Quick heads up, the Iron WEBINAR is below and ready to view. Remember you can use those for CPD.
In it, we discuss iron deficiency (and the simple test to diagnosis it) without anaemia causing chronic pain, mental health issues, fatigue, low thyroid, restless legs and more.
You can get 50% off any IRON PANEL if you order before next Friday midnight with the code: Goldilocks.
Click it for a direct link 👇️
Or 25% off an ANAEMIA COMPLETE panel, using code: Anaemia.
Click it 👇️
One per person, valid till Friday midnight – get your number
We have talked previously about restless legs, and the four common causes here:
- Vitamin D
- Magnesium/B6
- B12
- Iron
But as I learn and grow as a clinician and stay deep in the literature, I add more layers and depth to my care for patients, so now there is another one – HISTAMINE.
Remember, HISTAMINE is an excitatory molecule, absorbed from food and microbiome into the blood and made by the immune system.
You break it down in the gut and blood via the enzyme DAO, and inside the cell via METHYLATION (HNMT with B12/folate, B6/B2).
Think of it like a bucket, you are always adding more as you need some, and you need a few holes to let it out, or it overflows and causes havoc.
Such as:
And now we know given it’s an EXCITATORY molecule, it could also be involved with restless leg syndrome.
Now at this point, it is worth noting that we don’t really care about restless leg syndrome per se.
Yes, it affects their sleep, which is a big deal and in itself can cause a sustained inflammatory response that can drive a reduction in pain thresholds and increase in stiffness.
But really we are using restless leg syndrome as a proxy for a hyper-excitable peripheral central nervous system that might also mean it is involved in the persistence of pain/amplification and hypersensitivity to existing nociceptive inputs.
It can also explain a plethora of other symptoms, which might also traditionally be viewed as associated, such as anxiety and depression (remember it EXCITES your brain = more thinking) if you use the biopsychosocial model.
Just so we are clear, the diagnosis and correction of the root causes of restless leg syndrome may also result in a reduction of neuroinflammation, a reduction in peripheral and central hypersensitivity, which means the patient’s neuromechanical symptoms that most of them will attend your clinic for, are far more likely to respond to your chiropractic care.
Excess histamine in your system comes in a spectrum.
At the bottom end of the spectrum is histamine intolerance or histamine overload.
Then at the top end, we have Mast Cell Activation Syndrome or MCAS.
Remember, mast cells are the makers of HISTAMINE and, in MCAS, they are “overproducing.”
Though is that by mistake aka they are hyper-sensitive to a stimulus? Or is it appropriate if they have a persistent infection (in the gut) or perceived infection/threat in-situ (like gluten), and it is part of the defense system?
So a useful question is: Do patients with MCAS have higher rates of Restless Leg Syndrome than controls?
RLS was reported in:
- 40.8% of patients with MCAS
- 12.9% of controls
Note that association is not causation, but…that is a big increase of around 400% and, given it’s an EXCITATORY neurotransmitter, it is certainly worth looking at other symptoms that fit or if you have checked and treated for the other causes.
And as ever, we need to see the system as a whole and how it integrates together.
Could iron deficiency (usually without anaemia) which we know 100%, is one cause of restless leg syndrome, be related to histamine overload/MCAS?
There is growing evidence and several biologically plausible mechanisms linking iron deficiency with increased mast cell activity and histamine-related disorders.
In my view, this is one of the more interesting emerging areas of research.
Iron might be a natural regulator of mast cells
One of the strongest pieces of evidence comes from laboratory studies showing that mast cells become more reactive when they are iron deficient.
Mast cells possess iron transporters and appear to sense intracellular iron availability.
When iron availability is low:
- mast cells degranulate more readily
- more histamine is released
- production of inflammatory cytokines increases
Conversely, restoring iron reduces mast cell activation in experimental models.
Note this is not as yet demonstrated in RCT’s with humans, but as ever, we need to become comfortable being uncomfortable.
If in doubt, a trial of DAO x1 with each meal, and x1 before bed, plus Methyl B Hero for 2-4 weeks is a great treatment and a diagnosis.
Plus, ideally, a low/lower histamine diet.
Click here to make more 👇️
Bear in mind also that if a patient comes in already with a histamine intolerance/MCAS diagnosis, iron deficiency symptoms are remarkably similar. So always check with an IRON PANEL for £50 to be sure it is not a missed/misdiagnosis.
