Doctor A's Guide to MCAS: What You ACTUALLY Need to Know

We have a lot of content on mast cell activation, and we've been asked to do a mast cell activation 101, or mast cell for beginners. So let's break that down. Welcome to the channel. I'm Dr. A, and I use this channel to answer questions that you guys have and send in, and clinical questions that we get, and all sorts of other things. Been teaching and researching in the naturopathic and integrative medical community for over 30 years now, and I've been practicing a long time, and that's what we do on this channel is talk about all things medicine. In this one, we did get some really great questions that led me to think, well, let's break down the main areas where a person might have symptoms that might lead them to believe that they have a mast cell problem, mast cell activation disorder, mast cell activation syndrome, et cetera. So just want to go through kind of a 101 basics of mast cell and talk about where the major symptoms are. The first thing to keep in mind is that mast cells are part of a quartet of immune Immune cells that are there to initiate an immune response, protective response, inflammatory response. And so when they're working as they normally should, they are going to be helping us with foreign invading substances, maybe infection, stuff like that. When the mast cells and their cousins, I call them, get overly aggressive action going, we have inflammation and allergic phenomenon or paraallergic phenomenon that go on, and we're not supposed. To be having that. It's an overreaction. So mast cell disorders or mast cell activation syndrome, MCAS, is a clinical determination of the mast cell world being too hyperactive. Now, one of the more common things that's released are histamine and other inflammatory mediators. So these cells generally have granules in them, and when they're stimulated, they release these chemical granules, and those go and do things in your body. So let's go through the main areas where we might see things happening. The first would be one of your largest organs, your skin. So in the skin, we might see something like hives. We might see something like edema where you get swelling. We may see not classic hives, but red blotchy areas. A lot of times these areas will itch because of the inflammatory chemicals, but not always. The other thing that people will see with mast cell disorders is an easy flushing of the skin. And that's because you have inflammatory chemistry going around in your bloodstream, and then the peripheral capillaries that cause the flushing response might trigger very easily or even trigger for no apparent reason at all. So your skin is a big area where you will see mast cell type symptoms that go on. Now, with all of these body areas that we're going to talk about, they don't have to go on all the time because one of the things with mast cell disorders, and especially with clinical mast cell activation syndrome, is that you may go sort of in waves, and Those waves may be triggered by other things that are going on that put stress on the mast cells. So you know, in the morning you may not have any skin flushing or hive reaction, and then as the day goes on they may cycle through and get worse. The next area would be the ear, nose, and throat area essentially. So what we'd be looking at there would be the potential for itchiness around any of those areas. You can itch in your ear, itchy throat, itchy tongue, mouth, lips, etc. You also can. have swelling in those areas. So you could have, in an extreme case, you might get angioedema where you get swelling of the tongue and the lips, et cetera, maybe swelling in your throat. Those are obviously very dangerous to go on. You can get swelling in your ear too. And one of the complications with mast cell disorders is that you can have an ear infection-like setting where your auditory tubes or eustachian tubes, usually call them, aren't draining well because everything's swollen back there. And so then you get pressure building up in your ear, just Like if you had an ear infection as a little child. So that's not uncommon to have that happen as well. The other thing people will get is difficulty swallowing because of all of the swelling around there. People a lot of times with mast cell phenomenon may bite their tongue or their lips very easily because they're always more swollen than, than they ought to be. So they're a little bit larger and it's easier to bite down on them. Same thing with the tissues in the throat. And like I said, in the ear as well. Not too far away from the ear, nose, and throat area would be the esophagus and the stomach. And in mast cell disorders, we can have inflammation both in the esophagus and the stomach. So esophagus is where your food goes through when you swallow down to the stomach, obviously where you start major parts of your digestion. And there's a couple of reasons why the GI tract gets so much involved. One of the reasons is that a lot of GI tract function is sensitive to and potentially triggered or controlled by the same chemicals that the mast cells release. And so you may have like a hyperactivation of mucus in the mucous membranes or in the production of something like stomach acid or enzymes later or other stuff that's maybe not matching what you're eating. So you get digestive disturbance. Also, it's not uncommon for people with esophageal inflammation to be diagnosed with something called eosinophilic esophagitis, which is one— remember I said mast cells are kind of the leader of a quartet of cells? Eosinophils are one of their cousins that's of that quartet. Eosinophilic esophagitis is not an uncommon presentation also, which can be very irritating, can be very painful. And again, you could have esophagitis, gastritis, just poor digestion in your stomach, and really the whole rest of your digestive tube, as, as it were, whether it's a small intestine or large intestine, can be affected by mast cell disorders. So really it could be any number of things. In mast cell disorders, we see a propensity towards Bacterial and fungal overgrowth. You might have heard of SIBO and SIFO, SIBO and SIFO, or SIBO and SIFO, depending on where you are in the country. Those are common because you can have derangements, like I said, of the production of your digestive chemistry, but also just the motility, the movement through of the food and the digestion absorption. So any symptom you can get with swallowing through elimination of food, whether it's nausea, constipation, diarrhea, stomach pain, all of that very very common. Quick plug. Here, if you're a healthcare practitioner working with patients with these issues, I have a CE website and I do webinars on this topic and others. So we're going to put a link in the description below to the CE website link and the particular webinar of interest. Thank you. In the neighborhood of your esophagus are your lungs, and of course your lungs can get involved just like the upper part of your respiratory apparatus. And so you may have trouble with wheezing, chronic coughing, things of that nature. That's not uncommon. common at all. Shortness of breath, postnasal drip, which is really an upper respiratory problem, but it can create a lot of irritation causing you to cough a lot. Chest tightness, air hunger is really common with people with mast cell disorders, and on and on. Anything that your lungs do can be a problem. Now, right in between your lungs is your heart, and unfortunately, in people with mast cell disorders, we will sometimes see them having atypical type Dysrhythmias or arrhythmias, so that might mean that you may have heard of like PVCs, premature ventricular contractions. Those are very common in humanity, but allergic phenomenon in these inflammatory molecules made by the mast cell quartet—they can affect your heart as well. I have had patients where we work them up and they did a full cardiology workup, and there was nothing mechanically or electrically wrong with their heart, but they would get these premature ventricular contractions that would kind of. Crescendo and lump together at times, and it turned out that one of the big triggers were what's called an IgE-like Edward allergy reaction to particular foods. And when they don't eat those foods, their PVCs go down to nothing basically. And if they eat those foods, they'll start to have this thumping in their chest. So it's an example of how your heart can be affected. Also, you can have blood pressure changes that may go high or low. There's also a very common connection. You can look this up in the main channel. The what we call the evil triad two part. Parts of that are mast cell disorders and then POTS, positional orthostatic blood pressure problems, that go on as well. Another one we talk about a lot as a standalone symptom, although it never is standalone, is brain fog and other central nervous system effects. So one of the things to remember about your brain is that it works and is very sensitive to things like histamine and the other things released in those granules from the mast cell quartet, being mast cells and other immune cells that work The same. So if they're releasing a bunch of histamine or serotonin or heparin or other things like that, you want to keep in mind that although you have a blood-brain barrier, you also have mast cell activity inside of the central nervous system that can affect the brain. So in addition to brain fog, you could get headaches. You could have either new onset or exacerbation of things like anxiety, obsessive thoughts, depression, sleep disturbance, anything that can go on that your brain could controls. And the other one that is really common and sometimes not found for a while in the diagnostic workup is chronic central pain. So basically your brain is, you know, sensing how you're doing and how your pain level is, and you can have a change in your pain level because your brain resets what normal is. And if that is reset towards more sensitivity to pain, it can create a central pain-like syndrome. Also, you can have orthopedic symptoms, joint and muscle pain. And I have seen people when they are in a mast cell flare and they might have their finger joints or their wrist joints swell up, and it's not because they've hurt anything, it's because they're having release of these inflammatory chemicals. And you think, well, why would joints swell up? Well, it turns out we have 4 well-known histamine receptor types, and there's probably some subtypes as well, but there's 4 big ones. And we have representation from those histamine receptors inside of our joint capsules. And so it's not crazy to think that if I'm having a mast cell release that's inappropriate, I may have joint pain or swelling. Also, I may just have myalgia. I might have muscle pain that goes on. You can get what we might think of as systemic symptoms, such as overall fatigue and weakness. You can get numbness and tingling that might go on. You can lose consciousness. Remember I was saying that there's a connection between dysautonomias like POTS and mast cell problems? Well, that can make you dizzy when you Stand up, things like that. You can pass out, and then of course there's the most dangerous of all mast cell family types of symptoms, which would be anaphylactic reaction. So you can have an allergic reaction or a mast cell release reaction, mediator release reaction, and that can go around your body, and you can think, well, okay, you know I've got some joint swelling, or maybe I get a little more PVC, or my ear, nose, and throat is itchy or swollen. But anaphylaxis is where you go and your body goes in. to progression towards shock. And shock is where your body's trying to compensate. It eventually can't anymore, and your blood pressure and your pulse rate start to separate and go in 2 different directions. You can have, again, swelling. You can have complete loss of the ability to breathe, cardiac decompensation, all sorts of bad things in anaphylaxis. So when we think about mast cell disorders, just to sum this up, the first thing that we think about is the mast cells are the name brand cell for a quartet of cells that includes some very closely related immune cells, and they all are going to release different types of inflammatory chemicals in your body. The second thing we think of is that this is an inappropriate release of these mast cell or inflammatory chemicals. So the body is releasing a natural substance that it doesn't need right now. And then the third thing is going to be it can hit any of your body's systems, many specific things we didn't even mention here. But if You or a loved one tend to be having a lot of allergic phenomenon, and it seems to be getting worse over time, or it's affecting more organ systems. You might want to see some type of healthcare practitioner who works with mast cell activation. If you have chronic illness of any kind, we see this a lot with long COVID patients, autoimmune patients. As I mentioned, people with chronic digestive problems very very common. Again, you might want to have this brought into your. Chronic illness picture, because there are things that you can do to decrease the triggering of the mast cells. All right. Well, I want to thank everybody for all of the wonderful questions that you asked that led to this. Dr. A, this is the channel where we answer questions. Thank you for liking, sharing, subscribing, all the things. We really appreciate it. Love the community that's growing, and I'll see you all on the next video. But take a look at a couple videos we'll suggest here for