Hello, hello. Welcome back to another episode of uplift. For her. I am Dr Mallory craycraft, and today we are diving into a topic called MCAS, or mast cell activation syndrome. We actually did an episode on this before with Dr Zach Spiritos. That was great, and I encourage you to listen to it. But we got a lot of questions from people who are like, Wait, whoa, whoa, whoa, back up. What is this about? What are we even talking about? So I am going to break it down how I approach MCAS in the clinic. This is a condition that I treat a fair bit of in our clinic at uplift for her, and it can be very complex, and so it's really important to understand it the right way. Some of this will be a little bit of overlap with what our last episode with Dr Spiritos covered, but I hope maybe hearing it from a different angle will still be really beneficial to people.
My goal in this is not necessarily to make you diagnose yourself, but the topic of MCAS is really complex and really confusing and frustrating for people. So if this is something that is relevant to you, I hope that you will feel enlightened and feel heard and feel hopeful and that this is starting to make sense for you. Many people have never heard of MCAS, so it stands for MCAS, mast cell activation syndrome and the mast cells. Let me first talk about what those are mast cells, or cells in our immune system that line all of our entryways and exit ways. And so that would be things like our eyes, our nose, our sinuses, our mouth, our throat, our lungs, but also our gut, our bladder, our vagina, our blood vessels, our nerves along all of these passageways you have mast cells lining standing guard like like sentries, like guard dogs, their job is to alert if there's any sign of a bad guy and call for the backup from the immune system to come fight this bad guy. And so when that happens, when the masked cells call for backup, the immune system responds differently according to what the masked cells say. There are certain types of bad guys that when the mask cells see them, they will release a certain type of mediator, and that mediator will call for a certain reaction from the immune system. Think, swelling, right? If you break a bone, mast cells get massively triggered, and they say, Whoa, we've got badness going on here. We need some repair coming up. And so the body sends blood and fluid and inflammatory markers called cytokines. It sends all of these immune system supports to help heal. No problem. That's what's supposed to happen. Another example is if you get bitten by a mosquito, right? You get bitten by a mosquito the poison, is it venom, or is it poison? I'm not sure, but the poison from the mosquito, or the saliva from the mosquito gets injected into your bloodstream, and the body recognizes that is foreign, the mast cells get triggered, and they will call for backup. And as a result of that backup, you get a little welt, you get a little redness, you get a little bit of itching with histamine. That's the body's way to take care of things. So this is not a problem. Mast cells are not something you would want to live without, but where it becomes an issue is when the mast cells get hyper activated. So mast cell activation syndrome, or some people call it mast cell activation disorder, and this is where the mast cells are now becoming overly sensitive. They're getting triggered by too many things, and then they're releasing too many things, and the immune system is back here just responding to the messengers. The immune system is not going to turn off. It's going to respond every time it's called. And so you get symptoms based on this response from the immune system. Now here's how I would explain this in simpler terms. I think of the mast cells like a guard dog, and you have a good guard dog and a dumb guard dog. Good guard dogs only react to a true bad guy. They can sense whether that's a sketchy character or whether it's a nice person, and they will bark like crazy, and their owner will come running, right? So the guard dog is the mast cell. Their bark is the chemicals, the mediators that the mast cell releases, and then the owner would be the immune system coming for backup. Now some people have dumb guard dogs, right? You've seen these guard dogs. You've walked past these guard dogs. They bark at everything. They bark at cars, they bark at wind, they bark at their tails. They're barking for no good reason at all, but their owner has to come out every time because they're not sure if it's a real bad guy or not. And these dumb guard dogs then are very akin to these mast cells that get hyper activated. They're getting triggered too easily, and they're giving too many messengers to the immune system. This results in someone feeling very chaotic in their symptoms. Their symptoms vary day to day because the triggers vary day to day. Their symptoms vary because the messengers that the mask cells are releasing are varied, so it leaves someone feeling very odd and sometimes crazy. Some days you might get hives, then the next day you don't. Maybe some days you feel intense brain fog, and then you don't. Maybe you get anxiety or diarrhea or bloating, but it's very inconsistent and very difficult to track because of this, what we. See is that patients are not given this diagnosis of MCAS. They may say, I've gone to multiple doctors. I went to a neurologist for my migraines. I went to a gastro neurologist for my gut symptoms. I went to an OB GYN for my reproductive health symptoms. I have all of these issues, and no one has been able to really figure it out. Or that doctor put me on two medicines. The next doctor put me on two more medicines, the next doctor put me on two more medicines, and then I tried some stuff on my own. So now I'm on seven supplements, and I just feel terrible all the time, and I'm not getting better. This is kind of the classic patient that I see with MCAS. So again, the goal of this is not to make you self diagnose yourself, but to give you hope and to give you some direction, if this is starting to resonate with you and ring some bells. Now let's talk for a second more about the mast cells, and then I want to talk more about the symptoms. Mast cells release multiple different products. The most well known are histamine, prostaglandins, cytokines, and then you have leukotrienes, Heparin, and about 800 900 or 1000 other chemical mediators that are causing different reactions in the immune system. Let me first just talk about histamine, because this is the one we understand probably the best and one of the biggest game changers for patients. Histamine makes you feel very alert. It makes you feel very awake, so like insomnia or waking up in the middle of the night, it can cause skin itching or skin rashes. It can cause hives. It can cause watery eyes, sinus symptoms, chronic drainage, all of these things go along with histamine. The second one is prostaglandins. And prostaglandins have a lot of action throughout the body, but especially in our reproductive system. So prostaglandins are implicated with very heavy periods, very painful periods, PMS, PMDD, or mood swings before your period. And cytokines. Think inflammation, we think just that swelling that comes up. So maybe puffiness or puffy face, like my face is puffier than it should be. Maybe foot swelling, like your sock leaves a line at your ankle, just really this water retention and inflammation in general. Now, as we're talking through these we're starting to see like, gosh, this sounds like chaos in the body. I understand why someone wouldn't feel well, and I also understand why a patient would have gone to multiple doctors before. One of the questions people often have is, why have I not been diagnosed with this? You are describing me. This is exactly me. Every day is a different story. I'm super sensitive to medications. I get every side effect possible. I move to a new house, and then all madness breaks loose. The reason why people have such a difficult time getting diagnosed with this is because the lab testing that we have is not great. We can test for histamine we can test for prostaglandins, we can test for trip days, which is another mediator that gets released. But this process is meant to be quite acute. It's meant to be rapid. So you have a trigger, you have a reaction, the immune system does something, and that mediator that we're trying to test for in the blood or in the urine just goes away. The mast cells release it, and then it gets absorbed by the body. So it's why it creates such chaos, is because it's a rapidly changing process which makes it very difficult to catch on standardized blood testing. It's also very difficult to diagnose because it doesn't fit in the tidy boxes that we as Western trained doctors really prefer, right? We like things that you can break down in studies to one variable. If I give you x, you have y reaction and mast cell. Patients don't play by these rules. You might give them x1 day and they have a y reaction, and maybe the next day, you give them x and they have a Z reaction. It's totally all over the map. And so it can be really difficult to study. And anything that's difficult to study is difficult to pin down in the conventional medical training world. Now it does exist. It does exist in the medical literature, but because it's not neat and tidy, it's very difficult to train a doctor how to manage it. The other part that goes along with that is the conventional medical world is broken down into systems. Right? There are doctors who treat the brain, doctors who treat the heart, who treat the uterus, who treat the gut. We all have our little camp, and we like our little camp, we don't necessarily do great at learning about other people's camps, but in mass cell, you have to, you have to understand this interplay between all of the different systems together. And in the Western medical world, if a patient has this many symptoms, they'll say, Well, which doctor do I go to? Well, that's the problem. There isn't ownership in the medical world over this syndrome. Currently, as people are learning more about this and taking ownership, a lot of functional medicine doctors are taking ownership over this, because to be in functional medicine, we have to look at all the systems, and we look at how systems interact together, which is really essential when we're talking about MCAS. So you will find it more and more in the functional and integrative space. Family doctors sometimes do better than others, and immunologists or allergy specialists very frequently understand this. Hematology oncologists also have a better idea of this. If you go to an allergist, they may not be too keen on treating your periods, but if you go to an OBGYN. And they may not have a great idea at how to treat your anaphylaxis and rashes that keep popping up. So it really takes someone who's specialized just in MCAS to understand it, to spot it, to identify it, and then to know how to treat it.
Hey, everyone. I wanted to hop on here and share a quick update with you. As many of you know, creating this podcast has been such a meaningful part of what we do here, and we are incredibly grateful for every single listener who has tuned in, shared an episode or sent us a message along the way that said we're going to be taking a little break from releasing new podcast episodes for now. This isn't a forever goodbye, just a pause, and before we step back, we wanted to say thank you, truly. If you have enjoyed our conversations, learned something new, or felt supported by any of our episodes, it would mean the world to me if you would send us a quick message and let us know, hearing from our listeners never gets old and reminds us why we do this. If you feel called, leaving a rating or a review wherever you watch or listen to the podcast is another wonderful way to support the show, and of course, we're always so appreciative when you share episodes you loved with friends or family. And one more thing, if you or your company are interested in partnering with us or sponsoring future episodes, when we return, we would love to connect. You can email us at Hello at uplift for her calm or fill out the podcast sponsorship form on our website, also linked below in the show notes, thank you again for being here, for listening and for being part of this amazing community. We'll see you soon. Now I'm going to tell you how to treat it, but before I do, I do want to go a little more specifically into how we diagnose this. Sometimes we do the lab testing that I mentioned. I don't do it very often, but it can be nice if the lab testing is abnormal, for a patient to have documented objective evidence that they can then take to their doctors in the future and say, See, this is legit. I'm not making this up, that this is I truly do have this disorder. But otherwise, if we're not doing lab testing, or the lab testing doesn't show anything, then we're looking first at symptom questionnaires in history, as you can imagine, what I've just described, I get a pretty good idea from just someone telling me their history. They say I've been to 10 different doctors. I have every symptom imaginable. It doesn't make any sense. I can get a pretty good idea pretty quickly that this is mast cell activation syndrome. So questionnaire is looking for severity of symptoms and diversity of symptoms, and then history helps us understand this as well. Another portion that can be really helpful is sometimes we try medications for MCAS, and if people respond to it must have been MCAS. Now that's a very unelegant way to practice medicine. Fortunately, we have a lot of treatments that are very safe, like Claritin, like antihistamine, and that can be a really good objective marker of if someone has a bunch of symptoms, and you give them antihistamines and they feel 70% better, that's MCAS, that's that's pretty clear. So sometimes we just treat it and see how they feel. And that can also be part of the the confirmation of the diagnosis. Let me tell you a little bit more about the symptoms I mentioned some before, but I'm going to rattle off a long list of symptoms, because I want you to understand the breadth of symptoms that we're dealing with when we deal with someone who is suffering from MCAS. So first we think about skin manifestations, flushing, itching, rashes, hives, dermatographia, that's where you draw a line on your skin with your fingernail, and it turns bright red and fleshy and doesn't go away for a long time, bloating, diarrhea, constipation, food reactions that can be one day you ate an avocado and felt fine, and the next day your throat was closing up. Or one day you ate a meal and had no problems at all, and the next day you had leftovers and you had bloating and diarrhea. This can be all sorts of different food reactions, nausea, reflux, heavy periods, PMS, PMDD, cyclic anxiety, anxiety around your period, endometriosis, like pain or endometriosis, worsening symptoms around ovulation, can be really a good clue. Brain fog, anxiety, insomnia, sensitivity to light and sound and smell and fragrance and physical sensation, fatigue, dizziness, palpitations, air hunger, chest tightness, exercise intolerance. There's also specific vaginal symptoms that go along with this very closely that are just now being studied. And as a gynecologist, I can see there are symptoms that we've been trying to manage wrong for a long, long time that really play a role in MCAS. So you can see the symptoms are just all over the map. Now I want to talk next about what triggers these darn mast cells to do this to begin with. Why are they overreacting? We do think there's probably some genetic predisposition, although there is a gene that has been identified, but not everyone has it, so there's at least one gene, and probably others, we haven't identified that are predisposing genes or gene mutations that make these mast cells a little more trigger happy. We also know that trauma and a combination of things, I think, of a triad of a tipping point for when mast cell activation can really come flaring up. One of them can be. Genetic predisposition. One of them is some sort of vulnerability. So maybe that was pregnancy, maybe that was going through a hormonal shift like adolescence or perimenopause. Maybe it's a really stressful time where you weren't sleeping, or you were dieting and on a calorie restriction. Maybe an infection like the flu or covid, some sort of vulnerability that exposed these cells to be a little more Trigger Happy, combined with a genetic predisposition, combined usually with something that is psychologically stressful. Sometimes it can just be the physical feature, like an infection or something, but a lot of times it's I was dealing with this, and I was struggling with this infection, and then I lost my job or and then I went through a divorce, and this combination really sends the body reeling. Now I want to talk about this idea of reeling, because it does come up. We talk a lot about fight or flight and how stress can really worsen our health, and this has a factor here, but it's very different than people who are having health issues only related to stress. In that case, that's a matter of the nervous system, the vagus nerve, really being out of shape and and really just triggering this reaction to a stressor. So that would be, I come home to my kids and they say the wrong things to me, and I pop off and I'm just so super mad. Or maybe I'm at work and I'm under a deadline and my hair starts falling out, like those can be pretty specific to stress. This is very different. This isn't just vagus nerve activation. This is the literal cells going into a fight or flight response, or what's often coined as the cell danger response. So the cell is actually using every resource it has to put us into survival mode. And this makes sense, then why the immune system becomes trigger happy? Because it feels so endangered, so critical, that it has to up regulate all of its security systems that it can, which make it overreactive. But if you were really in a dangerous situation, overreactive would be life saving compared to under reactive so yes, stress can play a role, but this isn't the type of thing that if you just manage your stress, everything's going to get better. That's the hard part. Is we do have to manage stress, and we have to tell the nervous system that it's safe to calm down, but that's not enough. The cells have to be reprogrammed to calm down, and in order to do that, we've got to get the symptoms under control. So it can be really complex to treat. I'm often asked exactly what items I use and recommend. So I have a little gift for you. I have gathered my go tos in one spot on our Amazon storefront. If you need deeper sleep, you'll find the light blocking sleep mask that lives on my nightstand and that I use every night. If you're working on your bone density or your posture, check out the weighted vest I recommend for walks and workouts. We've also added the magnesium body lotion I reach for to calm the nervous system, my favorite laundry soap and cleaning products, and even the cast iron skillet that's currently sitting on my stove top. All of these and more are organized by category, so you can browse trusted products without the overwhelm of trying to figure out what's the best thing to buy.
You can head to amazon.com, backslash shop, backslash uplift for her, or tap the link in the show notes or from our website to explore the items I personally use and love. I hope this makes your life just a little bit easier. Now, back to the show so other specific triggers that we're looking for can be outside the body, things like temperature changes of heat or cold, too much sunlight or UV radiation, a large exposure to fragrances. So not necessarily a one time, but large exposure to fragrances over and over, like a new plug in that you put in your house that suddenly you feel really off and out of sorts. Other internal triggers can be challenges in your microbiome, so dysbiosis is what we call that SIBO parasites, mold exposure, chronic infection, poor estrogen metabolism, iron deficiency, nutrient depletion. These things aren't necessarily triggering the mast cell activation syndrome, but once you have MCAS, you may notice you feel worse after these triggers. Other triggers are high histamine, foods, aged foods, alcohol, leftovers, food additives, preservatives and medications, food dye or dyes in medications or supplements, chronic stress, trauma, overtraining, under eating. Maybe you try to diet and you feel so bad it knocks you flat on your back. These are all things that can trigger those mast cells at the time to explode or degranulate, send these chemical messengers and trigger the immune system. So we can see that how this can be so chaotic for the body. There's so many different little triggers that can be going off that can cause you to feel so erratic in your symptoms, so many triggers, plus so many symptoms, makes you feel a little bit like a crazy person right now. You've got all of these various triggers that can make you feel bad. You've got all of these different symptoms, and you've got all of these different systems, body systems that can be involved. It really can leave you feeling very alone and very lost and very scattered. I want to pause. There and just tell you a little bit about my own journey with MCAS. When I started this clinic of integrative women's health, I thought I was going to be like your gynecologist, but like a nice gynecologist, like the gynecologist that takes time with you and maybe talks about your diet and talks about stress and sleep, but also prescribes hormone replacement therapy and does your Pap smear in a non hurried, beautiful setting, right? And I realized very quickly, as patients are coming to me, that I was missing some some pieces there with how to treat people. And I really very quickly learned about MCAS because there were so many people whose bodies weren't playing by the rules. We would talk about stress, and we would talk about food, and we would talk about sleep and hormones, and they weren't getting one bit better as I learned about MCAS very rapidly, I saw that so many of my patients actually had MCAS and that I was missing it as well. So I have really learned how to find it and learned how to approach it. Now, a lot of patients that I see in my practice have been to other functional medicine practitioners, and it can be really difficult, because you go to someone you have a bunch of symptoms, a lot of functional medicine practitioners will say, let's do all the testing. We got to really figure out what's going on. So we're going to do blood work and urine testing and mold testing and gut testing and parasite testing and oat testing, and we're just going to find all the things that are wrong with you. And it turns out, they do find things that are wrong with you, and then they start treating them. And patients who have MCAS very frequently, this will backfire, and they will feel so much worse, they will start reacting to all of the treatments because their bodies weren't stable enough to handle the treatments. So it's really important, as I transition next into talking about the treatment approach, that we do it in a way that makes a lot of sense. You cannot treat MCAS patients willy nilly, or they will get sicker a lot of the time. So let me talk about how we treat it. When I think about MCAS, I think of the body being in a state of reactivity. It's overreacting to everything. I think of like a satellite spinning in space that you put in a little momentum to, and it will spin forever because there was no gravity to stop it from spinning. That's very much how these bodies can feel, is like something got them reacting and they're never going to stop their bodies feel so overreactive and their their lives become chaos because they don't know if they can go to work the next day or if they're going to be able to parent their little kids, because they just don't know what to expect from their body. So one of the first things we need to do is we need to help patients understand that they need to feel heard, they need to feel safe, because this process of going through all of these symptoms and all of these questions can leave them feeling very distrustful of the medical system. So one of the first things I have to do is say, I hear you. I'm here with you. I'm on this journey with you. It might be bumpy, it might be windy, but I'm here with you, and we're going to keep trying. And I find that's pretty essential. One of the next kind of unspoken order of operations is we need to get them back in tune with their body. It's very common in this case, for patients to become very adversarial with their body, to not trust their body, right? Because one day they eat something, they break out in terrible hives, and they're like, Well, of course you would, you dumb body. Like, of course you would, you're the body that does stupid stuff all the time. Fine, I'll go do something, I'll go take a nap, I'll go take some antihistamines. It creates this real troubled relationship of the person with their body, and that will reinforce then the fight or flight aspect. It's keeping those cells in that state of danger because it can't even trust you to do what you need to do. So that's a big problem as well. So we have to at least start the conversation of, can we get back in touch with our body? Can we listen to our body, show compassion to our body, understand that the body isn't broken. When it's doing this, it's not doing the wrong thing. It's trying to be helpful. So we need it to still react differently, but we have to understand that it's trying to be helpful, or we won't make any progress. The next step that I take when we're working through treating MCAS is I've got to stop that satellite from spinning. I've got to bring in some grounding, some stability, I've got to help patients feel somewhat better, and we do that in a lot of different ways. First, I think we have to get the biggest symptom. What's the most bothersome symptom? For some people, it's dizziness when they stand up. For some people, it's insomnia. For some people, it's really heavy periods. For some people, it's anxiety. We have to make a little bit of headway, and there are lots of different ways to do that, and we do that depending on the symptom. The next thing we do is we have to get those mast cells to settle on down. So when mast cells degranulate, one of the things we understand most about what they release is histamine. And very frequently their symptoms are related to histamine. Fortunately, treating histamine is safe and cheap and easy, so we usually will start right there with trying to get histamine under control. That can be as simple as antihistamines like Claritin or Zyrtec or Pepcid, you know, something just to get the histamine reaction to settle down. I think of it like that dog barking and me putting my hands over my ears. The dog's still barking, but it does. Have as much of a reaction on the cells. Their hands are over their ears, they're not hearing that messenger as much. So first we get histamine under control. The next step is we try to keep the mast cells from barking to begin with. That's called mast cell stabilization. I mixed my metaphors, keep the dogs from barking, keep the mast cells from degranulating. That's called mast cell stabilization. And there are lots of different things that we try in here. We try supplements called luteolin or pea or vitamin C or low dose naltrexone, ketafen or tirzepatide at really tiny baby doses can be helpful for this. So there's lots of things singular. There's couple others I'm missing. But there are ways that we can get those mast cells to stop reacting, and at this point in the treatment process, this could be a month in. It's very often three or four or five months in, so it can be really erratic, and it can take us trial and error to see. I have so many options that we can try, but we can only try one at a time, and you might have a reaction to one. So it can be a little bit laborious to get to this point, but by this point, what I'm hearing from patients is okay. I feel more stable. I know what each day is going to bring. Maybe I still have some brain fog, maybe my gut is still acting up, but I feel a little more stable.
The next step then is we look for triggers that we haven't identified and eradicate those so that would be things like SIBO and mold and chronic infection, maybe identifying covid and understanding why someone reacted to covid the way that they did. So that part is dealing with triggers, and then the last two segments along here are rebalancing the vagus nerve. Remember, this is all about fight or flight, but but deeper than that, it's about the cells actually feeling endangered. So there are devices that we can use. There are systems and programs we can use to help get the body back into a safe space, parasympathetic. And then the last part is limbic retraining. We actually have to train the brain to get out of fight or flight. So the brain has to settle down. The brain has to say, I'm safe now. So this can take a long process, and we can use prescription medications, we can use supplements, we can use lifestyle measures, and usually we have to dig deep into all three categories. This is something that when people come to an integrative women's health specialist, they're often saying, I want to get better with as little medical intervention as possible. I want to fix my system. I want to eat well, and I want to exercise well, and I'm all for that, but this is one place in MCAS that it doesn't always work very well to do that, usually we have to use something outside of the body, prescription medication or supplement to get the body to chill out, to calm down and be stable. And then we can come back here and say, let's make sure all of our foundations and our systems are in place, sleep hygiene and food and nutrients and all of these different things. But very frequently, we have to use a diverse array of tools to help getting people to feel better. Mast cell has some really interesting associations as well. It's very often associated with Ehlers, danlos or EDS spectrum. So connective tissue disease, where you're hypermobile, it can also be connected to pots, which is Postural Orthostatic Tachycardia Syndrome, which is when you get really dizzy if you stand up. It can also be associated with tumors, so weird growths, like fibroids or lipomas, it can be associated with mental health disorders. So it really is a complex disease state, and what I hope I brought here today is not hopelessness, because it does sound very complex, but the first thing before we can help these people feel better, if this is you listening, we have to identify that you could be this person, and then we can help people make big wins. We can help people feel better so they're not running around in this chaos. It really is quite, quite chaotic. I hope you feel, if this applies to you, I hope you feel hope, because you should. We can treat this now. We can't cure it, but we very frequently, can get it under control and then prepare you to limit triggers, to keep your body stable and resilient, and then to give you a toolkit. So you know, if you get a trigger, like you go on a trip and you end up with an MCAS flare that you know, I know how to deal with this. This is in my toolkit. I'm going to take these things, I'm going to make sure I optimize my sleep, I'm going to change my diet, and I'm going to get it under control, instead of going for years and sometimes decades of feeling this way. So please, if this applies to you, please seek help. Like I said. I treat this at my clinic, and this is something we really have put a lot of resources to understanding so we can help people feel better. So hopefully this was helpful to you. If this was helpful to you, we'd love to hear from you. It's always nice to hear from you, so we know how we can reach out and support you the best. We like to create lots of free material and free information for you so you can get feeling better and help point you in the right direction. I'll see you next time. Thank you so much for tuning in to today's episode. We are grateful for the incredible support from our sponsors and to all of you listening. We couldn't do this without you. If you enjoyed this episode, please consider subscribing on your favorite platform. You can find us on our website, uplift. Her.com, YouTube, Apple, podcast, Spotify, or wherever you love to listen. And if you found value here today, please share this episode with someone who would benefit from it. Leave us a comment or give us a review. It really helps us reach more listeners like you. Thank you for being part of our community. Stay tuned for our next episode. Lastly, this information is for educational purposes only and not intended to be medical advice.
