Understanding Mast Cell Activation Syndrome (MCAS)

Our immune system obviously plays a key role in our health, but what happens when it starts doing its job too well? While many may be familiar with autoimmune disease, a lesser-known immune system disorder, Mast Cell Activation Syndrome (MCAS), may affect more people than we realize.

What Is MCAS?

MCAS is a condition marked by overactive mast cells (key players in the immune system) that release too many chemical mediators into the body, causing a wide range of symptoms that can be severe or even life-threatening. And because symptoms can overlap or indicate other types of illness, MCAS can be particularly challenging to diagnose.

When mast cells are working properly, they fight off infection and disease by releasing a chemical mediator, such as histamine, cytokines, prostaglandins, or another of the 100-plus mediators they produce. But in people with MCAS, mast cells release too many mediators, which results in a variety of symptoms—even life-threatening anaphylaxis.

What makes this different than a normal allergic reaction is that MCAS episodes aren’t predictably triggered by something specific, such as pollen or a certain food. Instead, a person with MCAS may notice more frequent flares or episodes during periods of high stress or shifting weather. These are known as idiopathic episodes, meaning the mechanism of their causation is unknown—as in, they’re not caused by a specific allergy or another condition that activates normal mast cell response.

Symptoms and Triggers of MCAS

People with MCAS are at greater risk of experiencing anaphylaxis, which is a severe, life-threatening allergic reaction that can include difficulty breathing or swallowing, facial swelling, and loss of consciousness. However, MCAS episodes don’t necessarily have to be that extreme, and are characterized by one or more symptoms across two or more systems:

Skin: Hives or rash, itching, swelling, and/or flushing

Gastrointestinal: Vomiting, nausea, bloating, diarrhea, abdominal pain, and/or heartburn

Respiratory: Shortness of breath, wheezing, throat or tongue swelling, and/or nasal congestion

Cardiovascular: Rapid heartbeat (tachycardia), palpitations, low blood pressure, fainting, and/or chest tightness

Neurological: Headaches, fatigue, brain fog, muscle or joint pain, numbness or tingling, dizziness, and/or anxiety

As you can see, many of these are common enough symptoms experienced by those without MCAS, which is part of what makes the disease so difficult to diagnose. In order to confirm if you have MCAS, your doctor will run blood tests during flares to look for heightened levels of histamine and serum tryptase (an enzyme stored within mast cells).

MCAS triggers can be unpredictable and change often—what causes a flare one day may do nothing at the next exposure. However, common triggers include:

·      Certain foods

·      Hormonal changes

·      Exercise

·      Changes in weather/temperature

·      Scents, like perfume

·      Stress

·      Medications

·      Insect bites

How a Nutritionist Can Help

Because correctly identifying and formally diagnosing MCAS can be difficult, it is important to keep a diary tracking potential triggers and patterns. While management with medication may also be necessary, many people with MCAS find that certain diets can be helpful in managing symptoms and flares. Here is how I can support you on that journey:

1.     Help you identify food triggers and individual dietary restrictions. Along with tracking non-food triggers, a food diary can help determine if what you eat contributes to flare-ups. An elimination diet is extremely helpful but notoriously challenging to do successfully on your own. Also, dietary needs and restrictions are individual to your MCAS, so it’s important to determine what they are rather than follow an eating plan blindly.

2.     Ensure you maintain good health and nutrition. When a disease requires food restriction, it can be challenging to get enough vital nutrients. Some restrictive “diets” eliminate otherwise healthy foods that can trigger your symptoms. As such, it’s important to determine the foods you can eat so you get enough vitamins, minerals, and macronutrients every day.

3.     Help you eliminate certain non-food triggers through nutrition. If you notice that certain things such as hormonal fluctuations or medications tend to flare your MCAS, we can adjust your foods to level out the hormonal rollercoaster or manage other health issues to minimize dependence on any problematic medications.

4.     Keep you accountable. Following a set of dietary guidelines can be challenging, and when you work with me, I will help keep you on track. After all, following a specific diet only some of the time won’t help you see improvements in your symptoms.

5.     Provide support. MCAS is unpredictable, confusing, and stressful. I will provide a supportive framework to guide you through the tracking, journaling, and dietary experimentation. You don’t have to go it alone!

If you suspect that you may have MCAS, or have been diagnosed and are looking for support, you’ve come to the right place. Even with unpredictable symptoms and episodes, the right nutritional approach has been proven to ease the condition. Don’t spend another minute guessing at relief—schedule a consultation with me today!