What to Eat (and NOT eat!) with Mast Cell Activation Syndrome – Going Beyond Low Histamine Lists

Several years ago I was pulling my hair out trying to figure out what I could and couldn’t eat. I didn’t know about MCAS back then. I just knew I was reacting to most foods.

Every time I ate, my hands and feet would swell up and get red. I would itch all over and scratch until I bled. I had bad leaky gut which caused some foods to get into my bloodstream and keep me awake all night.

I remember when I counted the number of foods I could eat without reacting. The total was 30, and that included salt, pepper, and herbs.

If I had to eat another zucchini noodle I was going to scream.

I spent a lot of time studying and experimenting to figure out what was going on. Eventually I learned about histamines. I also learned about other types of inflammatory foods. I learned that many of the foods I had been taught were healthy were actually making me worse. And that what may be healthy for a lot of other people are really bad when you have MCAS.

I figured out how to eat foods that were healing for me. And how to spot foods that would make me worse. By making good food choices, I got my inflammation way down. I was eventually able to reintroduce a lot of foods. Today I eat a wide variety of healthy and healing foods. The itching, sleep issues, and leaky gut are gone. And my MCAS is under control.

Are you having reactions to foods?

Read on to learn what to eat and not to eat if you have MCAS.

Food forms the building blocks for everything in our bodies. Certain foods are healing. Other foods are damaging. Our food choices also affect how much inflammation we have in our bodies. Inflammation triggers mast cells to become more reactive.  The more inflammation, the more MCAS symptoms.

This can translate to allergies, constipation, diarrhea, itching, rashes, even sleep problems. The good news is you can learn what to eat and what not to eat with MCAS. This knowledge is the most important first step on your healing journey. So let’s start with the foods that you may not be able to eat. Then we’ll move on to ideas for foods you can try and see if they work for you.

Let’s Start with Histamines

If you have MCAS, you’ve probably heard about histamines. Your body naturally makes histamine, which is important for digestion. It is also a part of the immune system and nervous system. Proper balance of histamine levels is really important for good health. But with MCAS, these histamine levels can easily get out of control. Too much histamine is inflammatory. And that inflammation causes the mast cells to release even more histamine. (You can read more about mast cells here.)

The mast cells will also release over 200 other inflammatory chemicals. So it is really important to keep those histamine levels in check. Many foods naturally have histamines in them. And some foods cause the body to release histamine. Other foods block the release of the enzyme Diamine Oxidase (DAO) that breaks down histamine.

There are a number of high histamine food lists online. Here’s the problem with most histamine food lists. They were created through studies on small groups of people and were not well controlled. This means the researchers usually didn’t know if someone was reacting to histamine in a food or to something else. So what happened is that many foods that aren’t actually high histamine were put on the do not eat list. And some foods that are high histamine were put on the ok lists.

If you have MCAS, you probably have a hard enough time finding foods you can eat. So we don’t want to follow those lists too religiously. It is definitely important to identify the foods that are the highest histamine. You’ll want to rule those out. Beyond this, everyone is different in how foods affect them. You want to keep a food and symptoms journal to see how you respond to certain foods. This will allow you to make your own foods lists.  If you’d like a starter list, click here.

So What Foods are Definitely High Histamine?

Aged, Cultured, Fermented Foods and Leftovers: One rule of thumb is any foods with bacteria in them can create high histamine. So anything that is out of date, spoiled, moldy, or not really fresh is higher histamine. This also means leftovers become higher histamine the longer they sit.

That rotisserie chicken at the grocery that has been sitting all day is building high  histamine levels. Meat that has been sitting more than a day in the refrigerator section increases in histamines.  Fermenting, culturing, and aging increases histamines too. Beef is especially high histamine because it gets aged for at least 2 weeks before going to market.

So look out for these types of high histamine foods:

  •         Fermented alcoholic beverages, like wine, champagne, beer, whiskey, brandy
  •         Fermented foods: sauerkraut, vinegar, soy sauce, kefir, yogurt, kombucha, etc.
  •         Soured foods: sour cream, sour milk, buttermilk, soured bread, etc.
  •         Balsamic Vinegar and Vinegar foods: pickles, mayonnaise, olives, ketchup
  •         Cured meats: bacon, salami, pepperoni, luncheon meats and hot dogs
  •         Aged cheese including goat cheese
  •         Smoked fish, fish not gutted within 30 minutes of catch, anchovies, sardines
  •         Ground meat (Increased surface area increases histamines)
  •         Beef (aging process increases histamine)
  •         Smoked or processed meats: salami, bacon, ham, sausage
  •         Dried fruit: apricots, prunes, dates, figs, raisins
  •         Uncooked egg whites (histamine liberator)
  •         Leftovers

Fruits, Vegetables, and Nuts High in Histamines: Next we’re going to look at which of these foods you need to be careful with. Fortunately, there are just a few fruits, vegetables and nuts that are the highest in histamines or release histamines. Some of them might surprise you, though. If you are eating these foods, it would be a good idea to track how they affect you. I used to always itch badly when I ate walnuts or pineapple. Spinach made me not be able to sleep. And strawberries gave me a migraine. Do any of these foods bother you?

High histamine fruits, vegetables and nuts:

  •         Walnuts
  •         Cashews
  •         Peanuts
  •         Spinach
  •         Mushrooms
  •         Eggplant
  •         Avocado
  •         Pineapple
  •         Strawberries
  •         Most citrus (small amounts lemons and limes sometimes ok)

Processed Foods and Additives: You want to avoid packaged and processed foods as much as possible. Period. This may seem obvious, but many people with MCAS still eat lots of packaged foods. They think if the label says organic or gluten free then it must be healthy. Crackers, chips, cereal, and frozen dinners can be a problem. Canned foods, boxed nut milks, cookies, prepared sauces, and protein bars are higher histamine and inflammatory too. Anything that sits in a package becomes higher histamine. Packaged foods are highly processed to make them shelf stable. This destroys the nutrients your body so desperately needs. Avoid sugar, additives, colorings, flavorings – anything artificial.

In addition to avoiding processed and packaged foods, watch out for these additives that can wreak havoc with mast cells:

  •         Carrageenan
  •         Sodium Benzoate
  •         Potassium Sorbate
  •         Lecithin
  •         MSG
  •         Citric Acid
  •         Sodium Triphosphate
  •         Potassium Triphosphate
  •         Sodium Nitrite
  •         Maltodextrin
  •         Malic Acid
  •         Guar Gum
  •         Calcium Chloride
  •         Xanthan Gum
  •         Food colorings
  •         Smoke Flavoring
  •         Yeast Extract

Beyond Histamines – Rule out any other inflammatory foods

Let’s look at Lectins, oxalates, salicylates, sulfur, and FODMAPs. These are types of foods beyond histamine issues that can affect MCAS. Lectins are proteins founds in certain plants. More and more research indicates that lectins activate mast cells. Low lectin diets can make a big difference in mast cell issues. So you may need to consider whether lectins are affecting you.

Oxalates are tiny crystals that are also found in plants. People who have genetic predisposition to high oxalates can have trouble with oxalate foods. Yeast overgrowth also contributes to high oxalates. You can have oxalate issues from leaky gut as well.

Salicylates are found in many plants, especially in mint. Some people start to have trouble breaking down salicylates. This can cause a variety of symptoms similar to MCAS.

You can check your oxalate levels on a Great Plains Organic Acid Test to see if these might be an issue for you. You can reach out to our office if you are interested in checking your oxalates. I find oxalate issues in about 50% of my clients with MCAS. Salicylate issues are less frequent, but do occur. Sulfur foods can cause trouble for some people. It mostly affects people with genetic weaknesses for sulfur metabolism or those low in B6 and/or molybdenum.

FODMAPs are a type of short chain carbohydrates and sugar alcohols found in foods like beans, onions, garlic, broccoli, and cauliflower. Sometimes people end up with FODMAP sensitivity when their gut flora gets out of balance.  It can be tricky to track down sulfur and FODMAP sensitivities. These usually require elimination diets.

Be sure to think beyond histamines and consider whether you may have any other food sensitivities. At a minimum, I recommend everyone who has MCAS choose lower histamine and lower lectin foods. I learned I feel best eating lower histamine, lower lectin, and lower oxalate foods. But I definitely have oxalate issues. Not everyone has to be low oxalate. Identifying your personal food triggers can go a long way toward helping you feel better. I share my low histamine, low lectin food lists with all my clients. I also have cross referenced low histamine, low lectin, low oxalate lists for clients.

So What Can I Eat with MCAS?

Many of my clients see the high histamine food lists and feel like there is nothing left to eat. This simply isn’t true, though. There are so many nutritious and flavorful foods we can eat. It is easy to feel deprived if you just focus on the foods you can’t have. This is a sure road to feeling angry, resentful, and depressed. They key is to think about how much eating fresh, nutritious foods will improve your health. Focus on choosing the foods that are healing and that you enjoy. Sometimes it is good to splurge on yourself. I don’t mean buying a chocolate cake. I mean by spending a little extra time in the kitchen making something healthy for you and delicious.

Be sure you are eating fresh, whole, nutrient dense foods.  As produce ages, it loses nutrition. The fresher your foods are, the more vitamins, minerals, and antioxidants they have. When you have MCAS, you need as many nutrients from healthy foods as you can get. These nutrients support a healthy immune system. They are also necessary to make histamine degrading enzymes, like DAO and HNMT. So they also have the added bonus of helping to lower histamine.  Be sure to buy your produce as fresh as possible. If you can, get produce at the farmer’s market or even grow your own for the most nutrient dense options. The book Eating on the Wild Side* by Jo Robinson is a great resource on the highest nutrient varieties of fruits and vegetables.

Emphasize vegetables. Cover most of your plate with vegetables. Yes, this means lots of vegetables. Vegetables have nutrients and antioxidants you need to heal. These are histamine lowering, low oxalate, low lectin vegetables you can emphasize:

  • Arugula
  • Bok choy
  • Broccoli
  • Brussels sprouts
  • Cabbage, Green and Red
  • Cauliflower
  • Collards
  • Kale (flat dinosaur or lacinato kind – curly is high oxalate)
  • Napa cabbage / Chinese cabbage
  • Watercress

You can also try:

  • Onions – any kind
  • Leeks
  • Chives
  • Scallions (green onions – especially use green parts)
  • Carrots
  • Radishes
  • Daikon radishes
  • Cilantro
  • Asparagus
  • Garlic
  • Romaine, Red and green leaf lettuce
  • Kohlrabi
  • Mesclun
  • Endive
  • Dandelion greens
  • Butter lettuce
  • Fennel
  • Escarole
  • Mustard greens
  • Mizuna
  • Basil
  • Mint
  • Perilla (Shiso).

If you don’t have trouble with oxalates, you can also add in:

  • Artichokes
  • Beets
  • Celery
  • Okra
  •  Parsley
  • Radicchio
  • Rhubarb
  • Sweet Potatoes

Then eat moderate amounts of clean protein. If you eat meat, protein should come from pastured-meats like chicken, pork, lamb, and turkey. Be careful with beef, which is aged. Make sure meat is very fresh. You can call the butcher and ask what day the meat is delivered. Check the sell by dates and make sure you get the freshest packages. Other good options for pasture raised meats are farmers markets, US Wellness Meats*, and Vital Choice*.

Vital Choice is the only fish source I recommend because they guarantee their fish is low in mercury, pollutants, radiation contamination. They also ensure the fish is gutted and frozen immediately after catch. If you try their fish, be sure to try just a small amount first to make sure you don’t react. Those with both MCAS and histamine intolerance may still have a hard time with fish and may need to take DAO Enzyme* before meals.

Cook or freeze meat and fish right away to prevent histamine levels from rising. I cook meat while it is still a little frosty to keep histamine levels low. Avoid slow cooking, which allows histamine levels to go up.  Pasture-raised chicken, duck, or quail eggs are also a good protein source. Some people react to eggs. So test them for yourself. Be sure to cook egg whites thoroughly. Legumes can cause histamine release and are also high oxalate and high lectin. So you may need to be careful with these.

Healthy fats are needed for overall health too. Be sure you are getting enough good fats. Fats are necessary for healthy brain cells and to make your hormones. Also, some vitamins are fat soluble. This means they are best absorbed when eaten with fats. So add healthy fats to your vegetables to absorb the most nutrition. Healthy fat sources include: grass fed butter, very fresh extra-virgin olive oil, virgin coconut oil, grass fed ghee, cold-pressed flax oil, cold pressed avocado oil, and unrefined palm oil. Avoid canola oil, corn oil, safflower oil, and peanut oil. These are inflammatory.

Fresh nuts can be a good source of protein and fat. Walnuts, peanuts, and cashews are likely off the list for you because of their high histamine levels. There are still plenty of other nuts you can enjoy though. Low histamine, low oxalate, and low lectin choices are: flax seeds, macadamias, pistachios, coconut, and pecans in moderation. If you don’t have oxalate issues, you can also enjoy almonds (blanched to remove lectins in the skin), hazelnuts, pine nuts, sesame seeds, Brazil nuts (only 3-4/day), hemp seeds, and hemp protein powder. Buy nuts as fresh as possible. To make them more digestible, soak them overnight in salt water. Then dry in a food dehydrator or oven at 250 degrees. You can also make your own fresh nut butters using a VitaMix* or Blendtec* blender.

Season with a lot of fresh herbs. Fresh herbs are some of the highest nutrient and antioxidant foods. Cultures that use a lot of fresh herbs live longer than those that don’t use herbs. Plus, adding herbs to your meals will give them more flavor. If you enjoy your foods, you’ll be more likely to stick to making healthy choices.  Ginger, basil, chives, oregano, garlic, peppermint, rosemary are all excellent histamine lowering herbs. Avoid or restrict anise, cinnamon, cloves, curry powder, paprika, and nutmeg. These can liberate histamine and cause mast cell reactions.

Fruits should be eaten as a dessert. This is due to higher sugar content. Spikes in blood sugar affect the mast cells. Prioritize lower sugar berries like blueberries. Tart cherries and green apples are also good choices. Lemons and limes are ok, if you tolerate them. If you don’t have trouble with oxalates, raspberries and blackberries are lower in sugar. Other lower histamine, low oxalate fruits are: all types of apples, fresh apricots, cherries, fresh cranberries, fresh currant, cantaloupe, fresh figs, grapes (especially black), honeydew, kiwi, mango, nectarine, peach, pear, and watermelon. These have higher sugar levels though.

Some people do better with carbs and some worse. Experiment to find what
works best for you. I find grains increase my inflammation. I do better with
lower levels of carbs. I think this is because many grains are high lectin and
high oxalate. Too low carb keeps me from sleeping, though. Finding your own optimal carb intake takes a little trial and error. If you aren’t allergic
to latex plants (like bananas), then you might be able to use the flour of the cassava root as a carb. I use this to make tortillas and pizza crusts.

If you get cassava, be sure to buy Otto’s brand*. It is the only one that isn’t fermented. You can try these sources of low lectin, low oxalate carbs too: Tigernut flour (Gemini Organics is a good brand), flax meal, hi-maize resistant starch, coconut and coconut flour, shirataki noodles, rutabagas, and turnips. If oxalates aren’t a problem, then histamine-lowering sweet potatoes are a great carb choice.

Sweeteners should be kept to a minimum. Again, this is because increases in blood sugar can cause inflammation. And inflammation increases mast cell reactions. There are some good sweetener options that don’t affect blood sugar, though. These are stevia, monk fruit, and inulin. These come from plants, and our bodies don’t metabolize them like sugar. Be sure you get stevia, monk fruit, and inulin without other additives. Often they have sugar alcohols added, which isn’t good for MCAS. So you have to check the ingredients.

I use this 100% pure monk fruit extract from Smart Monk*. You can also use coconut sugar in moderation for a treat. Coconut sugar affects blood sugar more slowly than regular sugar. Honey, molasses, and maple syrup do have some good nutrients. They also have a big impact on blood sugar, so use sparingly. You want to be sure to avoid sugar, artificial sweeteners, and corn syrup. These are very inflammatory.

Handling Leftovers: Leftovers build in histamine quickly. You’ll want to freeze your leftovers if they are going to be kept more than a couple hours in the fridge. I always make a double batch of whatever I’m cooking. Then I freeze the leftovers in single serving containers. This makes it easy to pull out to take for lunch or have for dinner after a busy day. For lunches, I put the frozen meal in my lunchbox. By lunch time, it is usually mostly thawed. You can also thaw foods by running hot water over the container. Then reheat in a pan or toaster oven. Sometimes in a pinch you might have to use a microwave. I just trust that my nutrient dense foods outweigh any negatives of occasional microwave use.  I only store leftovers in glass to avoid chemicals from plastics leaching into food.

Still not sure what to eat?

Sample Meal Ideas: Here are some of my favorite low histamine, low lectin, and low oxalate meals and snacks:

  • Breakfast: Handful of macadamia nuts or pistachios, 2 hard boiled eggs, Green Smoothie
  • Low Histamine Green Smoothie (flax meal, lettuce, 1/2 green apple, blueberries, fennel bulb and greens, cardamom seeds, fresh cilantro, fresh oregano, fresh rosemary, fresh mint, watercress, a few red cabbage leaves, ginger, stevia)
  • Lunch: Chicken wrap on lettuce with fresh cilantro, shredded cabbage, shredded carrots dipped in a Ginger Dressing (whiz ginger, cilantro, ¼ clove garlic, pinch salt, 4 T olive oil in VitaMix or Ninja type blender)
  • Snack: Radish slices with grass fed butter topped with cracked sea salt and rosemary or cilantro
  • Dinner: Cassava crust pizza topped with homemade pesto (whiz up basil, olive oil, garlic, salt, pepper), sautéed onions or shallots, fresh oregano, and chicken
  • Dinner: Lamb chops or Pork Chops with mashed cauliflower (steam cauliflower and blend in food processor with butter, olive oil, salt, pepper, rosemary) and arugula salad
  • Dinner: Cauliflower Fried Rice – grated cauliflower, thinly sliced onions, grated carrots sautéed in sauce of toasted sesame oil, ginger, salt, cayenne, and garlic. I’ll usually scramble a couple eggs in the pan to make it stick together. You can also add some shredded chicken or pork.
  • Dessert: Green apple with macadamia nut, pistachio, or pecan butter
  • Dessert: Frozen Tart Cherry “ice cream” – whiz frozen tart cherries with just enough coconut milk to cover, pinch of raw vanilla powder, and a couple drops of stevia. I use Aroy-D coconut milk in 8.5 oz tetra pack from Amazon. It comes in a 6 pack* or a 12 pack*. This is one of the few brands without additives.

Healing foods are the foundation of recovering from MCAS. I always start with a conversation about foods with my clients who have MCAS. This article will give you the steps to start to make good food choices for yourself. But if you have MCAS, food changes are rarely enough on their own. There are more root causes for MCAS beyond food. If you’re worried or overwhelmed about Mast Cell Activation Syndrome (MCAS), you may feel afraid that you’re never going to feel well again. Don’t worry, though. Figuring out the root causes underlying your MCAS will give you a road map to healing.  Subscribe below to download my free guide to discover the 7 Most Common Root Causes of Mast Cell and what to do about them.

*Full disclosure: Some links in this website are affiliate links, which means I may make a very small commission if you purchase through the link. It never costs you any more to purchase through the links, and I try to find the best deals I can. I only recommend products that I love and use personally or use in my practice. Any commissions help support the newsletter, website, and ongoing research so I can continue to offer you free tips, recipes, and info. Thank you for your support!s

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Comments

  1. Pingback: 9 Insomnia Relief Supplements for Mast Cell Activation Syndrome (MCAS)

  2. Pingback: Macadamia Nut Butter - Low Histamine, Low Lectin, Low Oxalate, Low Carb

  3. Doris

    Wow this i sooooo what I needed this morning… Thank you very much… I hope we can learn more from you 🙂 Doris

    1. Beth O'Hara

      I’m so glad it helped you Doris! I have new stuff out each week, so be sure to sign up for the newsletter. Thanks for the comment!

  4. Pingback: Easy Low Histamine Mango Ice Cream (also Low Lectin, Low Oxalate)

  5. Pingback: Safe Skincare and Personal Care Products for People with Mast Cell Activation Syndrome or Histamine Intolerance and the TRUTH about the Toxins in Most Products

  6. Elizabeth

    I have Mast Cell Syndrome.
    I am taking oral cromolyn 4 ampules 4x’s daily.
    My problems is diarrhea,
    sometimes it’s so severe.My entire body feels on fire,If we go out the 1st thing I do is look for the bathroom.
    Elizabeth

    1. Beth O'Hara

      I’m so sorry you are dealing with this, Elizabeth. It sounds like there are some significant underlying gut triggers that haven’t been addressed yet. Have you read the root causes report? You are welcome to reach out if you need help with this.

  7. T

    I am down to one food trouble breathing swallowing dizziness fatigue Can barely walk – My stomach pain is horrible tight vagus nerve and I am so uncomfortable I can’t leave my bed :(:(Every smell bothers me my eyes pour, my nervous system and immune system is over active. I don’t know what to eat or supplements to take. Any help please. Anything I eat or take I feel worse. I’ve been diagnosed with campylobacter jejuni – babesia Cytomegalovirus- penicillium – candida – aspergillus – whole body pain – cryptosporidium- streptozmes – mcas – please help me Beth I feel like I’m going to end please help me

  8. Sue

    Beth, thank you for this comprehensive information.

    I’ve seen eggs on every high histamine list I can think of especially the egg whites. Have you found your clients do OK on eggs if they are cooked ?

    Also, what is the problem with lecithin ? I’ve been taking sunflower lecithin to give me the phosphytidal choline I need to digest fats.

    Thanks again,
    Sue

    1. Beth O'Hara

      Hi Sue,
      Freshly cooked eggs themselves aren’t usually a histamine issue. However many people have problems with eggs for other reasons. Uncooked egg whites are definitely a histamine liberator. This is why most people leave them out entirely. In my new Mast Cell 360 Low Histamine Diet: Phase I Elimination post, I remove eggs. I’ll be posting that this week. Then reintroduce in phase II. I’ve found sunflower lecithin to usually be well tolerated. Soy lecithin can cause issues due to soy sensitivities. -Beth

      1. Amber

        Hi Beth!
        Thank you for writing such a great article. Do you have any advice or links to food lists for people with MCAS and sulfur issues? I just got my genetic testing back showing I have sulfur issues and got so sick from a glutathione shot and a number of other things Dr’s have thought were healthy. I may have sensitivities to other things, but I’m unsure (though I suspect lectins).
        Unfortunately I also have EDS w/ cervical instability and POTS which makes me nearly bed bound and a full time walker user. I’m unable to cook or do dishes, but slow cookers with liners and disposable bowls, etc work.
        I’m also sick with what we think are mold issues, I had a c diff infection last year and the antibiotics messed up my stomach, I have h pylori, and more. Basically I’m a mess and it’s to the point that I’m afraid for my health. I’m in the process of trying to move and don’t have the ability to spend hours making food charts, but my reactions are getting so extreme with pain, rashes, hives, that I’m miserable.
        I’d really appreciate any advice you could offer to point me in the right direction. Thanks 🙂

        1. Beth O'Hara

          Hi Amber,
          I’m really glad you liked the article! I’m so sorry you are suffering with these things. I definitely get what you are going through. With the sulfur and glutathione issues, there are likely some major detox challenges. I had this problem too. You don’t want to go low sulfur for very long because it could make you worse. I really recommend at this point working with a Functional Practitioner, like me or someone with similar experience, on fixing your gut and detox challenges. Here is a link to schedule with me if would like to work one-on one.

          Also, here is a link to a new blog featuring a food list that I think will be helpful to you.
          Warmly, Beth

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