Living With MCAS: 12 Tips for Managing Mast Cell Activation Syndrome

Twelve lifestyle and treatment steps for mast cell activation syndrome, from diet and trigger avoidance to mast cell stabilizers, sleep and stress, meant to be added one or two at a time.

A woman kneels in a garden row, planting her second of twelve seedlings while the doctor waits patiently at the far end holding a tray of the rest.

Living with Mast Cell Activation Syndrome (MCAS) usually results in widespread mast cell activation syndrome symptoms that are seemingly unrelated. Unfortunately, most people go many years or even their whole life without a diagnosis.

In one paragraph: living with MCAS comes down to a series of lifestyle changes made gradually, one or two at a time, alongside a functional medicine doctor. Dr. Hoffman's twelve steps include a low histamine diet, avoiding non-food triggers, improving gut health, stabilizing mast cells with quercetin and vitamin C, H1 and H2 blockers twice daily, nighttime ketotifen, treating infections, lowering toxin load, targeted nutrients and herbs, a steady routine and reducing stress.

If you’ve been diagnosed with MCAS or suspect you have this condition, the best course of action is making a series of lifestyle changes and working with your functional medicine doctor. Fortunately, many of the changes are easy to implement and you’ll see the benefits from implementing them fairly quickly.

Try not to get overwhelmed by this list, instead pick one or two items and incorporate them into your routine. Add a few items week by week, and soon enough you’ll have a comprehensive plan that has the potential to significantly improve your symptoms and your quality of life.

1. Adopt a low histamine diet

Avoid leftover foods, alcohol, cured meats, canned fish, pickled and fermented foods, berries, citrus, nuts, chocolate, dairy, yeast, soy sauce, tomatoes, vinegar, and preservatives. A comprehensive guide to a low histamine diet can be found.

2. Avoid triggers of MCAS (non-food items)

Avoid temperature extremes, mold, emotional stress, insect bites, chemicals in personal products, medications that liberate histamine of block DAO, sodium benzoate (common food preservative), airborne chemicals, smoke, heavy metals and anesthetics.

3. Work on your gut health

Good gut health is a cornerstone of overall wellness and will help you get your MCAS under control. Cut back on food that damages the gut or causes inflammation. Take probiotics and a DAO enzyme (generic name Umbrellux DAO).

4. Stabilize mast cell mediator release

Stabilize mast cell release of histamine with quercetin and vitamin C.

5. Use H1 and H2 blockers every 12 hours

Try using 5 mg of levocetirizine twice daily and 20 mg of famotidine twice daily.

6. Block and reduce nighttime histamine release

You can block nighttime histamine release and get a better night’s sleep by taking 0.25 -1 mg of ketotifen or zaditen at night.

7. Treat existing infections

Treat any existing infections to help your body heal and reduce mast cell triggers. Get a thorough examination with your functional medicine doctor and test for any pathogens.

8. Identify and remove toxins and allergens

When you have MCAS, you’ll do your body a world of good by reducing its toxin burden. You can reduce your exposure to toxins in your daily life through cleaning up your personal care products and opting for natural solutions, using natural household cleaners, and removing mercury fillings.

9. Take helpful nutrients

Support your health with important nutrients that assist in treatment. Some of these include vitamin B6, alpha lipoic acid, vitamin C, selenium, omega-3s, N-acetylcysteine, methyl-folate, SAMe, and riboflavin.

10. Add supportive herbs

Take nigella sativa, butterbur, turmeric, ginger, and peppermint to support your MCAS treatment.

11. Get into a routine and stick to it

Try to stick to a routine because your body’s cycles are closely linked to your daily activities. This will also help you get high quality sleep, which is essential to reducing the impact of MCAS on your life.

12. Reduce stress

Stress can activate your mast cells and cause them to release mediators like histamine. Reducing stress is important for anyone living with MCAS.

For a comprehensive guide on Mast Cell Activation Syndrome, you can read my in-depth article, Mast Cell Activation Syndrome and Histamine: When Your Immune System Runs Rampant.

Mast Cell Activation Syndrome Diet

Another great resource for dealing with histamine and MCAS using a mast cell activation syndrome diet and exercise is through Yasmina Ykelestam at Healing Histamine.

Frequently asked questions

What foods should be avoided with MCAS?
A low histamine diet avoids leftover foods, alcohol, cured meats, canned fish, pickled and fermented foods, berries, citrus, nuts, chocolate, dairy, yeast, soy sauce, tomatoes, vinegar and preservatives.
What triggers mast cell activation syndrome besides food?
Non-food triggers include temperature extremes, mold, emotional stress, insect bites, chemicals in personal products, medications that liberate histamine or block DAO, sodium benzoate, airborne chemicals, smoke, heavy metals and anesthetics.
What medications are used for MCAS?
Dr. Hoffman describes using H1 and H2 blockers every 12 hours, such as 5 mg of levocetirizine and 20 mg of famotidine twice daily. He also mentions 0.25 to 1 mg of ketotifen or zaditen at night to block nighttime histamine release and improve sleep.
What supplements help mast cell activation syndrome?
Quercetin and vitamin C are named for stabilizing mast cell histamine release, along with probiotics and a DAO enzyme for the gut. Supportive nutrients include vitamin B6, alpha lipoic acid, selenium, omega-3s, N-acetylcysteine, methyl-folate, SAMe and riboflavin, and herbs include nigella sativa, butterbur, turmeric, ginger and peppermint.
Does stress affect MCAS?
Stress can activate mast cells and cause them to release mediators like histamine, so reducing stress is important for anyone living with MCAS. A consistent daily routine also supports high quality sleep, which helps reduce the impact of MCAS.
How do you manage MCAS?
Dr. Hoffman recommends a series of lifestyle changes alongside working with a functional medicine doctor, including a low histamine diet, avoiding triggers, improving gut health, treating infections, reducing toxins, keeping a routine and reducing stress. Rather than tackling everything at once, he suggests picking one or two items and adding a few more week by week.
Can you live a normal life with MCAS?
Dr. Hoffman says many of the lifestyle changes for MCAS are easy to implement, and their benefits often appear fairly quickly. Building them into a comprehensive plan has the potential to significantly improve symptoms and quality of life, and a steady routine with high quality sleep helps reduce the impact of MCAS on daily life.