MCAS: Why So Many People Feel Stuck — and Where I Start Instead

There has been a lot of conversation lately around MCAS and histamine intolerance. Because MCAS can be difficult to diagnose, the discussion often gravitates toward symptom management and supportive therapies rather than clarity around what’s actually driving the reactivity.

Mast cell stabilizers are a frequent focus, along with supplements like quercetin, luteolin, and DAO enzymes. Many people experiment with a low-histamine diet. Mold exposure, COVID, and Lyme are commonly suspected when symptoms worsen or seem to appear suddenly. Medications such as Zyrtec and cromolyn also come up often and are regularly listed on my health intake questionnaire.

By the time people find me, they are often taking two or three mast cell stabilizers, with twenty or thirty different supplements lined up on their kitchen counter.

They’ve tried multiple healing programs, parasite cleanses, and heavy-metal protocols. They’re down to four or five “safe” foods. And despite all of this effort, many still feel stuck — and often discouraged — with very little lasting improvement.

While the right combination of supports can sometimes provide relief, sustained healing is uncommon. More often, people end up in a cycle where one symptom improves, only for another to take its place.

What I see, again and again, is that meaningful change begins when the body finally has enough safety and stability to stop bracing.

MCAS Is Not One Thing

MCAS isn’t a single diagnosis or a single trigger. It’s a state of reactivity — a system that’s been under pressure for a long time and never really got a chance to come back down.

Mast cells are doing exactly what they’re designed to do: stay alert, stay responsive. But over time, the threshold for activation drops. Smaller stressors create bigger reactions. The system gets louder.

So What Does This Actually Mean?

It means we need to talk honestly about root causes — a phrase that gets used constantly, and yet is often misunderstood in practice.

There are many possible contributors to mast cell activation: infections, mold, toxins, hormones, nutrient deficiencies, emotional stress, nervous system overload. Most people have more than one and almost all MCAS sufferers have a significant history of trauma or prolonged stress.

But here’s the part that matters most: no matter what the root cause ends up being, if the system isn’t stable, deeper work doesn’t go well — and it doesn’t hold.

When mast cells are firing frequently, the body stays sensitized. Everything feels amplified. If we try to push detox, immune treatment, or aggressive protocols at that point, people usually feel worse. Not always because the treatment is wrong — though sometimes it is — but because the body doesn’t yet have the capacity.

Supports Are Tools, Not the Finish Line

Sometimes stabilization includes medications. Cromolyn sodium. Ketotifen. These can be genuinely helpful for certain people. They don’t fix everything, but they can take the edge off enough for the system to breathe.

Nutritional supports matter too — DAO enzymes, vitamin C, B vitamins, gentle liver support — especially when the gut is involved.

But we usually learn pretty quickly that these things aren’t the answer. I see them as bridges. They help the body regulate instead of constantly reacting, but they aren’t where healing stops.

Histamine Isn’t Just About Food

One of the biggest misunderstandings I see is thinking histamine is only a food issue.

It’s not.

Histamine rises when blood sugar drops. When sleep is poor. When digestion is strained. When circadian rhythm is off. When the nervous system is overwhelmed. Emotional stress counts just as much as physical stress.

That’s why someone can eat “perfectly” and still flare after smelling bleach, flying on a plane, dealing with pressure changes, or simply moving through a really full, demanding week at work.

The body isn’t being dramatic. It’s responding to a threat that it believe is real. This is where we need to start.

Multiple inputs fill the histamine bucket — and eventually it overflows.

Safety Is Physical, Not Conceptual

At some point, the work shifts away from asking what am I reacting to? and toward something more useful:

What helps my body feel safe? What are my current stressors?

Safety isn’t a mindset. It’s a physical state the nervous system experiences and so we need to be willing to feel into our body and ask the hard questions.

And no — endlessly scrolling on your phone doesn’t create safety. That dopamine hit might blunt symptoms for a few minutes, but the crash that follows often hits harder.

What does create safety?
For some people, it’s routine. For others, warmth, familiar foods, gentle morning light, or slowing the pace just enough that the day doesn’t feel like a sprint. Predictability helps. Rhythm helps. Small moments of pleasure and choice help.

When the nervous system settles, mast cells usually follow.

The “Immune Buckets” WE are Carrying

I often explain this in terms of buckets.

We all have them — stress, chemical exposure, decision fatigue, poor sleep, blood sugar swings, sensory overload. When enough buckets are full, symptoms show up.

Healing doesn’t mean emptying everything at once. That’s overwhelming and unrealistic. It usually starts with one small shift.

Preparing the night before so mornings aren’t chaotic.
Simplifying meals - preparing dinner in the morning or batch cooking.
Prepping protein so dinner feels doable.
Leaving early enough to stop for coffee and feel like a person, not a machine/chauffeur always on the go.
Reducing harsh cleaning products and choosing scents/essential oils for your home that help to stabilize your nervous system.
Turning down the constant stream of emails and notifications.

Turning on music that you love! Dancing!

The Basics We Skip (and Shouldn’t)

Even in thoughtful protocols, I see the same foundations missed.

Digestion and absorption are huge. If food isn’t being broken down and absorbed, nutrients don’t reach the systems that need them, and the immune system stays irritated. Low stomach acid, poor bile flow, and gut inflammation are incredibly common in MCAS.

Anemias are another big one — and I honestly don’t understand why this gets skipped so often. Iron status matters. Oxygen delivery matters. Get this stable first, or at least work on it alongside everything else.

Blood sugar matters more than most people realize. Drops signal danger to the body and drive stress hormones that activate mast cells.

Regular bowel movements matter because inflammatory mediators need a clear way out. When elimination is slow, symptoms linger.

And sleep matters. A lot. Poor sleep keeps histamine high and the immune system dysregulated.

These aren’t advanced concepts.
They’re simple. They’re just not glamorous and costly.

Why This Gets Skipped

Sometimes these steps get skipped because clients don’t want to start there. They want relief — which is understandable — and foundational work can feel slow or inconvenient. So practitioners try to meet them where they’re at by adding more things.

Other times, foundations are skipped because they don’t sell well. They aren’t exciting. They don’t come with instant buy-in. And in some wellness spaces, that means they’re bypassed in favor of expensive protocols that look more impressive.

Neither approach helps.

Skipping steps doesn’t speed things up. It usually makes the whole process harder.

Why I Don’t Skip Them

I’ve learned that progress comes from addressing all the root causes — and that root causes are often simpler than we expect, even when Lyme, co-infections, or other complex illnesses are present.

Sometimes it’s the easy stuff that shifts things the most.

That means making sure blood sugar is steady. Digestion is working. Bowel movements are regular. Sleep is supported. Life has some rhythm.

These foundations don’t replace mast cell stabilizers or targeted supports — they allow them to work.

I’m not willing to move past these steps just to create momentum or sell complexity when the body is asking for stability.