What is Mast Cell Disease?
Mast Cell Disease (AKA Mast Cell Activation Syndrome & Systemic mastocytosis) is a rare disorder that causes an excess number of mast cells in your body. Mast cells are a regular part of the immune system that exist in higher concentrations in several areas of the body, including the gut, brain, lungs, eyes & nose, skin, and circulatory system. Mast cells release a chemical called histamine, which you have likely heard of before in terms of allergies. They also release other chemical enzymes such as Tryptase, prostaglandin, & leukotriene.
Histamine is a compound which is released by mast cells in response to injury and in allergic and inflammatory reactions, causing contraction of smooth muscle and dilation of capillaries.This contraction can lead to symptoms such as bloating, loose stool, constipation, nausea, vomiting, headache, brain fog, fatigue, skin rashes, skin swelling, post nasal drip, stuffiness in the ears, nose, and head, and others.
Don’t get us wrong- Histamines, Tryptase, prostaglandins, Leukotrienes and other chemicals released by Mast Cells can be great and come in handy, especially in situations in which damage has occurred and cells need repair. Think of getting a cut on your skin- it’s these chemicals that cause burning to alert you that something needs your attention before the injury/ cut becomes infected.
If you have Mast Cell Disease, you may have experienced many of the symptoms mentioned, which can worsen symptoms of your IBS, IBD, skin conditions, allergic responses, fatigue, and more, affecting your quality of life and ability to enjoy a wide variety of foods. October is Mast Cell Disease Awareness Month as many of these symptoms can become most exacerbated in Fall, when Vitamin D is less abundant in the body, sugar is consumed more frequently in Holiday treats, and the weather is changing, triggering the immune system and increasing mast cell activity and histamine levels in the body.
Though this can be the experience of many, not everyone responds this way to histamines and other chemicals. Think of these chemicals getting dumped into a bucket, some people have an easier time dumping their bucket out, while others struggle to empty the bucket out before it gets too full, too heavy, and starts spilling all over everything around it.
Histamine and its effect on Mast Cell Disease?
The symptoms of Mast Cell Disease are very similar to those of allergic reactions and can lead to inflammation in the body that can cause temporary organ irritation and in some cases, long-term damage. Histamine is a chemical messenger released by cells in response to an allergy and inflammatory reaction to help fight invaders. It is a necessary part of the immune system. Those who suffer from Mast Cell Disease tend to be sensitive to histamine as it can cause a cascade of responses, as previously mentioned.
Where is all this histamine coming from?
Though we often think of histamines coming from flowers blooming and trees shedding leaves as seasons change, histamines can be released into the environment from plant pollen, it is abundantly available in many foods, released by the body in times when adrenaline increases with any physical stress on the body (strenuous exercise, internal or external injury, during flights), during times of extreme mental and emotional stress, and during hormonal changes such as times of the month when estrogen is higher like the week before a menstrual period. Histamine is often higher and moves into the gut more easily in the presence of inflammation in the body in cases of Dysbiosis, Small Intestinal Bacterial Overgrowth (SIBO), Small Intestinal Fungal Overgrowth (SIFO); chemical reactions to toxins, medications, supplements; and synthetic or environmental chemicals, just to name a few.
How is Mast Cell Disease Diagnosed?
Many may have symptoms of histamine intolerance, but may not meet criteria for a Mast cell Disease diagnosis. According to The Mast Cell Disease Society, some ways your care team may diagnose Mast Cell Disease can include:
Testing blood or urine histamine levels
Testing blood or urine Tryptase levels
Testing urine prostaglandin levels
Assessing for one’s positive response to histamine lowering medications
Assessing for an elevated number of Mast Cells during a bladder biopsy during cystoscopy or luminal GI tract biopsy during endoscopy
Assessing for presence of typical skin lesions
Performing a skin biopsy demonstrating characteristic clusters of mast cells
Performing a bone marrow biopsy
Who is at greater risk of Mast Cell Disease?
This is a rare disease that can be found in children or adults and affects men and women equally. Those with the greatest risk are those with the KIT gene mutation. If present in children, it appears within their first year of life.
Complications of Mast Cell Disease?
There can be some long term effects caused by Mast Cell Disease. Complications include anaphylactic reaction, rapid heartbeat, fainting, loss of consciousness, and shock. Blood disorders like anemia and poor blood clotting, peptic ulcer disease, reduced bone density, and possible organ failure.
How can I manage my Mast Cell Disease or Histamine Intolerance?
Though those who suffer from histamine sensitivity, histamine intolerance, and seasonal or situational allergies will benefit from lifestyle changes that can help with Mast Cell Disease, they may not need to be as diligent as those who have been diagnosed with a full-blown Mast Cell Disease. Some of these lifestyle changes that can help decrease symptoms include:
Dietary changes to support your #GoodGut in healing and reducing reactivity to histamines- we’ve outlined main points for you below!
Reducing exposure to sources of excessive histamine release
Consider swapping very high intensity or strenuous exercise with slower, less adrenaline-rasing types for a few months to reduce histamine release.
Swap high intensity cardio for brisk walking or jogging
Swap High Intensity Interval Training (HIIT) with low intensity weight training, pilates, yoga, or Low Intensity Interval Training (LIIT)
Focusing on techniques to help reduce your mental and emotional stress
Reducing exposure to things in the environment that may be driving histamine release, including:
Exposure to mold
Synthetic chemicals, which can act as endocrine disruptors and affect the delicate balance of hormones, especially estrogen
Excessive synthetic pesticides
Things that worsen dysbiosis and further SIBO, SIFO, and IBS symptoms
Supplements
Those with Mast Cell Disease should consider avoiding capsules made with methylcellulose or hemicellulose as they can be made from birch or spruce trees
Medications that can release Mast Cells
Speak with your prescribing provider and pharmacist to identify any that can worsen Mast Cell Disease and Histamine issues as well as those which may help such as Histamine receptor agonists and Cromolyn Sodium
What can I eat to manage my Mast Cell Disease or Histamine Intolerance?
As food can be a source of histamines, it is important for those with Mast Cell Disease to be aware of foods that are high and very high in histamine. This includes:
Aged and dried foods and beverages including alcohol, canned meats and beans, sea vegetables, dried fruits, aged meats, and pickled or fermented foods.
Most dairy and eggs, especially aged dairy
Fruits and vegetables that ripen very quickly and easily, such as those with many small seeds
Fruits and vegetables that need to be very ripe to consume
Foods that contain yeast and other fungi as they naturally release histamine
Foods & substances that are excitatory and can raise adrenaline- caffeine, alcohol, coffee, chocolate, tobacco, MSG
Spices made from small seeds
Some foods to avoid as they can increase the amount of histamine in the body:
Leftovers
Cured meats
Aged cheeses & other dairy
Eggs that are not freshly laid
Alcohol
Pineapple
Strawberries
Tomatoes
Kiwis
Dried fruits- Aged Dates, dried coconut
Aged Dates
Dried Coconut
Sea vegetables- Seaweed, kelp, etc.
Mushrooms and other fungi
Nutritional yeast
Chocolate
Coffee
D-lactate probiotics, which can release additional histamine
Overly ripe avocado
Overly ripe bananas
It is recommended to choose foods that can help with supporting a great gut barrier and structural gut health, those which facilitate gut movement AKA motility, and those that are low histamine. Foods recommended for those with Mast Cell Disease and Histamine Intolerance can include:
Blueberries
Blackberries
Cantaloupe
Honeydew
Plantains
Less ripe bananas
Jicama
Romaine lettuce
Iceberg lettuce
Cucumber
Zucchini
Carrots
Freshly cooked beans (not canned)
Lentil sprouts
Tulsi/Holy Basil tea
Pea shoot
Bitter Melon
Pumpkin seeds
Pumpkins seed tofu (pumfu)
D-lactate free probiotic strains
Regularly including foods in the diet that are a rich source of Di-Amine Oxidase (DAO), the enzyme that supports the breakdown of histamine can help break down histamines, reducing reaction to them, and reduce symptoms of Mast Cell Activation. These include:
Pea shoots/ sprouts
Lentil sprouts
Tulsi Holy Basil tea
Bitter melon
In addition to these foods, it can be valuable to include certain strains of probiotic that do not release additional histamine, and include a DAO supplement to help reduce histamine release.
Some of these specific strains to discuss with your care team can include:
Bifidobacterium infantis
Bifidobacterium bifidum
Bifidobacterium longum
Lactobacillus salivarius
Lactobacillus plantarum
Bifidobacterium lactis
Bifidobacterium breve
Consult with your care team when taking other probiotics as some strains can release histamine into your bloodstream and body.
And finally, including foods, herbs, and compounds that can stabilize Mast Cells, making them less reactive and less likely to spit excess histamine and other compounds into the gut and other affected areas of the body that you can ask your care team about include:
Quercetin
Bromelain
Vitamin D
Omega-3 fatty acids
Stinging Nettle
N-Acetyl Cysteine (NAC)
What Are My Main Takeaways About Mast Cell Disease and Histamines?
Mast Cells are a normal and healthy part of everyone’s immune system.
Mast Cells produce chemicals and compounds to help the immune system. These can include histamine, tryptase, leukotriene, and others.
An excessive number of mast cells can pour an excess amount of these chemicals and compounds into various areas of the body including the gut, brain, lungs, and other areas with mucous membranes such as the eyes, nose, & throat.
There are many lifestyle interventions to help manage Mast Cell Disease and Histamine Intolerance!
Need help navigating the lifestyle components of reducing Mast Cell Activation? Consult with your integrative Rheumatologist and Integrative Registered Dietitian Nutritionist to learn more about additional specifics or reducing Mast Cell Activation.
We love referring our patients to Dr. Micah Yu, an integrative, board certified physician in Rheumatology, Lifestyle Medicine, Internal Medicine, and is versed in Integrative Medicine and Functional Medicine at Dr. Lifestyle.
Need personalized support? Consult with one of the gut specializing Registered Dietitian Nutritionists on the Married to Health team!
References
Cohen, M. (2021). MCAS Diet | Mast-Cell Activation Syndrome. The IBS & Gut Health Clinic. https://ibsguthealthclinic.co.uk/mcas-diet-mast-cell-activation-syndrome/
Comas-Baste, O., Sanchez-Perez, S., Veciana-Nogues, M., Latorre-Moratalla, M., & Vidal-Carou, M. D. C. (2020). Histamine Intolerance: The Current State of the Art. MDPI. https://www.mdpi.com/2218-273X/10/8/1181/htm
(n.d.). Histamine Intolerance: Everything You Need to Know. Seeking Health Optimizing Life. https://education.seekinghealth.com/histamine-intolerance/
Li, Y. J., Li, J., & Dai, C. (2020). The Role of Intestinal Microbiota and Mast Cell in a Rat Model of Visceral Hypersensitivity. Journal of Neurogastroenterology and Motility.
(n.d.). Nutrition. The Mast Cell Disease Society. https://tmsforacure.org/nutrition/
Parrish, C. R., MS, RD (n.d.). Mast Cell Activation Syndrome – What it Is and Isn’t. NUTRITION ISSUES IN GASTROENTEROLOGY. https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2020/06/Mast-Cell-Activation-Syndrome-June-2020.pdf
Stuivenberg, G., Daisley, B., Akouris, P., & Reid, G. (n.d.). In vitro assessment of histamine and lactate production by a multi-strain synbiotic. SpringerLink. https://link.springer.com/article/10.1007/s13197-021-05327-7
Turner, H., MS, RDN (n.d.). The Low Histamine Biphasic Diet. Integrative and functional nutrition Academy. http://www.ifnacademy.com/wp-content/uploads/2015/06/Low-Histamine-Biphasic-Diet-Heidi-Turner-3-slides-per-page-1.pdf