Let’s take a close look at histamine intolerance and mast cell activation issues. They occur with variable degrees, types and severity of signs and symptoms and anywhere along the continuum from functionally mild to pathologically severe. In fact, it may be quite useful to think of a “spectrum” when addressing histamine intolerance and/or mast cell issues. Though histamine intolerance can be seen as an integral part of mast cell activation conditions, I’m leaving the question open here, making room for the possibility that the two issues may, at times, be distinct.
A few histamine & mast cell caveats
As a functional nutritional therapist, I don’t diagnose or treat medical conditions. Rather, I help my clients, whether diagnosed or not, address their functional health struggles with individualized nutrition and lifestyle plans. Also, please note that the information in this post doesn’t aim to imply a diagnosis.
Additionally, this post doesn’t intend in any way to criticize the scientific or lay literature on histamine intolerance, mast cell activation syndrome, mast cell activation disorder, mastocytosis, etc. Rather, my aim is to present a complementary perspective for those seeking a dynamic, practical and actionable approach.
That being said, one common misconception regarding MCAS/MCAD, in particular, is that if you do have it, it is extreme and permanent. And if that doesn’t apply to you, then you’re in the clear all the time, and none of the information in the MCAS/MCAD world applies to you.
However, in my experience, signs and symptoms can wax and wane depending on the situation. There are probably some genetic and/or congenital factors beyond our control that we can’t influence. Additionally, there are also environmental, lifestyle, functional health, nutrition, emotional, geographical, seasonal, and other modifiable factors that may provide more leeway than we might think.
I’m not in any way implying that if you or someone you know has grave and intractable symptoms, you/they are somehow doing something wrong or otherwise at fault! Believe me, I know that some genetic or other uncontrollable factors leave little room for improvement. Furthermore, we can’t always clearly pinpoint what makes things better or worse.
Here are some good resources to learn the basics about histamine and mast cell activation issues:
http://mastcellmaster.com/research.php
http://ohtwist.com/what-is-mcad
https://www.mastattack.org/ and, in particular, https://www.mastattack.org/tag/diagnosis/
https://mentalfloss.com/article/87506/one-gene-mutation-links-three-mysterious-debilitating-diseases
Mast Cell Interactions in Health and Disease
The Curious Link Between Estrogen and Mast Cells and Histamine
What tests are helpful in screening for histamine and mast cell issues?
It depends on what you have going on. But generally speaking, the markers I Iike to see include: whole blood histamine, serum tryptase and chromogranin A levels. Frequently, I like to see serum copper, serum ceruloplasmin and plasma zinc. Depending on what my client has going on, I may recommend asking their doctor for additional testing.
Keep in mind, however, that these markers can increase or decrease over time and, to some extent, are just a snapshot of what’s happening in the moment. In other words, the better you are controlling the situation, the more likely you are to get in-range readings, even with a history of mast cell activation and/or histamine issues.
The implications of your test results definitely change based on what, if anything, you’re doing on a regular basis to limit your triggers and control symptoms. Make sure you check with your health care practitioner(s) prior to your blood draw regarding whether you need to discontinue medications and/or supplements temporarily for more accurate results.
I think I have histamine intolerance and/or mast cell activation. Now what?
We can definitely address suspected MCAS on an as-if basis. Usually, this involves mast cell stabilizers and a nutrition and supplement regimen that helps limit exogenous histamine while at the same helping break down endogenous histamine. There are many mast cell stabilizers, and some people benefit from a combination.
Nutritional strategies
Oh, nutrition for mast cell and histamine issues! There’s a lot of very good and very complicated stuff online. Try not to get too lost in that just yet. Your diet may end up getting super-restricted without conferring sufficient symptom relief. There is no substitute for bio-individual, client-centered nutrition if you want the best results with the least restriction and stress! If this sounds good, we should talk!
When I work with clients with histamine and/or mast cell issues, we generally start with baby steps, removing major inflammatory, immune and gut stressors, aged and fermented foods, as well as most fish products. We make additional changes, if needed, as we go. Unnecessarily complicating the diet can aggravate all kinds of symptoms by adding to the overall stress load.
I individualize my work with each client, addressing the issue from a multi-faceted perspective, interweaving these five points:
- What environmental factors may be contributing to this response?
- What emotional factors may be contributing to this response?
- What microbial factors may be contributing to this response?
- What supplements can help dampen this response?
- What nutritional tweaks (not so much restrictions, but adjustments) can be supportive?
Whole foods, herbs, and whole-food supplements help stabilize mast cell activity
The good news is that vitamin C is a mast cell stabilizer. But the bad news is that some people have a hard time with high-dose ascorbic acid. Yes, most people do best on whole-food vitamin C supplements. Generally speaking, I recommend avoiding blends of many different ingredients if you have a number of allergic triggers. Instead, try single whole-food sources of concentrated vitamin C.
These include rose hips, acerola, camu camu, Douglas fir and others. If you’re allergic to any of the ingredients or their source foods, keep on looking!
Additionally, you can try adding ginger, which has some mast-cell stabilizing properties.
Stinging nettles are high in quercetin, and some people with histamine and/or mast cell issues benefit from drinking stinging nettle tea and using nettles as a regular ingredient in their normal cooking. You can make nettle soup, nettle pesto, sautéed nettles and more. However, if you gather your own nettles, make sure you use gloves while picking and prepping! They lose their sting when you dry or cook them, but there’s a reason why the term urticaria derives from urtica, which is the Latin for nettles!
Another mast-cell stabilizing food is chicory root (I love roasted chicory root “coffee,” but it’s essential to get it truly gluten-free. Read the fine print on the label and avoid anything that lists barley or rye in the ingredients, even if the product is labeled as gluten-free!
Chamomile, elderflowers, cinnamon, hibiscus, purple dead nettle, and feverfew also have mast-cell stabilizing properties. However, if you are sensitive or allergic to any of these or have specific contraindications, you’ll need to avoid that herb. For example, feverfew can lower body temperature, so if you tend to run cold, it may not be a great herb for you.
Mast-cell stabilizing supplements
Please note that everyone’s needs are unique. These are the supplements I generally find very helpful. Not everyone needs all of them.
Quercetin can reduce symptoms related to mast cell activation and histamine intolerance. This is an excellent study that reports on its efficacy.
Palmitoylethanolamide (PEA for short). While not very well-known in the US, this potent mast-cell stabilizer, pain reducer and modulator of neuroinflammation is a game-changer for many. Over the past few years, it’s become increasingly easy to source PEA in the US.
You can learn more about naturally occurring mast-cell stabilizing substances in these articles:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764846/
https://www.mastattack.org/2015/09/naturally-occurring-mast-cell-stabilizers-part-1/
Additional helpful supplements
In addition to mast cell stabilizers, you may want to try a probiotic that helps break down histamine in the gut, thus decreasing endogenous histamine production that can over-activate mast cells. Therbiotic Factor 4 by Klaire Labs is a good option. Another good choice is ProBiota’s HistaminX. And yet another one is GutPro by Corganic.
Additionally, appropriate methylation support (TMG, or others) may be helpful too because the methylation pathway is responsible for breaking down excess histamine, and methylation deficits can keep mast cell activity unnecessarily high.
Of course, each person’s needs are unique and individual!
Should I restrict oxalates?
Generally speaking, this is a complicated and very individually unique question. For this reason, please work with a nutritional professional who can guide you through answering this question and who can help you implement an appropriate game plan.
Sometimes, oxalates are an issue for folks with histamine and mast cell issues. If you have frequent UTIs, a history of kidney stones, or chronically sore muscles and joints, this may be a factor for you. However, remember that there are many other possible explanations for issues we can attribute to oxalate sensitivity, and oxalate sensitivity can cause a variety of other symptoms.
Additionally, oxalates are a bit of a rabbit hole for a variety of complicated reasons. If you suspect they are an issue for you, you can gradually and gently lower your dietary oxalates. These include almonds, spinach, buckwheat, okra, cashews and more. If you lower your oxalate intake too quickly, you may feel quite unwell. I’m a big fan of keeping things as simple and streamlined as possible and staying on a slow and steady path of progress. Furthermore, because there are many nutrition and supplement variables, it’s a good idea to work with a professional on this one if you can!
Help! My mast cell activation is triggering migraines, and I’ve tried everything!
I do find that a lot of people who think they’ve “tried everything” actually haven’t. In this scenario, a good long-term action step is to map out what you’ve tried so we can look at other options. This is definitely something I troubleshoot with my individual nutritional therapy clients.
By the way, if migraines are occurring in concomitance with allergic responses, widely construed (anything that is triggering excessive histamine release and mast cell degranulation), the migraine itself may be a symptom of the allergic response. Some migraine specialists are treating migraines prophylactically with mast cell stabilizers such as PEA and/or using the antihistamine cyproheptadine, a potent H1 inhibitor that also has migraine prevention effects. High-dose riboflavin is helpful to some people, while others benefit from melatonin. Of course, like any medication, its benefits and risks have to be weighed carefully on an individual basis between the patient and the medical team.
How we can work together
As a Nutritional Therapy Practitioner, I work remotely with clients worldwide, specializing in complex health conditions. I approach each of my clients’ health goals foundationally, from a root-cause-oriented, bio-individual and client-centered perspective. Did you know that I offer a complimentary discovery call to prospective clients interested in working together? Learn more and book your appointment today!
If you’re a holistic health provider and would like to learn more about how to work clinically with clients with complex issues, including mast cell problems, I’d love to have you in my clinical case study group.