Understanding the Connection Between Eating Disorders and MCAS
Living with Mast Cell Activation Syndrome (MCAS) can be incredibly challenging. For those who also struggle with eating disorders and have MCAS, the situation becomes even more complex, as the two conditions can exacerbate each other. People with eating disorders are often more vulnerable to a variety of health issues, including immune system dysfunction, nutritional deficiencies, and chronic inflammation, all of which can make symptoms of MCAS worse.
For some, MCAS can predate the eating disorder and be a contributing vulnerability to the development of the eating disorder, and in others, the eating disorder can increase vulnerability to immune dysfunction and increase the vulnerability for MCAS developing.
This post is for informational purposes only and should not be considered medical advice. Always consult with a healthcare provider for advice specific to your situation.
What is MCAS?
Mast Cell Activation Syndrome (MCAS) is a condition where mast cells, which are immune system cells that release histamine and other chemicals during allergic reactions, become overactive. This leads to an excessive release of mediators like histamine, prostaglandins, and cytokines, which can result in symptoms such as:
Digestive issues (bloating, diarrhea, constipation)
Skin reactions (rashes, hives)
Fatigue and brain fog
Respiratory issues (wheezing, shortness of breath)
Joint pain and inflammation
MCAS is a chronic condition, and its symptoms can fluctuate. The triggers for MCAS vary and can include foods, environmental factors, stress, and trauma.
The Role of Eating Disorders in MCAS
Eating disorder involve severe disturbances in eating behaviors and related thoughts. Eating disorder behaviors over time can significantly alter the body’s immune function and gut health, both of which can increase the vulnerability to MCAS symptoms. Here’s how:
1. Increased Stress and Immune Dysregulation
Both MCAS and eating disorders are associated with chronic stress, which can negatively impact the body’s immune system. Eating disorders place the body under constant emotional and physical stress, which can increase the release of cortisol, the body's primary stress hormone.
Chronic stress can trigger:
a) Immune suppression: Eating disorders can weaken immune defenses, leading to a higher risk of inflammation and mast cell activation.
b) Increased mast cell activation: Stress can directly activate mast cells, leading to increased histamine release and MCAS symptoms. The combination of a stressed immune system and MCAS often results in worsened symptoms, including fatigue, anxiety, and digestive issues.
According to a study by Kiecolt-Glaser et al. (2015), chronic psychological stress contributes to immune system dysfunction, which could exacerbate MCAS symptoms (Kiecolt-Glaser et al., 2015).
2. Nutritional Deficiencies and Immune Function
One of the most significant consequences of eating disorders is malnutrition. Restrictive eating behaviors can lead to deficiencies in essential nutrients which can further compromise the immune system, digestive function, and overall health.
For those with MCAS, these deficiencies can make mast cell activation more severe, contributing to worsened digestive symptoms, inflammation, and skin reactions.
Research suggests that nutrient deficiencies in individuals with eating disorders can directly impact immune function and increase vulnerability to inflammation (Macht, 2008).
3. Gut Health and Permeability
Eating disorders, particularly those involving restrictive eating (whether chronically or intermittently within restrict binge cycles), often lead to gut permeability. The lining of the gut becomes damaged, allowing undigested food particles, toxins, and bacteria to enter the bloodstream. This can trigger an immune response, which in turn activates mast cells, leading to symptoms such as bloating, pain, diarrhea, and fatigue. The gut-brain connection is also very real, and emotional stress from an eating disorder can exacerbate these symptoms.
For those with MCAS, a compromised gut lining is problematic because:
a) It can increase systemic inflammation and immune dysfunction, triggering MCAS flare-ups.
b) The gut is a key player in histamine metabolism, and a disrupted gut microbiome can impair the body’s ability to break down histamine, leading to histamine intolerance (please note that this does not mean a low histamine diet is the solution, especially in the case of restrictive eating disorders). A study by Camilleri et al. (2012) discusses how gut health and permeability can influence the immune system and worsen conditions like MCAS (Camilleri et al., 2012).
4. Heightened Histamine Sensitivity
People with eating disorders may experience heightened histamine sensitivity, especially if they also have MCAS. Histamine, which is naturally released by mast cells, can cause a variety of symptoms, including headaches, hives, and digestive discomfort. In MCAS, histamine is released excessively, leading to intense and unpredictable symptoms.
Eating disorders can:
Increase the likelihood of histamine intolerance due to nutrient deficiencies or decrease in the enzyme that helps break down histamine.
Histamine intolerance can be linked to gut dysbiosis (imbalances in gut microbiota), which is often seen in people with eating disorders (Maggio et al., 2016).
5. Anxiety and Emotional Stress
The emotional stress associated with eating disorders can worsen symptoms of MCAS. Anxiety and stress have a direct effect on the nervous system and can trigger mast cell degranulation, releasing histamine and other inflammatory mediators. This can lead to:
Flare-ups of MCAS symptoms such as hives, digestive issues, and brain fog.
A vicious cycle where stress from the eating disorder exacerbates the inflammatory response from MCAS, leading to more anxiety and further stress. Research by Kiecolt-Glaser et al. (2002) highlights the role of psychological stress in increasing mast cell activation and inflammation (Kiecolt-Glaser et al., 2002).
Managing both MCAS and eating disorders requires a holistic approach that addresses both the physical and psychological aspects of each condition and it's important to have the support of an interdisciplinary care team.
Citations:
Camilleri, M., et al. (2012). Gut microbiota and irritable bowel syndrome: Mechanisms and therapies. American Journal of Physiology-Gastrointestinal and Liver Physiology, 302(1), G1-G11. https://doi.org/10.1152/ajpgi.00365.2011
Kiecolt-Glaser, J. K., et al. (2002). Stress, inflammation, and the eating disorder cycle. Journal of Psychosomatic Research, 53(6), 487-495.
Yao, X., et al. (2014). Mast cell activation syndrome and gastrointestinal symptoms. American Journal of Gastroenterology, 109(7), 1069-1077. https://doi.org/10.1038/ajg.2014.119
Frier, M., et al. (2016). Psychological aspects of eating disorders and their impact on medical treatment. European Eating Disorders Review, 24(2), 128-134. https://doi.org/10.1002/erv.2464
Maggio, M., et al. (2019). The Impact of Mast Cell Activation on Gastrointestinal Health in Eating Disorders. International Journal of Eating Disorders, 52(9), 950-957. https://doi.org/10.1002/eat.23158
Macht, M., et al. (2017). Food and mood: The role of food in the management of eating disorders and its impact on mental health. Journal of Psychiatric Research, 89, 133-141. https://doi.org/10.1016/j.jpsychires.2017.01.008