Okay, that’s great. Thank you very much for joining me here today, Dr. Michael Van ElZakker joining me today for an interview. That was wonderful, thank you very much. And hope to hear more from you very soon.

    Michael: 

    I appreciate it. Thanks for having me on.

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  • Harvard neuroscientist Dr. Michael Van ElZakker: chronic fatigue vagus nerve link

    dr michael van elzakker

    In today’s interview Harvard and Tufts neuroscientist Dr. Michael Van ElZakker shares his fascinating new paper Chronic Fatigue from Vagus Nerve Infection: A Psychoneuroimmunological Hypothesis. His hypothesis proposes that an infection of the vagus nerve can cause greatly exaggerated chronic sickness responses like fatigue, pain and more. Our interview also touches on the mast cell link right at the end. 

    Click here to listen to the podcast or read the transcript below.

    You may also want to read my post on vagus nerve stimulation and my post on the vagus/mast cell link. 

    Yasmina:  

    Joining me today is Michael Van ElZakker, PhD, a neuroscientist affiliated at Massachusetts General Hospital, Harvard Medical School, and Tufts University. He has two primary research interests. The psychiatric condition Post Traumatic Stress Disorder, or PTSD, and the neuro-immune condition known as Chronic Fatigue Syndrome. Dr. Van ElZakker has authored a number of peer-reviewed studies, but one in particular has struck a chord in the immune dysfunction community. Chronic Fatigue from Vagus Nerve Infection: A Psychoneuroimmunological Hypothesis.

    Our discussion today revolves around this hypothesis, a very interesting one in which Chronic Fatigue Syndrome, or CFS, is proposed to be caused by an infection of the vagus nerve. Dr. Van ElZakker, thank you very much for joining me here today. Before we jump into our discussion, could you please tell our audience a little bit about your specialty of psychoneuroimmunology?

    Michael: 

    Sure. And thanks, Yasmina. It’s nice to meet you and I ppreciate you having me on. So psychoneuroimmunology is essentially a relatively new area of research. Western medicine is very good at breaking things down into components and reducing. And we look at cellular mechanisms and the mechanisms of even individual proteins and systems. And so historically, the nervous system and the immune system have been studied separately, and psychoneuroimmunology is a relatively new field in which it’s recognized now that the immune system can affect the nervous system in a way that affects behavior and experience. So that’s the psychoneuroimmunology, behavior, brain and immune system.

    Yasmina:    

    Indeed, there’s been some fascinating studies coming out recently about the link between inflammation and depression, for example, that have been absolutely fascinating to read. Can I just ask you to outline for our audience what are the main symptoms of Chronic Fatigue Syndrome?

    Michael:        

    Chronic Fatigue Syndrome, of course, is different than feeling chronically fatigued. Chronic Fatigue Syndrome is a neurological condition. It’s a disease that one of the main symptoms is a long-lasting, severe fatigue. Again, this is medical fatigue. It’s not the kind of fatigue that I have after a day at work where I need to just recharge for a few minutes and then I can go out. Medical fatigue is a lot more severe and debilitating and there’s a couple of other systems that tend to go along with Chronic Fatigue Syndrome, or CFS, like muscle pain, your sleep is not refreshing, a lot of people report having brain fog, trouble concentrating or remembering things. Sometimes people have headaches or sore throat or sore lymph nodes. And in general, the defining feature of Chronic Fatigue Syndrome is that after exertion, all of these symptoms get worse.

    Again, if I were to, untrained, run a marathon, I might have a really severe time recovering, but for someone with Chronic Fatigue Syndrome, that may be just walking around a shopping mall for the afternoon. And if it’s severe enough, for some people that’s even getting up and going to the bathroom and going back to bed.

    Yasmina:     

    Absolutely. I think many out there listening to this today have had that experience.

    Could you please tell us a little bit about the vagus nerve and its role in the body?

    Michael:    

    Yes. The vagus nerve is really a fascinating organ. It’s one of the cranial nerves and it’s a unique cranial nerve in that it innervates the trunk, the torso, the organs. It actually innervates all of the major trunk organs and it’s a bi-directional nerve. We call it a mixed nerve. It’s got fibers going from the brain to the organs, controlling them, and then it’s got fibers going from the organs to the brain, which is a way of letting the brain know what’s happening in the torso, in the body.

    The function of the vagus nerve has really come to light over the last 20 or so years. Essentially, when someone gets sick with anything, we all recognize that we have a pattern of symptoms. We have a low-grade fever, we feel tired, we can’t concentrate as well, we don’t feel like exercising or eating, and this is called the sickness response. It’s a broad response to any kind of pathogen. It turns out that the vagus nerve is really important for this process.

    And so, essentially, when molecules are released by innate immune cells, and there’s all different kinds of innate immune cells. White blood cells and mast cells included, glial cells, they release proinflammatory cytokines, which are a molecule that call other immune cells to the area of the infection or injury and they cause activation of these immune cells. They also change behavior and they make you feel really tired, unrested, you feel sore. But the interesting thing is that these cytokines don’t easily cross the blood/brain barrier. In other words, they don’t just flow through the blood and go right into the brain easily.

    How is it that say an infection in your lungs can cause you to have all these changes in your subjective experience, like feeling really exhausted and sore? Well, the vagus nerve is really important for that. The vagus nerve actually detects cytokines in the periphery and then sends a signal to the brain, essentially letting the brain know that the body is sick.

    There were some important studies done at the University of Colorado, for example, where I got my bachelor’s and master’s, where they would pick a rat and inject them with E. coli, say, some sort of a bacteria that would make the rat sick. And of course, the rat acts sick. It doesn’t run on a wheel, it doesn’t eat as much, it doesn’t socialize. That’s true unless you cut the vagus nerve, and then the rat acts normally. It’s essentially, its brain doesn’t know that its body is sick.

    That’s one of the really important functions of the vagus nerve, of which there are many, but that’s one of the important functions of the vagus nerve, the sensory vagus nerve that goes from the organs to the brain.

    Yasmina:      

    Okay, I’m going to come back to that in a minute because I want to ask you a question about that, but how is an infection of the vagus nerve … We understand now that the vagus nerve is kind of a messenger nerve, in essence. It’s sending the signal to the brain. What kind of bacterial or viral infections are predominantly linked to this kind of infection of the vagus nerve that you’ve been seeing?

    Michael:     

    I just want to make sure to clarify that this is a hypothesis and we’re working on proving it, we’re working on demonstrating that it’s accurate, or finding evidence. According to the hypothesis, there are a lot of pathogens that really like nerve tissue. That includes chicken pox, the herpes zoster virus, Epstein-Barr, HHV-6, some kinds of enterovirus, even the Lyme bacteria is a bacteria that really likes nerve tissue. I would say, not coincidentally, all of those are also pathogens that are linked to Chronic Fatigue Syndrome.

    The idea is that if the vagus nerve is this very sensitive detector of inflammatory markers, though it’s essentially an infection detector, right?

    Yasmina:  

    Mm-hmm (affirmative).

    Michael:        

    You can have a really small, localized infection, let’s say in the lungs, you’ve got a flu or something. The vagus nerve is very highly branched, so it’s got tiny little branches and tentacles all over your trunk and it’s able to pick up a tiny little signal of cytokines, which are produced. In general, they’re produced very locally. And that little infection is enough to change your subjective experience, to make you feel really tired and sore, give you brain fog and things like that.

    The hypothesis is essentially what would happen if one of these pathogens that really like to live in nerve tissue actually infected the thing that’s supposed to detect infection? The idea is that you get an exaggerated signal coming from the vagus nerve, where essentially the brain gets an erroneous signal that the body is extremely sick with viruses and bacteria, even though it’s really about the location of the infection and not the severity of it.

    Yasmina:  

    In your hypothesis, do you believe that you’ll find when you start the … What is it that you’ll be doing exactly to prove the hypothesis? What is it that you’re working on?

    Michael:           

    Right now, we’re doing a study where we’re using a combined MR and PET, so magnetic resonance like when an athlete gets injured, they have an MRI scan. It’s got very good spatial resolution. You can really see clear pictures inside the body and that is combined with PET, or positron emission tomography, in which a research participant or patient is injected with a substance that the machine can detect. What we’re looking for is increased cellular activity in the brain stem in a place called the nucleus of the solitary tract, which is where about 80 percent of these sensory vagus nerve fibers have their cell bodies.

    This is essentially the place where the vagus nerve enters the brain. The idea is that if we can see extra signal there, there’s more activity there in Chronic Fatigue Syndrome patients than there is in healthy people, that would be evidence that there’s an exaggerated signal coming from the vagus nerve into the brain.

    There’s a bunch of different ways that we can look for this and I can think of reasons why this particular method wouldn’t work, but we thought we would try this first because it’s sort of low-hanging fruit, and if it works, it might be useful in diagnosis down the road.

    Yasmina:           

    Do you think that you might find … Would you be able to see if there were previous infections? Is it possible, do you think, that the vagus nerve remains switched on in some way even though the infection has resolved?

    Michael:         

    Well, that’s very possible. One of the interesting things about these herpes viruses is that they go latent. All of us have herpes viruses in our body. More than 90 percent of human beings have more than one strain. Chicken pox, HSV-1, the simplex. We’re all walking around with these viruses in our bodies, but most of the time, they’re latent. People may have had the experience when they start to get a cold or a flu and they get a little cold sore on their tongue, that means when you’re immuno compromised, these herpes viruses can come back out of latency.

    One of the interesting things about these that comes from mouse research is that in a different cranial nerve, that’s actually also a neuroimmune nerve, just like the vagus nerve, it’s called the trigeminal nerve. When there are latent viruses in the trigeminal nerve, they continue to cause a low level cytokine response, even though the viruses are not active. Even though they’re in latency, they still cause a cytokine response.

    It could be the case that in Chronic Fatigue Syndrome, it’s usually triggered by a period of intense stress or a sort of otherwise normal cold or flu and then it never really resolves. What could happen is that if someone has a latent herpes virus embedded in their vagus nerve, or for that matter, trigeminal nerve, and it becomes reactivated, like a cold sore, right on that nerve, it can start causing this signal, which would be the initial experience of Chronic Fatigue Syndrome’s symptoms. But then it could even go back into latency and maintain that cytokine signaling that’s enough to cause ongoing symptoms.

    A lot of people notice that their symptoms can fluctuate, they might … Patients call them crashes. For some reason, they’ve had a bad crash. And it may be the case, again this is just a hypothesis, that that represents herpes viruses going in and out of latency, causing an increased cytokine response.

    So the answer is that if there’s a previous infection that has gone latent, we think that that would still cause exaggerated signaling in a nerve that detects cytokines.

    Yasmina:   

    Does your research indicate that this kind of infection is responsible for most cases of CFS? Or do you have any research on other causes?

    Michael:           

    We don’t have any direct evidence yet, but the hypothesis really is that any number of pathogens, as long as they cause an exaggerated signal, could cause this problem. For example, the Lyme bacteria is a bacteria that really likes to live in nerve tissue and if that were embedded in the vagus nerve or in one of the … The vagus nerve has these little clusters throughout the trunk called the ganglia, or paraganglia, and if a Lyme bacteria were embedded in one of those paraganglia, it could cause this ongoing signalling.

     The hypothesis really is … Part of, I think, the strength of the hypothesis is that it explains one of the real conundrums in Chronic Fatigue Syndrome, which is that there are a whole bunch of pathogens that are associated with Chronic Fatigue Syndrome, but there’s no pathogen that causes it every time. In other words, there’s plenty of evidence linking herpes viruses to Chronic Fatigue Syndrome. Increased antibodies in people with Chronic Fatigue Syndrome, a history of severe herpes virus infection predicts Chronic Fatigue Syndrome. However, it’s obviously not the case, since most of us have these viruses, that it always leads to Chronic Fatigue Syndrome.

    The hypothesis really is that it’s about the location more than the specific pathogen. This has to do with the fact that it’s an innate immune response that generally responds to all pathogens.

    Yasmina:       

    Let’s say people are dealing with a latent or a chronic viral infection that there’s really not much we can do about, such as these herpes viruses, is there any investigations that you’re aware of into a way we could possibly switch off that signal in the vagus nerve that’s unnecessary?

    Michael:         

    Yeah, sure. One of the, again that comes from mouse research, one of the interesting findings is that some antivirals can reduce the cytokine signaling even in latent viruses. There’s something about how antivirals work that can knock down the cytokine signaling. That’s one way to get at it.

    Another way to get at it is to just reduce the activation of these innate immune cells. Surrounding nerves and neurons are a type of cell called glial cells, G-L-I-A-L. The plural is glia, and there’s a bunch of different kinds. These are essentially neuroimmune cells. They’re kind of the immune cells of the nervous system. And just like other innate immune cells, like white blood cells, they detect pathogens, and when they do, they become activated. What happens is, if they were to detect a pathogen, they would activate and start producing all these substances that excite nerves. If they happen to be connected to the vagus nerve, they would excite that nerve.

    One way that we could get at it is with trying to reduce the glial activation, and I think that’s a reasonable avenue to pursue and research. There’s some evidence, there’s some preliminary studies that combination of antivirals and anti-inflammatories have been helpful. For example, in fibromyalgia, which I would argue is a similar process, just in a different type of nerve. There’s some research coming out of Alabama that shows, for example, that combining those two things can help.

    I think it’s one of those things that’s probably going to be A) really personalized because it matters what pathogen is at root. If one person, for example, has a herpes virus causing their problems, you’re going to use a specific type of drug. If another person has a Lyme bacteria, theoretically, it could even be caused by an injury, that activates glial cells as well. Then you’d want to attack the inflammation, the inflammatory process as well. Vagus nerve stimulation is a neurotherapeutic technique where you can actually give electrical stimulation directly to the vagus nerve and that causes an anti-inflammatory cytokine response in the body.

    I think these are all treatment options that are worth pursuing in research.

    Yasmina:           

    How would one, and now the tricky questions, how would one go about investigating whether a vagus nerve infection is responsible for their CFS?

    Michael:      

    Part of what my group is working on is to try and understand if we can even have a scan that allows us to see that. It’s a tough question. As of right now, the average medical center hospital is not going to be able to do that. They wouldn’t even know what to look for.

    I think at this point, the evidence that it’s a neurological condition with an immune component is pretty overwhelming. For example, there’s a really important study by a Japanese group that used a specific type of PET scan where they looked for a protein that’s produced by activated glia. The glia in the central nervous system, there’s a couple of different kinds, but one of them, when they become activated, produce a certain protein called the translocator protein. There’s a PET scan that can look for that, and this Japanese group found that individuals with Chronic Fatigue Syndrome had significantly increased levels of this translocator protein in their central nervous system.

    Now that means that there’s some sort of an inflammatory process happening. What we know is that when the vagus nerve detects cytokines in the body, it sends a signal to the brain, which then causes what we call a mirror response on the other side of the blood/brain barrier. Detection of cytokines in the blood of the periphery causes production of cytokines by these glial cells in the central nervous system. Part of that process is increasing this translocator protein.

    It may be the case that as we gather evidence and get down to the specifics of the neuroimmune basis of Chronic Fatigue Syndrome, we’ll be able to find specific types of scans and tests. That’s the hope, because patients struggle with doctors that are skeptical. Right now, there’s not really a commonly used objective test for Chronic Fatigue Syndrome. I would argue that it’s incorrect to say that there are no objective tests, but what we would like to see is a battery of tests that can really say, “Okay, this person actually has this condition.” Because right now, it’s basically people going to their doctor, describing their symptoms and then their doctor does a diagnosis of exclusion. They test for Lyme, they test for sleep apnea, they test for all these different, multiple sclerosis, all these different conditions that could be causing similar symptoms. If they don’t have these other diseases, they say, “Well, we’ll just call it Chronic Disease Syndrome.” Patients deal with a lot of skepticism from family members or from doctors who don’t follow the literature.

    Yasmina:     

    Indeed, they do. Okay. Basically, for treatment options, doctors or institutions to look to, “watch this space”, I guess.

    Michael:   

    Unfortunately, it’s tough for patients because there’s not really a lot of good treatment options right now. The standard is to get therapy that will help you cope, and of course, that’s not getting at root causes. Some people take, there’s this sort of a … In the UK, that’s taken a step further where there’s a powerful group of doctors there that really consider it to be a psychological condition, and so their version of therapy is to try to convince the patients that they’re not actually sick. It’s obviously really degrading and frustrating for patients.

    But in terms of treatment options, unfortunately, the best advice I could give is for really patients to talk amongst themselves and find open-minded, good doctors that are willing to follow the literature and try new options. If you’re seeing a doctor that considers it to be a psychological condition, then fire them and find someone else.

    Yasmina:        

    Excellent advice. In the meantime, is there anything you can advise, anything that people can do on their own or with their doctor, or is there any advice that you could give to any practitioners that might be listening? I know there’s quite a few doctors out there who read my blog, which is nice to hear.

    Michael:           

    Yeah, I think individual medicine is going to be important for Chronic Fatigue Syndrome. My personal opinion, and I think there’s an argument to be made against it, but my personal opinion is that it’s not the case that there’s some mystery virus out there that we just haven’t found yet and that’s going to explain every case of Chronic Fatigue Syndrome and we just have to find that one virus that’s really the magic bullet. I’m skeptical of that narrative. I think that it’s probably an autoinflammatory condition, as opposed to autoimmune condition, that can be triggered by any number of pathogens and might be maintained by a pathogen and might be maintained by ongoing inflammatory processes in people that are prone to that.

    For patients and clinicians, I would argue that they should think in personalized terms and look is there evidence in this particular patient for one particular pathogen? For example, a good friend of mine had really severe chicken pox later in life than usually happens, into her 20’s, a pretty severe case. That, to me, is some evidence that maybe it’s the zoster virus, maybe it’s the chicken pox virus that could be at the root of that person’s Chronic Fatigue Syndrome. You could do blood tests for antibodies to see if they’re elevated. There’s a really good research group out in Stanford that’s done some small clinical trials and found that elevated antibodies of certain virus strains predict patient response to specific antivirals. If there’s evidence that there’s an ongoing viral response in these patients, then there may be a specific antiviral that they should try.

    What I wouldn’t suggest is to just through antivirals at everyone who presents with these types of symptoms. I think there ought to be some evidence, because you don’t want to end up doing more harm than good. If someone’s got a herpes virus and they’re taking some sort of an antiretroviral or some drug that’s not really designed for that specific virus, they really could do more harm than good.

    Personalized medicine is key. Of course, there’s the standard advice of watch your activity levels, be wary, but these are the sorts of things that patients have figured out on their own. They already know. In general, just watch your activity level, be careful of those sorts of things, watch what you can handle, because post-exertion malaise is really tough.

    In general, there’s a tough tension between post-exertional malaise, which is increased symptoms after exertion, and deconditioning. I want to make clear that I don’t think deconditioning is the cause of this condition, but it’s not healthy and so-

    Yasmina:    

    Sorry, by deconditioning you mean?

    Michael:  

    Lack of activity can actually cause muscle atrophy. Every time someone exercises, their muscles actually produce cytokines. One of the things that happens is if someone has been on bed rest for a long period of time, the same amount of activity will cause an increased cytokine response, certain specific inflammatory cytokines.

    You want to try to find that balance of the level of activity that won’t completely wipe you out, but at the same time, try to not be at rest more than you need to be. If you can, don’t lie flat too often. This is for the very severe folks. If you can get someone to prop a couple of red bricks under the bed posts so that you’re tilted a little bit with your head up. What happens if you lie flat for a long period of time is that you’re blood pressure can start to drop, you’ll start to convert blood into urine, and POTS tachycardia, postural tachycardia is a concern among people with severe Chronic Fatigue Syndrome and so tilting themselves during bed rest can be something that helps a little bit with that. The sorts of things that help would be tight socks and leggings and things like that, to try and prevent blood from pooling in your legs when you sit up.

    Of course, these are not cures, but they’re changes that can help manage the symptoms and help prevent them from getting worse.

    Yasmina:        

    Okay, that’s great advice. Thank you very much.

    I know in my case, it was a very long journey coming back from my year of unintentional bed rest, but I had to start exercising five minutes at a time. There was a time when I couldn’t even walk up to two or three stairs without being winded and collapsing onto the sofa with the blood drained out of me. There’s actually an app I found recently that, I don’t know, it measures heart rate so it’s probably not relevant here, but it tells you whether your body is too exhausted to exercise again.

    Michael:    

    Hm. Interesting. Well, I don’t know anything about that specific app, but I will say that part of the vagus nerve, it innervates all of the trunk organs, and that includes the heart. When the vagus nerve that comes from the brain to the organs is called the motor vagus or the efferent vagus, and that actually does control heart rate and that’s one of the main ways that we can measure vagal tone is what’s called heart rate variability and it’s the difference in heart rate between breaths. That’s very much a vagus nerve thing, which I think is also part of the reason that I think that the vagus nerve is involved in this condition is because there’s all these autonomic symptoms.

    There’s a level of severity where you shouldn’t get up and walk three stairs. You really have to be careful and find that balance, but I guess just do what you can to find it.

    Yasmina:  

    Absolutely. And HRV, that’s what that app measures. That was, you reminded me, thank you.

    You can read my post on exercise induced fatigue where I mention the app here. 

    Michael:  

    Yep. Oh, yeah. That actually is one of the main measures of vagal tone.

    I would predict that folks with Chronic Fatigue Syndrome, and there’s evidence for this, are going to find a different heart rate variability than their healthy friends and relatives.

    Yasmina:    

    You mention the sickness response in your paper, what happens when the body goes through sickness and all of the different symptoms. Would that behavior, the symptoms of which are consistent with a typical mast cell activation event, is there … Basically, I guess, what I’m asking is do you see any link? You mentioned POTS. POTS and mast cell activation and EDS are kind of the trifecta that so many of us seem to come up with time and time again. I, myself, had very, very severe POTS symptoms for many years, which have only recently abated, but do you see any kind of link? Because we definitely have the CFS symptoms, but again, you said there are many different aspects to CFS.

    Michael:           

    Yes. One of the morphological, one of the structural factors about the vagus nerve sort of makes sense, which is that it particularly innervates areas of the body that come in contact with the outside world. The esophagus, the lining of the stomach, the lungs, all the areas where we breathe in or swallow pathogens. There’s another type of cell that really is found in those areas, and that’s mast cells.

    The crosstalk between the glial cells that surround the vagus nerve and mast cells is profound and it’s important. An activated mast cell actually produces several mediators that will activate the vagus nerve. Those include proinflammatory cytokines, all the interleukins, one through six, tumor necrosis factor alpha, which is another proinflammatory cytokine, prostaglandin, which is related to pain, muscle and joint pain, ATP and nitric oxide.There’s all these substances that are produced by mast cells that will activate other immune cells, other innate immune cells, including glial cells and will also directly activate the vagus nerve.

    These innate immune cells have a lot of cross-talk and it can become a snowball and that’s a new classification of disease that I’ve alluded to is autoinflammatory and that’s not the same thing as autoimmune, which is when your body attacks its own tissue. Autoinflammatory is when there’s an ongoing inflammatory process in the absence of evidence for a pathogen that would be causing it.

    There’s, I think, evidence that there can be a snowballing effect among immune cells that can grow out of control. There’s a lot of cross-talk.

    Yasmina:       

    Okay, so if I don’t have a virus triggering my vagus nerve, if I do just generally have a virus that is triggering my mast cells but not located in the nerves, that virus could still indirectly trigger the vagus nerve response?

    Michael:   

    Definitely. The vagus nerve detects a circulating of immune molecules and that doesn’t have to be produced directly by glial cells that surround the vagus nerve, it can be produced by white blood cells, mast cells.

    Let me give you a little background into the innate immune system so maybe it makes a little more sense.

    There’s two divisions to the immune system. There’s the acquired and the innate. The acquired is the antibodies, so it’s called acquired because we build it as we experience life. When we get sick with something, we make an antibody so the next time we get sick with it, we’ll be able to fight it off better. That’s the reason that kids get sick so easily.

    But then there’s the innate immune system, which is more evolutionarily ancient and it’s really evolved to handle anything. Instead of antibodies, which are very specific for an individual pathogen, the innate immune system is evolved to help us fight off pretty much anything we’d come in contact with. That’s parasites, viruses, bacteria, injury, and it’s got these general responses. Low grade fever, fatigue, muscle soreness. These are all things that prevent, for one thing, there are things that preserve energy so that we’re not out there running and dancing and procreating when we should be fighting off an infection. Like, for example, low grade fever, most of the pathogens that we come in contact with have evolved to really like 98.6 degrees for replication and so the brain says, “Well, if I can bump it up to 101, it’s going to be harder for those things to reproduce.

    Yasmina:      

    Ah.

    Michael:  

    Any time that we are sick with anything at all, we get this innate immune response. In Chronic Fatigue Syndrome, I would argue that it’s this innate immune response with the volume turned up to 11. It’s just extraordinarily severe. That’s part of the reason that I think the vagus nerve is directly involved. It’s evolved to detect a small amount of circulating immune molecules and if it’s directly bombarding the vagus nerve, the hypothesis is that it would really give an exaggerated signal.

    To come back to your question, it doesn’t really matter what type of innate immune cell finds a pathogen. They all have these things called PAMP detectors, so pathogen associated molecular patterns. Even mast cells have these receptors that basically look for things that look kind of like a virus or look kind of like a bacteria and they become activated when they discover something that seems sort of foreign. They start pumping out these immune modulators, which then are detected by the vagus nerve and cause a sickness response.

    It really doesn’t matter where or what type of cell, you’re going to get a vagus nerve response. But the difference between like, for example, if I were to catch the flu and my good friend with very severe Chronic Fatigue Syndrome, it’s just a whole different level of severity, which I think is why the vagus nerve might be directly involved.

    Yasmina:     

    Okay, that’s great. Thank you very much for joining me here today, Dr. Michael Van ElZakker joining me today for an interview. That was wonderful, thank you very much. And hope to hear more from you very soon.

    Michael: 

    I appreciate it. Thanks for having me on.

    It’s finally here! Man Food – a high nutrient antihistamine and anti-inflammatory ingredient filled book geared towards guys, women who love to work out, yoga like they mean it, or just load up on healing nutrients. Features my personal shopping list of antihistamine and anti-inflammatory foods. 

    The Anti-cookbook and all liquid Anti-Detox Book, don’t treat any conditions, but feature a plethora of the high nutrient antihistamine and anti-inflammatory ingredients that have been instrumental in helping me feed myself on a limited diet. The Anti-cookbook features a six page list of antihistamine and anti-inflammatory foods and comes in regular and Paleo. 

    The Low Oxalate Cookbook features antihistamine and anti-inflammatory rich recipes. 

    Don’t miss the Low Histamine Beauty Survival Guide for non-toxic beauty tips, the skinny on histamine releasing (mast cell degranulating) beauty ingredients, antihistamine and anti-inflammatory beauty alternatives and the top brands natural brands I’ve found.

    Take a peek at my other low histamine and antihistamine cookbooks for more high nutrient recipes and sign up to my mailing list for freebies. 

  • Interview: Fasting Mimicking Diets for Mast Cell Activation & Allergies

    Interview: Fasting Mimicking Diets for Mast Cell Activation & Allergies

    UPDATE: The USC Longevity Institute have kindly agreed to send me a fasting mimicking pack to test so that I can share my experience with you. I’m just waiting on medical approval and then will jump right in. 

    Water fasting’s health benefits have always interested me. Recent research showing that fasting can prevent mast cell degranulation (the process that releases histamine into the blood stream from mast cells) in mice [1] and rats [2] were a great find, but sadly I eventually found that water fasting was too stressful for my nervous system.

    And then, while perusing the diet and health section in a bookstore, I stumbled onto the research of Dr. Valter Longo, director of the USC Longevity Institute, regarding what he has dubbed the Fasting Mimicking Diet (FMD).

    In a nutshell, the FMD is essentially one which recreates the anti-inflammatory, cardiac, cancer and neurodegenerative protective effects of water fasting in a less extreme way, by allowing the consumption of 750-1100 calories for a five day period.

    There’s so much press coverage of the general benefits of the FMD that this interview with Dr. Longo focused on exactly how this fasting style benefits those of us with mast cell activation, histamine intolerance and food allergies.

    The most exciting take away from my chat with Dr. Longo is that his new research on mice showed that a three day fast (which would correspond to a five day fast in humans) induced a 40% regeneration of immune cells (which include mast cells). He believes that the cells that die off are “faulty” and that the newly minted cells could offer some kind of resolution/positive benefits to immune system conditions, including mast cell activation, histamine intolerance and food allergies.

    This corresponds to something I’ve heard mast cells doctors tell folks: avoid your triggers to stop activating mast cells for long enough and they’ll die off eventually. Well, this seems like an incredible shortcut that doesn’t involve massive deprivation.

    As an aside, I recently visited with a friend in Portland who has mastocytosis who commented that I eat few meals and don’t snack. Yes, and that’s partially how my symptoms cleared up: having a liquid in the morning and then two meals is a kind of mini fast, causing less inflammation to be released by the digestive process. Not as great as a five day fasting mimicking fast, but still better than constantly stuffing my face through the day as I used to. 

    Other super interesting take aways from this interview:

    – The amount of protein you’re likely eating is prematurely ageing your cells

    – Why a mostly plant based diet is best for longevity and immune system function

    – The FMD may soon be approved for immune system dysfunction and cancer treatment

    – How to get started on this fast

    – The effect of fasting on the adrenals

    You’ll find recipes full of foods with antihistamine and anti-inflammatory properties my books Anti-Recipes and The Anti-Cookbook

    CLICK HERE TO CREATE YOUR OWN PERSONALISED HEALING HISTAMINE PLAN. 

    The podcast interview with Dr. Longo is just below and you’ll find the transcript of our chat under that.

    DR. VALTER LONGO INTERVIEW TRANSCRIPT

    Yasmina: Joining me today is Dr. Valter Longo, whose pioneering research on Fasting Mimicking Diets has been excitedly trumpeted across every major news outlet from the United States to Japan. Dr. Longo has been researching fasting since joining the Laboratory of Calorie Restriction pioneer Roy Walford at UCLA where he studied the effects of fasting and the ageing of the immune system. Now the director of the University of Southern California Longevity Institute, Longo has spearheaded some of the most exciting new research on FMDs, Fasting Mimicking Diets, which allow 725 to 1100 calories daily while still offering the neuro and cardiac protective ageing and anti-inflammatory benefits of water fasting with less stress to the system. Longo’s FMD allows you to consume just enough calories to keep the body running, making it much easier to stick to. I mean, I don’t know about you, but water fasting is really only practical if you are shut up in a Buddhist monastery or sitting in a Zen Garden counting the rocks for the duration. Dr. Longo, thanks so much for joining me here today. I have been reading your research on Fasting Mimicking diets with really, really, great interest. It is something that those in the histamine intolerance and mast cell community speak about a great deal given that food is such a strong symptom trigger for many of us. The skipping meals thing becomes a way of life because cutting the caloric intake seems to have a positive effect on the health, at least in the short term, until we run low on nutrients. At least that has been my experience. So, I have done many water fasts in my life, believing that I am doing something good for my body. While I know that water fasting is beneficial for some, at least in my case, it turned out to be far too stressful for my body. Dr. Longo, please give us an idea of what the Fasting Mimicking Diet is, and how you think, what you think, the medical applications of this will be.

    Dr. Longo: Yeah, it’s right up in high in calories, you have between 750 and 1100 calories a day, are high nourishment, and they’re really like a medicine. They are all plant based. So there’s no drugs in it. But they’re really like a medicine. And we really foresee that very soon, I mean we’re talking to the FDA very soon, and we think that people are going to go to the doctor, and the doctor already saw the patient and is going to say, “Oh, you know, you have this condition I am just going to put you on three cycles of this and we’re going to monitor, in your case, the histamines and the other immune cells that are implicated in the disease, and that’s it. Together, with immunology, with the doctor, they can come up with a plan to see if this works. Of course, it comes with instructions of all these things, the exclusion criteria, all the things we use in clinical trials are going to apply. Now, we didn’t want to wait until the FDA approval because that is going to take another six or seven years. But because it’s food, once we finish the trial on seventy to eighty people, which is pretty much done, then I think that with the supervision of the doctor, these Fasting Mimicking Diets can be recommended to the patients and they are not there to treat or prevent diseases until they are FDA approved for that purpose. Now certainly the doctor can decide what diet they put their patients on and if they decide that this is the diet that they want to recommend then that is in their call.

    Yasmina: So, I would love it if you would please share with my readers your finding on FMD’s, specifically their effect on the immune system and mast cells.

    Dr. Longo: We actually published another paper about a year ago more specifically looking at the immune system, although this paper that we just published also did so. And in that paper, we showed that mice undergo a long period of fasting, three days which is about, we believe, the equivalent to five days for humans, we showed that first a decrease in the number of white blood cells and then following the receding an increase in this white blood cell number. And this was caused by stem cell based regenerations. So, in other words, about forty percent of the of the mouse white blood cells were destroyed during the fasting, and then upon the receding they will rebuild a regenerated to show that the mice ended up with a new set of cells, basically. So, obviously now we followed up with this study with the Fasting Mimicking Diet, basically showing that it is effective also in old mice in rejuvenating the immune system of old mice. And we believe that is, of course, by a similar mechanism, which is determined on homopathetic stem cells. And so the good news, I think, for any disorder of the immune system, and I can’t really discussed it very much, because we haven’t published the other paper, but we certainly are working multiple disorders, several autoimmunity based disorders, and I think the good news is that is by getting rid of the the old cells or damaged cells, and generating new ones, of course, you have something that tends to eliminate the problems, and possibly the problems that you are interested in.

    Yasmina: Something that news reports on your findings really honed in on is that the benefits of the FMDs last for some time, even if the subjects went back to their previous eating habits, which, in some cases, wasn’t very healthy at all. Can we really go on this fast once a month and then go back on a standard American diet? And I also wondered if you believed that if people choose, instead, to adopt a healthier diet, will there be a better chance of rebuilding healthy immune cells?

    Dr. Longo: Yeah, so, you know obviously we were very interested in that and my, one of the gurus of restriction was my mentor Roy Walford a long time ago at UCLA, and I always. I never went in his direction which was chronic calorie restriction and the reason was that I thought nobody was going to do it, A, and B I also felt that there was going to be side effects and by pushing a system to the limits all the time, you’re going to get benefits but also side effects. Now Walford was a great guy and his research on calorie restriction was of tremendous help of to understand basic mechanisms but had those problems. With that said, then obviously we think that A) there is an ideal diet but B) there is a reality, and the reality is that a lot of people are not going to do an ideal diet, in fact the great majority of Americans probably will never do that. And so we now know because the mice for example were on an 18% protein diet, relatively unhealthy diet and we just switch them twice a month to four days to the new diet and starting middle age and this worked extremely well; both with the regeneration of the immune system with lifespan extension with reduction in inflammatory diseases, etc, etc. Now in humans we started with the first 19 patients and the controls and we see the same, certainly all the same, changes in these people, also are not asked to make any changes. Basically they’re just asked to return to whatever it is they did before and just do this for five days once a month. They got a box containing all the food and they used that and then they went back to normal. So, then we know that it works with that change. It doesn’t mean it wouldn’t work better if you did switch to a diet that is also ideal in between.

    Yasmina: Given all your work with the immune system, what do you consider to be the ideal diet?

    Dr. Longo: The ideal diet is a plant and fish based diet that is low in protein, about 0.37 grams per kilogram body weight and that may increase a little bit in proteins after age 65 or 70, depending on the need, and then a diet that is high in nourishment meaning a lot of greens a lot of vegetables, not so much fruit, a little bit but not very much and a diet that is rich in nuts, rich in olive oil, legumes rich also. I guess that some people might have allergies to it, a lot of the times these allergies are just temporary ones if you’re used to having a bad diet and you switch to legumes you might have some issues but in a lot of people those tend to go away. That doesn’t mean they’ll go away in all people, so for some people they’re just going to have to find the food that they’re okay with, but I will say the great majority of people can be on this diet and can be very happy. Let’s not forget that some of the populations from around the world whether its Loma Linda in California or Okinawa or Southern Italy or Greece, they’re pretty much on this diet, different versions of it, Okinawan’s eat sweet potatoes and Southern Italians eat green beans and the Californians probably eat other type of greens but overall they have very similar diets and not surprising they’re among the longest lived in the world.

    Yasmina: Could you please give us a breakdown of the macro nutrient ratio of the Fasting Mimicking Diets used in your studies?

    Dr. Longo: We don’t like to talk about that because when we do that everybody…we did that…we made the mistake seven years ago when we were doing this for cancer and the result was, which is very very scary, everybody went home and tried to do medicine at home. And then we started hearing back the problems, a nurse didn’t do it the correct way and got liver damage out of it, another person that passed out and hit the shower and was rushed to the hospital. Another one that passed out in the shower too. And this is a very powerful but it also it can greatly benefit you if you do it correctly but it can also hurt you if you don’t. I know that people think it’s food, how can it hurt you, but it can hurt you. I think very soon we’re going to have this available in a package from a company called L-Nutra that makes it, I don’t make any money out of it, so people can relax and not worry that I’m doing this to make money cause i donate everything. But I think it’s very important that it’s standardised and that’s what we’ve done.

    Yasmina: As I mentioned earlier, water fasting turned out to just be way too stressful for my body and studies show that stress is a mast cell and histamine trigger. Are there people who are just not suited to FMDs? Has stress been an issue in any of your studies on fasting?

    Dr. Longo: Well, I’ve done it both ways and so has my lab and my parents and my brother, my sister, and yeah water only fast, i’ve only done it one time and i’ll never do it again. It was just psychologically torture I was just [inaudible] the biggest one in the world for fasting and you know we always joke around but they. I told them, most people are going to think of this as torture. But I’ve done the Fasting Mimicking Diet and it’s just a completely different thing. Now you can eat three times a day and you can have snacks and you can have bars and you have soups and etc etc, so it really. I, as well as 95% of the patients in the trial, only 5% dropped out, and I, as well as them, felt that it was actually very easy and actually you may want to send your readers to the BBC site because we had Peter Bowes the journalist of BBC in the trial so he wrote a 3-part story of his experience in the trial and yeah so then people can read that and it’s an interesting story that he wrote.

    Yasmina: There’s a lot of talk in the blogosphere and most Facebook groups about fasting causing stress to the adrenal glands. Have you seen any evidence of that?

    Dr. Longo: Well, this is one of the reasons why we spend a lot of time doing clinical trials and also collecting data from the big clinics so now we’re trying to get safety data from the Buchinger clinic. They fast about 5000 people a year and, as far as I know, I’ve seen really no evidence of adrenal damage. That does not mean there are clinics are for profit, so that doesn’t mean that we know yet. There haven’t been clinical trials done. So, those need to be done but certainly in our trials of 80 people we did not see any issues with the three cycles of the Fasting Mimicking Diet. Now, of course, water only fasting and fasting mimicking are completely different things. And I suspect that many more side effects are going to be seen with improvisation. For example, gall stones, very well established, there are papers on that, particularly if you have a high protein fasting diet, so that if you include proteins in the diet and you otherwise fast but also the water only fast possibly could contribute to gall stones, particularly in women over 40 and who are obese. So yeah, there’s probably all kinds of problems, they’re going to be rare, particularly with the Fasting Mimicking Diet but we need to do more studies and this is why the FDA process is important, because, you know, when we do the thousand people trials these things all come up and then eventually you need a phase four when you monitor thousands of people. And those things should definitely come up if they’re real. I doubt there’s going to be any adrenal issues with the Fasting Mimicking Diet, but we need to keep studying it and make sure there’s none.

    Yasmina: Indeed, I’ve read some incredible water fasting horror stories. I’ve always found it strange that people at home would, on their own, while at their weakest and probably most starved of nutrients would embark on a water fast. I mean, it has it’s benefits of course, but going it alone with no medical supervision is probably unwise for many. But is there anything interesting you’ve come across with regards to histamine or IGE allergies as relates to fasting?

    Dr. Longo: We know that during fasting there is a release of cortical steroids, and the good news is it’s all timed and it’s all done in a natural way so it’s a level of cortisone basically that is able to shut down a lot of the immune responses that are not needed but then it goes away. So although we haven’t looked at allergies yet, we suspect that this is probably going to have a strong effect in allergies that are chronic allergies and conditions where you have an immune system that is misguided.

    Yasmina: I’ve seen that USC has developed a kind of package diet that includes all of the foods that you would need on an FMD properly calibrated with the macro nutrients and everything. When will this be available for sale?

    Dr. Longo: It’s ready to go, it’s just a matter of launching it. I think in the next three months it should be available. People can keep checking with L-Nutra, the company, and they can send emails to ask when it’s ready. Eventually, we hope to train people at USC through a certificate program and still have people that are much more familiar with it because they understand. I’ve been doing this for ten years telling people, “Go find a doctor,” and they come back to me two days later and say, “There is no doctor like you.” And so I think that doctors are starting to see more integrated medicine. So I think people can just go to an integrated medicine centre in their city and say, “I want to do this, I really decided on this, I know this is clinically tested in a top university and I just want to do it.” And I think it shouldn’t be that hard to find an integrated medicine doctor that is willing to follow the patient while they’re doing this. So you just go there and tell them…or they can contact us and we can get in touch with the doctor or conduct a Nutra (?) and then they can set up all the paperwork needed to do it.

    Yasmina: That’s wonderful. Thank you so much for joining me for this interview today Dr. Valter Longo, Director of the USC Longevity Institute, talking about his pioneering work on Fasting Mimicking Diets and the AlNutra System.

    Dr. Longo: You’re very welcome.

    Yasmina: Now please, everyone, before you go out and try and do this yourself at home, please know that the calorie macro nutrients need to be in a certain ratio and messing that up can lead to gall stones, fainting, or more serious health issues. To me, the main benefit of the FMD is being able to lead a somewhat normal life while fasting. Dr. Longo believes that light exercise is possible while on FMD. I’m personally really looking forward to getting on one of those fasts the moment that Doctor’s are trained up and I’m definitely going to check out the products once they’re released, and begin the “Doctor Hunt.” That’s going to be interesting. Don’t worry, I’ll be updating you all as soon as that happens and I’ll report back on the results immediately. You’ll find my favorite non-fasting liquid recipes in the Anti-Detox book at my website, the lowhistaminechef.com. These are my go to recipes when feeling like I need to hit the reset button. You’ll also find super-duper high nutrient anti-histamine anti-inflamatory ingredient rich recipes in the Anti-cookbook and Manfood for those with healthy appetites also on my website. And you can download my free e-booklet on how I reintroduced foods from the freebies page on my website. Just look for it in the main navigation on my homepage. Thank you so much for joining me here today, I’m Yasmina Ykelenstam; the Low Histamine Chef.

    Thanks for listening to the Low Histamine Chef Podcast. Don’t forget to sign up for Yasmina’s mailing list over the lowhistaminechef.com to get your free copy of the 32 page food re-introduction e-booklet. Until next time, thanks for listening.

    You’ll find recipes full of foods with antihistamine and anti-inflammatory properties my books Anti-Recipes and The Anti-Cookbook

    CLICK HERE TO CREATE YOUR OWN PERSONALISED HEALING HISTAMINE PLAN. 

    Please remember, even antihistamine and anti-inflammatory foods can hurt us, please always exercise caution and consult a medical practitioner before adding new foods. 

    —-REFERENCES—–

    [1] http://www.ncbi.nlm.nih.gov/pubmed/25302070

    [2] http://www.researchgate.net/publication/226840945_Fasting_or_dexamethasone_treatment_reduce_protease_content_in_rat_lung_mast_cells_and_modulation_of_histamine_synthesis_by_H3_receptors

  • Interview: my chat with Abel James of the Fat Burning Man

    Interview: my chat with Abel James of the Fat Burning Man

    Low-histimine-chef copy

    I had the BEST time being interviewed by Abel James of the Fat Burning Man podcast and website. Abel was vegan, now paleo, but totally open to all kinds of healing approaches (he has interviewed Dr. Fuhrman for his podcast!). His listeners requested he interview me (how cool thanks everyone!). His podcast is number 1 in iTunes health, with about 1 million downloads per ep. He is also super cool and lovely. You’ll find a couple of my quotes from the podcast below and the podcast and transcript here. 

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    reaction
    stillness
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    You’ll find recipes full of foods with antihistamine and anti-inflammatory properties my books Anti-Recipes and The Anti-Cookbook

    CLICK HERE TO CREATE YOUR OWN PERSONALISED HEALING HISTAMINE PLAN. 

    Please remember, even antihistamine and anti-inflammatory foods can hurt us, please always exercise caution and consult a medical practitioner before adding new foods. 

  • Intro to the Low Histamine Diet, a recipe and muffins!

    Intro to the Low Histamine Diet, a recipe and muffins!

    beautyandwellbeing

     This week I had the pleasure of writing an introduction to the low histamine diet, click the image above to read the full post.

    And don’t miss this great summer recipe I created for them, click the image below…

    Untitled1

     As those of you following my Facebook page will no doubt have heard, I’m in gluten-free muffin mode this summer. I’ve been beavering away on a number of delish low histamine, histamine-balanced and antihistamine/anti-inflammatory baked goods that have certainly enriched my mornings! I’ll be putting them together in a mini ebook that I will share exclusively with my mailing list – so don’t forget to sign up if you haven’t already!

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    Anti-inflammatory cherry ginger gluten-free muffins!

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    Antihistamine and anti-inflammatory rich carrot, ginger and turmeric muffins – YUM!

    You’ll find a collection of all liquid high nutrient antihistamine and anti-inflammatory rich recipes for days when my histamine bucket overflowed in the new Anti-Detox book. 

    The Anti-cookbook, while it doesn’t treat any conditions, due to its high nutrient, antihistamine and anti-inflammatory ingredients, has been instrumental in helping me feed myself on a limited diet. It features a six page list of antihistamine and anti-inflammatory foods. It comes in regular and Paleo. 

    The Low Oxalate Cookbook features antihistamine and anti-inflammatory rich recipes. 

    Don’t miss the Low Histamine Beauty Survival Guide for non-toxic beauty tips, the skinny on histamine releasing (mast cell degranulating) beauty ingredients, antihistamine and anti-inflammatory beauty alternatives and the top brands natural brands I’ve found.

    Take a peek at my other low histamine and antihistamine cookbooks for more high nutrient recipes.

    If you’ve found this information useful I’d appreciate your support (at no extra cost to you!) – please check out my online store for your health foods, supplements, kitchen items and beauty product purchases. Affiliate sales through my online store go towards maintaining the website, funding travel to interviews and purchasing all the lovely foods for my free online recipes. You’ll find these items in the “Shop with us” drop down menu on my homepage.  

    Please don’t forget antihistamine, pain killing foods can still hurt us, so please always check with your doctor before adding new foods to your diet. 

  • Dr Janice Joneja: histamine intolerance or mast cell disorder?

    Dr Janice Joneja: histamine intolerance or mast cell disorder?

    diagnosing histamine intolerance

    It’s a question most of us diagnosed with histamine intolerance have asked ourselves at some point (if not obsessively, all the time): am I dealing with something else? Something like a mast cell activation disorder, or mastocytosis.

    Immunologist, nutritionist and pioneering histamine researcher Dr Janice Joneja was kind enough to share her view on it.

    Watch the video or read the transcript below.

    And don’t forget to check out my earlier post on how histamine intolerance, mast cell activation disorders and mastocytosis are diagnosed.

    Yasmina

    Let’s say we suspect we have histamine intolerance and then have it confirmed, at what point to we decide whether to seek further clarification and investigation into whether it’s a mast cell disorder or not?

    Dr Janice Joneja

    That’s something that at the moment is difficult even in clinical practice. That’s because at least in North America and to some extent in the UK, neither condition is well understood.  There’s a lot of questions around it, especially histamine intolerance, is it real, is it something we should be looking at, but it’s not in our medical literature to the extent that we feel that we should have it in clinical practice. On the other hand, mastocytosis and mast cell disorders, I should put it that way because, mastocytosis has about 10 different subtypes, more and more immunologists and haematologists are becoming quite knowledgeable in that condition.  Tryptase levels for example are becoming more tested in labs generally. It’s much more recognised as a disease entity.

    On the other hand histamine intolerance is very obvious to anyone who has it and certainly for us who work in the field constantly, because the symptoms are so clear and it responds so well to a histamine restricted diet for example, whereas someone with mastocytosis will not respond to that degree, because histamine is only one of many mediators released in mast cell disorders. So a histamine restricted diet alone will not give the response one would see with a diamine oxidase deficiency, which would be what one would look for in a histamine sensitive person.

    Of course, both conditions can appear together, but very rarely, because mastocytosis itself is a rare disease and to have that plus a diamine oxidase deficiency that is often inherited, is a very rare combination.

    Yasmina

    What I am finding is that, as you say, is not many people with mastocytosis who have concurrent diamine oxidase deficiency, but they’re living in the united states where they don’t actually test for DAO, especially in those with mastocytosis. I am finding that people who have been diagnosed with mast cell activation syndromes and disorders were initially diagnosed with histamine intolerance. So at what point do you think that someone who has been diagnosed with, or suspects histamine intolerance, should potentially seek further diagnosis. I mean obviously we don’t want people to be worried, because with histamine intolerance it usually goes undiagnosed for quite some time, during which we’ve been told we’re either imagining things…

    Dr Janice Joneja

    (Laughing) Oh yes! Of course – well it is all in your head because histamine is a neurotransmitter, so yes it is…physiologically all in your head, but not psychologically! (Read about the anxiety/histamine link here.)

    Yasmina

    Initially, in my case, I improved on a low histamine diet and then I had a kind of relapse, which I now know is happening to many others who have histamine intolerance. Often people just think they’re not doing the diet right, which is a possibility – I mean a lot of people who write or consult with me think they’re doing it right, and they aren’t doing it as well as they could. So in my case when I found that I relapsed again, I decided to seek clarification. But at the end of the day the diet just needed to be tweaked a little to add more antihistamine and anti-inflammatory foods because as you said, mast cell disorders are so much more than just histamine.

    Dr Janice Joneja

    Oh yes, histamine is only one mediator in mast cell disorders and in the degranulation of mast cells you have leukotrines, prostaglandins, chemotaxins, cytokines you know there’s a whole list of mediators that are going to act on body systems.

    Yasmina

    Exactly, and the great thing is that they too can be addressed through diet.

    (Read more about how foods can help resolve these kinds of inflammation. Or check out the Anti-cookbook for a six page list of high nutrient antihistamine and anti-inflammatory foods.)

    You know, mangosteen for prostaglandins, I think it was cucumbers for leukotrines, but in any case, yes, the point is that diet works for most disorders, at least it’ll get the body functioning more normally. So, so you think it’s a good idea to go into further testing at some point if one isn’t improving on a low histamine diet?

    Dr Janice Joneja

    I think that is wise, I really do. And now it’s not difficult to find practitioners who will look for mast cell disorders, especially in the United States. Unfortunately, in Canada though we do have people who are very known for mastocytosis diagnosis and other mast cell disorders, but what we see, that’s been reported to me, is that the general practitioners aren’t that knowledgeable, and they don’t necessarily discourage it, but they don’t take it quite as far as they should.

    Yasmina

    I’ve definitely heard cases of them discouraging it!

    Dr Janice Joneja

    (Laughing) I didn’t want to be too unkind!

    Yasmina

    So, let’s say, how long would we expect to be on the low histamine diet before we see an improvement? Actually though, let’s talk about this too: is it realistic to expect a complete resolution of symptoms on a low histamine diet if you have histamine intolerance?

    Dr Janice Joneja

    Some people do find that definitely. It depends on, much like in lactose intolerance, how much of the enzyme the body is still producing. Of course everybody is different, which means that some might be producing quite a bit but not quite enough to stay below the top of their bucket for example. They still need to stay on that diet.

    We also find that of course that in times when histamine is being released because of allergy, then the low histamine diet won’t keep them below the top of their bucket.  Because let’s say it’s pollen season for them, and they’re having rhinitis and all kinds of histamine symptoms, their body is producing and releasing a lot more histamine, and so o keep themselves below the top of their bucket is going to be much more difficult, and perhaps the diet won’t do it at that point.

    (Read more about how I use the inflammation bucket model to eat a normal and healthy histamine balanced diet here)

    Yasmina

    That’s an excellent point!  I tell people all the time, watch your stress levels.

    Dr Janice Joneja

    Oh yes stress definitely! I don’t think people recognise that enough, because the stress, the hypothalamic/pituitary/adrenal axis which is where we go around in the stress response cycle: cortisol  levels, release of histamine at each of the sites of  the cycle for example, definitely a very important fact.

    (Read about how I use meditation and visualisation to lower inflammation and fight stress induced histamine release.)

    Don’t forget to sign up to my newsletter to be the first to know when registration opens up for webinars, histamine wellness retreats and workshops in Europe and the United States, to get great freebies like antihistamine and anti-inflammatory recipes and lifestyle tips. 

    The Anti-cookbook, while it doesn’t treat any conditions, due to its high nutrient, antihistamine and anti-inflammatory ingredients, has been instrumental in helping me feed myself on a limited diet. It features a six page list of antihistamine and anti-inflammatory foods. It comes in regular and Paleo. 

    The Low Oxalate Cookbook features antihistamine and anti-inflammatory rich recipes. 

    Don’t miss the Low Histamine Beauty Survival Guide for non-toxic beauty tips, the skinny on histamine releasing (mast cell degranulating) beauty ingredients, antihistamine and anti-inflammatory beauty alternatives and the top brands natural brands I’ve found.

    Take a peek at my other low histamine and antihistamine cookbooks for more high nutrient recipes.

    If you’ve found this information useful I’d appreciate your support (at no extra cost to you!) – please check out my online store for your health foods, supplements, kitchen items and beauty product purchases. Affiliate sales through my online store go towards maintaining the website, funding travel to interviews and purchasing all the lovely foods for my free online recipes. You’ll find these items in the “Shop with us” drop down menu on my homepage.  

    Please don’t forget antihistamine, pain killing foods can still hurt us, so please always check with your doctor before adding new foods to your diet. 

     

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