Managing Mast Cell Activation Syndrome (MCAS) Through Diet

Mast Cell Activation Syndrome (MCAS) is a complex and oftentimes misunderstood condition that affects many individuals – approximately 17% of the population.1,2 MCAS presents with a variety of symptoms ranging from mild to severe and affects many different organ systems. Due to the varied presentation of MCAS, treatment is incredibly personalized. In this blog, we will review what MCAS is, some common symptoms, and discuss nutritional strategies to aid in its management. 

 

What is MCAS? 

 

Mast cells are a type of white blood cells. Mast cells play a big role in the immune system, particularly in defending the body against infections and allergic reactions. These cells are especially prevalent where our body interacts with the outside world, such as in the mouth, gut, skin, genitourinary system, and lungs.3 Mast cells can stimulate over a thousand mediators, including histamine, heparin, and other inflammatory factors. When mast cells are working appropriately, they release these factors in situations of anaphylaxis or locally during a bug bite.  Yet, when mast cells become hyperactive, as in MCAS, they over-release these mediators in situations that wouldn’t normally warrant a reaction. This overactivation can lead to a wide range of symptoms across multi-organ systems. 

 

What are symptoms of MCAS?

 

Symptoms of MCAS vary widely person to person. MCAS symptoms tend to get worse with stress, including stress from malnutrition.3 Symptoms involving five or more organ systems, with no other disease process better explaining the symptoms, can be considered indicative of MCAS.1,3 

 

Some symptoms include skin reactions (itching, hives), digestive issues (bloating, diarrhea, nausea), respiratory symptoms (wheezing, coughing), neurological symptoms (headaches, brain fog), and cardiovascular problems (heart palpitations, low blood pressure).1,3 Each person’s presentation, severity, triggers, and subsequently, treatments are unique. 

 

How can nutrition impact MCAS? 

 

Food plays a key role in MCAS because certain foods can either promote or inhibit activation of mast cells. Some individuals with MCAS have food sensitivities that exacerbate symptoms. Considering the symptoms experienced by folks with MCAS vary widely, personalized approaches to nutrition are needed.

 

Consider a low histamine diet 

 

Histamine is one of the mediators released by mast cells. Thus, avoiding high histamine foods can help with symptom management for some individuals.

 

Examples of high-histamine foods include:

  • Fermented dairy, such as cheese, yogurt, sour cream, buttermilk, and kefir
  • Fermented vegetables, such sauerkraut, kimchi, and pickles
  • Fermented or cured meats, such as salami and sausages
  • Fermented soy products, such as tempeh, miso, soy sauce, and natto
  • Fermented grains, such as sourdough bread
  • Kombucha, wine, beer, and champagne
  • Vegetables like tomatoes, eggplant, and spinach
  • Salted, frozen, or canned fish, such as sardines and tuna
  • Vinegar
  • Tomato ketchup

 

Examples of histamine releasing foods include:

  • Citrus fruits (oranges, lemons, grapefruit)
  • Tomatoes
  • Chocolate
  • Spinach 
  • Avocados 

 

Examples of lower-histamine foods include:

  • Fresh meats (chicken, turkey, lamb, and fresh fish)
  • Fresh fruits
  • Gluten free whole grains (quinoa, rice, oats)
  • Fresh vegetables (such as zucchini, carrots, cucumbers, leafy greens)

 

Leftovers can increase histamine levels. Thus, for some folks, leftovers may trigger symptoms. Freshly cooked foods tend to be more tolerable. Pro tip: if you have leftovers, freeze fresh foods and thaw/cook/eat the same day.

 

Identify other food triggers 

 

Because mast cells release over a thousand mediators, only one of which is histamine, some folks may experience other food triggers. These triggers may include food additives (such as sulfites and benzoates) and certain food dyes. Additionally, common food allergens (gluten, dairy, eggs, nuts) can exacerbate MCAS symptoms for some individuals. 

 

A personalized approach to nutrition is necessary for managing MCAS. Working closely with a RD to determine possible triggers, removing the triggers from your diet, and keeping a symptom log can be really helpful. An elimination diet should only be followed under the guidance of a RD to ensure that nutrient needs are able to be met. Additionally, elimination diets are not meant to be followed for the long term, the long term goal is to diversify and liberalize the diet as much as possible, while managing symptoms. 

 

Incorporate more anti-inflammatory and gut-friendly foods

 

Include more anti-inflammatory rich foods, such as:

  • Omega-3 rich foods (salmon, flaxseeds, chia seeds)
  • Herbs and spices, such as turmeric and ginger 
  • Monounsaturated and polyunsaturated fats found in olive oil, avocado, nuts, seeds

 

Include more gut friendly foods, such as:

  • Bone broth (rich in collagen and amino acids to support gut healing
  • Probiotic rich foods – if tolerated, like yogurt and kefir
  • Prebiotic foods – that nourish gut friendly bacteria – onion, garlic, leeks, asparagus 

 

Other lifestyle factors to consider 

 

Considering the role stress plays in activating mast cells, stress management is a key component of managing MCAS. Incorporating stress management into your day to day life is important. Perhaps this includes breathing exercises, getting regular sleep, incorporating joyful movement, journaling, or talking with a trusted friend and/or therapist. 

 

Also, quercetin has been identified as a powerful herbal mast cell stabilizer.4,5 Quercetin is a type of flavonoid, a class of plant compounds known for antioxidant and anti-inflammatory properties. 

Common food sources of quercetin include:

  • Apples
  • Onions (especially red onions)
  • Berries (such as blueberries, blackberries, and cherries)
  • Grapes
  • Leafy greens
  • Broccoli
  • Green tea
  • Capers and olives

Quercetin also comes in supplemental form. As always, consult with your RD and MD prior to beginning a supplement regimen. 

 

Conclusion

 

Nutrition can play a significant role in managing MCAS. While it may take time to pinpoint exactly the approach that works for your body, reducing symptoms and improving quality of life is possible. By paying attention to how food affects your body and adjusting your nutrition approach accordingly, you can take proactive steps towards managing your symptoms. The RD team at Laura Cipullo Whole Nutrition is here to support you in managing MCAS. 

 

References

  1. Afrin LB, Ackerley MB, Bluestein LS, et al. Diagnosis of mast cell activation syndrome: a global “consensus-2.” Diagnosis. 2021;8(2):137-152. doi:10.1515/dx-2020-0005
  2. Akin C. Mast cell activation syndromes. J Allergy Clin Immunol. 2017;140(2):349-355. doi:10.1016/j.jaci.2017.06.007
  3. Gaudiani J. Mast Cell Activation Syndrome (MCAS) & Eating Disorders Blog Part Two: Diagnosing MCAS. July 28, 2022. Accessed January 13, 2025. https://www.gaudianiclinic.com/gaudiani-clinic-blog/2022/7/28/mast-cell-activation-syndrome-mcas-amp-eating-disorders-blog-part-two-diagnosing-mcas
  4. Weng Z, Zhang B, Asadi S, et al. Quercetin is more effective than cromolyn in blocking human mast cell cytokine release and inhibits contact dermatitis and photosensitivity in humans. PloS One. 2012;7(3):e33805. doi:10.1371/journal.pone.0033805
  5. Kaag S, Lorentz A. Effects of Dietary Components on Mast Cells: Possible Use as Nutraceuticals for Allergies? Cells. 2023;12(22):2602. doi:10.3390/cells12222602

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