Episode #152: MCAS and Implants with Dr. Tania Dempsey, MD

Why You Should Listen

In this episode, you will learn about the connection between Mast Cell Activation Syndrome and medical implants.

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About My Guest

My guest for this episode is Dr. Tania Dempsey.  Tania Dempsey, MD is an expert in chronic disease, autoimmune disorders, and mast cell activation syndrome.  She is sought after internationally for her knowledge of chronic immune dysregulation and has attracted patients from Israel, England, Thailand, and France.  Dr. Dempsey utilizes integrative medicine to get to the patient's root causes of their illness.  Her purpose is to understand why people get sick and to help patients understand their body and why it fails them when it does.

Key Takeaways

• What is the difference between primary and secondary MCAS?
• What are the primary triggers of MCAS?
• What is the connection between MCAS and MCS?
• What are the best lab tests to explore MCAS?
• Do breast implants contribute to MCAS?
• What is capsular contracture?
• Can fungus and mold be found in breast implants?
• Do biofilms grow around breast implants?
• Does explantation lead to improvement in MCAS patients?
• Do metal implants in the body trigger MCAS?
• Are there options for material compatibility testing that can be evaluated before implant placement?
• Can hernias be repaired without the use of mesh?
• Do dental materials play a role in triggering MCAS?
• Do fluoroquinolones trigger MCAS?
• Are gentle approaches to detoxification better tolerated in MCAS patients?
• Is there a potential downside in over-stabilizing mast cells?
• Can Th1/Th2 modulation interventions help to reduce MCAS symptoms?
• Does a focus on the limbic system and vagus nerve lead patients to improvement?

Connect With My Guest

https://DrTaniaDempsey.com

Interview Date

September 10, 2021

Transcript

Transcript Disclaimer: Transcripts are intended to provide optimized access to information contained in the podcast.  They are not a full replacement for the discussion.  Timestamps are provided to facilitate finding portions of the conversation.  Errors and omissions may be present as the transcript is not created by someone familiar with the topics being discussed.  Please Contact Me with any corrections. 

[00:00:01.00] Welcome to BetterHealthGuy Blogcasts, empowering your better health. And now, here's Scott, your Better Health Guy.

[00:00:14.09] The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.

[00:00:34.21] Scott: Hello everyone, and welcome to episode number 152 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. Tania Dempsey, and the topic of the show is Mast Cell Activation Syndrome and Implants.

Dr. Tania Dempsey is an expert in chronic disease, autoimmune disorders, and Mast Cell Activation Syndrome. She is sought after internationally for her knowledge of chronic immune dysregulation and has attracted patients from Israel, England, Thailand, and France.

Dr. Dempsey utilizes integrative medicine to get to the patient's root causes of their illness. Her purpose is to understand why people get sick and to help patients understand their body and why it fails them when it does. And now, my interview with Dr. Tania Dempsey.

This is our second conversation on the podcast with Dr. Tania Dempsey. We talked about Mast Cell Activation Syndrome and Bartonella in episode 106. Today, we'll be talking about mast cell activation and implanted medical devices. Thanks so much for being here again, Dr. Dempsey.

[00:01:44.26] Dr. Dempsey: Oh, it's my pleasure. Thanks for having me.

[00:01:46.21] Scott: What is the difference between primary Mast Cell Activation Syndrome and secondary Mast Cell Activation Syndrome, or even idiopathic Mast Cell Activation Syndrome? And then, in your patient population, what is the split between these different types? And how do you determine the type of mast cell activation that a particular patient is dealing with?

[00:02:08.03] Dr. Dempsey: I think that's an important question that we kind of set the stage herewith. Your primary Mast Cell Activation Syndrome is essentially a condition which really starts at birth or very early on in life.

There is probably a series of mutations that occur at the level of the mast cell. It's usually one type of mutation that for each individual person. So they call it clonal, so it's a set of genetic mutations, but it's the same in that one set of mast cells that causes it to be inappropriately activated and reactive.

And in patients with primary Mast Cell Activation Syndrome, they can have over the course of their life a series of events, triggers that can escalate their underlying primary Mast Cell Activation Syndrome.

In secondary Mast Cell Activation Syndrome, these are patients who probably don't have the genetic predisposition, so to speak, of having Mast Cell Activation Syndrome.

But they have a trigger that then causes the mast cells to go awry, causes the mast cells to react, and in some ways, we say it's inappropriate, but some of it is appropriate if there's an infection that starts the ball rolling on the mast cell activation. Then that infection is going to keep the mast cell going until the infection is cleared.

So in secondary Mast Cell Activation Syndrome, you eliminate the trigger. Let's say it's an infection or a exposure or a chemical; you eliminate the trigger. And theoretically, the mast cells should reset and go back to normal.

Where they are, they're ready to react appropriately. Idiopathic, I would say, is probably a combination of both, and I would say that that's probably the vast majority of what we see, is that a lot of my patients in my population most of them are sort of born with that predisposition.

They have a history that starts very early on in life, that has a sort of flavor that there's some dysfunction of the mast cells. Over time they've had triggers that have made it worse.

But there are some triggers that, when eliminated, their mast cells can reset to some extent, and they can definitely improve and be well for sort of long periods of time. So I sort of think of it as really probably, again, most of our patients have a combination.

[00:04:53.08] Scott: When we think about Mast Cell Activation Syndrome and this hypervigilant immune response that leads to inflammation and many different symptoms in those patients with chronic conditions, what portions of the triggers of Mast Cell Activation Syndrome would you say originate from outside the body versus inside the body? And what are some of the key triggers that you most commonly see in your patient population? 

[00:05:18.14] Dr. Dempsey: I think that the initial insults that happen are primarily environmental. Even if I take, when we talk about internal, and we talk about an infection, in internal infection, it came from the environment.

So really, in my opinion, it really is the environment that is setting the stage for this. And the types of things that we see are really anything that the mast cell reads as bad, foreign. And it could be as simple as, for people who have allergies, for instance, it could be pollen in the air.

It could be more severe pesticides, chemicals, things that again we breathe in, things that can go through our skin. Infections, mold, mycotoxins, any kind of toxin, anything again that the mast cell reads as inappropriate.

I think that usually starts the cycle, the vicious cycle of Mast Cell Activation Syndrome, for a lot of patients. But of course, we can't forget that there are lots of internal signals like hormones and other things that the mast cells read as well.

And often, it's a perfect storm. It's a hormone disruption associated with a chemical exposure, associated with, let's say, a barometric pressure change, right? So I have patients the weather is changing, a storm is coming in, pressure changes, mast cells read that change.

They're also for women, they're maybe in that part of the menstrual cycle, where they're approaching the menses, and they're maybe having a lot of stress in their life, and maybe they didn't sleep well.

And then you have this perfect storm of the mast cells reading, things in the environment, and things internally, and that's really a recipe for disaster, unfortunately for the patients.

[00:07:30.03] Scott: So talking about those environmental triggers essentially, one of the things that I heard Dr. Theoharides say was that a cell phone can actually also activate mast cells. And so, I wonder do you see electromagnetic field exposures as a trigger for mast cell activation in some of your patients?

[00:07:47.10] Dr. Dempsey: Yes, absolutely. And it's a real problem, and I struggle to really find solutions. There are various things that we tell patients to do, right? Shut their phones off at night, or make sure you don't put anything electronic next to your head.

There are certain tricks, right? There are these devices that sort of block the transmission of the EMFs. But at the end of the day, it's a tough problem, and definitely, I have patients who have that problem. I will say that most of the patients who have that problem though also have other triggers, so it's usually not just one thing. I rarely see patients with just one trigger.

And often, when they have the EMF reactivity, they also have had exposure to mold. They might have had Bartonella infection; they're just some key other conditions that sort of synergize with that. And so, it's again like that perfect storm.

[00:08:49.07] Scott: So this next question is a little long, so I'll just put the question out and then I'll let you run with it. And that is with various implanted devices; there can be metals, there can be chemicals that trigger an immune response.

You recently worked with Dr. Miller, Dr. Afrin on a study that explored the crossover between Mast Cell Activation Syndrome and multiple chemical sensitivities.

And I'm wondering, are these essentially the same condition? Is the activation of the mast cells a potential explanation for Multiple Chemical Sensitivity? And then are there some people that maybe have chemical sensitivity but don't have issues with the mast cells, or maybe they just haven't been diagnosed yet?

[00:09:32.01] Dr. Dempsey: Yes, I mean, this is a really critical question. Because if you take the population of patients that have chemical sensitivity, and you take the population that have Mast Cell Activation Syndrome, and you add it up, it's a large group of patients.

And you could argue that they do overlap, and you can argue that the mast cells are a driving force in chemical sensitivity. And that's sort of what we were trying to show in this study. Essentially, we were using questionnaire, and we were correlating the answers to the questionnaire, and the questionnaire is called the QEESI that Dr. Miller designed.

We used the QEESI, and then we correlated with the diagnosis of Mast Cell Activation Syndrome in our patients, and we again wanted to see how many of our patients with mast cell activation syndrome had chemical sensitivity or toxicant-induced loss of tolerance which is how Dr. Miller refers to a TILT.

And so what we are showing, right? We can't prove it; this is not that type of study. But what we are showing is that they're definitely, in our opinion, looks like the mast cells are potentially responsible for the development of chemical sensitivity.

That there's a trigger, a pesticide exposure, a chemical exposure and something implanted in the body. There's something toxic, mold etc., that triggers the mast cell, and in a subset of patients, those patients will develop this increasing sensitivity to the environment.

And so the challenge we have with the study, which is still we're still struggling to get published, by the way. So it's been in review; the problem is that the medical community doesn't seem to accept, want to accept this view, which is really unfortunate.

Because to me, it's sort of common sense. Maybe for you too, and maybe for a lot of our listeners. To me, it's sort of like, well, yes, of course, that makes sense.

And you know what I love Dr. Miller is amazing, Dr. Claudia Miller, she really pioneered the work on chemical sensitivity, and she is sort of now the light bulb goes off for her, and she said yes, this is what I've been seeing, is what I've been doing for the last 20, 30 years.

It makes sense that the mast cells had to be primed. First, there was an initiating event, and then it sort of spirals. So we hope to get the this published and out there because I think it's important information for a lot of people and certainly will change how we approach treatment.

[00:12:21.22] Scott: Is your working hypothesis that Multiple Chemical Sensitivity almost always or always involves the mast cells? Or are there potential explanations for non-mast cell-associated Multiple Chemical Sensitivity? Try that three times.

[00:12:39.28] Dr. Dempsey: I'm not going to say it; I'll let you say it. Well, that's the question; our hypothesis is that Mast Cell Activation Syndrome explains Multiple Chemical Sensitivity. Again, it's hard to prove.

Really would need to be done; the research would have to be done in the lab. They would have to be, so there'd be some basic science stuff, basic bench work. And then a randomized controlled trial, where you can actually try to figure out the answer to that.

But from the research that we've done, from the patients that we care for, plus these QEESI questionnaires correlated with our data points, it seems like the link is very strong. Yes, the question is, are there other things that could explain it? Probably.

I know in medicine; nothing is ever a hundred percent. And so, I'd be reluctant to say that MCAS is a hundred percent of the time responsible for chemical sensitivity.

But I would say that it's a large proportion, and we need to figure out the other part. What is the other reason why people have that and not have mast cell activation?

[00:13:59.02] Scott: Yes, and I think it's exciting because historically, when I've heard MCS, it was kind of more of a label, you have it, but no one really seemed to know a lot about what to do other than maybe supporting the liver.

And so if this then brings people to an understanding that they can actually do something for the patient, to make their life better and minimize their suffering, I mean I think it's incredibly exciting research, and we'll be interested to see where that leads us in the future.

There are many tools that can be used to test for the presence of mast cell activation. My observation has been that none of them have really emerged as consistently helpful, that there's sample collection and transport issues and other things.

When you do the test, do you need to challenge it first? All of those things? And so you've been at this for a while now, I'm wondering what testing options do you find most consistently helpful in your patients with Mast Cell Activation Syndrome.

And how often are you able to confirm with laboratory assays versus treating empirically based on symptoms history clinical presentation?

[00:15:03.25] Dr. Dempsey: I really try not to treat patients empirically unless I just really have exhausted all options for getting an answer. But most of the time, the majority of the time, I will get an answer.

If I can't find Mast Cell Activation Syndrome as the root, but they have symptoms that look like Mast Cell Activation Syndrome, I might go about treating some of that.

I know that it's a part of their story, but I also know that if I can't prove it, there has to be something else that is either resembling MCAS or is in the secondary realm of MCAS, kind of causing the mast cells to inappropriately react.

But there's a trigger that can be eliminated, and then the MCAS can be reversed. And I think that in my experience, those secondary MCAS patients are the ones that are hardest to diagnose with MCAS and that the primary MCAS patients are the ones that are, you want to say easier because nothing about this is easy.

But it does seem like we can get the answer more easily. And so, I would say at least 80% of my patients I can prove with at least two markers, two mediators that they have MCAS. Now, in terms of which ones are the easiest to find or which one I see most, I would say that a plasma histamine is by far the easiest thing to do.

Because every lab can do a plasma histamine, and so yes, there may be some issues with transport, with temperature, but less so than other tests. So if people can start with a plasma histamine and maybe a chromogranin A, which is a little bit debatable depending on which group or consensus you kind of go towards in the MCAS world.

So sort of in our world where I live, chromogranin A is a good marker, decent marker for Mast Cell Activation Syndrome, and also easy to test for. If the levels are really high, then I'll worry about neuroendocrine tumors and other things.

But generally speaking, a slight elevation of the chromogranin A and an elevation in histamine can sometimes give me the answer. I almost never find the answer with a tryptase, and elevated tryptase levels often just represent a genetic issue called hereditary alpha tryptasemia.

And so those are people who have higher levels of tryptase because they have more copies of the gene that makes tryptase, but that doesn't necessarily mean they have Mast Cell Activation Syndrome. I rarely see; I have a handful of patients that have had that typical tryptase level is low; they're in the middle of a flare, their tryptase these levels goes up.

And according to the consensus-1 criteria really put forth by a group of mast cell specialists, they really believe tryptase, they really put all their eggs in one basket there, and they sort of use tryptase as the diagnostic tool.

And if I did that, then that really very small percentage of my patients would meet that criteria. So I checked tryptase on the chance that it will provide some information, but histamine and chromogranin A again pretty easy to do.

Heparin is probably by far the most sensitive and specific marker for Mast Cell Activation Syndrome. And heparin is an interesting chemical because it's a drug; it's a blood thinner, right? So it's used for blood clots.

But it happens to be a drug that our own mast cells can make, and when mast cells are activated, they're more likely to release heparin. The issue with heparin is that it does have to be temperature controlled.

There are a variety of issues, and the lab has to be able to measure it in very minuscule amounts because it's not like the mast cells are making enough, like the drug proportion of things; this is a small amount.

So we have a lab that has been able to measure it at very low levels, and when we see some amount of heparin in the blood, that also is a really great tool and great marker for Mast Cell Activation Syndrome.

So that actually has changed my practice in the sense of I'm able to diagnose more people because of that heparin level.

[00:19:44.06] Scott: You know that's really interesting too with a heparin because I'm guessing even when you see elevations in the Mast Cell Activation Syndrome patients, that many of them simultaneously are dealing with hypercoagulation.

[00:19:56.25] Dr. Dempsey: Yes. And while they're dealing with hypercoagulation on one end of things, they're hemorrhaging during their menses at the same time. And so it's really, the pathways are obviously very complex.

[00:20:14.16] Scott: Do you find it better to run the tests when someone is in the middle of a flare? Or to provoke it with histamine triggers? Or is that not generally helpful?

[00:20:25.13] Dr. Dempsey: I have not found it to be helpful, so I usually don't have patients do that. And even patients are worried, they're taking antihistamines, they want to know if that's going to interfere with the testing.

And generally speaking, it doesn't usually; I'll get the answer most of the time. Yes, on rare occasions, I have to have them stop some things. But I never provoke, because I mean the patients by the time they've come to see me, they're so ill.

I don't want to make them more ill; I just want to get some answers. And usually, again, we might have to do a few rounds of testing, we might not get it on the first shot, but persistence usually gets us the answer. And again, if I don't get the answer on two or three rounds of testing, then I'm convinced that there's more to the story.

There always is more to the story; by the way, I rarely have straightforward MCAS patients that just have MCAS. They almost always have a lot of other issues, whether it's the gut, whether that it's their immune system, whether it's mold exposure, chemicals and all that other stuff. But in those that I can't find markers on, I know that those are bigger issues for them.

[00:21:35.03] Scott: Dr. Raj Patel, Dr. Talia Hale, they've talked about a correlation between MMP-9 and mast cell activation. I'm wondering if you've seen a correlation with MMP-9 as well?

[00:21:46.23] Dr. Dempsey: You know, on occasion, I think it can be helpful. I've sort of moved away from doing those CIRS tests; that's sort of in the realm of that kind of testing. I found them to be a little bit all over the place and not necessarily helpful in the diagnosis.

The same could be true for, let's say, VEGF, vascular endothelial growth factor theoretically is made by the mast cell. And so you would think, well, if patients have high levels of VEGF, does that mean that they have more mast cell activation? Maybe.

Their mast cells, in particular, are making more VEGF, but I have so many MCAS patients who have low VEGF, which you can also look at and say, well, that means something too, right?

Maybe that's mold or something else, right? So it's complicated. So these markers are helpful, but I would never diagnose anybody based on them.

[00:22:50.18] Scott: Yes. And I think some people with elevated VEGF would argue that that could happen in Bartonella as well, so to your point, it's like okay, there are so many different factors involved.

I did a podcast a couple of years ago now with Dr. Lu-Jean Feng, who talks about breast implant illness about explanation.

What's your experience been in terms of your chronic illness population, whether or not breast implants can be a contributor to their condition. And do breast implants potentially serve as a trigger of the mast cells?

[00:23:25.09] Dr. Dempsey: Yes, absolutely. And I'm thankful that there's more attention being paid to this, that the media and the general medical community is starting to accept some of this. I mean, again, to me, this is commonsensical.

Everything I do is about common sense, right? So you put something foreign into your body, and your body doesn't like it. I mean, of course, it doesn't like it, right? I mean, there are probably hundreds of thousands of women, maybe more who have implants, who are fine, okay.

And so their immune system doesn't recognize it as bad, that's great. But again, you think about it, for some, it's the silicone on the outside, some of it is the silicone in the inside, some of it is leaking, some of it is mold growth, I mean there's probably a lot of factors.

But again, there's something that's in the body that's foreign; the mast cells will see it as foreign in a subset of patients. Again, and if I say that MCAS is probably about 20 percent of the population according to a research study out in Germany was about 17%, that's a lot of people that have it.

And so, the potential for women with implants to have a worsening of their underlying immune status is pretty high. I think the mast cells are involved; I would also argue that the other parts of the immune system are going to be activated.

And yes, and it's problematic. And I and I would also just take it one step further and say we're not just talking about implant, or we shouldn't just talk about implants, breast implants because there are other implants, and there are other materials that we put inside the body, right?

We use mesh for hernia surgeries and other things, right? And some of my MCAS patients have had mesh move to other parts of their body, away from where it was placed. That's the mast cells, like basically pushing it out, doesn't want it there.

So really, all these things can be problematic. And I think we need to start thinking about it before we start putting these things into people's bodies.

[00:25:44.04] Scott: Absolutely, yes. And I'm excited we're going to talk about some of those things as we continue the conversation as well. Talking a little more about the breast implant situation, talk to us about capsular contracture after breast augmentation.

Is that an immune response associated with the mast cells and the fibroblasts? Is that what's essentially creating the capsule? And what are the mast cells reacting to in these implants? You touched on that a little bit.

Is it the chemicals? Is it the shell of the implant? The silicone versus saline matter? What's actually happening there? But maybe in this capsular contracture, let's talk about how that ties into this immune response.

[00:26:25.29] Dr. Dempsey: Yes. I mean, look, I'm not a breast surgeon, I'm not a plastic surgeon, so I'll keep it sort of basic. But I have many patients who have had that reaction, the contraction in one breast often, not the other.

So there's something about why it's happening and why not; maybe it's the way it was placed in that breast, maybe. I think about it as anything that is done to the body, even if it's a cut, right? So a cut has to be made essentially, right? To get the implant in.

So you're cutting through tissue, you're cutting through cells. So it's not just the mast cells, but there are other cells that are going to react and try to heal that wound. And so I wonder if it's how the wound is made, how the implant is put in.

Again, why does it often happen on one side and not the other? I rarely have patients who have both sides. And again, these are patients that have MCAS; they've proven they've had MCAS. So again, I can't prove that the mast cells are involved in that process, but I can say that it makes sense to me that it does.

And I have a colleague in Canada, who is a breast surgeon, who is actually trying to do research on this. And I've been trying to help him and try to navigate how to figure this information out because his question is it Mast Cell Activation Syndrome that's causing breast implant illness?

So not just the contracture part, but just in general, is that the cause of the issues? And so I think this needs to be studied. But yes, I would argue that an immune response to just about anything that the body reads or the mast cell read as foreign is going to set off an inflammatory reaction.

[00:28:29.05] Scott: Yes. So in a way, it's interesting; it sounds like this contracture is potentially a protective response of the body, similar to what you were talking about with, okay, let's try to move this mesh, let's try to get it; out, right?

That it's essentially kind of walling off that foreign body so that it's maybe less of a trigger for some of these other inflammatory symptoms.

[00:28:52.12] Dr. Dempsey: Maybe.

[00:28:52.28] Scott: Yes. Do you think that stabilizing mast cells can lead to fewer complications post-breast augmentation? Is there a connection that's been observed between mast cell stabilizers and the development of capsular contracture, for example?

[00:29:08.18] Dr. Dempsey: So this is something that I would really love to study and look at. So in the patients that I'm seeing right now, right? They've already had the complications. Where they need to get the breast implants out, they have the contracture; they have breast implant BII, breast implant illness. They have something, right? I wish I knew those patients before they had the surgery.

Because the question is, could we prevent any of that if their immune system is better equipped to deal with the assault on it. And I would argue, though, just based on the other things that I do, if a patient gets a vaccine, right?

So I have patients they want to get the COVID vaccine; they need another vaccine. Sort of the same thing we're putting something in the body, we use pretty aggressive mast cell-targeted treatment, to sort of stabilize the mast cells, to minimize the side effects from that.

So I would argue that if we could do that before the surgeries, breast implant surgery or any other surgery, I think the outcomes will be better. In my patients who have had surgery for other reasons, though, okay.

The better they go in prepared, and the better their surgeon understands what they need, perioperatively, for their mast cells, the better their outcomes are after surgery, that I can say.

[00:30:39.06] Scott: In terms of the prevalence of the development of mast cell activation or autoimmunity after these implants are placed. Do you notice any difference between silicone versus saline? Or does it seem to be about the same?

[00:30:54.06] Dr. Dempsey: Yes, I think the issue is that the cover of the implant, most of the time, is silicone. And then it could be filled with saline, or it could be filled with silicone, that's my understanding of it.

There are other materials that go into that covering. So to me, it actually doesn't seem to make much of a difference of what's inside. I would argue that leaking of silicone when those implants leak would be probably more problematic than saline, but by the end of the day, it's material that shouldn't be there.

[00:31:30.07] Scott: You mentioned mold associated to implants previously. So let's talk a little about fungal issues, mold issues associated to breast implants.

Have you seen that once the explanation has been done? Is that something that's testable? Can we identify mold from these explanted implants? And then how do we think mold is getting into the implants? Is it actually in them, or is it around them?

[00:31:55.09] Dr. Dempsey: Well, it could be both. I mean, we have seen, the problem is that again, the capsule of the implant is supposed to be pretty tight, right? So it's not supposed to leak; it's supposed to keep the material inside.

But there may be holes, microscopic holes, so things are leaking. And as long as there's liquid material, as long as there's something that living organisms can use and attach to, you're going to get growth. And so I've seen it both ways.

I've seen implants that have been removed that have mold inside. And I've seen it where they have mold outside. Thankfully, there are surgeons who are really interested in this and are sending the samples out for testing.

And not all, unfortunately, but there are more and more, and they're finding that. Again, it's liquid, and it's going to foster growth of other things. And bacteria as well, not just mold, can be problematic, and we've seen people be extraordinarily sick.

[00:33:08.26] Scott: And when people are testing for mold, is it most commonly Aspergillus, or what type of molds do we see in these implants?

[00:33:16.11] Dr. Dempsey: Yes, it's a good question. I mean, off the top of my head, I mean, I could probably pull up the pathology reports and tell you what has been found. But yes, Aspergillus is definitely a big one. I think we've seen Candida, certain strains of Candida on a couple. But yes, I'm sure the potential for others is there.

[00:33:36.20] Scott: I know there's some where they actually have kind of a port where they can fill them after they're implanted, and it seems like I've heard people talk about that as another potential way that certain things get inside that then can grow as well.

[00:33:49.04] Dr. Dempsey: Correct, absolutely.

[00:33:50.13] Scott: Yes. Let's talk about biofilms, so do biofilms grow around these implants? And if the answer is yes, does that potentially lead to a congregating location for many different pathogens in the body, making conditions like Lyme and co-infections even more difficult to treat?

[00:34:09.28] Dr. Dempsey: Yes. I mean, I think biofilms really are probably the main reason, in my opinion, that so many patients continue to be sick after they've been treated for Lyme, Bartonella, mold etc. So biofilms are a huge issue.

And yes, I think about the biofilm as like a web, like a spider web, it's really sticky, lots of things get stuck in there. And so again, anything that, any insult to the body, a wound, a cut, something getting in is going to promote an inflammatory response.

And the inflammatory response is going to cause tissue that's sticky, sort of like fibroblasts and other things that again set things up for pathogens to get basically stuck in and promote their growth. So, of course, you'll see that with the implants.

[00:35:12.01] Scott: If we look at some of your patients that have had mast cell activation, that was believed to be associated with their breast implants, and then they had them removed. Do you commonly see reduction in their mast cell symptoms?  Is that required in some of your patients to really move the needle towards health if they're dealing with mast cell activation and they have breast implants? What's the kind of clinical course after explantation?

[00:35:40.11] Dr. Dempsey: So it's sort of interesting. In a large subset of my patients who have had explant surgery, they initially experience a pretty radical improvement.

They really do feel like the toxins are just taken out of their body, and they do feel better, and they notice a shift; many of them are just so happy to have done that, to get better. Having said that, I think the disappointing piece of this is that many of those women will still have some symptoms. And I think there are a few ways you have to look at it. I would argue that many of them probably had primary MCAS; they didn't know necessarily, they didn't correlate the symptoms they've had for years.

I can think of one patient who had a lot of GI issues; SIBO had some hormonal imbalances through her life. There's sort of the flavor; I would call the flavor of MCAS, but generally very healthy, right? So these women they're overachievers, and they're doing a lot of stuff.

But they have these subtle health issues that are going on, and then they have implants for a variety of reasons. And then slowly, their health starts to go down. Again, mast cells get activated, the immune system gets activated.

Some of them start having autoimmune markers show up; I've certainly seen that all of a sudden, their ANA is positive. And then you remove it, and there's an initial reprieve, the immune system takes a deep breath, like okay, we've gotten rid of this, the mast cells has kind of calmed down a little bit. But the reality is that the mast cells were already dysfunctional before the implants, in most cases, at least in the cases that I see.

And you still have to deal with the dysfunction as a whole. But taking the implants out, taking one trigger out, can be really remarkable. For some women, it's the main trigger, and then they can control everything else pretty easily.

For others, it's a combination of triggers. So those patients that get their implants out but that don't get better, I've spoken to a number of surgeons around the country who are concerned about the patients that they've explanted who don't get better, and they don't know why.

Because when they take the implants out, they see all these abnormalities, they know there was a problem, but then they want to know why the patients didn't get better.

And so those are the patients that we need to look at to see whether it's possible they have mold, and they weren't tested for it. Maybe they're still living in a moldy environment.

So it's sort of like this sort of interaction between internal mold and external molds. They are a little bit of a mold factory themselves, but they're also breathing in air that has it.  Maybe they have underlying Lyme or Bartonella, and I would argue that Bartonella is probably the biggest thing we see, sort of correlated with patients not necessarily getting better despite our best efforts.

[00:38:51.24] Scott: And it's interesting as you're talking about kind of primary and secondary mast cell activation. I know you do a lot in the world of Ehlers-Danlos Syndrome as well, and there's kind of that same concept, right?

Those genetic Ehlers-Danlos that's kind of what we're talking about maybe more primary where that's been there all along potentially, versus more secondary or triggered by something else like Bartonella, for example.

And so it seems like there's a correlation between the mast cell activation, the Ehlers-Danlos in both of them having kind of that primary and secondary potential.

[00:39:27.00] Dr. Dempsey: Correct.

[00:39:27.22] Scott: If we think of chronic illnesses as kind of a bucket that's overflowing, triggering the mast cells, many things like mold, and EMFs, Lyme, Bartonella, Babesia other parasites, pesticides, chemicals, metals I mean this is a long list.

How significant do you think the breast implants are compared to all of these other things? Does it kind of end up high on your list of potential triggers? Or is it just one of many things that we need to explore?

[00:39:58.07] Dr. Dempsey: Yes. I can't say that it's the worst trigger by any means. It could be the worst trigger for that patient. But I never put all my eggs in one basket; I'm never going to just look at the implants; we're going to look at all the factors.

So for the individual patient, we might find that the implant is by far the most important factor. That we've ruled out mold, they don't have Lyme; they don't have co-infections, they don't have heavy metals.

So really, it does seem like the implant for them is the biggest factor that has to be dealt with and treated. But for me, looking at the environment both externally and internally, everything could potentially be the straw that breaks the camel's back, right?

That's the big thing that changes the patient's life. Could be a viral infection, right? The patient gets a virus; they don't know what virus, maybe it's Epstein-Barr, maybe it's something else.

And then now it's years of chronic fatigue, and mast cell activation and other things. So it's really based on the person's mast cells as to what is going to be worse.

[00:41:10.24] Scott: So let's talk about some other types of medical implants. Let's talk about metals in things like knee replacements, hip replacements, very common.

Do you see orthopedic implants as triggers for mast cell activation? Or other immune dysregulations, the resulting inflammation? And if so, what can we do to support those people in need of these types of procedures?

[00:41:33.26] Dr. Dempsey: Yes, we definitely see it. And there are a number of labs that are trying to measure immune reactions to different metals. You can measure an immune reaction to titanium and nickel and some other things.

And I have patients that are in need of orthopedic procedures; they need a hip replacement, knee replacement. But they're in the middle of a really bad mast cell flare, and we worry about now we're going to introduce something else in.

But they really need to have that done. And so sometimes we can look at these tests; I can't say that I have found those tests to be really a game-changer. I don't think those tests are really measuring mast cell activation, but they may be measuring some other immune reactions; it could be helpful.

But I guess the main thing is really just supporting their mast cells as a whole. We do the best we can. If we know they have a nickel problem, I'll talk to the surgeons and say, is there any implant that has less nickel there? By the way, there are no implants that have zero nickel in them, by the way.

And I did some research on this, or stents, or other things, it's really remarkable. So it's about trying to minimize the effects; you might not be able to eliminate it. And again, better mast cell support going into the surgery is going to be key.

[00:42:56.29] Scott: And is this testing similar to the malaise testing that originated with Dr. Vera Stejskal’s work?

[00:43:03.07] Dr. Dempsey: Yes, correct, that is one of the ways you could test.

[00:43:06.22] Scott: Excellent. Are there differences in mast cell reactivity? If we're comparing, let's say, a static implant that maybe does become encapsulated or have biofilms versus a more dynamic implant like a joint replacement that maybe can produce wear particles over time and become more of a systemic toxin.

Do they seem to have a difference in terms of their potential as triggers for the activation of the mast cells?

[00:43:33.06] Dr. Dempsey: I mean, I would say just sort of anecdotally, and just again from a common-sense perspective, it probably makes sense that it could. But hard to say, yes, good question.

[00:43:47.09] Scott: And I'm assuming then that even things like metal plates or metal or plastic screws may be used in a shoulder operation or after a broken bone or a spinal fusion.

It sounds like these also have the potential to trigger the mast cells, and we need to really give that some thought in terms of how to best support that immune system when we're doing these types of procedures.

[00:44:08.25] Dr. Dempsey: Yes, absolutely. And to be clear, I have mast cell patients, MCAS patients that have had spinal surgeries, have had different, they have material in their body that's foreign.

And we don't see necessarily correlation in those patients to that material, and a worsening of their condition or anything else. So I just want to be clear, right?

Not all MCAS patients are going to react to these materials; not all MCAS patients are going to have a problem with breast implants; not all MCAS patients are going to have problems around surgery. But understanding all this obviously and going into it prepared is better; it's better for the patient.

[00:44:53.03] Scott: Let's come back to the hernia conversation and the mesh material that's often used in these scenarios. Dr. Dietrich Klinghardt, many years ago, probably 15 years ago now, he said that I had had a hernia caused some issues.

But I decided not to do anything about it because it wasn't significant, and I was concerned about this potential. And so, what is the mesh made out of? My understanding is some of them are kind of almost like a plastic material.

Can it be a trigger for the mast cells? And then do you have recommendations if someone needs to address a hernia? What's the least triggering way or the best way to approach that?

[00:45:31.12] Dr. Dempsey: Yes. I mean, listen again, I'm not a surgeon, and this would be a great question for a surgeon who was really interested in MCAS because then we can kind of look at it from a few different angles.

I mean, again, I have MCAS patients who have had hernia surgery, have had mesh plates, or mesh plates for other things and are fine. They have no complications, and they say that was the best thing they could have done, and it changed their life so that they can go on and do what they need to do.

But I certainly have patients who have problems; I have patients whose mesh moves. I have patients whose mesh becomes inflamed, patients who develop chronic pelvic pain because of that mesh in that area, of both men and women.

And again, it's sort of what else can be done? I think they need to; I think that research does need to look at better material. I think, like in dentistry, they're always looking at better material to put in our mouth.

They've got to think about better material as far as even stents, for when people have stents placement for cardiac reasons, to open up arteries. Same thing with this.

All these metals or plastics or whatever they're using, they have a lot of toxicity potentially associated, so I do think they need to look at that. But I would also argue that even if you do the hernia surgery without mesh, and there are surgeons who are still doing that, they're still an insult to the body. There's a cut; they go in, they have to close things off, that's still going to stimulate mast cells to some to some extent. And MCAS can change how tissue heals.

And so, we sometimes will see patients who have keloids like scar tissue and that scar tissue actually can become problematic; it can become painful, especially if it's deep, deeper in. And so my point being that you really could have an endless array of complications, but for the most part, right?

Most people do fine. You go in thinking about this in a smart way, and you hope that the things that we can do not just pharmacologically for MCAS, but also thinking about the healing process, right?

With vitamin C or other nutrients, right? Making sure that the patient is optimized from their health going into any procedure is going to be ideal.

[00:47:56.05] Scott: So let's talk a little more then about the dental procedures as potential triggers for mast cell activation. If we think about amalgams or composites, adhesives and glues and orthodontics or braces or dentures.

Do you see those as common contributors to your mast cell activation patients? And then, what considerations should we give to the potential for activating the immune system when we're doing these types of dental procedures?

[00:48:25.02] Dr. Dempsey: Yes. I have quite a few patients really struggling with various dental work that they need, dental appliances. Many of my patients have had to change their dental appliances; they spent thousands of dollars trying to figure out what's going to be right.

Since MCAS is correlated with Ehlers-Danlos, EDS or hypermobility syndrome, many patients have airway issues, so they have sleep apnea. And we often will need some kind of appliance, if not a CPAP machine, which is a whole set of other issues associated with.

So they have these things in their mouth that are just trying to help them. And yes, they often but not always react to the materials. And so, it is a little challenging to have; it's challenging to find dentists who are willing to entertain these ideas and try to find solutions. I've had patients, one of the biggest things I see with the dental stuff is really something called Burning Mouth Syndrome.

So you can get Burning Mouth Syndrome; it does seem to be correlated with Mast Cell Activation Syndrome; I consider it a symptom of MCAS. But very often, patients will say that they had something in their mouth, some kind of procedure that made it worse or brought it out for the first time.

And I've had patients who have had, let's say, even a crown put in, right? Not a major procedure, actually. There was one patient who had the crown itself was a composite material, but under the crown was a metal, and the metal was exposed a little bit under the crown.

And again, I'm not a dentist, so I don't know all those specifics. But every time her tongue touched the metal on that crown, her mouth was on fire.

I think I spoke to that dentist like at least five times, if not more, and he refused to listen to me or the patient, and I really had to sort of really insist that the patient go to another dentist because he could not wrap his head around that little metal that was exposed that was like less than a millimeter was causing the problem.

It could have been the composite material; it could have been the metal. But nonetheless, it was very traumatic, actually. When the mast cells are activated in the mouth and the nerves are stimulated, the whole body is on fire, right? And that's how patients say. They just that in the mouth now makes the sort of the entire nervous system activated.

[00:51:07.01] Scott: It's interesting when we're thinking about things like even retainers, or dental aligners, or anything that could potentially lead to some reaction.

And I know there are some biological dentists that will maybe use things like ElectroDermal Screening, or Electro-acupuncture According to Voll, or different systems of kinesiology or Autonomic Response Testing or something like that.

Have you found any of those types of energetic testing options helpful in determining what things to use? Or are you relying on like a Clifford compatibility testing? What are you finding most helpful to potentially minimize this being another trigger in the bucket for your patients?

[00:51:48.15] Dr. Dempsey: Yes. I mean, I think you need to use all the tools you have. There's never going to be one process, one technique that's going to be right for everyone. People who are sort of energetically tuned in, especially if you have someone who knows how to do the energetic testing, it can be very helpful, absolutely.

And I encourage people to do again what they feel comfortable with. What I find interesting this is totally anecdotal, but in the MCAS world, I have not found energetic testing to be as reliable as if, let's say, I'm testing for treatment for Lyme disease or something else.

I'm certainly not an expert, but I can use some testing, and I have practitioners and colleagues that do it. If you're trying to figure out what herb, let's say, would work for Lyme, right? Sometimes that energetic testing can be very helpful.

But when it comes to MCAS, trying to figure out what would work for MCAS, what materials might make MCAS worse, there's a lot of inconsistency. And I've had colleagues tell me that they've noticed that too that they can't really pinpoint it the same way. I'll just throw that out there for what it's worth. 

[00:53:00.04] Scott: And then, if we think about dental implants, have you noticed differences in terms of mast cell activation?

Looking at a titanium implant versus a zirconium implant, for example, do the zirconium implants seem to be less stimulating to the mast cells?

[00:53:15.27] Dr. Dempsey: So the biological dentists that I've spoken to feel that is the case. They feel that zirconium is a better option for patients who are sensitive. So I go with what they say, and I think that makes sense to me.

Titanium, we are seeing more and more reactivity to titanium, and maybe it's because it has been used for so many years in different areas of the body. Whether it's in joints or dental implants etc. Titanium is a key metal.

And so I wonder if, just over time, people have become sensitized to it and are more reactive. And so, with zirconium, maybe we won't see the same thing; it's a different type of material. The problem is, from what I understand, is that zirconium is not as durable, not as strong.

And so the concern that some conventional dentists have is that you might wind up having to repeat that implant, whereas titanium will last longer. So it's about risk-benefit for every patient.

[00:54:20.04] Scott: Do you find that some of your mast cell patients even potentially react to, let's say, titanium dioxide in supplements? Do we need to be careful about silicon dioxide and titanium dioxide, and those types of fillers and binders and flow agents and those types of things?

[00:54:36.01] Dr. Dempsey: You bring up a really important question because really, I talk about this with my patients all the time, and that's this issue of excipients.

So everything we put in our body from supplements, food, medications etc. Have these fillers in them. They have ingredients that are added to them. And in many cases, the mast cells can react to some or many or all of them, depending on the patient.

Now I certainly have patients who are really not sensitive to various fillers, they're not sensitive to supplements, but they have MCAS manifesting in other ways.

But yes, I would say the majority of my patients that have at least one if not multiple things that they are sensitive to, and magnesium stearate, microcrystalline cellulose, titanium dioxide all these things could potentially be recognized by an individual's mast cell as foreign.

And I think that the real important research that has to be done is to be able to look at the mutations in an individual's mast cell population and to be able to determine what that mutation does in terms of reactivity.

Will we ever be able to identify that these mast cells are more sensitive to XYZ? And then when we know that, can we target treatment better, right? I have a dream, like I dream of this, that we're going to be able to figure out at a molecular level what patients react to because that would take the guesswork out of a lot of this, right?

We would know, okay, titanium is not good for that because they have this genetic mutation in their mast cell. So anyway, we can dream, you know.

[00:56:24.01] Dr. Dempsey: No, but I mean, that would be amazing. Because they kind of do that now with T-cell tests, where they then take the T-cells and expose them to different microbes and things, and see what the reactivity of the immune system is.

And so that would be tremendous if you could test various agents against a specific individual's mast cells and see what things were leading to triggering of that. So I'm sure you're going to make that happen.

There is a lot of overlap between POTS, EDS, mast cell activation; we talked about that in our prior podcast.  Some people find themselves dealing with these conditions after using some medications like fluoroquinolones, for example. I'm wondering what your thoughts are on the potential for fluoroquinolones to trigger Mast Cell Activation Syndrome in these patients that have been flocked.

And then can other medications like antidepressants, can they trigger mast cell activation? What are some drugs that might be potential triggers in this population?

[00:57:22.13] Dr. Dempsey: Yes. So again, this goes back to the previous question about excipients and ingredients. I believe that some of the patients who have drug reactions may be reacting to a formulation of the drug and not the drug itself, and we certainly see that quite a bit.

Now I'm not talking about really severe reactions, but even still. I mean, I could argue that I've had patients be anaphylactic towards one formulation of medication and not to another.

Now it's hard to get a patient who's been anaphylactic to one formulation of the same medications to try it again; I'm not saying we do that very often. But the point being that there can be a lot of variability because a lot of the drugs are made overseas.

We don't know what goes into many of them; even if we have an ingredient list, we don't know where those ingredients come from. So I think that is a big problem. But then yes, if we look at, let's say, the fluoroquinolones.

Again, I would say that most of the patients that I've seen with fluoroquinolone toxicity had probably underlying MCAS. I can't prove they had underlying MCAS, but there’s a story for it that the fluoroquinolones made worse; definitely brought it out. I would argue, though, that there's almost always a genetic susceptibility to fluoroquinolone toxicity.

And I understand that there's some research looking at how to sort of screen patients who might be more susceptible to the toxicity issue. So again, it's a little bit complicated. But I would say that fluoroquinolones are a class of drugs that I almost never prescribe because of my fear of reactions.

There are probably not many other classes of drugs that I stay away from like that. So I can't say, for instance, that antidepressants as a general rule are problematic for MCAS. They can be, but I also have patients who get remarkable relief with an antidepressant for, let's say, a neurologic condition, or maybe even depression.

And that actually calms down the MCAS because their body's less stressed out. So again, I can never say always or never because it's human beings; everything is variable.

So I try to stay away from saying these are common drugs that are problematic, and kind of really look at the patient and try to figure out what may be problematic for them.

[01:00:00.08] Scott: Yes, the whole excipient conversation is an interesting one. Because sometimes I see in the biohacking community, and people that are coming out with new supplements and longevity things, and they sound great.

And then you read the ingredients, and I think I don't want to take titanium dioxide and silicon dioxide and all these things every day.

Or you get a new pharmaceutical medication, and it's in a beautiful pink and purple and turquoise capsule, and you know that there are food colorings and all these other kinds of things in there.

And so I think that's why it's also important to work with your practitioner, make sure that the supplement line that you're using is ideally considering those kinds of things. There are product lines like Pure Encapsulations and others to try to minimize those things as much as possible.

When we're treating chronic infections or environmental toxicants like heavy metals, do you find that in Mast Cell Activation Syndrome, patients that a gentler approach might be better accepted by the body, as compared to a more aggressive one that might then be triggering the mast cells even more?

[01:01:05.02] Dr. Dempsey: Yes, absolutely. I have so many patients who come to me after they've been treated aggressively for their underlying tick-borne infection. They've been on months, years of antibiotics.

They come to me they're on three antibiotics and doing heavy-duty detoxes and heavy-duty supplements and herbs, and they're getting worse, right? So their chief complaint is I'm being treated for all this, but I'm getting worse; what's going on? And I would argue that they're just; their immune system is in overdrive. Their body can't handle all that.

And I would argue that the symptoms they're having is not; a lot of them sort of associate the symptoms with this condition we call Herxing, or Herxheimer reaction, which is a die-off reaction.

And I will tell you that almost that's not Herxing, that's mast cell activation, that is an inflammatory reaction to the drugs and the herbs and everything else that you're using, as opposed to the die-off of the bug.

We're past the bug at this point; by the time the patients come to see me, it's just much, so much more than that. And so, yes, I do take a gentler approach. And definitely, my style on this has changed over the years.

I certainly was much more aggressive earlier on, before I really understood MCAS, right? The more I understand MCAS, the gentler I am. And what I find really fascinating is that there are plenty of patients that I have now that previously I would have treated more aggressively for their tick-borne infection.

But I actually don't have to treat them for their tick-borne infection when I take care of the foundation of their body, right? So I've worked on, I mean I've always done this, but I've worked on their gut, and their nutritional status and their diet, right? We're setting the foundation, and then we identify, let's say, they have MCAS.

So I am stabilizing their mast cells, I'm reducing their mediators, I'm reducing their cytokines, and reducing inflammation. And then their immune system could deal with the underlying infections better. And so I have this one patient that's about 12-13 years old, who came to me with Bartonella and Lyme and aggressive antibiotics and not getting better.

And once we switched over, I mean, I don't doubt that he has all those infections probably still persistent in the body, but probably like dormant, so to speak, right? Quiet.

But as soon as we started working on the MCAS and we found the right combination of things for his mast cells, it is just, I mean, mind-blowing actually where this kid has come. And the mother says, well, what do we do about this Lyme and Bartonella stuff that keeps coming up, right? I said nothing.

Actually, we're going to do nothing. We're going to watch it, and maybe it will come out at some point, and we'll be ready because his immune system and his MCAS is better controlled. So if we have to treat it, it will be easier to treat. But I really emphasize it a lot because that's one of my frustrations in the Lyme community; I think we have to just step back a little bit.

I'm a firm believer that those infections are important, and they need to be addressed. But I think you have to address that immune system, and if MCAS is playing a role, do that first, set the stage, then figure out what the patient needs.

[01:04:35.09] Scott: Yes, I 100% agree. And I'm even surprised sometimes just people going on a low histamine diet like sometimes 50% of their symptoms go away or what's left are significantly less significant.

And so, I agree this is a big piece of the puzzle. A lot of times, I kind of personally have been a little concerned about getting super aggressive with heavy metal detoxification; people want to do IV DMPS and DMSA and all these kinds of things.

I think if the metals are also potential triggers of the mast cells, and you're really just moving these things aggressively through the body, it seems like you can really end up shooting yourself in the foot by triggering more inflammation, that then at the end of the day is going to minimize your detoxification potential. And so it kind of ends up doing the opposite, I think, of what we were hoping.

[01:05:26.28] Dr. Dempsey: Yes, I agree. And I almost do no heavy metal detox anymore. Ten years ago, I did, never with IV, but generally, really looked at it as an important factor. Now, are heavy metals problematic? Yes, they are.

But to be honest, it's very hard to really detox the body of metals; it's very hard to get them out of the body. But if you can get the body just functioning better, and the immune system better, and the gut better, and the detox pathways better overall without trying to pull things out of the system, you're going to be better off, patient's going to be much better.

[01:06:05.17] Scott: Is there any potential downside to aggressively stabilizing or quieting the mast cells in that they do important things in the body and are intended to be there as part of our immune system. Can we over-stabilize mast cells?

[01:06:21.23] Dr. Dempsey: Yes, that's a really great question. And that's a question that I have patients ask me quite a bit because yes, they are concerned, right? It's about balance. We want to make sure that we're helping the immune system, not hurting.

But we have to remember that when we talk about MCAS, we're talking about mast cells that are dysfunctional, mutated, abnormal, they are not normal, they're not helping actually anything.

So while we're working to stabilize those mast cells to get them less reactive, we're not stopping good mast cells from working; we're stopping bad mast cells from working. Now, will you inevitably block some of the good mast cells while you do this? Yes, you might.

But the truth is that we have an abundance of mast cells; it's almost impossible to control all of them or stop all of them from working.

So it really works out. And in fact, I would argue that again, the patients whose mast cells are better controlled, their inappropriate mast cells are not acting as inappropriately, overall their immune system actually is better, they are better able to handle the stressors of daily living, the viruses, and infections that they're exposed to.

And that's what's fascinating to me; it's like that key, that control over that part of the immune system just automatically balances the other part of the immune system.

[01:07:50.04] Scott: So I really like that perspective because I've heard people argue on the opposite side of that as well. And say, well no, stabilizing mast cells actually has some downsides, and so I like the way that you presented that, and it makes a lot of sense.

If we look at the immune system simplistically as a balance between Th1 and Th2, I tend to think of mast cell activation more of a Th2 shift. And so, I'm wondering if interventions that are aimed at reducing Th2 and or supporting Th1, if that leads to improvement in mast cell activation symptoms.

[01:08:26.12] Dr. Dempsey: Yes, I think that's an interesting way of looking at it. And I would say probably, that a lot of that is true. I have seen the opposite as well. And again, when it comes to medicine, nothing is ever 100 percent.

So with autoimmunity, right? We always talk about the Th1 or the Th2 or Th17, right? We understand that there's an imbalance, but it can go both ways.

And the same can hold true for MCAS. So I would say that yes, supporting Th1 can be helpful; it's definitely something that we do. But it's not going to work all the time because it's not always associated in each patient.

[01:09:09.03] Scott: Have you observed patients benefiting from limbic system retraining to calm their mast cell activation tools like Annie Hopper's Dynamic Neural Retraining System? Or Ashok Gupta's The Gupta Program.

And then, given that mast cell activation is a hyper-vigilance syndrome, does the limbic system play a role? Can we also maybe tie that in with working on the vagus nerve and parasympathetic tone and kind of calming the system down? What role do limbic system and vagus nerve play in this mast cell conversation?

[01:09:43.08] Dr. Dempsey: Yes, I think this is an actually really important tool or important approach to with MCAS patients. And I encourage all my MCAS patients to think about how they're going to deal with stress.

So that's like a conversation we have. Whether it's meditation, whether it's deep breathing. I love James Gordon's work and belly breath, and so there are just simple tools. But then some patients definitely need a more specific program, right?

A more comprehensive program that's really targeted towards their limbic system. Again overall, where you want to calm down their autonomic nervous system, we want to calm down their sympathetic nervous system, right?

And so there are lots of ways to do that. But these programs where there's Gupta, DNRS can be very helpful at targeting the limbic system specifically. Which then obviously interacts with the autonomic nervous system.

And so I've seen incredible results; I've seen patients who have been able, who could only eat three foods all of a sudden can eat all foods. I mean, we've seen some really amazing transformations. It's rarely going to be the key for everything, right? It's often not one technique, one procedure, one treatment that's going to be the thing that changes everything; it's usually a combination. But when used in combination with other things we use, I think it can be very helpful. So I'm a big proponent of that, and I encourage my patients to do it.

I definitely get some pushback; not all patients feel comfortable doing it, it doesn't resonate with them, and so that's actually just going to make them more stressed out. So I would say that there's a fair number of patients who don't want to go down that path.

And if they don't want to go down that path and do those programs, then we do sometimes look at these other vagal nerve programs, or ways to sort of again, we're getting at the autonomic nervous system from another angle.

And that can be helpful and sort of quieting things down. So I'm a big fan of these different techniques, and it's about really making sure that it resonates with the patient and that they will get the most out of it.

[01:12:01.18] Scott: Any favorite tools in that realm that you like to use?

[01:12:05.03] Dr. Dempsey: Out of all of them, I think DNRS is probably the one that I have seen the best results with that I have. I can say that there's a more defined response. But I have patients who say, oh, this has worked, this has helped.

I have patients who meditate, who do belly breathing, who do other things that feel like that's, it's all helpful. But I like DNRS because it just seems more targeted, specific, methodical.

[01:12:35.02] Scott: Yes, and that's the one I have the most experience with. I did it myself for seven months, an hour a day; I did feel like it was very helpful. But to your earlier point, it is not the only thing people need to do.

And I think sometimes this gets a little confusing. I think sometimes people think that the message that Annie Hopper is sending is, well, if you're in a moldy house and you just do DNRS, everything is going to be great.

That's really a misunderstanding of her teachings. Her teachings are that DNRS is done on a platform of environmental awareness, and of course, if you're living in a moldy house, you really want to fix the tiger, so to speak, before you start trying to reboot or recalibrate the limbic system.

And so I think your point was an important one, that there is a timing for when these things make sense and have the most potential to help.

And that you still do need to consider those underlying triggers and how to address them, and this is not going to be the one solution. But I agree; I've seen it be pretty miraculous for many people.

[01:13:35.26] Dr. Dempsey: Thank you for saying that; I think that's an important point.

[01:13:38.01] Scott: Have you found tools like LDA or LDI, low-dose allergen therapy, low-dose immunotherapy. Can those create more immune tolerance to some of the materials potentially that are in the various implants that we talked about?

Can we modulate the immune system so that these implanted materials are potentially better tolerated?

[01:14:00.07] Dr. Dempsey: You know I don't have experience myself doing LDA or LDI; we don't do that in the practice right now. I have colleagues who do it; I have patients who come to me, who are doing it.

And I would say anecdotally; there seems to be some positive effects for some. I can't say that it's a game-changer, right? There are some things that we do that I think are game-changers like DNRS could be a game-changer for the patient.

It may not be but could be. There are other interventions that we do that I could say wow, that's a game-changer. And I've just never seen LDA, LDI, those types of treatments be the game-changer. But for the right patient, some of my patients have said that it was helpful. So I don't feel strongly about it.

[01:14:49.20] Scott: And extending on that, how about tools like homeopathy or NAET, the Nambudripad Allergy Elimination Technique, or BioSet or other tools that are kind of getting the nervous system to be less reactive to different materials. Have you had any patients where maybe that helped to calm their MCAS, particularly associated to some of these implanted materials?

[01:15:15.22] Dr. Dempsey: You know, my problem is that I really love all these different techniques and different ways of doing things. I love homeopathy, I love the concepts, and I think that there are patients who respond well. I have colleagues who do NAET; again, I'm fascinated by it; I think it's a great tool.

I hate to say it because I really do love the concepts. I can't say that my patients are really, again really changed by these techniques.

In fact, I have one patient who's been doing NAET probably for ten years, maybe more, and it seems like what happens is maybe she's less intolerant to some things but then more intolerant to other things.

And it becomes the sort of vicious cycle because if that's all you're doing, and again you're not working on all the other factors, how successful is it going to be? So I think again, with all these tools like you said, you have to look at your triggers, and you have to eliminate your triggers the best you can.

And then you have to use various methods together in a gentle way, to produce the best results. So my point is that yes, I can't say any of those are really going to be amazing for everyone.

[01:16:31.00] Scott: You mentioned game changers, and so that's a good segue into my next question. Which is what interventions or treatments are exciting you the most right now in the field of MCAS? And what do you see as really moving the needle for your patient population?

[01:16:46.03] Dr. Dempsey: So I'm excited about peptides. And I was sort of; I may be a little late to the game of peptides. A lot of people have been talking about it for years, and I think it makes sense on some levels for the immune system, the number of peptides for that, right? For anti-aging and things like that, right?

But interestingly, again, some of this is anecdotal, and we really do need more research in this area. But when I again focus on the things that are potentially making a patient's MCAS worse, then again, it can be helpful.

So if I have a patient who has MCAS and autoimmunity and immunodeficiency, actually, that's a very common trifecta. So they may have common variable immune deficiency; they might have low IgG, IgA. They might also because of that, being what's going to having autoimmunity, and so maybe they have Crohn's, Lupus, Rheumatoid Arthritis or some flavor or something, Hashimoto's.

But they also have evidence of Mast Cell Activation Syndrome, and again I would argue that there's some connection between all of them. And so I'm working on their mast cells, and maybe I'm working using anti-histamines, maybe I'm using other blockers or stabilizers. I'm working on their foundation, and their diet, and all that.

But, maybe if I also focus on the other parts of their immune system that are in concert with the mast cells, I can overall get them their mast cells better. And so sometimes, like using things like thymosin alpha and KPV and some others.

What I've seen is that it's a little hit or miss; people can still react, they're still right, there's still always going to be problems, nothing is ever going to be great for every single person. You start to see things for the right patient population; these peptides could potentially make a big difference.

And because my patient population is so really largely tick-born infection and mold, there's immune disruption from the infections and from the mold and mycotoxins. And so again, we're sort of working on that piece.

And so I'm excited about how that's really affecting the MCAS part. So when I started doing the peptides, I was doing it for their immune system, but I wasn't so convinced that we would see the effects at the level of the mast cell.

And yet, we're starting to see that. So I have one patient, for instance, who has a lot of Urticaria, hives, itching, food intolerances, etc. And so we have her on a lot of mast cell-targeted therapy. But then we started some of these peptides very slowly, of course, one at a time, very carefully.

And what's interesting is that while she gets relief from the mast cell-targeted therapy, it's never a hundred percent; it's always like a breakthrough. But now we add this other piece on, and all of a sudden, everything just seems to be like dampening down; that's exciting.

[01:19:49.07] Scott: Do you find BPC-157 helpful in your mast cell patients? And when you're using KPV, is that the oral KPV or the injectable version?

[01:19:58.06] Dr. Dempsey: The challenge is really now being able to get the injectable like there are a lot of places that don't have it. So I've been using more oral KPV and an oral BPC-157. If we can find the injectable one, there are a few pharmacies now that have it. So the BPC-157, to me, is not as exciting as others have made it out to be.

On paper, it sounds too good to be true. In practice, it's I don't know rarely a game-changer as I keep saying, right? It's not usually like the thing that's going to change everything.

Sometimes it does help in concert with the other things that we're doing. But thymosin alpha probably is the one that and that's injectable and also hard to find. It seems to be the one that I've seen the biggest shift with.

[01:20:48.23] Scott: Wonderful.

[01:20:49.15] Dr. Dempsey: And also, I'm sorry, I'll add one more thing. For the ME/CFS population, the chronic fatigue syndrome patients, anecdotally thymosin alpha does seem to be helping the chronic, the fatigue, interestingly. And I don't understand it completely.

[01:21:04.01] Scott: Yes, it's super exciting. I mean, having been in this Lyme and mold illness realm for over 20 years now myself, I think there are newer tools, the research is accelerating, the solutions are accelerating like it really is an exciting, hopeful time as compared to years past.

And so it's really exciting to see some of these things that being available to patients. My last question is the same for every guest, and that is what are some of the key things that you do on a daily basis in support of your own health?

[01:21:32.06] Dr. Dempsey: I am very in tune to my body and to what I put in my body. So a couple of things I definitely watch and follow as healthy a diet as possible. It's grass-fed, organic. I am carnivore, so I only do eat meat, and that's a topic for another conversation. But for me, that's what works. I have to have some kind of activity.

I have to move, and so whether it's walking or running or weights, I mean I'm lucky that I can do that stuff, and I know a lot of listeners can't exercise or don't feel well. But this is sort of what I've done over the years to get to where I am, right? I've had issues and chronic issues over in the past, and so I've come a long way.

So I love to run, I love to walk, I love to be active. And I am trying to meditate on a more regular basis; that's one of the goals that I set for myself. I often am pretty good about belly breathing and taking a moment, but meditation is the one thing that I always say that I have to do more of.

[01:22:41.06] Scott: This has been such a great conversation, so informative. I've probably known you maybe four or five years now, and what I always love is just your passion to find solutions for your patients, your passion to educate and share your knowledge with other people.

To minimize their struggle, minimize their suffering. And I just really want to thank you for not only being here today but for everything that you do and all of the information that you share, so thank you so much, Dr. Dempsey.

[01:23:09.13] Dr. Dempsey: Oh, thank you so much, that's very sweet.

[01:23:13.06] Thank you to learn more about today's guest visit DrTaniaDempsy.com.

[01:23:30.25] Thanks for listening to today's episode. If you're enjoying the show, please leave a positive rating or review, as doing so will help the show reach a broader audience. To follow me on Facebook, Instagram, Twitter, or MeWe, you can find me there as BetterHealthGuy.

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Disclaimer

The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.