Top Ten Tips to Help MCAS Patients Tolerate Treatment
Tolerance is often the biggest obstacle for those with MCAS who are trying to uncover and resolve their root causes. Below are ten strategies we’ve used successfully to help clients increase tolerance and move forward in their healing process.
How to Introduce New Interventions
Start slowly. Introduce one new item at a time, increasing gradually over 3–4 days (or even 7–10 if needed). Take the 5th day as a break to assess how you feel.
If you feel okay, keep it and move on.
If not, remove it and move to the next item.
1. Address Enzyme Bottlenecks
With MCAS, enzymes that modulate glutamate, dopamine, and adrenaline can become bottlenecked—even without genetic predispositions. Contrast your supplements and medications with your lab results to identify potential blocks. For example, certain elevated cytokines result in higher glutamate.
If glutamate is elevated, focus on strategies that help lower glutamate to improve tolerance.
Elevated adrenaline and glutamate make you feel like you’re reacting to everything. We find clients often confuse histamine and food reactions with these neurotransmitters when they are elevated.
2. Reduce Oxidative Stress
If homocysteine and glutathione are low, it may suggest an upregulated CBS enzyme and underlying toxin load. In these cases, focus on supporting sulfur pathways—or avoid items that worsen CBS activity—while you look for and address the root toxin source.
3. Support Circulation and Adrenal Balance
In hypoadrenergic POTS, low blood pressure can reduce circulation and trigger adrenaline surges. Work with your primary healthcare provider to stabilize this, as constant adrenaline dumping can make tolerance extremely difficult.
4. Rebuild Iron and Oxygen Balance
Long-term dysbiosis can deplete iron, promoting hypoxia and excess nitric oxide, which further disrupts motility and gut balance.
I learned this firsthand during pregnancy: when anemia developed, I experienced reflux and constipation. Iron infusions resolved not just the anemia—but those gut symptoms as well. The body (and gut) truly depend on healthy circulation.
5. Try Topical Nutrients
When oral supplements aren’t tolerated, start with topicals. Vitamin D lamps, nutrient creams, and baths (with magnesium, sulfur, or boron) can be gentle and effective entry points. Our clients often find that injections of B vitamins work better than oral supplements.
6. Consider Prescription Support
Sometimes a prescription is a bridge to tolerance. Prescription-grade mast cell stabilizers or anti-inflammatories can help severely reactive individuals calm inflammation enough to progress.
7. Explore Peptides—With Caution
Peptides can be game-changers for some. Around 50% of our clients find them significantly helpful—but they’re not for everyone. Many peptides interact with hormones and neurotransmitters, so side effects like mania, anhedonia, or akathisia ARE VERY possible. Always review your hormone and neurotransmitter labs (and labs specifically related to the peptide you are trialling) before starting.
8. Assess and Optimize Mineral Levels
Minerals are among the most underrated tools for improving tolerance.
Manganese helps lower glutamate (but requires iron as a cofactor).
Boron regulates calcium, magnesium, and vitamin D.
Even subtle deficiencies can affect enzyme function and sensitivity.
9. Don’t Overlook Hormones
Low estrogen or progesterone—common during peri- and menopause—can promote both MCAS and gut dysbiosis. A hormone-literate provider can help rebalance this layer of your physiology.
10. Be Patient and Strategic
Healing MCAS is often about sequencing—addressing what your body can handle now, and building tolerance layer by layer. With the right strategy and support, your system’s resilience improves and treatment options expand.
