EP.396/ Could MCAS/Mast Cells Be Contributing to Your Endo Belly and IBS Symptoms?
Okay so a couple of months back I did an episode on mast cells, MCAS and endometriosis - so, if you haven’t listened to that episode, it’s a short one, and I would listen to it to get you up to speed on what mast cells are and their function, what MCAS is and what the connection is to endo.
Today, we are talking about how MCAS, or even just mast cells, could be contributing to your endo belly, IBS and/or SIBO.
But let’s just do a super quick recap before we get started. Mast cells are immune cells that are like guards stationed around the body, ready to respond to a threat, injury, etc. They release inflammatory chemicals in response to these perceived threats, but in MCAS, these guards are extra jumpy and extra cautious, and fire off at normal stimuli, it could be the food you eat, your environment, stress or more.
Mast cells line the intestines and stomach and are present to respond to allergens, pathogens, injury, infection, etc. and intestinal histamine levels are significantly elevated when gut inflammation is present.(1) These mast cells seem to orchestrate at least some of the symptoms and the severity of symptoms we see in IBS.(2)
Research has shown that MCAS gastrointestinal symptoms include:(3)
Heartburn
Nausea
Bloating
Vomiting (not always common but I see it in my sickest clients or acute reactions)
Altered bowel movements (a significantly higher level of degranulating mast cells have been found in the colons of people with severe constipation, but diarrhea is often present, especially during acute MCAS reactions)(4)
Abdominal pain
Visceral hypersensitivity
Difficulty swallowing
Dyspepsia
Gastritis (in absence of NSAIDS and h.pylori)(5)
Research also shows:
IBS patients have been found to have a higher density of mast cells and histamine in contrast to those without IBS.(6)
Activated mast cells and high levels of histamine located by nerve cells has been linked to abdominal pain in IBS patients.(7)
One study looked at IBS patients who hadn’t responded to treatment, and found that 19 out of 20 had MCAS symptoms, and 11 of the 12 that were tested for MCAS markers were positive.(8)
Additionally, another study found that 58% of IBS patients experience GI reactions to histamine foods.(9)
MCAS and SIBO
And in terms of SIBO, a 2020 study found that SIBO is common in MCAS patients, but that it doesn’t explain gastrointestinal symptoms in all MCAS patients. SIBO was positive in 30.9% of 139 MCAS patients in comparison to just 10% of those without MCAS.(10)
Research has also found that mast cells are elevated in the small intestine of people with MCAS(11)
MCAS is thought to be a possible risk factor for SIBO development, whilst SIBO can also trigger or contribute to worsening MCAS symptoms: The over active mast cells can alter motility and possibly damage the migrating motor complex, which can contribute to SIBO development (but is unlikely to be the sole root cause in my experience). In turn, the overgrowth of bacteria and the resulting LPS levels, trigger a reaction from the mast cells, creating an inflammatory environment that does further damage, and further triggers mast cells, creating a cycle.(12) It’s also worth noting that some bacteria can directly raise histamine levels.(13)
In my experience, MCAS clients are typically much more reactive to SIBO treatments, and tend to feel more unwell, so committing to treatment can be very difficult, especially when it makes them feel worse.
Often, treatments need to be introduced much slower and at lower levels. In my experience, herbs are most volatile in this demographic, and I find histamine safe probiotics, the elemental diet or rifaximin are better tolerated, if treating SIBO.
But additionally, I also find it’s helpful to get my MCAS clients as stable as I can first, before working on SIBO. Yes, SIBO is a trigger so they will only improve so much, but I can usually get them out of the extreme MCAS states and less reactive, which makes addressing SIBO much easier for them.
If you do have SIBO and MCAS, SIBO is unlikely to be the only culprit of your IBS/endo belly symptoms - the MCAS will also be playing a role, so calming and solving that is important. It’s also important to identify if MCAS co-conditions POTS and hEDS or HSD (part of the triad) are present, because they also have a significant impact on the gut and can cause IBS symptoms and bloating, so finding out if you have those, can help you to better improve your symptoms.
Now, as you know, there are normally a few causes behind each person’s endo belly and MCAS is only part of the puzzle, and won’t be part of the puzzle at all for some, but because of the emerging connection between endo, MCAS and IBS/SIBO, I felt it was important to share here!
If you want to learn more about the root causes of endo belly and IBS in the endo demographic, and you’re keen to understand the SIBO, MCAS, POTS and hEDS connection too, I am running a free workshop on Thursday July 23rd, 6pm British Summer time, live on Zoom. If you can’t attend it live, you’ll be able to watch the replay. You’ll learn what the emerging evidence is showing us about endometriosis and the gut microbiome, some of the key root causes behind endo belly, co-conditions to look out for, and what kind of treatments you might need to consider.
To sign up, go to: https://www.theendobellycoach.com/free-endo-belly-workshop and I’ve put the link in my show notes.
1) https://pubmed.ncbi.nlm.nih.gov/24286351/
2) https://www.sciencedirect.com/science/article/pii/S2666379124005275, https://pmc.ncbi.nlm.nih.gov/articles/PMC4819856/, https://jgld.ro/jgld/index.php/jgld/article/view/229, https://onlinelibrary.wiley.com/doi/10.1111/nmo.14339
3) https://sa1s3.patientpop.com/assets/docs/295890.pdf
4) https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2036.2011.04684.x
5) https://pubmed.ncbi.nlm.nih.gov/9287964/
6) https://pubmed.ncbi.nlm.nih.gov/19596012/
7) https://pubmed.ncbi.nlm.nih.gov/14988823/
10) https://www.scivisionpub.com/pdfs/small-intestinal-bacterial-overgrowth-is-common-in-mast-cell-activation-syndrome-1371.pdf, https://sa1s3.patientpop.com/assets/docs/295890.pdf
11) https://sa1s3.patientpop.com/assets/docs/295890.pdf
12) https://www.scivisionpub.com/pdfs/small-intestinal-bacterial-overgrowth-is-common-in-mast-cell-activation-syndrome-1371.pdf, https://sa1s3.patientpop.com/assets/docs/295890.pdf, The Suggested Relationships Between Common GI Symptoms and Joint Hypermobility, POTS, and MCAS - PMC
13) https://pmc.ncbi.nlm.nih.gov/articles/PMC9102523/
Podcast links
https://www.theendobellycoach.com/podcast/what-does-mcas-have-to-do-with-endo
https://www.theendobellycoach.com/podcast/lipopolysaccharides-endo-pain-growth
Need more help or want to learn how to work with me?
Ways to work with me:
One to one coaching info and application - £500 off this July.
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Live and Thrive with Endo 2.0 DIY online course
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This EndoLife, It Starts with Breakfast digital cookbook
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