When Cromolyn Sodium Isn’t Enough
Recently I saw a new patient who had been diagnosed with MCAS, where the diagnosis was confirmed with a positive biopsy of the gastric mucosa. The patient was prescribed cromolyn sodium, but unlike most of my patients who have a positive response to the drug, this exacerbated the symptoms in this patient.
What she did respond to was tirzepatide, the GLP-1/GIP peptide that is being used for diabetes mellitus, but also weight loss and is indicated for patients with Obstructive Sleep Apnea.
Recently, rheumatologists are prescribing tirzepatide in micro-doses for patients with rheumatological issues.
For rheumatologists the reason for using tirzepatide is for weight loss. For people who are overweight and have joint issues, weight loss helps alleviate the strain on already overburdened joints, allowing the patient to be more active and have less pain. This is a very important reason, however there are other positive effects of tirzepatide that help not only in rheumatological patients but other patients that are dealing with chronic inflammation.
Tirzepatide has been shown to have many positive effects on inflammation by stabilizing the patient’s metabolic environment and quieting down the body’s overactive immune response, especially to environmental triggers that are unavoidable. One recent study showed that nearly 90% of MCAS patients started on tirzepatide or some other sort of GLP-1 agonist reported improvement in symptoms.
How Tirzepatide Reduces Chronic Inflammation
The mechanisms that help achieve improvement are several. First, it acts as a metabolic stabilizer by evening out sudden spikes and drops in blood glucose levels that may trigger a mast cell response. Second, it smooths out glucose variability by decreasing gastric emptying and improving insulin sensitivity. Third it reduces post meal stress by reducing GI volatility and decreasing glucagon response which would cause a spike in blood sugars.
Tirzepatide is also showing that it can cause downregulation of systemic inflammation. By lowering systemic inflammation the patient is less susceptible to triggers causing mast cell flares.
The key take away from all of this is that tirzepatide helps regulate glucose, and when it comes to managing chronic inflammation strict glucose control is paramount. Next the sugar blues.
