Mast Cell Activation Syndrome and Related Conditions

Kelly McCann, M.D.

Thank you Nafysa, I’m so happy to be here today. I think we’re gonna have a great time. A little bit about myself, I am a medical doctor. I did medical school at Tulane University in New Orleans. I got a masters in public health while I was there as well. And then went on and did a dual residency program in internal medicine and pediatrics. I had a brief stint in Oregon and got sick, and then decided I needed to do more training. So I went to Arizona to dry out after being in Oregon, and worked with Dr. Andrew, while at the Arizona Center for Integrative Medicine. 

So I was one of the residential fellows in that fellowship. And then went on and did functional medicine with IFM. I trained with Dr. Walter Crinnion in environmental medicine, trained with Shoemaker, and Patricia Kane, learning about phosphatidylcholine. And then more recently, I’ve been learning a lot about mast cell activation, from some of the greats like Lawrence Aron, and many other doctors. And so that’s where I am practicing in Southern California. I have a practice there. It’s a private practice. And we see very complicated medical patients, just like you guys do.

Nafysa Parpia, N.D.

Very exciting.

Kelly McCann, M.D.

Thank you.

Nafysa Parpia, N.D.

Yeah. Thank you for being here. We always have so much fun on our interviews and in our conversations. So you are doing a mast cell summit of your own coming up. When does it start Kelly?

Kelly McCann, M.D.

Yeah, so that will be in the end of August, beginning of September. So August 27th through September 4th, that’s with HealthMeans. So you can look for that upcoming.

Nafysa Parpia, N.D.

Fantastic.

Kelly McCann, M.D.

Thank you.

Nafysa Parpia, N.D.

Yeah, I’m excited. So let’s start talking about mast cell then. Why not?

Kelly McCann, M.D.

Yes, one of my favorite things to talk about.

Nafysa Parpia, N.D.

Yes, I love it. So, let’s talk about what mast cell activation is. Kelly, would you like to start by telling our audience what it is?

Kelly McCann, M.D.

Sure. So for those of you who don’t know, mast cells, M-A-S-T, are part of our immune system. And they are the part of our immune system that fights foreign invaders. They’re born just like a red blood cell. And then they make their way from the bone marrow to different sites in the body where they live the rest of their lives. And those sites line in the areas of interface between ourselves and the outside world. So they line our upper respiratory tract, our whole GI tract, lungs, they’re on our skin, they’re in our brain, general urinary tract, so like bladder. So when they perceive foreign invaders, they’re filled with all these chemical messengers called mediators. And when they perceive a threat, they will dump all their mediators and cause an inflammation reaction.

Nafysa Parpia, N.D.

Yes. And so the big buzzword right now is histamine.

Kelly McCann, M.D.

Yes.

Nafysa Parpia, N.D.

And I love that you’re talking about all these mediators because often people think it’s only about a histamine reaction, but we know that mast cells have a repertoire of a thousand mediators. So, when our mast cells are flaring, it’s not just histamine but it’s a thousand others. So people think that they can just block the histamines and they wonder why they’re still having these symptom cells, because there’s a thousand other chemicals out there that are flaring.

Kelly McCann, M.D.

Exactly.

Nafysa Parpia, N.D.

And I love how you talk about how they’re throughout our whole system. And so people say, but I don’t have runny eyes and a runny nose, I don’t have a hives. So I don’t have mast cell activation syndrome. Let’s talk more about that. What kind of symptoms do you see in people Kelly, your patients?

Kelly McCann, M.D.

A ton of symptoms. So everyone is unique. And we now understand that the mast cells, this is not a genetic disorder, but there is a genetic component to it. So people have a predisposition and then they can develop changes in some of the genes over time that cause a variety of different presentations. So people can have fatigue. They can have brain fog, they can have chest pain and palpitations. They can have a ton of GI symptoms, anything from heartburn, reflux, bloating, gas, diarrhea, constipation, you name it. The GI tract is often involved. People can have bladder issues. I have a lot of young women in my practice who have menstrual issues, uterine spasms, and pain with menstruation. People can have neurological symptoms and psychiatric symptoms as well. Anxiety, depression, mood disorders. And then of course that all common brain fog that people have.

Nafysa Parpia, N.D.

Right?

Kelly McCann, M.D.

Yeah. And I think Nafysa we missed a little step. So, I mentioned that the mast cells are everywhere and everyone has them. But when people have mast cell activation, that’s a different situation. So our mast cells are built to fight foreign invaders and toxins. However, some lucky people, get their mast cells to the point where they’re triggered all the time. So that’s the activation part.

Nafysa Parpia, N.D.

Exactly.

Kelly McCann, M.D.

Yeah. Right, right. Where those mast cells are hypersensitive. And so they will dump those chemical mediators at things that they shouldn’t necessarily be reacting to. Like eating a food that normal people would have an okay time with, these sensitive people whose mast cells are hyperactive, will dump their meteors and you get an inflammatory response. And so it’s an abnormal activation of these mast cells. As opposed to a cancer where you have too many of those mast cells. That’s very, very rare. Probably one in 10,000 people have that. So most people will have this activation issue.

Nafysa Parpia, N.D.

Right. So mast cells are guards in our body and they protect our bodies from invaders. So, when there’s a perceived threat from a virus, a bacteria, a parasite, or even an allergen, the mast cells are activated to release the chemicals to protect our bodies. So it’s like a normal response, a normal inflammatory response. That’s supposed to be transient and it is transient in most people. But then when there’ve been lots of insults to the body and Kelly will talk about this in a minute too, when there’s been these insults to the body, then the muscles are in a hair trigger. And that’s when they start to dump all of these different chemicals throughout the different sites of the body where they line and hence all of these symptoms across the board, throughout all of our symptoms, through all of our systems that is.

Kelly McCann, M.D.

Right.

Nafysa Parpia, N.D.

And so mast activation syndrome, or mast cells being on a hair trigger is a secondary issue. And there’s these primary issues that cause this to happen. Let’s talk about what causes this. I bet there’s a lot of people out there saying, “Well, that does sound like me. I’ve got GI issues and I have brain fog and I have genital urinary symptoms, and my muscles and my bones hurt. Sounds like me.”

Kelly McCann, M.D.

Right?

Nafysa Parpia, N.D.

But, why?

Kelly McCann, M.D.

Yeah, good question. So it’s a bit like peeling an onion sometimes, trying to figure out what infections can be present that will trigger this for people. And of course the name of your summit is chronic illness and mycotoxins, and certainly mycotoxins and molds from water damaged buildings are some of the most common triggers for people. I see that a lot. But then in terms of infections, Lyme disease of course and the co-infections that come with Lyme disease such as Bartonella the Babesia. I mean I think Bartonella is probably one of the biggest triggers for mast cell activation, along with mold and mycotoxin exposures. But there are other ones too, I don’t know about you, but I’m seeing a lot of tick born relapsing fever in my patients, very common here in California. Licia, Anaplasma, Babesia as I mentioned, the Rickettsia species. I do think that sometimes Epstein Barr and some of the viruses can trigger mast cell activation in people as well.

Nafysa Parpia, N.D.

I agree. I’m seeing all of that. In fact I’m seeing a whole myriad of these infections in people. All the tick borne infections that you just mentioned and a high viral load, also seeing it in long haul COVID as well.

Kelly McCann, M.D.

Yeah.

Nafysa Parpia, N.D.

That’s a big one, and I’m actually seeing long haul COVID mimicking chronic tickborne illness.

Kelly McCann, M.D.

And I really, I mean, I know the research is ongoing, but I really have a suspicion that the people who end up with long haul COVID have these underlying infections and they don’t know it. And the COVID virus will then trigger mast cell activation and thus they have this presentation of chronic fatigue and all of these chronic symptoms. Discord anemia, the POT symptoms, the Postural Orthostatic Tachycardia syndrome, are very common with mast cell activation as well. So for those folks with long haul COVID, I really would encourage them, and I’m sure you’re doing this too, to look for these underlying infections, to look for mold exposure, because those are the predisposing factors that I think are tipping them over the edge.

Nafysa Parpia, N.D.

Right. That’s exactly what we’re doing at our clinic. So we’re taking a step back and saying, “Okay, what could be causing this?” Actually we’re part of the long haul COVID group with Dr. Bruce Patterson. And so we’re giving them the medications that are appropriate, but oftentimes we’re seeing, wait a second, these medications are not working. Why is that? So we’re taking a step back, and we’re looking at them the way we do our typical patients with complex chronic illness. Stepping back and saying, “All right, let’s cast a wide net and make some diagnoses here.” 

And sure enough there’s always, not always, almost always, chronic infections in the background that have been there or subclinical infections that means the patient didn’t know that infection was there. They didn’t even have symptoms of it, but it was an infection that was quietly there brewing. And then the inflammatory cascade from COVID or any other infection that came along, causes flare and inflammatory cytokines. And a flare in mast cells as well, to bring it back to mast cells and mycotoxin. We’re seeing people with mold and mycotoxin illness to have COVID long haul.

Kelly McCann, M.D.

Right. Right. There’s a couple analogies that I really like that I think are helpful for people. Very simplistically if you’ve got your immune system here, and these infections are being suppressed by your immune system and you’re asymptomatic and then you get COVID, what happens? Well the immune system, in some ways, very simplistically maybe get suppressed. And now these infections kind of flourish. It gets suppressed when you’ve got all these cytokine storm, right? So that’s one analogy or visual that helps people kind of conceptualize these issues. I also use the analogy of standing on the edge of the cliff. So, you’re standing on the edge of the cliff, but you don’t know how close to the edge you are and you get COVID or you move into a moldy building, and bam, you fall off the edge of the cliff.

Nafysa Parpia, N.D.

Which is true, people are holding at the edge.

Kelly McCann, M.D.

Yes. Right. Until it’s too late, and then you’re down at the bottom of the cliff and we have to haul you back up. It’s kind of fascinating when I look at my patient population that I’ve been working with for a long time, I have to tell you, I have very few long haul COVID patients. Because we’ve been doing all the work. They’re not teetering at the edge of the cliff.

Nafysa Parpia, N.D.

It’s true. When our patients get COVID, they’re fine. ‘Cause we’ve been treating those infections. We’ve been treating the underlying issues. But as for treatment for a long haul is the people who have not been our patients, new people, I’m sure with you too.

Kelly McCann, M.D.

Yeah.

Nafysa Parpia, N.D.

Right?

Kelly McCann, M.D.

Yeah. It’s very interesting. I can count on one hand. Actually, maybe three fingers. How many long haul COVID patients I have amongst my patients that have been patients for a long time. So, yeah.

Nafysa Parpia, N.D.

Same with vaccine injury. So I’m not seeing vaccine injury amongst my patients who are so sick. They do just fine with the vaccine. I believe, I don’t have the proof, I don’t have the data, I wish I did.

Kelly McCann, M.D.

Right. Right. This is speculation on our part.

Nafysa Parpia, N.D.

Speculations, absolutely. I wanna make sure this is clear to our audience, but I believe that my patients were so sick with so many infections, so many environmental toxicants, mast activation syndrome flaring, autoimmune disorders. They get the vaccine, they get COVID, they’re fine.

Kelly McCann, M.D.

Yes, because they’re being treated, right?

Nafysa Parpia, N.D.

‘Cause they’re being treated, cause they’re being treated.

Kelly McCann, M.D.

Yeah.

Nafysa Parpia, N.D.

Yeah.

Kelly McCann, M.D.

So, word the wise, go find a good functional integrative medicine doctor who knows chronic illness, and get yourself checked out. Even if you’re feeling okay. I mean,

Nafysa Parpia, N.D.

That’s right.

Kelly McCann, M.D.

I don’t know.

Nafysa Parpia, N.D.

I have goosebumps as we’re talking right now. I look down like whoa. We’re all standing at the edge of the cliff right now. That’s the thing. We’re all there because we’re in a global trauma, we’re in a global pandemic. We’re all there. So we need to, you know.

Kelly McCann, M.D.

Do all the things that we can do to bolster our immune systems and reduce our inflammation and reduce our exposures, yeah. This is obviously things that have not been talked about in the wide media. Like we should be eating really healthy, cleaning up our diet, losing weight, exercising, getting good sleep among all of those things, that we know as practitioners to recommend to our patients. And then hopefully our broader audience will start to be taking stock of, and really implementing is eating organic, eating grass fed. Avoiding those chemicals as much as possible, making sure that their homes don’t have water damage and leaks. And if they do addressing them, so that the total load is not too great. 

So this is a concept from environmental medicine, where we talk about the total load. And what I mean by that is, everything that we’ve ever been exposed to, from the time that we were born, when mom gave us all of her toxins, all of those things are in our bodies. Whether that mom gave us infections or toxins, and then everything that we’ve been exposed to, up until this moment, is part of our total load. And I like the sink analogy where our bodies are a sink, and the drain and the size of the drain is our capacity for detoxification. And the bigger the drain, the deeper the sink, the more we can handle. But if we have a really shallow sink and a really narrow drain, we can’t handle a whole lot. And those folks are the canaries in the coal mine. When they get too many environmental chemicals, or mold exposures, or infections, they’re gonna overflow. And that overflow is what we’ve been talking about. Mast cell activation, not feeling well, long haul COVID, all of those things.

Nafysa Parpia, N.D.

All of that. And so I think that the shallowness of the sink or the depth of the sink and how large the drain is, has a lot to do with our genes and our environmental triggers. So we can look at people’s genes of detoxification, or genes regarding inflammation, or regarding cognition. And so, it’s like the environment causing certain genes to express as epigenetics. So people do have, I love that analogy of the sink and then drain, because people do come into the world with different sizes sinks and different size of drains. And so then what goes into the sink is also different.

Kelly McCann, M.D.

Right. Right.

Nafysa Parpia, N.D.

The different chemicals. Add that to the genetic predispositions and boom, you have a chronic illness or not.

Kelly McCann, M.D.

Right.

Nafysa Parpia, N.D.

And all of that. Let’s talk about the pentad, tell the audience.

Kelly McCann, M.D.

Okay. So I can’t claim that I came up with this, but other colleagues, including Andy Maxwell, who’s a pediatric cardiologist in Northern California, coined the term pentad. And what was happening was that, my colleagues and I were starting to see that there were conditions that overlapped with mast activation. So people with connective tissue disorders such as hypermobility or Ehlers-Danlos syndrome, have a greater likelihood of developing mast cell activation because of the lax connective tissue. And those folks also tend to have more dysautonomia, it’s a very fancy term. And it really means that the autonomic nervous system, the part of our nervous system that lets us breathe, and not have to think about it, that digests our food, that regulates our temperature, blood pressure, heart rate, that system gets outta balance and outta whack. 

And one of the most common manifestations is what we call POTS, or Postural Orthostatic Tachycardia Syndrome. Where when people go from lying or sitting to standing the heart rate jumps and they don’t feel well. So that’s one form of dysautonomia. There are other forms too, like an inappropriate tachycardia, or orthostatic intolerance. That’s when the blood pressure drops when you stand up. So that’s part of the pentad. And then the other aspects of pentad, which we see really commonly, autoimmune conditions, which is rampant. I probably don’t have to tell your audience about autoimmune conditions, but Hashimoto’s rheumatoid arthritis, lupus, celiac disease, inflammatory bowel disease, et cetera.

So those are your autoimmune conditions, which are really common in the pentad patient. And then lastly, gastroparesis. Excuse me. Gastroparesis is gonna be when the stomach is not appropriately emptying, and so it’s kind of sluggish and that causes a lot of GI symptoms. So that’s the pentad. But on top of the pentad, we also have kind of surrounding conditions, which tend to show up in these folks too. Like leaky gut, like tethered cord, like restless leg syndrome or SIBO, chronic fatigue, menstrual issues, PCOS, anxiety and depression, PANS and PANDAS, things like that. So these clusters, when we think about the pentad patients, it really starts to make a lot of sense. And the literature is just now starting to come online and recognize that there is overlap in many of these patients, 30, 40, 50% overlap in some instances.

Nafysa Parpia, N.D.

I see all the time in our practice.

Kelly McCann, M.D.

Yes.

Nafysa Parpia, N.D.

I mean, the patients have all of these symptoms of the pentad, I’d say 90% of our patients do. And so how do we make this better? The patients might be wondering that, right? Okay. So I have all of this going on. I have pots, I have lax ligaments. I have GI issues, my stomach going empty. I have mast cell activation. Some of them don’t even know these terms, but they might say, those of you listening today, you might not know these terms, but you might say, all right. A food sit in my stomach for a really, really long time. Or sometimes I get these flares of illness. And then I feel like I’m about to sprain my wrist when I’m picking up a frying pan. I can’t even do that. Or my heart starts pounding and I don’t know why. And I’ve been to the cardiologist and the cardiologist says, I’m fine. And everybody says, there’s nothing wrong with me. So, you know.

Kelly McCann, M.D.

How do you start to address, this good question? I believe that there’s a lot of information out there on the internet and can empower themselves. Your listeners can empower themselves to do some more research. But then probably the most important thing that they can do, is find an educated practitioner. Functional medicine doctor, naturopathic doctor, who understands this. Probably not somebody right outta school, because the level of complication, is it requires a practitioner with experience. Somebody who’s been around and seen these patients and taking care of them. Because it is really challenging. Not only to just make the diagnosis, but then to how to move somebody from a place of being very ill to a place of wellness. And that takes a lot of effort. And it’s many moving parts.

Nafysa Parpia, N.D.

Yes. It takes a lot of effort on the part of the doctor.

Kelly McCann, M.D.

And the patient.

Nafysa Parpia, N.D.

Patient.

Kelly McCann, M.D.

Their families.

Nafysa Parpia, N.D.

Yeah. So when we’re treating you for these issues, you’re a moving target. And so your treatment plans need to move with you. We need to watch you like a hawk as we’re treating you. And absolutely the doctor needs to have experienced. Not only that, but even experienced doctors, whether they are naturopathic doctors, or functional medicine trained MDs, we’re not taught this. We’re not taught in medical school, even in IFM, no.

Kelly McCann, M.D.

This is graduate level practitioner work. And so, I can put on a plug for ICI. So we belong to an organization, called the International Society for Environmentally Acquired Illness, ISEAI, ICI for short. And this is an organization that I really received to be graduate level training. Because we recognize that mold and chronic infections and environmental toxicans can all play a role. And as you know, our conferences coming up in May for practitioners, and we are going to be addressing these issues of hypermobility, and mast cell activation, disodernomia. So hopefully if folks are looking for practitioners, they can go to the ICI website, and those practitioners will start to be the ones that you can turn to for help with these complex chronic illnesses.

Nafysa Parpia, N.D.

Yes. So ICI educates practitioners.

Kelly McCann, M.D.

Yes.

Nafysa Parpia, N.D.

Who have an interest. So this really has to be a passion for a doctor to get the extra training, like both you and I have had. Kelly, we’ve done so much outside of medical school to be at this place where we can help these patients. I’m just so honored to be on the board of ICI, where we can help educate newer doctors, or doctors who are seasoned doctors, but newer to this.

Kelly McCann, M.D.

Right? Yes, me too.

Nafysa Parpia, N.D.

Yes. So they can just go to the ICI website, right? To look up doctors who are trained.

Kelly McCann, M.D.

That’s exactly right. Yes.

Nafysa Parpia, N.D.

Right.

Kelly McCann, M.D.

That’s a good resource for your listeners.

Nafysa Parpia, N.D.

Yes.

Kelly McCann, M.D.

So shall we talk about how we might start to work with folks like this?

Nafysa Parpia, N.D.

Let’s talk about it.

Kelly McCann, M.D.

Okay. Well, oftentimes we’re doing things simultaneously. We’re trying to help with addressing the individual symptoms that people have to make them feel better. It’s a really hard and overwhelming to think about having to do detox and killing treatments, and all this other stuff all at one time. So, the practitioners are really working and I work really hard to educate, and simultaneously calm things down. So with our mast cell patients in particular, we can’t dive into treating Lyme or sometimes even mold because they’re so sensitive to things it.

Nafysa Parpia, N.D.

An important topic as people come in, sometimes they might already have a diagnosis of Lyme disease, a lot of them do. And that’s the only thing that’s been diagnosed with. I’ve got Lyme and I’ve been on antibiotics for two or three years, it’s just not working. Can you find another way to treat the Lyme? I just wanna go for it. I just wanna treat the Lyme. And I say, you know what? There’s a reason it’s not been working. It’s because you’re sensitive to everything. You’ve got this immune dysregulation, you’ve got this hyperactive immune system, and a weak and a dampen immune system simultaneously. We’ve gotta calm that down before we can come in and kill the infection. So I know we need to kill those infections, but not right now. So let’s take a step back and prepare you for this. Which is what I think you’re talking about.

Kelly McCann, M.D.

Absolutely. Absolutely. And that preparation looks different for different people, of course. But when we’re talking specifically about mast cell activation, I do find that they’re so sensitive. Sometimes they can’t even take regular pharmaceuticals because they react to the inactive ingredients in the formulations. When we look at the pharmaceutical industry and we look at all the inactive ingredients, there’s a lot of crap in there. And patients will often have adverse reactions. Not to the pharmaceutical itself, but to all of the junk in it.

Nafysa Parpia, N.D.

Yeah, there’s the colors.

Kelly McCann, M.D.

Yes. They call them excipients. There’s oftentimes gluten and dairy and corn derived products in dyes, in those medications. And so sometimes we have to do compounded versions of those, which are much cleaner. And sometimes we even can’t give much. So then that’s where we look at, coming down the limbic system and the amygdala, and working with the vagus nerve. Again, to help bring more regulation to the body. So that it’s not in fight or flight all the time, hypervigilant and reactive.

Nafysa Parpia, N.D.

So I wanna backtrack for a second. So, when talking the audience now, so when we give you. when a doctor like Kelly or I, okay? So not a doctor who’s not seasoned in this, tries to treat your mast cells. I’m saying try, because you might be reacting to even compounded medication from the compounding pharmacy. You might be reacting to herbs. And we know, all right, let’s step back, and we’re gonna treat your nervous system. We’re gonna treat your immune system simultaneously before we can even treat your mast cell or that part of your immune system. We have to treat the nervous system…

Kelly McCann, M.D.

Right?

Nafysa Parpia, N.D.

Acupuncture, it might need mean limbic retraining. It might mean doing Annie Hopper’s DNRS, or Dr. Gupta’s DRNS. It might be working with a healer or a body worker, very simple treatments to calm your nervous system down. And then we’ll come in and we’re gonna give you some herbs, or some compounded medications and see how you do. You might need to take a small amount. But usually once we calm your system down, your nervous system, then you can start to handle the herbs and the medications.

Kelly McCann, M.D.

Right. Right. I have a couple of patients that, they’re often opening up capsules and taking like a quarter or an eighth of the capsule. And they can tolerate that. But if they took the whole capsule, they’d have problems. And so slow and steady is the name of the game with many of these folk. Whether that’s the pharmaceuticals or even the herbs.

Nafysa Parpia, N.D.

Are you finding that more of your sensitive patients are able to tolerate the compounded pharmaceuticals more than herbs the first time around?

Kelly McCann, M.D.

Oftentimes, yes. Yeah.

Nafysa Parpia, N.D.

Me too. 

Kelly McCann, M.D.

Yeah. So I use a lot of compounded antihistamines, and compounded low dose naltrexone. I use that a lot too for people, compounded ketotifen which is only available as a compounded medication, unless it’s an eye drop. And so, yeah, I do like ketotifen and cromolyn for folks. Those single ingredients with no additives and excipients it’s much safer way to go for most mast cell patients.

Nafysa Parpia, N.D.

Right. I love the ketotifen ’cause it stabilizes the mast cells themselves, and the cromolyn is particularly for the gut. But I also see that it helps the gender urinary system a lot as well.

Kelly McCann, M.D.

Right, right. And it’s so interesting because we think we’re just blocking the mast cells. So cromolyn for the audience, the cromolyn is a oral medication that you take that literally acts as a barrier between what you’re ingesting, what you’re eating, and the mast cells which are lining the gastrointestinal tract. And so it’s taken before meals and be before bedtime. And it can absolutely help many GI symptoms. But when the mast cells dump their mediators, the mediators have asystemic effect, meaning the mediators can affect different regions of the body. And so fatigue could get better. Your skin could get better. Brain fog can go away. It’s really fascinating how a local medication that doesn’t really get absorbed, that box mast cells can have systemic effects.

Nafysa Parpia, N.D.

Right. These are the things we see every day. There might not be enough literature on these things, but when we’re talking about what we see in clinic.

Kelly McCann, M.D.

Correct.

Nafysa Parpia, N.D.

Yeah. And I love that you and I see the same things. I mean, it’s more proof.

Kelly McCann, M.D.

More validation that we’re on the right track.

Nafysa Parpia, N.D.

Yes, exactly. So tell me about phosphatidylcholine and how you use it in your practice.

Kelly McCann, M.D.

Sure. So phosphatidylcholine is really not a mast cell stabilizer per say, but it is one of the things that I love for so many things. So if the audience would envision a cell, from cell biology, on the outside of the cell, there are what we call phospholipids. And on the inside of the cell, remember we have that lipid by layer. So on the outside is where phosphatidylcholine lives. And so it’s got a head group and a tail group, and it creates that lipid by layer of every cell in the body. So this is something that we obviously make, because we have to, we have to make our cells. 

And those little tails are mostly omega-3 and omega-6 fatty acids. And when we use phosphatidylcholine as a supplement, it has this regenerative capacity, I think. Because what it’s doing is it’s healing your cells. So here’s my visual that I use with patients. If my pen is a toxin and my fingers are the cell, when you take phosphatidylcholine, it literally pulls out the toxin or infection, or the abnormal cell, and it heals the cell. And so we’re only as healthy as our cells are healthy. So if we take phosphatidylcholine, it starts to allow for better healthier cells.

Nafysa Parpia, N.D.

All the time when you’re talking, because what you’re telling your patient is the same thing I tell mine, I give him the same visual. Here’s a cell, here’s a toxin in the cell, pull it out and it heals the cells. It’s true. Yeah.

Kelly McCann, M.D.

So yeah, love PC. And the thing that’s so amazing about it, is it works for everything. So it works for mold toxins. It works with chronic infections like Lyme disease, and Bartonella and Babesia, which are intracellular infections. And so it’s gonna help heal that. It helps with environmental chemicals, heavy metals. There’s actually literature, that show that it mobilizes heavy metals, which is really cool. And phosphatidylcholine is very prevalent in the mucus membrane. So 90% of the phospholipids in the gastrointestinal tract, are phosphatidylcholine. And so we take it orally. 

We’re really working on healing our GI tracts too. And so many people have leaky gut as a component of their illness. And phosphatidylcholine is really essential for healing that. In fact, there were several studies where they used phosphatidylcholine to heal ulcerative colitis. Now ulcerative colitis would be on the spectrum of leaky gut to inflammatory bowel disease. It’s full on ulcers in the gastrointestinal system. So much more severe form of leaky gut, if you will. And phosphatidylcholine by itself orally, was able to heal the intestinal lining. So cool. And with mast cell activation, I think it’s getting at the roots that are triggering it. And so that’s why I’m using it. So as with everything that we’re talking about, when we start working with our mast cell patients, we start low and slow. 

Maybe I’m using like 16th of a teaspoon every couple of days. And then some people can tolerate it really well and can take several grams a day, which is great. But for those sensitive people, a little teeny, tiny bits, until they’re able to tolerate more is wonderful. And then IV forms of phosphatidylcholine are just magic. Because they bypass the gut. They bypass a lot of the mast cells. I don’t think we have many mast cells right in our veins. So you put them PC right in the veins, and it’s really, really helpful. Particularly for brain fog and our mold patients. So I love phosphatidylcholine.

Nafysa Parpia, N.D.

I do too. Yeah. We use a lot of it. Now some people, when they get phosphatidylcholine it backfires. They’re not able to handle it. So I love it for all the same reasons that you do. I’m sure you see this in your practice as well. What I’m about to explain, but I wanna mention it to the audience. There are people who have phosphatidylcholine. They have a phosphatidylcholine IV for the first time, and they feel worse. They’re exhausted. They just wanna sleep the whole next day or the whole next three days, maybe they get a headache. Why is that? I think of phosphatidylcholine as the paint that goes on the house. So now if we’re gonna paint a house, where the wood is already crumbling and deteriorating, it’s just not gonna work. So we need to sand off that wood first. So phosphatidylcholine and glutathione happens with the same patients that can’t tolerate glutathione. I think of these as the end products of our detoxification pathways. And so a lot of times, we need to shore up these patients’ co-factors of detoxification. They might need minerals first.

Kelly McCann, M.D.

Right.

Nafysa Parpia, N.D.

Because if you don’t have a mineral status that’s adequate, then no matter how much we try to pull metals out of your system, or other toxins out of your system with phosphatidylcholine or glutathione, or even heavy metal chelation agents. Those toxins are just gonna recirculate. So timing is critical. A lot of people may wonder, “You’re talking about it like it’s the best thing on earth. How come it’s not for me?” But that’s why. It just means there’s other steps that we need to take before you’re ready for it. And when you’re ready for it, it’s magic.

Kelly McCann, M.D.

Right. Exactly. Yes. I do see that. Fortunately not everyone has problems with it. The vast majority of people are able to tolerate some form. And so, yeah. Definitely have to go back with those who can’t tolerate it in order to prepare them for it, certainly more recipients involved.

Nafysa Parpia, N.D.

It’s very similar to the people who are not able to tolerate mast cell activation treatment directly. We have to take other steps back, before we can go the place where the patient wants to go, or where we in our heart even wanna go, ’cause we wanna see the patient move quickly through treatment. But sometimes it’s slow. Because we have to do a lot of preparatory work to have you ready for the big guns.

Kelly McCann, M.D.

Exactly.

Nafysa Parpia, N.D.

Yeah. Yeah. Kelly, what do you feel like nobody’s talking about in this subject? What would you like to say that maybe isn’t spoken about enough?

Kelly McCann, M.D.

Gosh, Well, good questions. I do think that we haven’t really touched on EDS, and so we can touch on some hypermobility issues, which is not anything that I learned in any of my, so this isn’t stuff that people talk about at ILADS, which is the International Alignment Associated Diseases Societies, certainly not in Institute of Functional Medicine. And the hypermobility is not really recognized by most of our conventional colleagues either. I had this epiphany one day, I was sitting with a patient, and she has Lyme and we had gotten her mostly better. And she had a lot of like allergies and sensitivities. 

She was allergic to latex. So she couldn’t have latex bras and all that. And she was telling me about, she’s in her seventies, and she was telling me about, how when she had her son, her back went out. And she stood up and she made this motion about how her back went out when she was pregnant. And I was like, “Oh my God, you have EDS.” My thought went off in my head, just the way that she moved. And I could see the laxity in her muscles and joints, and it was astounding. And since that time, and she had had osteoarthritis, she had had two knee replacements at that time. And when we made this discovery, she was able to go back to her family and say, “Hey guys, like, I think we have this.” And it was true. All the family members were hyper mobile. One brother had an aortic aneurysm, the other one had a detached retina. And just all of these things that hadn’t really been identified and pulled together. 

So for her and for our listeners, understanding if you’re hyper mobile, that your joints are more delicate that they need to be protected. That there are ways of moving and exercising, that before all the damage gets done, that we can really help preserve that. So people who can do party tricks with their joints and like put their leg behind their head and things like that, it’s great party tricks, but it sets that person up for, degenerative joint disease and chronic pain. If something happens and they get too much damage, or they move into a moldy building or something like that. So I think that, it’s not just the hypermobility that I wanted to talk about, but really how awareness and education is so critically important for like preventive medicine or not really doing enough preventive medicine.

Nafysa Parpia, N.D.

I agree. And these are the people who love to do yoga, but they might not like to do strength training. And they love their yoga because they’re so good at it, but we need to tell them all right. Also do some strength training to get some stability around joints. Now I bet a lot of them are wondering, wait a second, what is a moldy building or what is getting an infection have to do with my joints? So I wanna stop for a minute and help them understand this. So when we have an infection, it’s not usually one infection, usually it’s a myriad of infections. When we have a toxin, it’s not just one toxin, it’s usually many metals, many other toxicants. 

We measure them, we test for them, we see them. And then we know that this combination of toxins and infections causes inflammation in the body. And circle back to mast cell activation syndrome causes that as well. So mast cells tenderize the ligaments. Inflammatory cytokines are gonna cause inflammation around these ligaments. So you already have lax ligaments and now we’re aggravating them. And that’s when the patient usually walks through our doors. Right, Kelly?

Kelly McCann, M.D.

Right. 

Nafysa Parpia, N.D.

So that’s how the hypermobility piece is connected to everything else we’ve been talking about.

Kelly McCann, M.D.

Yes. I also have this visual in my head, that the steriokits the little organisms, or even the microtoxins, when there’s lax connective tissue. So imagine that our connective tissue is supposed to be tightly woven. And now it’s more lax. Maybe there’s some spaces in there for little organisms and whatnot to infiltrate. And so, they can get into the tissues much more easily than somebody who doesn’t have that lax connective tissue.

Nafysa Parpia, N.D.

You know Lyme loves the connective tissue and the nerves. So all the more, if you have lax ligaments.

Kelly McCann, M.D.

Yeah. And even if people have lax ligaments and not these infections, the microtraumas of repeated actions, of repeated like leg behind the head, kinds of yoga positions will damage those joints. And that leads to osteoarthritis down the line.

Nafysa Parpia, N.D.

Yes. Yeah. Kelly thank you for such a great interview.

Kelly McCann, M.D.

Oh, you’re welcome.

Nafysa Parpia, N.D.

I always have so much fun. Is there anything else you wanna say to the audience before we say goodbye to them?

Kelly McCann, M.D.

I would just encourage you all to stay true to yourself. Know that what you’re experiencing is real. And if you’re not getting the answers that you need, keep seeking the practitioners who will help you out. Because there are practitioners out there and it may take a few and it may take a village, to really figure out some of the more complicated folks, but there are answers out there and there is healing available.

Nafysa Parpia, N.D.

Absolutely. Thank you.

Kelly McCann, M.D.

You’re welcome Nafysa, thank you so much. I had a great time.

Nafysa Parpia, N.D.

Thank you. We’ll talk soon.

Kelly McCann, M.D.

Okay. Bye. Bye.

Nafysa Parpia, N.D.

Bye.