Getting used to Cooking and Living with MCAS
Sections on this page
Trying New Foods
Dietary restrictions vs. medications
Sources of histamine and triggers in foods
Safe food handling
Food additives, pharmaceutical, and chemical triggers
How to get flavor!
Research you should know about
Introduction
This site is focused on Mast Cell Activation Syndrome (MCAS), the hyper-sensitization of mast cells—not Mastocytosis, which is an excess proliferation of mast cells.
Within MCAS, every patient is different. This is likely because mast-cell reactivity is controlled by a wide range receptors. How these receptors lead to sensitization is still not fully understood, but it is not unreasonable to suspect that individuals with MCAS may have different fundamental causes. As such, the advice of one mast-cell patient may not work for another!
This fact creates a challenge for any website purporting to offer mast-cell-safe recipes. For example, the vast majority of “low histamine” recipes out there on the web do not work for me—and unsurprisingly, they often contain foods that are known to contain mast-cell activators. The recipes collected on this site do work for me, but because they are also grounded in an understanding of mast-cell biology, my hope is that they will work for most people. That said, because our understanding of mast-cell biology remains incomplete, it is important for you to test and go slowly.
Trying new foods
When trying new foods, I recommend this approach:
(1) Start with small portions. This reveals whether a reaction exists without overwhelming your system.
(2) Avoid mixing multiple unknowns. Doing this makes it impossible to identify the culprit if you do react.
(3) When warranted, try variations and brands. Sometimes a food is actually safe, but it is the food processing that is at issue, so it can be worth investigating whether a particular preparation or brand may be safe.
(4) If you have a reaction, wait a few days before trying another novel food; this gives your body—and your mind—time to recover.
(5) If you think you may have had a very mild reaction, try it a second time on another day in a slightly larger portion. Sometimes there can be an ambiguous perceptions of a mild reaction the first time, which may be driven by anxiety around the fear of a reaction, resulting in a false positive; Obviously, if you have a clear and significant reaction to a food, don’t try it again without good reason!
It helps to have a rapid-recovery plan that you can implement the moment you realize a reaction is showing up. This gives you confidence that you have the situation under control and minimizes the damage of the reaction. My recovery plan is a fast-acting liquid-Benadryl antihistamine (I poke a hole in a gel cap and mix the liquid contents into a full glass of water) + 1 fexofenadine or similar long-lasting antihistamine. Depending on your health profile, adding mild exercise, aspirin, or caffeine might also help—consult your doctor for advice.
Keep a list of what foods work and don’t. In the beginning it’s easy to remember major items—but as you live life, it becomes harder to keep track of the more unusual foods. Did you react to fresh oregano, or was that thyme? What about loganberries? A note on your phone, or in a journal, is a worthwhile investment.
Dietary restrictions vs. medications
It can be tempting to pre-medicate in order to indulge in foods that you particularly enjoy. This is a personal choice, but I do not recommend it. I have found that even small food reactions have a cumulative effect that erodes your body’s health. In the clinic, my colleagues have seen stubborn patients that continue to drink coffee or eat favorite foods and try to get by with medication. In the long run, their lives and health are far less good than those who are willing to be disciplined.
I’ll note that this advice stands in contradiction to the advice of some MCAS specialists who warn against food restriction because they are concerned about people eating too narrow of a diet and developing nutritional deficits. This is a valid concern, so it is worthwhile to have a wide range of recipes at your fingertips to keep up the variation. I also recommend using a food tracker such as Cronometer periodically to monitor your maco- and microneutrinet intake. I do not recommend food tracking on a continuous basis, however. It becomes oppressive and reinforces a “sick” identity, but in for roughly a week every six months is wortwhile. If you discover a dietary shortcoming, you can compensate by adjusting your habits by adding targeted supplements.
Many vitamins themselves can cause problems because of how they are prepared. My go-to brands are Pure Encapsulations (most reliable), Thorne (generally reliable), and Now (OK for some things). I don’t recommend multivitamins, which are almost never MCAS-safe.
Sources of histamine and triggers in foods
Histamine is the mast cell trigger most people know about, but it is far from the only one. “Low-histamine” alone is not sufficient for safety. Many foods that people label as “high-histamine” may contain no significant histamine at all—the phrase has become a catch-all that obscures the actual science behind what causes mast-cell reactions. Many other chemicals can trigger reactions too, such as solanine found in nightshades (potatoes, tomatoes, eggplant, ppepers), albumins in eggs, etc.
True histamine in food comes primarily from bacterial metabolism of protein through a process called histidine decarboxylation. This bacterial metabolism also produces related “amines,” which can also be problematic. To be clear, the bacteria per se are not the problem; the bacterial levels in food can be perfectly safe for human consumption, or even beneficial in the case of probiotic bacteria. The problem is the histamine and other chemicals they have left behind. Sterilization through cooking or pasteurization does not help: it kills bacteria but does not break down the histamine already present. This is why, for example, UHT milk is often worse than fresh milk. While UHT milk has fewer bacteria when you buy it, it was exposed to higher bacterial levels before the pasteurization process. The whole history of the food matters.
Bacteria reach especially high levels during fermentation. Many foods are intentionally fermented during production, including ones you might not know about: coffee, tea, chocolate, vanilla, buttermilk, yogurt, hard cheese, bread, beer, wine, tofu, soy sauce, vinegar, and many more. All contain substantial amounts of histamine as a result. Other foods can be incidentally fermented, such as air-dried fruits or baked goods made that heat up slowly. The common thread is whether a food has been moist (necessary for bacterial growth), lacks natural antibacterial features, like a fruit’s skin or high salt or acid content, and has sat at room temperature or above for significant time. When all three conditions are met, histamine risk is generally high.
Safe food handling
Given the above, you can see that safe food preparation and handling is as important as the food itself! Sometimes a food can be perfectly fine, but it’s how it was handled that makes it problematic. Thus some people may write-off certain foods based on a bad experience, not realizing that a good version can be found. pepper: air dried black peppercorns slowly ferment in the sun, resulting in devastating levels of histamine. By contrast, green peppercorns, which are preserved in brine and sold in jars, are fine! (In fact, green peppercorns contain piperine, which strongly inhibits mast-cell degranulation, blocks IgE signaling, and reduces production of cytokines—all positives for MCAS patients).
Because food handling matters as much as the food itself, you might discover that one brand of packaged food is safe while another is not. For example, I find aged basmati rice is unsafe, but western-style basmati is fine. Some brands of rice cracker are fine, others not. Some types of butter are safe, others not. Reading the labels helps, but they don’t give the whole story.
In general, I have found that brands producing food in industrial supply chains tend to be safer than boutique brands—sad but true. Industrial food processing generally involves rapid prep and cooking by machines, blast refrigeration, and higher volumes with shorter shelf times. All of these combine to help deliver a product that has seen the least bacterial action possible. Watch sell-by dates on packaged foods, and try to buy the freshest versions possible. For example, I have a rule that chicken—even if from a trusted supply chain—it must have a sell-by date at least 7 days into the future in order for me to find it safe to eat. Details of these types of things can be found in the Know Your Ingredients section of this site.
Paying attention to bacterial action in your own kitchen and food storage is just as important. Don’t leave protein-rich foods out on the counter for prolonged periods of time—especially cooked proteins. Place unused food portions in the fridge immediately. For high-risk items, it can help to place warm foods first into the freezer for about 45 minutes, then transfer them to the fridge to accelerate the cooling and arrest bacterial action faster. Some foods I’ll eat as leftovers for a couple days, but others (e.g., like those containing coconut milk) I will only eat for up to 18 hrs of fridge storage, after that the risk is too high.
Baking is also tricky. Ovens tend to heat food slowly, promoting significant fermentation on the interior surface. Small cookies are generally fine, but bulky items can become problems (though I have some tricks to help you out here—such as pre-sterilization of ingredients).
Hidden Triggers: Additives and Medications
Chemical additives are a also hidden sources of problems. For this reason, I tend to prefer organic produce—though for most things it’s not strictly necessary (strawberries are a notable exception). Some “natural flavors” and most of the FD&C dyes are of questionable safety. With dyes, Yellow #5 (tartrazine) and Carmine Red are the most dangerous. Yellow #6 (Sunset Yellow) and Red #3 (Erythrosine) are borderline. Less problematic are Red #40, Blue #2, Blue #1, and Green #3.
Dyes can also be found in the coatings on medications, so watch your prescriptions. For pharmacy drugs, white pills are generally safe inasmuch as they are free of dyes; if your pills are not white, ask the pharmacist for a list of the inactive ingredients (a.k.a. excipients) in the drug, which includes the coloring agents. In the United States, you may get more traction asking for the drug’s full NDC code with the format xxxxx-xxx-xx, then look up the NDC yourself at the NIH’s DailyMed website. For each drug, vendor, and dosage the NIH hosts a dedicated monograph about that drug. Section 11 of the monographs (titled “Description”) should contain a list of excipients and coloring agents. Colorants made from minerals are generally fine (though some people report reactions to titanium dioxide). It’s also worth watching non-colorant excipients; some binders, like xanthan gum (made from bacteria), are problematic.
How to get flavor when cooking!
With so many restrictions, it can feel like flavorful food is forever gone. This website is devoted to overcoming that. The individual recipes are a start, but there are also some general principles that you can learn and use to create your own tasty, MCAS-safe meals.
Let’s start with the five basic mouth flavors (as opposed to aroma, more on that below) that you learned in school: salty, sweet, sour, umami/savory, and bitter. All of these are readily available to you in MCAS-safe, concentrated forms and can be added to almost any food at will. The principal strategy when adapting a recipe into something that is MCAS safe is to realize what each prohibited ingredient is doing in these five categories, and then to add back these mouth flavors from other sources.
Let’s take Parmesan cheese as an example. The real thing is very dangerous from an MCAS perspective. Can we make a safe version? Deconstructing its flavor, it’s very salty and savory, it’s a little bit acidic in a particular dairy sort of way, and it has a granular texture that carries these flavors in clumps rather than dissolved into the food. To make a substitute, I collect the components: salt, MSG (a source of umami/savory), and lactic acid powder and mix them with coarse almond flour. I gently fry the mix in MCAS-safe butter (another source of dairy flavors). The crumbly result is something that—while not at all cheese on its own—does a reasonable job approximating what Parmesan does when added to your pasta.
Let’s look at the concentrated sources of these basic flavors, which are pretty obvious but merit a few points of discussion.
Salt: salt flavor comes from salt—but there are subtle variations you might appreciate. Iodized salt can be metallic tasting, and while it contains a necessary nutrient, it does impair the flavor of most foods. Pink Salt can have a more complex, ‘creamier’ presentation. Sel Gris can be more earthy tasting.
Sweet: the obvious and most potent form is cane sugar, but don’t hesitate to think about other sweeteners for their aromatic properties: honey, molassas, jams, fruit pastes, etc. There are other sugars (e.g., lactose, fructose, dextrose), but their use in recipe building is not significant.
Sour: Here is where it gets interesting. Different kinds of acid taste different. You can buy MCAS-safe acid powders and add them (or diluted solutions) to your foods to substitute for all kinds of problematic ingredients. Citric acid gives that lemon-sharpness (no lemon aromatics, though, but you can get that with lemongrass). Lactic acid powder can add the sort of tartness you find in cheese and yogurt. Malic acid is the tartness of apples. It’s good for tarting up fruit-forward dishes without making them too lemony-sour. I’ve long tried to find a safe form of acetic acid, which is the acid flavor of vinegar, but I have not been successful. Ascorbic and tatric acids are still other options, but they are not very useful for most applications.
Savory/Umami: Beyond proteins themselves, the principal way to add savory flavor is with MSG (monosodium glutamate). Some people recoil at the idea of adding MSG, and believe it can cause headaches or other problems. Glutamate is indeed a bioactive molecule, but it’s naturally present in many savory foods (e.g., soy sauce, cheese, etc). The only real distinction between natural MSG and synthetic is that commercial MSG salts are actually racemic mixtures and will likely, therefore, have additional bioactive effects that naturally occurring MSG does not have. Let your body be the judge. Naturally produced (non-racemic) MSG is available, but is usually extracted from processes that involve fermentation and simultaneously produce histamine.
Bitter: The primary sources of bitterness I use in my cooking are spicy olive oils and flaxseed oil. If you’re looking for more of a coffee-like bitterness, oven-toasted date seeds work—but are extremely difficult to grind. Another unusual source of bitterness are nitrates found in cured meats. Nitrates are actually doubly active on T2R receptors (bitterness) and salt receptors, and have a slightly metalic quality. This combination can be achieved using celery and ioidized salt (I use this in my MCAS-safe sausage). Bok choi is another source of nitrates. Note, some MCAS patients with dysautonomia may have a nitrate sensitivity (and some, like me, benefit from the nitrates). As always, go slow and test.
Apart from the big five, there is a second type of mouth flavor: chemesthesis. This is responsible for pungent spiciness. The primary sources of these flavors are the chemicals gingerol (ginger), pipperine (black pepper), allyl isothiocyanate (horseradish/wasabi/mustard), and capsaicin (from chili peppers). Unfortunately, all the common sources of these chemicals are disallowed in the MCAS diet, leaving us with a very bland palate. Fortunately, one of these, pipperine, is available through green peppercorns, which come jarred in brine.
Complementing the mouth flavors are the aromatics detected by the nose. Rarely are there substitutes. Lemongrass for lemon is one. Black Salt (a.k.a. Kala Namak) is a potent source of sulphur, and a few grains can be a useful substitute for onion and garlic. But in general, given the enormous diversity of aromatic flavoring compounds, it is impractical to compile a library of substitutions. However, there are two reliable ways to get aromatics into your cooking. First, start with great ingredients. Factory-farmed produce can be devoid of aromatics. Given the limitations MCAS already puts on your ability to eat tasty food, its worth starting with good, flavorful ingredients if you can source them. Try farmers’ markets and seasonal produce to increase your chances, and explore a variety of local stores. Second, build the aromatic flavor density by taking advantage of the Maillard reaction—the browning of foods during cooking. Frying, grilling, or roasting food until it has golden color or even light char, introduces a wide array of novel aromatic flavors. Good cooking skill involves controlling time and temperature to maximize this flavor development. While browning doesn’t substitute for the missing added flavors of a traditional recipe, it makes the primary ingredients taste wonderful on their own.
Now that you have the building blocks of flavor, here are the two secrets to producing a good recipe.
First is realizing that a truly balanced dish involves layering all (or at least most) of the five basic mouth flavors on top of complex aromatics. While it may seem counterintuitive to add a pinch of sugar to a savory dish, or a dash of salt and acid to a sweet dessert, doing exactly that is often what’s needed to balance the flavor profile. That’s why starting with a roasted or grilled protein (umami + high aromatic content), and finishing it with a little olive oil (bitter), a sprinkle of salt, a touch of sweetness, and a splash of acid goes a long way toward achieving a restaurant-grade meal.
Second, and distinct from flavor, is the physical experience of the food: texture and mouthfeel. A great dish needs physical contrast, like a satisfying crunch paired with creaminess. If something seems flavorful but boring, try to find a texture contrast to amp it up. Fats play an absolutely vital role here. They provide a rich, coating mouthfeel that carries and prolongs the aromatic compounds on your palate, so do not skimp on the fats if you want great, rich flavors.
When you layer these three concepts—mouth-flavor completeness, aromatic development, and physical mouthfeel—you can see how a complete dish comes together. With this framework in mind, you can create excellent, MCAS-safe dishes from scratch.
Research Highlights
Finally, I’ll note that (as of 2025) the have been several reports (here and here) of MCAS patients starting GLP-1 drugs and observing their food sensitivities disappear. GLP-1 drugs come with their own set of concerns, but you might discuss this with your doctor.