15 November 2016

Mast Cell Activation Syndrome (MCAS): When Histamine Goes Haywire...

Mast Cell Activation Syndrome (MCAS): When Histamine Goes Haywire...

Mast cells are present in most tissues throughout the human body, especially connective tissue, skin, intestinal lining cardiovascular system, nervous system, and reproductive organs. They are part of the allergic response designed to protect us from threat and injury.  When the body is exposed to a perceived threat, the mast cells secrete chemical mediators, such as histamine, interleukins, prostaglandins, cytokines, chemokine and various other chemicals stored in the cytoplasm of the cell.  These chemical messengers produce both local and systemic effects, such as increased permeability of blood vessels (inflammation and swelling), contraction of smooth muscle (stomach cramps and heart palpitations), and increase mucous production (congestion, sneezing, etc).   Historically, we thought of mast cells only in relation to an allergic or anaphylactic response.  We now know they play a profound role in immune activation, development of autoimmunity and many other disorders, such as POTS (postural orthostatic tachycardia syndrome).  Sadly we are seeing a large increase in patients presenting with mast cell disorders and MCAS.  I believe it is in part do to the onslaught of more pervasive environmental toxins, molds and chemicals.
Withouts mast cells, we would not be able to heal from a wound.  They protect us from injury and help the body to heal.  Unforunately, overactive mast cells can cause a variety of serious symptoms.

Symptoms of overactive mast cells may include:

  • skin rashes/hives
  • swelling/edema
  • flushing
  • itching
  • abdominal pain
  • nausea/vomiting
  • diarrhea
  • wheezing
  • shortness of breath
  • heart palpitations
  • anxiety, difficulty concentrating
  • headaches
  • brain fog
  • low blood pressure
  • fatigue
Mast cell activation syndrome (MCAS) is a condition symptoms involving the skin, gastrointestinal, cardiovascular, respiratory, and neurologic systems. It can be classified into primary (clonal proliferation or mastocytosis), secondary (due to a specific stimulus), and idiopathic (no identifiable cause). Proposed criteria for the diagnosis of MCAS included episodic symptoms consistent with mast cell mediator release affecting two or more organ systems with hives, swelling, flushing, nausea, vomiting, diarrhea, abdominal pain, low blood pressure, fainting, heart palpitations, wheezing, red eyes, itching, and/or nasal congestion.  For a diagram of all of the varied symptoms histamine can cause, click here.

Triggers may be medications, foods, supplements, hormones, opioids, stressors (physical or emotional), cold temperature, heat, pressure, noxious odors, chemicals, insect bites, trauma or environmental toxins.

We commonly see mast cell activation syndromes associated with CIRS (chronic inflammatory response syndrome) in response to biotoxins, such as mold, inflammagens, and lyme-related toxins.


Low MSH and Mast Cell Disorders?

As mentioned above, we frequently see histamine intolerance and MCAS in patients with mold-related CIRS (chronic inflammatory response syndrome).  It is interesting to note that a common finding in CIRS is low MSH.  According to this study in the Journal of Investigative Dermatology, alpha-MSH plays an immunomodulatory role during inflammatory and allergic reactions of the skin.  In addition, there is evidence that MSH induces mast-cell apoptosis (cell death).


Definition of Mast Cell Activation Syndrome (MCAS)

  1. Typical clinical symptoms as listed above
  2. Increase in serum tryptase level or an increase in other mast cell derived mediators, such as histamine or prostaglandins (PGD2), or their urinary metabolites,
  3. Response of symptoms to treatment
Mast cells can be activated by both direct and indirect mechanisms as a result of exposure of the host to pathogens.

Diseases Associated with Mast Cell Activation Syndrome (MCAS)

  • Allergies and Asthma
  • Autism
  • Autoimmune diseases (Hashimoto's thyroiditis,  systemic lupus, multiple sclerosis, bullous pemphigoid, rheumatoid arthritis and others.Eczema
  • Celiac Disease
  • Chronic Fatigue Syndrome
  • CIRS (chronic inflammatory response syndrome)
  • Eosinophilic Esophagitis
  • Fibromyalgia
  • Food Allergy and Intolerances
  • Gastroesophageal reflux (GERD)
  • Infertility (mast cells in endometrium may contribute to endometriosis)
  • Interstitial Cystitis
  • Irritable Bowel Syndrome (IBS)
  • Migraine Headaches
  • Mood disorders - anxiety, depression, and insomnia
  • Multiple Chemical Sensitivities
  • POTS (postural orthostatic hypotension)
Mast cells are known to be the primary responders in allergic reactions, orchestrating strong responses to minute amounts of allergens. Several recent observations indicate that they may also have a key role in coordinating the early phases of autoimmune diseases, particularly those involving auto-antibodies.

Lab Tests for Mast Cell Activation Syndrome (MCAS)

  • Lab tests specific to mast cell activation for suspected MCAS may include:
    • Serum tryptase (most famous mast cell mediator)
    • Serum chromogranin A
    • Plasma histamine
    • Plasma PGD2 (chilled)
    • Plasma heparin (chilled)
    • Urine for PGD2 (chilled)
    • PGF2a
    • N-methylhistamine
  • Tryptase is the most famous mast cell mediator. Serum tryptase value is usually normal in MCAS patients, but sometimes it is elevated.  Tryptase values that show an increase of 20% + 2 ng/ml above the baseline level are considered diagnostic for MCAS.
  • Chromogranin A is a heat-stable mast cell mediator.  High levels can suggest MCAS, but other sources must first be ruled out, such as heart failure, renal insufficiency, neuroendocrine tumors and proton pump inhibitor (PPI) use.
  • Heparin is a very sensitive and specific marker of mast cell activation.  However, due to its quick metabolism in the body, it is very difficult to measure reliably.
  • N-methylhistamine is usually measured in a 24 hour urine test to account for the variability in release over the course of the day.
  • Prostaglandin D2 is produced by several other cell types, but mast cell release is responsible for the dominant amount found in the body.  PGD2 is less stable than histamine and metabolized completely in 30 minutes.
  • Other less specific mast cell mediators that are sometimes abnormal in MCAS patients include Factor VIII, plasma free norepinephrine, tumor necrosis factor alpha, and interleukin-6.


Treatments to reduce MCAS symptoms and lower histamine

  • H1 Blockers
    1. hydroxyzine, doxepine, diphenhydramine, cetirizine, loratadine, fexofenadine
  • H2 Blockers
    1. Famotidine (Pepcid, Pepcid AC)
    2. Cimetidine (Tagamet, Tagamet HB)
    3. Ranitidine (Zantac)
  • Leukotriene inhibitors
    1. Montelukast (Singulair)
    2. Zafirlukast (Accolate)
  • Mast cell stabilizers -
    1. Cromolyn
    2. Ketotifen
    3. Hyroxyurea
  • Tyrosine kinase inhibitors - imatinib
  • Natural anti-histamines and mast-cell stabilizers
    • Ascorbic Acid
    • Quercetin
    • Vitamin B6 (pyridoxal-5-phosphate)
    • Omega-3 fatty acids (fish oil, krill oil)
    • Alpha Lipoic Acid
    • N-acetylcysteine (NAC)
    • Methylation donors (SAMe, B12, methyl-folate, riboflavin)
  • Certain probiotics decrease histamine production
    • Lactobacillus rhamnosus and bifidobacter species 
  • DAO Enzymes with meals - Xymogen HistDAO or Histamine
  • Decrease consumption of high histamine foods (more on histamine-restricted diet)
    • Avoid alcoholic beverages
    • Avoid raw and cured sausage products such as salami.
    • Avoid processed or smoked fish products. Use freshly caught seafood instead.
    • Avoid pickles
    • Avoid citrus fruits.
    • Avoid chocolate
    • Avoid nuts
    • Avoid products made with yeast and yeast extracts
    • Avoid soy sauce and fermented soy products
    • Avoid black tea and instant coffee
    • Avoid aged cheese
    • Avoid spinach in large quantities
    • Avoid tomatoes, ketchup and tomato sauces
    • Avoid artificial food colorings & preservatives
    • Avoid certain spices: cinnamon, chili powder, cloves, anise, nutmeg, curry powder, cayenne pepper

Specific Symptom Treatment in MCAS

  • Headache⇒ paracetamol; metamizole; flupirtine
  • Diarrhea⇒ colestyramine; nystatin; montelukast; ondansetron
  • Colicky abdominal pain ⇒ metamizole; butylscopolamine
  • Nausea⇒ metoclopramide; dimenhydrinate; 5-HT3 receptor inhibitors; icatibant
  • Respiratory symptoms (mainly increased production of viscous mucus and obstruction with compulsive throat clearing) ⇒ montelukast; acute: short-acting albuterol
  • Gastric complaints⇒ proton pump inhibitors
  • Osteoporosis, bone pain⇒ biphosphonates, Vitamin D plus calcium
  • Non-cardiac chest pain⇒  H2-histamine receptor antagonist; proton pump inhibitors
  • Tachycardia⇒ verapamil; AT1-receptor antagonists; ivabradin
  • Neuropathies ⇒ a-lipoic acid
  • Interstitial cystitis⇒ pentosan, amphetamines
  • Sleep-onset insomnia/sleep-maintenance insomnia⇒ triazolam/oxazepam
  • Conjunctivitis⇒ preservative-free eye drops with glucocorticoids for brief course
  • Elevated prostaglandin levels, persistant flushing⇒ incremental doses of acetylsalicylic acid (50-350 mg/day; extreme caution because of the possibility to induce mast cell degranulation)


  1. Mast Cell Activation Syndrome, A Review
  2. Mast cell activation disease: a concise practical guide for diagnostic workup and therapeutic options
  3. Presentation, Diagnosis and Management of Mast Cell Activation Syndrome by Dr. Afrin
  4. Histamine and Gut Immune Mucosal Regulation
  5. Dr. Theoharides presents “Mast Cell Disorders”
  6. Diagram of Histamine Symptoms
  7. Mast Cell Aware
  8. A Tale of Two Syndromes
  9. Mold Histamine Connection

08 September 2016

How the Immune System can Control Your Behavior

If someone you love is experiencing depression or finding less pleasure in social activities, you might want to look deeper.   It is quite possible that hidden infection or inflammatory condition may be causing the changes you observe.  Have compassion...there is often more to it than meets the eye.  I have seen many relationships crumble when one person is suffering from immune dysfunction and social isolation and the other does not see the illness for what it really is.

Our immune system is a powerful force inside each one of us!  This protective system is charged with the job of responding to foreign invaders to keep us in optimal health.  Most of us don't think too much about this system until it is not working correctly.  I treat many patients that suffer from overactive or under-active immune systems due to chronic infections, like tick-borne diseases;  toxic exposures, like mold and mycotoxins; or autoimmune diseases, like multiple sclerosis, lupus or Hashimoto's thyroiditis.  Although many patients understand the important role of the immune system in protection and defense, few people know that it also controls our behavior.  A recent study in Nature discussed the role of cytokines activated when the immune system goes on red alert and the connection to social isolation and autistic behaviors.  It's even plausible that changes in immune function may lead to personality changes!

Sickness and Depression

Perhaps no connection has been more studied than that of immune activation and inflammation and the link to depression.  Systemic infections cause the patient to allocate limited resources, conserve energy and prevent spread of infection.  The resulting sickness behavior is common to most infections, including viruses, bacteria and multi-cellular parasitic infections.  There is a broad spectrum of symptoms – fever, nausea, decreased appetite, malaise, fatigue and achiness – all of which may aid in the fight to conserve resources and increase isolation-type behavior.  In animal models we see sickness associated with a decrease in time  seeking interaction with a other animals as a result of diminished motivation for social exploration.  Symptoms of depression appear after pro-inflammatory cytokines are produced by the body or if they are administered experimentally. The fact that inflammation often leads to later depression suggests a cause–effect relationship.  It indicates that immune activation can precipitate depression. Many symptoms of inflammation-induced depression overlap with sickness behaviors, including fatigue, changes in sleep pattern, lack of interest in daily or pleasurable activities (anhedonia), changes in appetite or body mass and unexplained aches and pains

Inflammatory Cytokines and the Brian

A recent article about inflammatory cytokines and brain signaling discussed inflammation and the brain:
When considering the pathological signaling cascades in immunological disorders of the brain, certain cytokines might be considered of key importance, with their presence determining the course of a particular disease. Interleukin-1 (IL-1), IL-6, IL-17, and TNFα are critical for the pathogenesis of inflammation in certain brain disorders. Targeting these cytokines or their receptors can alter the course of several neurological diseases, but the effects may be beneficial or harmful.
We understand from this article that the inflammatory signals of the immune system (cytokines) have a profound effect on the brain.  Many patients battling systemic inflammatory or autoimmune disorders suffer from an "inflamed brain" and all that goes with it... symptoms like depression, anxiety and insomnia.  The role of cytokines on behavior can be summarized by saying that TNFα (sickness and depression) and IL-1β (sickness) alter behavior by direct actions on neurons of the brain.

Gaba may affect the immune system too...

GABA, an inhibitory neurotransmitter in the brain, has a similar inhibitory effect on the immune system. Antigen presenting cells (APCs) of the immune system have gaba receptors and therefore, gaba can directly inhibit the function of these immune cells. What this means is the neurotransmitter from the brain may have a direct inhibitory effect on the body's immune system.  This article on Gaba and the immune system states....Intricate and reciprocal regulatory relationships exist between the nervous system and the immune system, mediated in part by chemical messengers.


Insults to the body, from the outside or from the inside, activate cells of the innate immune system. 

17 June 2016

Seven Reasons a Brain Injury can Destroy Your Gut!

Seven Reasons a Brain Injury Can Destroy Your Gut

According to the CDC, incidence of hospital visits for traumatic brain injury have increased over the past decade.  It is one of the leading causes of disability world-wide.  You may know that the gut and brain are intricately connected but did you know that many people who experience brain trauma often experience resulting gut issues?   The gut problems come from alternations in the gut-brain axis or the communication network between our intestines and our cerebral matter.   When this delicate network is disrupted, it may result in dramatic gastrointestinal dysfunction, chronic pain or even disability.
According to Dr. Kharrazian, there are seven key ways in which traumatic brain injury can alter GI function, each of which may contribute to your chronic gastrointestinal disorders.
  1. Autonomic Dysregulation - this occurs when the autonomic nervous system no longer appropriately  controls things that should come automatically, like heart rate, breathing, and gut motility.   If the system becomes overactive to a sympathetic stimulus the result may trigger a chronic pain loop that is hard to control, leading to abdominal pain.
  2. Disorders of visceral sensing and processing - Visceral sensing is the gut's way of telling the brain what is going on.   Sensations in the gut such as temperature, pH, contractility communicate with the brain to notify the body what is happening in the digestive system.  Disruption of these sensing circuits is one of the main factors implicated in irritable bowel disorders (IBS).  Brain injury often contributes to a broken communication network between gut and brain.
  3. Increase in intestinal permeability (leaky gut) -  After brain  injury the tight junctions that connect the cells that line your gut often become dysfunctional and allow large molecules to enter from the digestive tract into the blood stream.  Normally these tight junctions are protecting you from the large molecules, such as undigested food particles, bacterial parts or other luminal contacts that could cross over into the blood stream.  We know that the increase in intestinal permeability is a key factor in the development of autoimmune diseases, from Hashimoto's thyroiditis to multiple sclerosis.
  4. Compromise of intestinal mucosa - Very commonly after brain injury, there is a compromise in the health of the mucosal lining.  We see this in patients in the Intensive Care Unit (ICU) as well... anytime the body is under massive stress, there is a tendency for the mucosa that lines the gut to atrophy and die.  The changes we see are often immediate and occur within minutes after brain injury, severe trauma or infection.
  5. Breakdown of the blood-brain barrier (BBB) - The BBB, as it is affectionately known, protects your delicate gray matter from outside chemicals and inflammatory agents that may cause problems if allowed to enter.  After a brain injury, this barrier is often compromised, allowing massive inflammatory triggers inside the brain where they do not belong.
  6. Brain Immune Dysfunction  - The Central Nervous System (CNS) controls much of the immune system and the production of inflammatory signaling molecules, like cytokines.  If there is an injury to the signaling mechanism it may contribute to either over-activation or under-activation of the immune system  This can lead to either immune compromise or autoimmune disease, where the body attacks itself.
  7. Impaired gut motility - Sadly we see this as a factor in many disorders such as intestinal dysbiosis and SIBO (small intestinal bacterial overgrowth).   The impairment in smooth muscle contractility of the gut mucosa leads to dysmotility. This dysmotility leads stagnation  and alteration in bowel function and even malabsorption.  Ultimately patients may have very severe symptoms related to this problem of abnormal peristalsis in the gut.
Can see how these many mechanisms of action on the gut after brain injury may contribute to chronic pain and dysfunction, not only in the gut but the immune system as well?  Here's some simple things you can do to ensure you will maintain a healthy gut for life!

So What Can I Do to Maintain a Healthy Gut?

  1. Eat a variety of colorful organic and local produce
  2. Avoid genetically modified foods and glyphosate which contribute to a leaky gut
  3. Take a daily multi-strain probiotic to support your microbiome and immune system
  4. Eat prebiotic-rich fruits and vegetables to feed your healthy gut bugs
  5. Protect your noggin!  Wear a helmet if you are skiing, biking or doing any activity that involves risk of head trauma
  6. Try Restore, my favorite new product to restore gut health and heal tight junctions.  Call Amy at #303-993-7910 if you would like more info....

Although we cannot predict or even prevent a head injury, it's important to realize that if it does happen to you, your gut function may be affected.   Start NOW to take steps to develop a healthy gut microbiome in the meantime!

15 May 2016

Is a Hidden Infection Causing Your Fatigue?

Are you suffering from unrelenting fatigue that doesn't seem to respond to any intervention?  Perhaps you've asked your doctor to check your thyroid function and it came back normal.  Perhaps you've been testing for iron-deficiency anemia this, too, was normal.  Or perhaps you've been told by an integrative medical doctor that your adrenal function is suboptimal.  Maybe what you haven't thought of is the fact that you could be harboring hidden pathogens in your body that are robbing your energy and stealing your steam!
If basic testing fails to reveal a cause of your fatigue, you may want to have your doctor test for occult infection. More sophisticated investigations can reveal the presence of all kinds of pathogens capable of colonizing the body and evading the immune system.  Some of them include: Parvoviruses, HHV6, Epstein-Barr, Cytomegalovirus, Mycoplasma, and Borrelia burgdorferi. Other patients have a history of chronic fungal infections or biotoxin exposure.  A history of chronic mold exposure is a feasible explanation for such symptoms, as is the presence of B. burgdorferi.
Chronic fatigue syndrome is a complicated disorder characterized by extreme fatigue that can't be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn't improve with rest.
Chronic fatigue syndrome has eight official signs and symptoms, plus the central symptom that gives the condition its name:
  • Fatigue
  • Loss of memory or concentration
  • Sore throat
  • Enlarged lymph nodes in your neck or armpits
  • Unexplained muscle pain
  • Pain that moves from one joint to another without swelling or redness
  • Headache of a new type, pattern or severity
  • Unrefreshing sleep
  • Extreme exhaustion lasting more than 24 hours after physical or mental exercise
If you see a good medical detective, a physician trained in functional medicine, they can work with you to test for any of these underlying causes of the fatigue,
A study of 375 patients with apparently no cause for their disabling fatigue revealed pathological stimulation of white blood cells with abnormally elevated patterns of natural helper and natural killer cells, important infection fighting agents in the immune system in 53% of patients.  It showed depleted levels of IgG subclass three in 59% of the study population.  More than 50% had circulating immune complexes and many tested positive for ANA antibodies, usually seen in autoimmune diseases like lupus.

Why is it that some patients who get an infection recover and have no fatigue and others may be colonized with pathogens and suffer from intractable lack of energy?

It appears that part of the answer lies in the genetic polymorphisms or variances in our bodies response to infection and inflammation.  For those who develop severe fatigue in response to toxic exposure, like mold or infection, their immune systems respond more robustly to the threat with massive production of cytokines, like IL-ß1 or TNF-alpha.
Moreover, polymorphisms in TNF-alpha,IL-1β, interferons (IFNs), IL-6, and IL-10, acting together or separately can make the severity and response of immune system more profound in response to infection.  Why does this happen?  Well these pathogens can trigger TLR's (toll-like receptors) by either PAMPs (pathogen-associated molecular patterns) or DAMPs (damage associated molecular patterns).  Activation of the TLRs causes a massive cytokine surge that becomes like a domino-effect and keeps on going unrelenting in susceptible individuals, contributing to the inflammation, depression and fatigue.  This vicious cycle of pro-inflammatory cytokines that continue to trigger more inflammation and amplify the cycle, leading to more damage and inflammation.
The initial infection followed by chronic inflammation of the immune system could explain the cause of fatigue in these genetically susceptible individuals.  Some patients also suffer from cognitive dysfunction, memory loss, or brain fog as well.

What are some common hidden infections that may be causing your fatigue?

  • Epstein Barr Virus (EBV)
  • Cytomegalovirus (CMV)
  • Human Herpes Virus (HHV-6)
  • Parvovirus (Parvo B19)
  • Mycoplasma sp.
  • Borrelia Burgdorferi
  • Chronic mold and mycotoxin exposure
Chronic fatigue syndrome is just a label.  It's useful to identify a group of symptoms that causes significant fatigue and may affect one's life dramatically causing inability to function or hold a job. It does not represent one clincial entity but the cause may be multi-factorial and different in each individual.  It may share a final common pathway of dysfunctional immune activation and inflammation that keeps on going in a self perpetuating manner (like the Energizer Bunny gone bad!)  From a functional medicine perspective it's important to get to the root cause of the chronic fatigue symptoms and cognitive impairment.   Most of these infections, including the inflammatory response (CIRS) to mold and mycotoxins can be measured by ordering conventional lab testing through a knowledgable practitioner.  Ask your doctor to see if he can help you determine the root cause of your fatigue.  Treating the root cause (or infection in this case) just might give you back your life!


  1. The Putative Role of Viruses, Bacteria, and Chronic Fungal Biotoxin Exposure in the Genesis of Intractable Fatigue Accompanied by Cognitive and Physical Disability
  2. A narrative review on the similarities and dissimilarities between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and sickness behavior

17 January 2016

Have you been feeling the pressure to make New Year's Resolutions that you know you won't keep? It's the beginning of another year... a blank canvas on which to write out all your dreams and goals. You may be reminiscing about all the wonderful things last year held for you or perhaps recalling some great loss or regret as well.

This year instead of loading on more pressure and setting yourself up for failure with insurmountable goals that you know you won't achieve, I'm sharing a simple list of eight habits that form the foundation of success for me. If you commit to doing them daily for just thirty days, they may become habits for you, too. Believe it or not, it's really the small daily habits that have the ability to transform your life into what you've always dreamed it could be!

Eight Habits that Changed My Life

  1. Show Kindness: Be kind to everyone you come in contact with, from your boss to your barista. Simply appreciate others for who they are, not what you would like them to be or what they can do for you. Find surprising ways to bless others with a unexpected tip or word of encouragement. Put aside your personal agenda and look at interruptions in your day as opportunities to serve others. Bob Goff reminds us how in one of my favorite books, Love Does.
  2. First things First: Do your most important tasks first thing in the morning. Start with an intention and prayer and then move on to the tasks that matter most. Don't get caught in the urgent by default like most people do. Be deliberate instead of just responding to the crises that come your way. The classic book by Steven Covey is a great place to start if you want to learn more.
  3. Say No: Stop saying "yes" to every request that comes your way. Practice saying "let me think about it" before an automatic yes comes from your lips. I like to process important decisions for at least twenty-four hours and sleep on it before committing. Agree to only what is in line with your main mission. What is your mission? Define what you enjoy the most and do the best and then stick to it. Need help defining it? Read Essentialism... it may change your life!
  4. Recharge: Go to bed every night with enough time to get eight hours of sleep and wake up refreshed, preferably early. I am usually in bed by 9pm and will even say no to events that require me to be up past my bedtime as I know it will affect my productivity the following day. It's a standing joke that I may decline an invitation because "it's past my bedtime" but I always wake up refreshed without an alarm at 5am and my most productive, undisturbed hours are before the rest of the world awakes.
  5. Move: Make time for activity every day. Try something new....free weights in the morning, yoga at lunch or a leisurely stroll in the evening. Better yet, grab a friend or your spouse and enjoy great company and conversation while you work-out. My husband and I often jog in the mornings. On the way home, we walk and talk, discussing our plans and praying for our day.
  6. Enjoy! Find joy in simple things that don't cost you anything at all... a gorgeous sunrise, the sensation of cool grass on your bare feet, a snowflake on your tongue, playing fetch with your puppy, the gentle touch of a loved one, or the smile of a stranger. Many of the things that make our life most satisfying are free!
  7. Eliminate! Get rid of what no longer serves you... make a habit of cleaning out closets and other spaces in your home. Without intervention, junk accumulates and wastes our precious brain power and energy. Don't be afraid to give things away, especially things of value. There is no greater joy than sharing what God has blessed you with. This practice will ultimately free you from reliance on material things in your life, too. Need motivation? Check out the Life-Changing Magic of Tidying Up.
  8. Practice Gratitude: Perhaps the most powerful habit is gratitude... Be grateful every day and make it a habit, like brushing your teeth. Before you fall asleep, list at least three things you are grateful for every single day. Did you know that the two qualities most predictive of life-long happiness are gratitude and life-long learning? (If the title of this article was "Nine Habits", the next one would be commit to life-long learning so you get a freebie :-) )

None of these things are difficult but they require a change in mindset. Philippians 4:8 sums it up nicely, "Finally, brothers and sisters, whatever is true, whatever is worthy of respect, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if something is excellent or praiseworthy, think about these things." 

Wishing you the BEST year ever!