When Food Sensitivities Take Over: The Mast Cell Connection
It seems that in this modern era of genetically modified organisms (GMOs), processed foods, and chemically laden products, there is an astronomical increase in food sensitivities and allergies. Consult any natural or functional medicine practitioner and you are sure to be assessed for food sensitivities/allergies and leaky gut syndrome.
Autoimmune Disease and Leaky Gut
If you have a chronic illness such as autoimmune disease, fibromyalgia, chronic fatigue syndrome, etc., it is likely that you deal with the consequences of leaky gut syndrome on a daily basis. Simply stated, this means that the tight junctions in the small intestine that prevent larger food particles from entering the blood stream have developed leaks. This allows larger food molecules to easily enter the blood stream. While this may sound relatively benign, in fact it is quite troublesome for the immune system. While adept at identifying well-broken-down proteins (as amino acids), carbohydrates (as sugars), and fats (as fatty acids), the immune system does not recognize these larger molecules as the food required for energy production, and consequently tags them for destruction in much the same way your body might attack a bacterial or viral invader.
This means the next time the food is ingested, your body can mount a much faster attack. So your once-beloved food suddenly causes you symptoms that can affect digestion (constipation, diarrhea, acid reflux, gas, bloating), skin (rashes or hives), brain (mood changes, poor concentration), respiratory (congestion, runny nose, sneezing, wheezing) or even metabolic control (blood glucose levels).
For most people with leaky gut syndrome there are only a handful of truly offending foods. While IgG blood tests for various food sensitivities may turn up seemingly large numbers of foods, usually there are only a few that are in the high or even moderate category. By and large we find that the vast majority of IgG antibodies are in the lowest level. This means that the food may be safely eaten when rotated in the diet. It may be safely eaten periodically (often one to three times per week). However, on occasion, I come across someone who has very few foods that are safe. Often these clients may be down to only five to ten foods. The questions are, in this situation, “What caused the problem in the first place?” and “What can and should I eat?”
Mast Cell Activation Syndrome
Mast cells are immune cells used in both allergic and inflammatory reactions. They are located in the skin and mucous membranes so that they may guard the body against the environment and its intruders. They are most well known for their role in allergies and anaphylaxis, where they lose their histamine load, which causes a host of symptoms ranging from minor sniffles or hives to full on anaphylaxis, a potentially life-threatening reaction. Mast cells are also important in wound healing and defense against infection. In some people, however, these mast cells tend to overreact, causing seemingly endless reactions that often do not make sense. These reactions can occur in response to food, drink, chemicals, changes in temperature, hormones, and even exercise. This disorder is called mast cell activation syndrome (MCAS).
A Range of Symptoms
In MCAS there is mast cell hyperactivity that can cause a variety of symptoms and signs that can range from fatigue, fever, weight gain or loss, sinusitis, wheezing, nausea, vomiting, diarrhea, mood disorders, and even anaphylaxis. Most pronounced, however, is the loss of food after food after food. It can happen as a secondary disorder to autoimmune disease or other inflammatory conditions (including leaky gut syndrome). For some people the cause is considered idiopathic, indicating that we do not have a good explanation for why it is occurring. Regardless, what we see is a magnified response to essentially normal stimuli. Contrary to what one would expect, there is no real increase in the amount of mast cells. Rather, the mast cells can either become both more active and produce extra inflammatory mediators, or they are simply more easily triggered to degranulate.
MCAS and Disease
There are numerous diseases associated with mast cell activation including fibromyalgia, irritable bowel syndrome, bladder pain syndrome, interstitial cystitis, chronic prostatitis, burning mouth syndrome, unprovoked anaphylaxis, Kounis syndrome (mast cell activated coronary angina), postural orthostatic tachycardia syndrome, atopic dermatitis, autoimmune disease, drug allergy, chronic fatigue, depression, intractable migraine, rage (explosive disorder), chronic uticaria, rosacea, exercise induced anaphylaxis, autism, some seizure disorders, female sexual dysfunction, polycythemia, and Ehlers-Danlos syndrome.
Signs and symptoms of mast cell disorders include the following:
• Fatigue and weakness
• Environmental sensitivities
• Weight loss or obesity
• Light headedness/faintness
• Difficulty focusing
• Sinusitis and rhinitis
• Canker sores
• Burning mouth pain
• Cough, wheezing, loss of breath
• Increased mucus production
• Tachycardia (fast heart beat)
• Hypotensive episodes (very low blood pressure)
• Non-cardiac chest pain
• Coronary artery vasospasm
• Abdominal pain
• Nausea with or without vomiting
• Acid reflux
• Cramping and bloating
• Enlargement of the liver or spleen
• Bladder pain
• Bone and muscle pain
• Itching, rashes and hives
• Dermatographia (when the skin is lightly scratched, raised wheals, similar to hives, appear)
• Depression, anxiety, and brain fog
Diagnosis and Treatment
MCAS is quite difficult to diagnose as it is not generally found with routine laboratory or radiologic testing. For this reason, patients are often dismissed or prescribed antidepressants. Even if suspected by the practitioner it may be difficult to confirm a MCAD diagnosis. Markers that may help with diagnosis include serum tryptase, serum chromogranin A, plasma heparin, Urinary N-methylhistamine, urinary prostaglandin D2, and urinary leukotriene E4. For this reason, many practitioners will diagnose the disorder if two or more symptoms are present with or without correlating lab tests. The key player in diagnosis is whether or not the treatment is effective.
Ironically, this seemingly complicated disorder has a surprisingly simple treatment plan. H1-blockers like Zyrtec, Claritin, and Allegra, and H2-blockers such as Pepcid or Zantac are the primary medications used for this disorder and they are readily available over-the-counter. Many patients also require Singulair, a leukotriene inhibitor (prescription only) and a mast cell stabilizer such as the prescription Chromolyn Sodium or the supplement quercetin. Epi-pens are also prescribed to those with a history of anaphylaxis.
While medications can certainly help get symptoms under control, it is important to understand that other more functional strategies are important in helping to heal the body. First, helping to heal the gut and improve digestion can help prevent further of the food sensitivities that can contribute to mast cell activation.
Genetically, many people with this disorder have mutations to the enzymes DAO, APB1, or HMNT, all of which help to breakdown histamine. For many, a low-histamine diet can be essential at the onset of this disorder. Foods high in histamine include fermented foods, alcohol, pickled foods, mature cheeses, smoked meats, shell fish, beans, nuts, and wheat. Some foods are considered histamine liberators. These include most citrus fruits, strawberries, cocoa and chocolate, nuts, papaya, beans, tomatoes, wheat germ, and additives (benzoate, sulphites, nitrites, and glutamate). Foods that block diamine oxidase (DAO) can also be problematic and include alcohol, black tea, energy drinks, green tea, and mate tea. Most fresh meats, fruits, vegetables, eggs, grains, cooking oils, herbs, and non-citrus juices are considered to be low in histamine. Other known dietary triggers may include sulfur, gluten, oxylates, salicylates, and lectin.
Working with a practitioner to identify triggers is essential in determining a safe diet. Improving metabolic processes is also helpful. Nutrigenomic analysis can identify mutations to enzymes in methylation, detoxification, transulfation, urea cycle, and mitochondrial pathways, that may, in fact, worsen symptoms. Then, this information can be used to create a unique action plan to improve health.
Jessica Pizano is the owner of Fit to You, LLC, which offers personalized training programs and nutrition/health counseling. Her concentrations include genetics and nutrigenomics, general health and fitness, weight loss, food allergies/sensitivities, autoimmune disease, post-rehabilitative work, training/nutrition for medical conditions, obesity intervention, pre- and post-natal exercise and nutrition, and Pilates. A certified personal trainer and a corrective exercise specialist through the National Academy of Sports Medicine, she is also certified in mat Pilates through PHI Pilates and earned her Clinical Exercise Specialist and Longevity Wellness Specialist through the American Council on Exercise. She completed her training to practice Health Coaching at the Institute for Integrative Nutrition and is certified as a holistic health practitioner through the American Association of Drugless Practitioners. She is completing a master’s degree in human nutrition that emphasizes functional medicine at the University of Bridgeport. Currently, Jessica practices personal training, nutrition counseling, and nutrigenomics in her studio in Avon. She may be contacted at (860) 321-7234 or online at www.fittoyouct.com.