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When Food Sensitivities Take Over: The Mast Cell Connection

March 2, 2015

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
• Fever
• Environmental sensitivities
• Weight loss or obesity
• Light headedness/faintness
• Anaphylaxis
• 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
• Diarrhea
• Abdominal pain
• Nausea with or without vomiting
• Acid reflux
• Malabsorption
• Cramping and bloating
• Enlargement of the liver or spleen
• Bladder pain
• Bone and muscle pain
• Itching, rashes and hives
• Flushing
• Dermatographia (when the skin is lightly scratched, raised wheals, similar to hives, appear)
• Angioedema
• 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.

Dietary Changes

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.

19 Comments

  1. Lisa

    April 24, 2016 at 10:17 pm

    How often have you witnessed someone making a full recovery from vascular ehlers danlos syndrome using your protocol?

  2. Jessica Pizano

    April 25, 2016 at 12:25 pm

    Hi Lisa,
    Vascular Ehlers Danlos is unfortunately a genetic disorder that has no known cure. However, there are many things we can do to help control some of the symptoms, including histamine intolerance and mast cell disorders. It is often quite possible to get symptoms greatly under control allowing for a much improved quality of life. Each case is quite different, but I have certainly seen many who have had significant improvement in symptoms.
    Best,
    Jessica

  3. jenny

    May 3, 2016 at 12:23 pm

    Hi, I’ve had ongoing bladder pain symptoms and was diagnosed with PBS. I then saw a brilliant private doctor who thinks I have MCAD or/and histamine intollerance.I had a carcinoid tumour found at the time of the worst pain (around 6 months ago) and he thinks this is related. I can’t afford to see him again but are there nhs tests for MCAD? Have you ever heard of a carcinoid link before?

    • Jessica Pizano

      May 3, 2016 at 1:10 pm

      Hi Jenny,
      Carcinoid tumors are often related to mast cell disorders. Here is an article that you can pass along to your physician. http://jhoonline.biomedcentral.com/articles/10.1186/1756-8722-4-10

      However, bladder pain issues are also commonly linked to mast cell activation disorders. Often mast cell patients end up with a host of diagnoses before finally having a global mast cell diagnosis that covers all of the symptoms. Typical testing for mast cell disorders include serum histamine, tryptase and heparin within four hours of a reactive period; chromographin A, prostoglandin D2, and serum norepinephrine.

      Best of luck!

  4. Jill

    May 5, 2016 at 4:00 pm

    I just realized I may have mast cell disorder after years of searching for help for my chronic headache. I also have interstital cystitis and a myraid of other symptoms. Any suggestions on where to start? THanks!

    • Jessica Pizano

      May 5, 2016 at 5:22 pm

      Hi Jill,
      Mast cell activation disorders can be very tricky to diagnose. Often a mast cell aware allergist/immunologist or hematologist is the right place to start. They generally look at markers such as serum histamine, heparin and tryptase within four hours of a reactive period. Serum norepinephrine and chromographin A are also often elevated. A 24-hour urinary n-methylhistamine level may also be helpful. If you are looking for a doctor that is an expert on mast cell, Dr. Afrin at the University of Minnesota is the best doctor for MCAD, though he has a very long waiting list. There is also Dr. Castells and Dr. Akin at Brigham and Women’s Hospital in Boston and Dr. Maitland who is in upstate NY (though her first available is in February 2017). If you have a good primary care doctor or allergist that is willing to run testing, I often coordinate care for mast cell patients in my practice. Best of luck!

  5. Kathy

    May 6, 2016 at 4:13 pm

    I have mast cell disorder and presently taling h1,h2, cromolynn,singulair and prednisone. I am followed by an allergist. I also tested positive for small intestinal bacteria overgrowth(Sibo) but can not take the antibiotics. I went to see a naturopath who wants to treat me with activated charcoal and a lactose pill with an antihistamine content .do you think this would be safe

  6. Jessica Pizano

    May 7, 2016 at 10:46 am

    Hi Kathy,
    Witt knowing your mast cell triggers or the exact contents of the supplement, I can offer you a few basic tips. First, try to avoid lots of fillers in the supplements. The cleaner the supplement the less likely you will have a reaction. Similarly, single ingredient supplements work best at first. Also, I often have clients test the supplement mixed in an oil that is tolerated or even water on their skin to see if there is a skin based reaction first. If it goes well then a small amount may be tried internally before increasing the dosage to tolerance. Going slowly is the key. I wish you the best of luck treating your SIBO infection.

  7. Noreen

    May 11, 2016 at 11:39 am

    Dear Jessica
    I live in the U.k and can not find anyone who can advise me on a low histamine diet for my mass cell syndrome,
    Is there any way you could help me with my condition and am happy to pay your costs ?
    I love what you have written on MCS and I feel you could help and guide me online .

  8. Jessica Pizano

    May 12, 2016 at 12:41 pm

    Hi Noreen,
    I believe we have spoken via e-mail already. I am certainly happy to help with your mast cell issues. You can contact me via my web site at http://www.fittoyouct.com.
    Best,
    Jessica

  9. Bridget

    May 14, 2016 at 4:12 pm

    I suspect MCAS or a closely related issue is at the heart of my problems, but it has not been diagnosed. There are no specialists anywhere near where I live. At any rate, I have interstitial cystitis, acne, insomnia, low blood pressure, itching, bloating, rhinitis, food sensitivities…the list goes on (most of which disappeared almost completely during my pregnancy a couple years ago). But my most notable problem is scoliosis. It was diagnosed as adolescent idiopathic scoliosis years ago when I was 13, and I ended up having surgery for it. That’s been over 20 years ago now, but I still deal with back pain and tightness. My recent research indicates inflammation of the connective tissue is likely a central player in scoliosis. I know mast cells are in connective tissue, but I have not found any information linking scoliosis with a mast cell disorder. Do you know of any such research?

    • Jessica Pizano

      May 16, 2016 at 2:28 pm

      Hi Bridget,
      Mast cell activation disorders are closely connected with Ehlers-Danlos syndrome (particularly type III, hypermobility type). This is a connective tissue disorder that often results in scoliosis. There is more information available online via the Ehlers-Danlos Society at http://ehlers-danlos.com/

      Best of luck!
      Best,
      Jessica

  10. Marie

    July 18, 2016 at 6:47 pm

    Hi Jessica, I recently discovered about mast cells disorders and I suddently realized that perhaps this is the cause of my daughter’s as well as my problems. She has been suffering from irritable bowel since young, at some point she was diagnosed with Crohn’s, has malabsorption of vit B12, strange painful cystitis, Hashimoto and when she was very young, had atopic dermatitis. As for myself, I had violent urticary crisis as a child, I am allergic to bee/insect bites, acid reflux, and lately multiple inflammations. Could well be A mast cell disorder that I’ve passed on to my daughter, what do you think? Any practicians in Europe you can recommend?

  11. Jessica Pizano

    July 19, 2016 at 12:52 pm

    Hi Marie,
    I am so sorry to hear that you and your daughter have been struggling. There is a European Registry for doctors of mastocytosis. While not exactly mast cell activation syndrome, this is a good place to start. You can find their website here: http://www.ecnm.net/homepage/

    I wish you the best of luck!

  12. Hannah Mason

    January 7, 2017 at 12:05 pm

    Hello. I have a family member with MCAD who recently was diagnosed with breast cancer. She had a bilateral mastectomy right away, but would like to opt out of chemo and radiation in favor of holistic treatment. She is having a hard time finding a naturopathic dr to work with her because they are unfamiliar with dealing with both cancer and MCAD at the same time. She is already on a strict rotation diet and eats better than anyone I know. Any advice is welcome!

    • Jessica Pizano

      April 6, 2017 at 1:51 pm

      Hi Hannah,
      So sorry for the delay in my response, I am so sorry to hear about the mast cell and cancer that is likely to treat the cancer naturally. I might recommend consulting with a place like Cancer Centers of America. While they are not specific to mast cell, they are used to treating cancer naturally. Best of luck!
      Best,
      Jessica

  13. Trudi Thomae

    April 4, 2017 at 8:05 pm

    Thank you so much for your article.
    When I read mast cell disorder the other day I thought there might be a relation between my sinusitis, bronciectasis and now I.Cystitis.
    Does this sound reasonable? in your list of foods to avoid you do not mention coffee but tea, chocolate and cacao. This would be true from my experience. Did you leave out coffee on purpose?
    Many thanks! Trudi

    • Jessica Pizano

      June 14, 2017 at 8:48 am

      Hi Trudi,
      Yes, certainly all of your symptoms could be connected if you have a mast cell disorder. In terms of coffee, the caffeine can sometimes be a problem but otherwise it is actually a mast cell stabilizer. This is why I have left it off of the list.
      Best,
      Jessica

  14. Tom Rosinski

    June 10, 2017 at 3:54 pm

    Hi Jessica, I love your articles on Mast Cell Activation Disorder. I was diagnosed with MCAD and Prostate Cancer at Mayo Clinic in 2014. The Cancer and Mast Cells interacted and put me into some horrible episodes. I have had most of the symptoms listed above including Angioedema, Anaphylaxis, and many others. I had extremely high prostaglandins D, and norepinephrine. I take aspirin 325, claritin (4 a day), zantac, singulair, advil if anything is starting. I have environmental reactions to; extreme heat, cold, perfume/cleaning fluids, altitudes. I have food sensitivity to aged and smoked meats(beef and pork), processed foods, cured bacon, dried fruits, aged cheeses, some French and Italian wines (high in sulfites), milk, soy sauce, beer, and aged alcohols (Vodka is ok and pinot noir wines). Nuts are up in the air. Strawberries can turn me completely red.

    My question; I would like to test for all of the additives that you listed (benzoate, sulphites, nitrites, and glutamate) I bet I am sensitive or allergic to all of them. What type of tests can I take, and where can you do this?

    The food sensitivities are mostly from trial and error. not from testing, do you have any suggestions

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