Living with Mast Cell Activation Syndrome (MCAS) usually results in widespread symptoms that are seemingly unrelated. Unfortunately, most people go many years or even their whole life without a diagnosis.
If you’ve been diagnosed with MCAS or suspect you have this condition, the best course of action is making a series of lifestyle changes and working with your functional medicine doctor. Fortunately, many of the changes are easy to implement and you’ll see the benefits from implementing them fairly quickly.
Try not to get overwhelmed by this list, instead pick one or two items and incorporate them into your routine. Add a few items week by week, and soon enough you’ll have a comprehensive plan that has the potential to significantly improve your symptoms and your quality of life.
1. Adopt a low histamine diet
Avoid leftover foods, alcohol, cured meats, canned fish, pickled and fermented foods, berries, citrus, nuts, chocolate, dairy, yeast, soy sauce, tomatoes, vinegar, and preservatives. A comprehensive guide to a low histamine diet can be found here.
2. Avoid triggers of MCAS (non-food items)
Avoid temperature extremes, mold, emotional stress, insect bites, chemicals in personal products, medications that liberate histamine of block DAO, sodium benzoate (common food preservative), airborne chemicals, smoke, heavy metals and anesthetics.
3. Work on your gut health
Good gut health is a cornerstone of overall wellness and will help you get your MCAS under control. Cut back on food that damages the gut or causes inflammation. Take probiotics and a DAO enzyme (generic name Umbrellux DAO).
4. Stabilize mast cell mediator release
Stabilize mast cell release of histamine with quercetin and vitamin C.
5. Use H1 and H2 blockers every 12 hours
Try using 5 mg of levocetirizine twice daily and 20 mg of famotidine twice daily.
6. Block nighttime histamine release
You can block nighttime histamine release and get a better night’s sleep by taking 0.25 -1 mg of ketotifen or zaditen at night.
7. Treat existing infections
Treat any existing infections to help your body heal and reduce mast cell triggers. Get a thorough examination with your functional medicine doctor and test for any pathogens.
8. Identify and remove toxins and allergens
When you have MCAS, you’ll do your body a world of good by reducing its toxin burden. You can reduce your exposure to toxins in your daily life through cleaning up your personal care products and opting for natural solutions, using natural household cleaners, and removing mercury fillings.
9. Take helpful nutrients
Support your health with important nutrients that assist in treatment. Some of these include vitamin B6, alpha lipoic acid, vitamin C, selenium, omega-3s, N-acetylcysteine, methyl-folate, SAMe, and riboflavin.
10. Add supportive herbs
Take nigella sativa, butterbur, turmeric, ginger, and peppermint to support your MCAS treatment.
11. Get into a routine and stick to it
Try to stick to a routine because your body’s cycles are closely linked to your daily activities. This will also help you get high quality sleep, which is essential to reducing the impact of MCAS on your life.
12. Reduce stress
Stress can activate your mast cells and cause them to release mediators like histamine. Reducing stress is important for anyone living with MCAS.
For a comprehensive guide on Mast Cell Activation Syndrome, you can read my in-depth article, Mast Cell Activation Syndrome and Histamine: When Your Immune System Runs Rampant.
Another great resource for dealing with histamine and MCAS using diet and exercise is through Yasmina Ykelestam at Healing Histamine.
Dr. Bruce Hoffman, MSc, MBChB, FAARM, IFMCP is a Calgary-based Integrative and Functional medicine practitioner. He is the medical director at the Hoffman Centre for Integrative Medicine and The Brain Centre of Alberta specializing in complex medical conditions. He was born in South Africa and obtained his medical degree from the University of Cape Town. He is a certified Functional Medicine Practitioner (IFM), is board certified with a fellowship in anti-aging (hormones) and regenerative medicine (A4M), a certified Shoemaker Mold Treatment Protocol Practitioner (CIRS) and ILADS trained in the treatment of Lyme disease and co-infections. He is the co-author of a recent paper published by Dr. Afrin’s group: Diagnosis of mast cell activation syndrome: a global “consensus-2”. Read more about Dr. Bruce Hoffman.
Hello,
Have had several people tell me to get checked for what they had some kind of mast cell problems.
Havnt yet as thought then if had it, Dr would prescribe something would react to ,but since oesto might be caused by it and have some slight symptoms even when eat better and carefull of environment.
Most anithistamine react to but found Ketotifen at market that rid eye pain and helped feel more brain normal. If take more than twice a week, get sick. Rarely get flu or colds in last 20 yrs, so wonder if anithistamine increases immune system or decreases (so get a cold) immune system.
Have found what helped the most was slowly decreasing oxalaic acid foods,(got worse for a while ).
(now need to keep fingers toes warm as chillblain, trying quick fast exercises for a minute).
I have had continually flaring MCAS for over one year. I’m on all H1&2 blockers, cromolyn, DAO, but quercetin, ketotifen, and vit. C cause cardio/pulmonary reactions. I’ve gone from 162 to 125 lbs. due to limited foods. Next stop: NG tube. I have a doctorate, have been seriously researching all aspects of the syndrome, but I need a MCAS -aware functional medicine specialist in my area: Brandon/TampaBay, FL 33569. Do you have any recommendations? If so, I’d appreciate it. Thank you, and best wishes.
Check into limbic system retraining
I have a doctorate too but not in medicine so check what I say out w your medical doc. or dietician. My biggest qualification is that I’m mother & co-caretaker of my daughter who has MCAS et al. I’d hate to see you have to go to feeding tube. My daughter’s tolerated food is seriously limited too. What has helped her maintain weight is that I make sweet potato & rice flour rotis for her every week, with nothing else added: no salt, spices, or fat. This helps her maintain weight & satisfies hunger. It takes many hours to make the roti, but it’s worth it for her. If you want the recipe, lmk.
Valarie, Im wondering if you were able to find a doctor in FL. Im in NW FL and desperately trying to find someone who treats mast disorders. Id appreciate any info you could provide.
Thank you
Try NAET treatment
Website : http://www.NAET.com
Very informative and specific advice is great!
Thank you!
What foods can I eat to help clear up my gut. So sick right now ,been to ER, 25 times since nov2019.
Hi Pat. Please contact our clinic using our contact page or you can give us a call at 403-206-2333.
This seems to be exactly what is going on with me when I notice the hives and feeling I’m going into anaphylactic shock and I frantically take a Benadryl. This will defiantly help me. Thank you so much 🙏🏻
Thank you! I am glad you were able to find information that may help you seek alternatives.
My trptase level is elevated at 24 the oncologist I was reffered too. Has order a bone marrow biopsy. I’m very worried now. All of my symptoms match up with. Mast Cell activation symptom. Is normal to still need a bone marrow biopsy ?
how did you make out?
This level of tryptase is significantly elevated. I would follow the directives of your oncologist for the time being. Patients with MCAS rarely have elevated serum tryptase to that degree. However, that being said, make sure that you consult with a doctor well versed in MCAS so as to cover all your diagnostic bases.
Thanks, Bruce. Great summary of practical approaches to MCAS.
I generally stay on a low histamine diet and use a probiotic that is formulated for this – Flora Symmetry – quite a different mix of organisms that regular probiotics. It seems to take several months for the probiotics to really take effect. I have been gluten free for 10 years as gluten was definitely a trigger. I use quercetin – Herbs of Gold Quercetin Complex. I having been take probiotics and quercetin morning and night for a few months. I think this regimen has helped a great deal.
I also take fexofenadine 180mg if I eat high histamine foods. I am thinking of taking the fexo morning and night as well. I had sleep apnea (common with MCAS) and using a CPAP machine has helped immensely with cognitive and mood symptoms.
A gluten free low histamine diet is a bit challenging to start with but worth it, I think. Just plain meat, veges and salad really. No spices or sauces except garlic and ginger. Fruits are limited to pears and apples. I eat dairy to counteract the osteoporosis risk with MCAS but suspect my symptoms would be less without it. I still drink wine and eat chocolate sometimes (life is too short..) but not too much and taking a fexo generally controls the skin symptoms.
Good luck everyone. Feeling better is in your hands.
Thank you for sharing your regiment with the community, it is always helpful for others to see how their peers can make their own choices with MCAS. For further information please contact us at the clinic.
This information is so wonderful. I have POTS, MCAS, POVS, Psoriasis, psoriatic arthritis, fibromyalgia, PTSD, Anxiety and Manic Depressive. I’m having some really bad flares and I’m working on eliminating certain foods, cleaners and outdoor triggers. I’m suffering in the skin area and my stomach issues. I’m having major food triggers and I’m getting to the point of not eating much. With all of my illnesses working together and against me, I quit my career of 23 years and I am at home. I filed for disability and I finding that some drs do not understand MCAS. I really appreciate your information. This is easier to understand. MCAS is so confusing. Thank You.
Thank you for taking the time to read this article, I am glad you were able to find this helpful to you and I hope others will be able to use this to help spread understanding of MCAS.