March 21


Mast Cell Book Review

By Sue Ingebretson

March 21, 2017

activation, book review, chronic illness, fibromyalgia, Lawrence Afrin, Mast cell, MCAS, Never Bet Against Occam, treatment

Have you heard of Mast Cell Activation Syndrome – MCAS? The fibromyalgia and chronic illness community can adopt these 8 Key Takeaways from this powerfully crafted book on the subject of MCAS, Never Bet Against Occam, written by Lawrence Afrin, M.D. And, of course, there’s much more to learn.

What is the Occam hypothesis?

You may have heard of the phrase, Occam’s (or Ockham’s) Razor and wondered what it meant. Because it’s about simplification, sometimes it’s used in jest to make light of a heavy subject. In a nutshell, this hypothesis states that when looking for a solution to a problem, the one that’s simple and has the fewest assumptions is probably the one that’s most correct. The important part to understand is that the answer that’s the most obvious is not always the right choice.

Here’s a quick and humorous 1 minute YouTube video  on Occam’s Razor in a bit more detail. (As a bonus, it’s narrated with humor in a posh English accent!)

Why is this hypothesis relevant to chronic illness?

When it comes to chronic illness, the whole process of diagnosis is incredibly frustrating. No one in the chronic illness is surprised by this statement. Most of us could write an encyclopedia with what doctors have told us we DON’T have.

Some of us begged, cried, and pleaded with our doctors for an answer. Others didn’t have to wait as long. But it was an exercise in frustration, nonetheless. The process of seeking, looking, learning, and investigating matters. It counts. It’s this very process that provides solutions. The process of plucking a simple answer from the weeds of confusing symptoms is key.

How does this hypothesis go awry in the medical world?

In medicine (as in other disciplines, too) the intention of the study often re-directs the findings. Here’s a frightening scenario that I’ve come across not once but twice in the recent past. I have close friends who’ve sought medical attention for their out-of-control yeast/candida infections. They were instructed to change their behaviors and told that THEY were causing the problem. (Interestingly, food-related behaviors were never mentioned).

Rather, they were told that they shouldn’t wear jeans, should find the “perfect” cotton and polyester blend for their undergarments, and they should not use seat heaters in their cars!

Here’s why this is interesting.

Both of my friends were on chemotherapy medication protocols.

Chemotherapy drugs specifically target all rapidly reproducing cells – including the stomach and digestive system. Yeast, candida, fungus and similar overgrowth issues are common for those undergoing chemotherapy treatments. The fact that chemotherapy creates dysfunction in gut flora is well understood in the medical community. Chemotherapy and the microbiome.

But rather than discuss this obvious issue, their doctors pointed to extraneous behaviors. Of course, all of the discussed behaviors (and more) have an impact on gut health. But in this instance, it’s the greatest impact that can’t be discounted. One friend – after our discussion – even went back to her doctor to ask about the prescribed medications. He replied that the chemo drugs would not impact her chronic yeast infections as much as her use of seat heaters.

I kid you not.

This is the Occam’s philosophy in action (when it’s not applied). I understand that a doctor feels his course of treatment is primary, but to deny obvious connections to undesirable side-effects, and then point the finger at the patient, is unconscionable in my book.

Speaking of books … now that you understand the Occam hypothesis, let’s dig into Never Bet Against Occam by Dr. Afrin. 

Why did Dr. Afrin write his book?

One thing that’s clear throughout the over 450 pages of this book is that Dr. Afrin cares. Yes, he’s intuitively curious and loves the investigative side of research. But he truly cares about his patients and those who seek out his expertise. This fact leaps from every page.

We should all experience such care.

Dr. Afrin’s obvious intention is to share his discoveries – in clinical detail – so that readers can follow his path. This book is for health professionals who can follow his diagnostic patterns as well as patients who’ll recognize themselves in much of the case study details.

Dr. Afrin began to connect the dots between his patients who had seemingly unrelated symptoms. He looked for commonalities and diagnostic proof. His hypotheses were sometimes met with success and at others, with frustration.

Such is the study of mast cell activation syndrome.

What is Mast Cell Activation?

Mast Cell Activation Syndrome (MCAS) is a type of mast cell disease. Mast cell is an immunological malfunction where “normal” mast cells that are present in most of our body tissues become overactive. This hyper or over-reactivity leads to a myriad of symptoms including many that are familiar to the fibromyalgia community. These include skin issues, breathing issues, digestive dysfunction, heart palpitations, swelling, and more.

Previously, mast cell disease was diagnosed with a narrow set of limited criterion and it was believed to be rare, affecting only a very small number of patients. Dr. Afrin’s research has proven a much more prevalent existence of this syndrome when using improved testing and a widening of the diagnostic criteria.

And, now onto the overview that you’re looking for. I’ve narrowed down the key takeaways from Never Bet Against Occam to the following:

8 Key Mast Cell Book Takeaways

  • Chronic illness in general is heterogeneous, meaning it’s messy and complicated!
  • The body is a complex system of networking signals. And, it’s important to note that these signals may reflect just a small piece of the picture rather than the whole.
  • If your doctor doesn’t ask questions, doesn’t propose options or solutions, or simply doesn’t seem interested in your health history – go find another! (NOTE: Dr. Afrin doesn’t actually say this at all. It’s my personal takeaway after reading hundreds of pages of his meticulous patient documentation notes.)
  • Sometimes the most obvious symptoms (or the ones that bother us the most) aren’t the ones that help medical professionals to arrive at a conclusive diagnosis. It’s therefore important to share everything that’s going on – whether you believe it to be important or not.
  • As with Occam’s hypothesis, the solutions to a chronic illness diagnosis lie in the obvious answers with the fewest assumptions.
  • Don’t skip over the AMAZING APPENDIX. Wow! The plethora of detailed information found in the Appendix is worth the price of the book alone. It’ll be on my shelf as a go to resource for medical terms, laboratory tests, diagnoses, and more.
  • Chronic illness is systemic (affects multiple systems of the body). Symptoms will show up to varying degrees, in gut health, brain function, skin/hair health, eye health, energy levels, immune system function, connective tissue health, and more.
  • MY MOST SURPRISING TAKEAWAY: If lab test results aren’t what you expect – consider them as a clue rather than as the final answer. It was abundantly clear throughout this book that lab results are far from fool-proof. There are patient handling errors, lab handling errors (more than you think!), and even diagnostic errors when labs are assessed. Unfortunately, many lab tests are cost prohibitive not to mention a pain to do. Re-running them is not always practical. It’s a good thing that this book gives a plethora of suggestions of what labs to request and how to optimize your results.

Mast Cell and Fibromyalgia

You may wonder why mast cell activation is discussed in the fibromyalgia and chronic illness community. Confusing and hit or miss symptoms are a hallmark of both conditions. Here are Dr. Afrin’s own words on the subject.

Many patients with mast cell disease have been previously diagnosed with fibromyalgia, raising the possibility that mast cell disease might underlie the condition it at least a portion of the patients who have it. It’s interesting to note that it’s been shown that there are roughly ten times as many mast cells found in random skin biopsies in patients with fibromyalgia as compared to patients without fibromyalgia.

Obviously, there’s much more research to be done.

What’s missing?

While this was in no way the intention of Dr. Afrin’s book, there was little in the way of discussion on the causes of mast cell over reactivity and chronic illness. It’s interesting that Dr. Afrin’s take, in part, is what he calls, a “genetic fragility factor.” In my book, FibroWHYalgia I used a term meant to bring levity to the heavy and depressing subject of the assignment of a chronic illness diagnosis. I called it Systems-Gone-Berserk syndrome.

His approach to root causes focuses on genetics, while mine is on systemic dysfunction. What triggers those root causes is a deeper subject for another day.

As a favorite topic of research, many of my articles and blogs discuss genetics. Even more, I love to explore and expose the positive and encouraging topic of epigenetics. This exciting science points out that while we do bear genetic markers for some health conditions, we also have the greater opportunity to override these tendencies by what we consume, do, experience, and even by what we think.

For more info on this healing topic, check out this ProHealth article entitled, Epigenetics, Fibromyalgia and YOU!

I hope you’ve enjoyed this enthusiastic review and two thumb’s up recommendation of Dr. Afrin’s book, Never Bet Against Occam. I hope you have a better understanding of the powerful meaning behind the title of his book and how that relates to your own healing journey. Be sure to check out the detailed treatment protocols and more from Dr. Afrin.

Have you read this comprehensive and resourceful book? If you or someone you know deals with a confounding collection of symptoms that have yet to be identified, consider reading this book — and then hand it to the doctor!

I’d love to hear what you think. Share your ideas in the comments below. 

  1. Thank you, Sue. You give me a light of hope with your info and reviews. At least I am not looked at as a silly woman any more when I say I have Fibro. Though needs to be more discussion on Polymyalgia as many people are incorrectly diagnosed.

    Ive had Fibromyalgia for 30 years. At this length I am one of few still standing, literally. Today is a day Id really rather get in a ball in a corner and cry. But I wont. I will do my Feldenkrais exercises and then make a healthy lunch. (Rubbish with nibbling extra bits tough, sigh. But like eveyone else, they cheer me up. Maybe I lack Dopamine – my grandmother and my father and my cousin all had Parkinson’s disease.)

    Fyi All the talk about bone soup.. Isnt it bone marrow and gelatine we need? From what Ive read, Fibromyalgia folks lack gelatine in their system. So I have just started trialling this on myself. Not bothering with cooking up bones but whole simply cooking the whole chicken, meat with bones attached in an “enclosed” way, ie casserole, so nothing is lost. The gelatine comes out as expected. Though with leaky gut it is hard to absorb nutrients.

    Sorry! My thank you turned into a big chat. So thanks again for sharing. It is appreciated. Shirley. (Australia)

    1. Shirley – you’re a wealth of knowledge! I hope you give yourself a (gentle) pat on the back for all that you’ve already learned. I can tell that you’re someone who will make great improvements in your health because you’re willing to try new things and give them a chance to work. As you’ve mentioned, bone broths can be very healing – especially for the digestive system. There are also lots of recipes available that use healthy forms of gelatin. It’s great that both of these foods are becoming more readily available too in easier to prepare forms. I hope you keep me posted on your progress and I’m happy to welcome you to this Rebuilding Wellness community.

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