QUESTION 1: I have several patients right now who seem to suffer from histamine and mast cell disorders.
Do you start with one supplement at a time. If you do, how long do you have to wait to start the additional supplement. From my understanding the process is to start with methyl B12-> methyl folate-> P-5-P-> Vit C -> Mg -> B1 -> Copper -> B5)

ANSWER 1: Excellent question. No answer works every time. Think of it this way; You have three exit pathways, Acetylation, Methylation and MAO and then Histaminase / DAO. The Methylation/MAO one is most complicated and most fraught with collateral pathway crossover and weird side effects of Tx. The DAO one is usually ignored and in need of a lot of help and the Acetylation one is likely to be plugged up elsewhere. I start with Acetylation support and DAO support and methylate them last (unless you know they tolerate methyl support fine, then add that in. Tx from the outside in (peripheral pathways to more central.)
-B-5 at 500 mg then up to 2-3 grams a day for a while
-P5P at 30-200 mg in the evening
-Mg to bowel tolerance
-Cu at 1-3 mg a day (but usually a GOOD multi trace is BETTER (all pathway co-factors are trace mineral dependent so addiNg them adds to tolerance of Tx and often in the most sensitive I add Trace Mins for 2-4 weeks before many other B-Vits.)
-Vit C at 1- 3 Grams a day

Once that is ok add methylators.

QUESTION 2. How long do you have to wait in between dosing as you taper up from test dose to pharm dose.

ANSWER 2: I let them know to taper up as soon as the feel it won’t aggravate. And tell them if they do aggravate to (a) wait 3 days at the higher dose and then decrease if needed as many aggravations are temporary, and (b) aggravation is part of the process and if they aggravated previously it doesn’t mean they will aggravate always. Usually once collateral pathways are “happy” the aggravation is less.

QUESTION 3. How long do patients need to stay at the pharm dose before moving to maintenance dose?

ANSWER 3: Totally dependent on things like age, list of SNP’s to deal with, and how long to get to Tx response. Generally 3 months to 1 year is what I see. And if they do have SNP’s at particular enzyme pathway “maintenance doses” may be higher no matter what for biological reasons (see webinar #1 in the series mentioned below.)

QUESTION 4. Also- I find that these patients tend to be VERY sensitive to treatment. Specifically, I have one patient is gets very wired from B vitamins- can you suggest how to progress with those more sensitive.

ANSWER 4: They all are sensitive. Two huge factors, aside from the peripheral effects Histamine is a neuro-stimulant and all of these folks act psycho a lot of the time. In the early days I usually have them take some OTC H-1 blocker (non sedating during the day and sedating at night) just to control this a bit, unless they are already on one. They have to be on the supps long enough for them to work! The other factor “wired from B-Vitamins” is common in about 50-75% of them. It is never “b-vitamins” but rather specific B vits that push pathways they are unready for and cause hyper-excitation. [That is a topic of the many genomic-methylation classes, and the whole topic of the next two webinars this month and next – Webinar]

Another huge issue is Histamine is largely made in the gut and those who can’t reduce it often have or develop gut dysbiosis and more histamine all the time. I have seen total serim IgE for example drop by 50-75% with proper gut clearing. SO never leave the gut out of the Tx equation in these cases.

Here is an excerpt from my patient handout on this type of Tx: “Your body, its history of trauma, stressors and insults is unique from any other human. The way your body creates symptoms (or does not create symptoms) is unique to you and everything your body has experienced. So the fact that two people have the same “SNP” is helpful to the point of the biochemical support we may employ but can be less relevant to the intensity and order in which we support you as a whole person. Given the genetic SNP reports and your history a large part of what we have to do is support your system where there are breakdowns one “layer” at a time. If we do not do this in a particular order your system will have different reactions than desired. Please note that as we introduce support nutrients it is common to have odd and even apparently negative reactions. It is typical to want to stop what you are taking when this happens, but that is the opposite of what needs to happen. Nothing you take will cause you danger – so please continue to take as prescribed the supplements listed in the doses and timing listed below.
Throughout this process the doses or even the agents may need to be adjusted or changed after enough time has elapsed. The other phenomenon is the idea of the following progression:
(1) Test Dose
(2) Repletion Dose
(3) Maintenance Dose.

There is no one size fits all but this progression is the most tolerated and helpful in the long run. Obviously periodic follow up and reassessment is required!

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