Avoid Frustration – Figure Out What You Can Eat When You Have MCAS

This post provides ideas for figuring out what you can eat when you have MCAS.

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What is MCAS?

This is a concise explanation of MCAS from Mast Attack:

“Mast cell activation syndrome (MCAS) is a serious, chronic health condition that affects all organ systems. It increases the risk of anaphylaxis, which can be fatal. Complications of MCAS can include organ damage. It is often disabling. It is often found alongside other conditions such as Ehlers-Danlos Syndrome and POTS. It is not well-known among medical providers. It is difficult to test for. Treatment revolves around blocking mast cell mediators with things like antihistamines and mast cell stabilizers. Most people are not able to manage their diseases simply by avoiding triggers. Most people need medication, and often, a lot of it. Most people have symptoms every day and sometimes experience bad mast cell attacks and anaphylaxis. MCAS is in no way a mild or minor health issue. It should not be minimized and neither should the experiences of the people living with it.” – Mast Attack

Do you know your typical symptom progression?

One of the keys to understanding the level of your bucket is knowing your symptom progression. It is helpful to keep track of the symptoms you are having and to evaluate whether they are escalating. Symptom escalation means that the level of your bucket is rising.

Knowing your symptom progression in a symptom flare is the key to developing your own rescue plan. In this post, I discuss how to determine your own symptom progression. Once you know what typically happens in your symptom progression you can design a rescue plan to address those symptoms.

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What you can eat when you have MCAS – safer foods

What can you eat if you are trying to eliminate possible MCAS food triggers? Some foods actually lower histamine, so they can help offset the histamine-containing foods you eat, as well as the histamine naturally occurring in your gut and in your body. But it really depends on your specific triggers, but here is a list of foods considered to be pretty safe bets:

What you can eat when you have MCAS – tolerated foods

• Apple*, pears, pomegranate seeds, mango, blueberries, cranberries, cherries, watermelon, and dried currants
• Zucchini, fennel, celery, kale, romaine lettuce, pea shoots, endive, cucumber, asparagus*, radish, leek, broccoli, bok choi, onions, chives
• Non-aged cheeses, such as ricotta and mozzarella
• Gluten-free baked goods made from scratch with allowed fats and sweeteners
• Monk fruit* (avoid sugar alcohols)
• Seeds (chia, flax, sunflower, pumpkin, hemp, and others)
• Organic meat cuts that have been frozen promptly during processing, such as chicken and turkey. Some people can tolerate red meats and fish that have been flash-frozen immediately after slaughter/catch.
• Capers*, rosemary*, turmeric, sea salt, thyme, parsley, cilantro, basil, lemon balm, sage, garlic, ginger*
• Olive oil, avocado oil, ghee, coconut oil
• Herbal teas such as chamomile, tulsi, lemon balm*, rooibos, and decaffeinated green tea
• Mineral waters such as San Pellegrino, Perrier, and generic brands

*Histamine lowering

Here is an image I created for family members to help them know what I can safely eat, but again your tolerated food list is going to be unique to you.

Symptom logging to determine sensitivities

It is important to track what you eat, and your reactions, to narrow down food sensitivities. Check out my post on Food Tracking here.

I have found I can tolerate Monk Fruit as sweeteners, but not any other sugar substitutes. For example, I get neuropathy from Erythritol. Stevia has been shown to negatively impact liver, thyroid, and cholesterol levels. I can tolerate a small amount of tiger nut flour and lupin flour (legumes) but not any other legumes, period. I can tolerate Avocados, no problem, a little bit of raspberries, new potatoes, and cashews are usually not a problem. But I can’t do any citrus except lemon and lime juice. I can tolerate ricotta and mozzarella cheeses fresh; while cheddar and gouda work for me as dehydrated Moon Cheese snacks. I can eat pistachio and macadamia nuts, but absolutely no peanuts or almonds. When I am in a good place (relatively low bucket level) I can tolerate a small amount of coconut aminos (fermented coconut sap), and an occasional ½ c. of A2 yogurt (once a week) that is portioned and frozen. But, I can’t tolerate any other fermented foods.

For me, another compounding factor is that I have thyroid nodules, so I am trying to avoid as many oxalate-containing foods as I can to try to calm down whatever is causing thyroid nodules to form and grow. And a further complicating factor is that I am on a Keto diet for inflammation (which means very limited carbs). So, believe me, I’ve felt the frustration of being extremely limited in what I can eat! In future posts, I will go into detail about how and why I do the Keto diet and share apps and tools that are helpful for maintaining it.

What you can eat when you have MCAS – food prep

Food preparation and storage are also important factors in food tolerance for MCAS. Any food that is prepared and then kept will begin to accumulate histamine. Foods like ground beef that have a high surface area accumulate histamine very quickly. As a general rule, it’s best to buy meat that is frozen, keep it frozen until right before you intend to cook it, quickly defrost it, and cook it using a relatively brief cooking method, such as in an Instant Pot, or braising. Then leftovers should be portioned into airtight food storage containers and frozen immediately. I use pint mason jars with screw-top lids for a lot of my frozen entrees.

At first, these extra steps can feel to food preparation can feel daunting. It involves more advanced planning. But once you get a meal or two portioned and frozen you will have those meals ready to go for coming meals as you continue to track reactions and fine-tune your food tolerance list. And it beats having a scary mast cell symptom attack!

Honestly, when you go slow and track carefully, it takes several months to figure out a list of well-tolerated foods. It takes patience, and you will likely throw out lots of foods you can’t tolerate at first (or give them away to friends or family members who can eat them!) It feels wasteful, and I hate to waste food.

What you can eat when you have MCAS – avoid processed foods

Another issue with MCAS is intolerance of processed foods. This means that in addition to taking extra precautions with food prep and storage, you are basically making every meal homemade. With trial and error, you may figure out that you are able to tolerate prepared foods, especially frozen ones. But many people cannot tolerate the spices, sauces, and preservatives found in processed foods, let alone the shelf-time that they sit accumulating histamine. 

I’ve had good luck with Amylu’s chicken breakfast sausages, Amy’s organic turkey burgers, Evolved Keto Cups, individual squeeze packages of MCT oil and Sunbutter, Moon Cheese, and ChocZero chocolate chips and syrups. But otherwise, I tend to react to most processed foods. Most rice, even organically grown rice, is tainted with arsenic,

Another factor to keep in mind in determining which foods you can tolerate is that many processed foods can contain cross-contaminants in addition to being high in histamine. For instance, pre-shredded cheese often contains anti-caking agents and regular baking powder and many spices contain gluten unless they are specifically labeled “gluten-free.” In addition to containing a lot of histamine, prepared meats may have marinades or spices that you could react to.

What you can eat when you have MCAS – cookware

Yet another consideration in determining your food intolerances is what you are using for cookware and food storage containers. Many MCAS patients react to nickel which is a metal used in many cookware items. Green Pan makes ceramic pans that many patients seem to be able to tolerate well. Borosilicate glass is another pretty safe option for bakeware. MCAS patients often react to food cooked with plastic or nylon utensils, as well as plastic wraps, bags, and storage containers. For people who are sensitive glass storage containers seem to work well. Mason jars are relatively cheap and last a long time.

What you can eat when you have MCAS – meal planning

Starting a new diet can be overwhelming! Meal planning is one way to eliminate some of the stress. At least at the beginning, it can be reassuring to have a meal plan. That way you know what meals are coming up, and what ingredients you will need to buy, prep, cook, and freeze. See my Two-Week Meal Plan post for ideas on how to make a low-histamine Keto diet work for you.

Eat a variety of foods!

It is healthiest to eat the widest variety of foods that you can tolerate, though I am guilty of reaching for the same ingredients day after day. For breakfast and lunch, I try to rotate fats and protein powders in my Rocket Fuel Tea, vary my snacks, and add seasonal veggies to my salad such as cucumber, pea shoots, zucchini, and radishes, depending on what is coming out of my garden. As you build up your freezer meal stores you will have more variety to rotate dinner entree meals, and more snacks and desserts to pull from. On the weekend when I have more time I usually make several recipes and freeze portions, such as Low Histamine Cheesy Crackers, an entree, and a dessert.

What do you think?

I’d love your reply below!