Mast Cell Activation Syndrome (MCAS) is one of the most overlooked drivers of symptoms in POTS patients. In this episode of the POTS Podcast, Dr. Joseph Schneider breaks down how immune dysfunction, gut health, and neurological inflammation are deeply connected—and why treating MCAS is essential for long-term recovery. By understanding how mast cells impact multiple systems in the body, patients can begin to address root causes rather than just symptoms.
Podcast Episode
MCAS and Its Link to POTS
MCAS is a condition where mast cells—immune cells responsible for releasing histamine—become overactive, leading to widespread inflammation and multi-system symptoms.
For many POTS patients, MCAS is a major underlying contributor to their condition.
Symptoms Affect Multiple Systems
One of the defining characteristics of MCAS is how broadly it affects the body.
Common symptoms include:
Skin:
- Hives, flushing, itching
- Easy bruising and inflammation
Cardiovascular:
- Dizziness and lightheadedness
- Tachycardia and chest discomfort
Gastrointestinal:
- Nausea, vomiting, reflux
- Swallowing difficulties and cramping
Respiratory:
- Wheezing and asthma-like symptoms
This overlap often makes MCAS difficult to identify—but critical to treat.
Brain Fog and Neurological Impact
MCAS doesn’t just affect the body—it directly impacts the brain.
Patients may experience:
- Brain fog
- Headaches and migraines
- Fatigue
- Cognitive slowing
- Difficulty finding words (aphasia)
This happens because inflammation can affect the blood-brain barrier, allowing harmful substances to influence brain function.
The Gut-Brain Connection
A major driver of MCAS symptoms is gut health.
When the gut barrier is compromised:
- Food particles leak into the bloodstream
- The immune system reacts aggressively
- Inflammation spreads throughout the body
This “leaky gut” response can worsen:
- Skin reactions
- Digestive symptoms
- Neurological issues
- Cardiovascular instability
Supporting gut health is essential for calming mast cell activity.
How MCAS Is Diagnosed
There is no single definitive test for MCAS.
Instead, diagnosis relies on:
- Recognizing symptom patterns
- Food sensitivity testing (IgG-based)
- Identifying triggers such as histamine-rich foods
- Evaluating underlying infections or inflammation
By identifying and removing triggers, patients can significantly reduce immune reactivity.
Treatment: A Holistic Approach
Effective MCAS treatment requires a multi-layered strategy, including:
Nutrition & Diet:
- Eliminating trigger foods
- Reducing histamine intake
- Supporting gut healing
Supplements:
- Quercetin to stabilize mast cells
- Probiotics to support microbiome balance
Functional Testing:
- Food sensitivities
- Mold and toxin exposure
- Infections (Lyme, Epstein-Barr, etc.)
Neurological Support:
- Strengthening the autonomic nervous system
- Improving brain-body communication
Why the Nervous System Matters
A key insight from this episode:
👉 A stronger nervous system leads to a more stable immune system
When the nervous system functions properly, it helps regulate:
- Immune responses
- Digestive function
- Inflammation levels
This is why neurological therapies are essential in managing both POTS and MCAS.
Restoring Function and Quality of Life
With the right approach, patients can:
- Reduce flare-ups
- Improve energy and mental clarity
- Return to school, work, and daily activities
- Regain control over their health
The goal is not just symptom relief—but restoring full function and quality of life.
Start Your Recovery Journey
If you’re experiencing:
- Unexplained inflammation
- Chronic fatigue
- Brain fog
- Digestive issues
- POTS symptoms
MCAS may be part of the picture.
The Hope Brain and Body Recovery Center offers comprehensive testing and personalized treatment plans to address the root causes of your symptoms.
👉 Visit https://hopebraincenter.com/ to schedule a consultation and start your recovery.
Frequently Asked Questions (FAQ)
What is Mast Cell Activation Syndrome (MCAS)?
MCAS is a condition where mast cells release excessive histamine, causing widespread inflammation and symptoms affecting the skin, gut, heart, and brain.
How is MCAS connected to POTS?
Many POTS patients have MCAS, as both conditions involve dysregulation of the autonomic and immune systems, leading to overlapping symptoms like dizziness, fatigue, and inflammation.
What causes MCAS symptoms?
Triggers include food sensitivities, infections, toxins, stress, and gut health issues such as leaky gut, all of which can activate mast cells.
Can MCAS cause brain fog?
Yes. Inflammation from mast cell activity can affect the blood-brain barrier, leading to brain fog, fatigue, and cognitive issues.
How do you test for MCAS?
There is no single test. Diagnosis is based on symptom patterns, food sensitivity testing (IgG), and identifying inflammatory triggers.
What foods should be avoided with MCAS?
Common triggers include histamine-rich foods such as fermented, pickled, and smoked foods, along with any foods identified through sensitivity testing.
Can MCAS be treated naturally?
Yes. Treatment often includes dietary changes, gut healing, supplements like quercetin, and reducing inflammation through a holistic approach.
Why is gut health important for MCAS?
A damaged gut barrier can trigger immune reactions that worsen mast cell activation and systemic inflammation.
Does improving the nervous system help MCAS?
Yes. A healthier nervous system can regulate immune responses, reduce inflammation, and improve recovery outcomes.
When should I seek help for MCAS?
If you have persistent symptoms affecting multiple systems—especially alongside POTS—it’s important to seek a comprehensive evaluation.
👉 Visit https://hopebraincenter.com/ or call +1 (610) 652-4732 to schedule a consultation.
Transcript
00:00
Dr. Joe Schneider
Foreign.
00:05
Dr. Joe Schneider
Welcome to my POTS podcast. I’m Dr. Joe Schneider and after 35 years as a functional neurologist, a personal journey through stroke recovery and helping thousands of patients, I’m here to share breakthrough solutions for POTS neurological wellness. From getting out of bed in the morning to rebuilding your nervous system, this is your guide to understanding and overcoming neurological challenges. Let’s begin this journey to recovery together.
00:34
Dr. Joe Schneider
Hello. Today we’re going to be talking on MyPods podcast. We’re going to be talking about mast cell activation syndrome. When were talking in previous podcasts, we’re talking about that when people come in with pots, they have a broad based symptomatology that runs through the brain. Brain fog, headache, migraine type headaches, body pains, chronic fatigue, digestive problems with women’s cycles, problems with rectal dysfunction, and all types of things that have to do with autonomic and circulation. We said that really POTS is a broad spectrum. It’s a dysautonomia. And part of that broad spectrum has been mast cell activation syndrome. Most of the patients that come to us with POTS have mast cell activation syndrome. Mast cells are cells that have these vesicles in them within tissue throughout the body that are that release histamine.
01:49
Dr. Joe Schneider
Now, histamine works in the body that causes an inflammatory reaction, mostly allergic type reactions, but it can have like a ton of problems. Like a lot of the patients that come in with mast cell activation syndrome. How do they know? Well, they know because they have hives, they bruise easily, itchiness, a burning feeling, flushing, they look pale complexion, or it could be a red complexion or red blotches throughout their skin. Now hives can be these nodules come up on your skin and they’re very inflammatory and they can be painful also. So a mast cell activation system syndrome can actually be seen mostly with skin symptomatology. Now that’s really interesting because most patients do have that, but if we talk about the cardiovascular effects of mast cells, we’re talking about really that it affects your cardiovascular system.
03:05
Dr. Joe Schneider
Now some of the symptomatologies from that would be lightheadedness, dizziness, non cardiac chest pain, pre syncope, arrhythmia and tachycardia. Now that you know, that sounds like my POTS patients right there. Then we also check for your gastrointestinal syndrome. So with that, you’re going to be getting diarrhea, constipation, cramping, intestinal discomfort. Now, one of the symptoms that I’m finding with a lot of patients coming in is nausea and vomiting where they can’t even eat, they vomit an acid reflux. Swallowing difficulty, where you get some issues with the esophagus or esophagitis. I’ve treated a lot of kids that were young with esophagitis and it can be very painful and difficult swallowing and throat tightness or an inability to speak because of the throat tightness or an unwillingness to speak because of throat tightness.
04:15
Dr. Joe Schneider
So you’re seeing like a broad spectrum of issues that go on with mast cell. So skin, cardiovascular, gastrointestinal. Now if we go through with like an allergic response, you’re going to see a lot of respiratory issues like congestion, coughing, wheezing, asthmatic type symptomatology. That happens with patients that have mast cell activation where they’re producing too many reactivities in their immune system or the mast cell creating that histamine, it causes dysfunction in the body. And then we also worry about systemic type of reactions like anaphylactic type shock syndrome where you need like an EpiPen to control it. So mast cells are different than the immune cell basophil, but basophils are similar to mast cells and they are allergic type immune cells and they produce histamine. Also, another big symptom of patients that have POTS is brain fog.
05:33
Dr. Joe Schneider
So brain fog, headache, fatigue, lack of concentration, mild cognitive problems and sleep disturbances. So if we have a patient that has POTS and they’ve also been diagnosed with mast cell activation syndrome, then we really have a complicated mess. So we have neurological issues and then we have immune reactivity that’s causing these problems. So how do we settle down the immune system? Well, there are nutrients or supplements that we can use that help to. The big one is usually quercetin. They use quercetin to really calm down allergic responses to your environment. Now these also, these allergic responses can have a effect on the blood brain barrier. And that was just told that. I used that a lot in my last podcast. And the blood brain barrier is that barrier from the brain to the body that keeps out unwanted material.
06:46
Dr. Joe Schneider
Now when that gets inflamed like it would on mast cell activation syndrome, then you’re going to start having some cognitive problems. You’re going to have brain fog. You’re going to maybe have aphasia where there’s a word in your head that you just can’t get out. You may have slowness in your auditory reception or your auditory processing, you may have slowness in your visual processing that can cause these type syndromes. Now if you want to look at allergies or sensitivities. One of the biggest offenders in that group of issues would be your gut barrier. So you got blood, brain barrier that could be inflamed and you have your gut barrier be inflamed. Or you can have what’s called a break in your tight junctions and you could have a leaky gut.
07:39
Dr. Joe Schneider
Now, with leaky gut and sensitivities, it can cause all the issues that you’re having, like the skin issues, the cardiovascular, the gastrointestinal, the neuropsychiatric type responses, your respiratory system, and it can cause you to start having swellings. That could be similar to having anaphylactic type reactions. That’s all pretty scary, you know. But to evaluate your gut is very important. Now there’s two parts to the gut that you really have to explore now. One is the development of sensitivities where the barrier’s been broken. You have food that leaks, what’s called leaky gut leaks into your bloodstream and your immune system reacts to it like it’s a foreign substance, which is what its purpose is. Anything that foreign comes into the body needs to attack it. So you can cause local inflammation and then over time you can cause inflammation throughout the body.
08:43
Dr. Joe Schneider
Now, when patients come to the office, we always want to do a food sensitivity test. And a food sensitivity test will tell us which foods are reacting to immune system. We use the immunoglobulin G I G G to look at a long term or more of a long term type of reaction to it, rather than looking at ige, which is really a short term reaction to food. And then when we find food sensitivities, we eliminate that food from the diet. And that can really kind of cut down the mast cell reactivity. It can improve the way the body responds. They also talk about histamine type foods that causes histamine. Normally when you eat them, like pickled foods and smoked foods can be part of that.
09:45
Dr. Joe Schneider
The other part of the gut is the gut has more bacteria, more fungal forms, more parasites in it than the number of cells in the body. Now that’s pretty freaky. There’s more of those cells in the body than there are now. There’s more cells of the bacteria, fungal forms and parasites than there are cells in the body. So it’s really not a clean environment. But we have what we call probiotics. And probiotics are good bacteria that have a healthy reactivity to not only the cellular barrier in the gut, but also what’s called the mucus barrier. So before you get the cells, you have a mucous barrier in which all these microwave organisms live. And they create a symbiotic relationship with the body, which makes digestion a happier process.
10:51
Dr. Joe Schneider
When that mucus barrier breaks down to bad bacteria, fungal forms or parasites, then it gets to the cellular level and that’s where you start having some real inflammation. And that inflammation goes to the blood brain barrier and causes problems in the brain. Now one of our brain scans, the brain core brain scans will give us a indication of whether the brain has inflammation in, could be inflammation due to food sensitivities, infection. It could be due to a trauma, a brain trauma. It could be a psychiatric trauma, it could be a continuous psychiatric trauma through time. It could be an emotional type trauma where you’ve been under stress for so long that your body is responding to that. We do respond by doing those testing. We also do mold testing.
11:55
Dr. Joe Schneider
We also do, we’ll do Lyme testing, we’ll do testing for Epstein Barr, cytomegalovirus, herpes simplex. So we want to look at different infection agents that may still be in the body. Could be Lyme, could be other types of things, and then we want to see what that effect of the histamine inflammatory cycles that are actually changing the way your body functions. There’s no strict test for mast cell activity in the body. It’s usually due to the symptomatology, the variety of symptoms that you’re having. If you’re having hives, you’re having redness of the skin, you’re pale, chronic fatigue. Then we know that your mast cells are hyperactivated and if they’re hyperactivated on a continuous level, they’ll have far reaching effects, especially if you have pots. The reason we’re going through this is it’s feedback from our patients. So the other aspect is eds, right?
13:12
Dr. Joe Schneider
So mast cells will affect your joints and your joints can get very sore, they can swell. They also can become hypermobile due to the mast cell activity where the joint feels like they’re dislocating or there’s no stability around the joints. So any activity that you do or exercise that you do, then those joints are going to go out of place, they’re going to crack, they’re going to pop, and then that can cause an inflammatory reaction like a sprain strain that goes really wrong and produce a lot of swelling. So to effectively look at patients with a POTS diagnosis or a diagnosis of dysautonomia, you have to look at your immune system and how it’s Reacting and you have to look at your brain and your neurological system.
14:15
Dr. Joe Schneider
Now the question arises, and something that I think about every day is that when we get individuals with an immune type issue that’s affecting them, like mast cell, could be other type of immune like issues. If you have a better functioning brain, does that cause you to have less reactivity in your immune system? Now, we have had a lot of kids that come in that when they get an illness or they get a cold or a flu or something like that, they’re down for the count for three, four weeks, maybe five weeks at a time. And they miss a lot of school. And then they have a hard time getting themselves together. If they’re participating in extracurricular activities, they can’t get their extracurricular activities.
15:09
Dr. Joe Schneider
And then when we find that when we treat them, when they do get a cold or flu, it’s two or three days and then they rejuvenate quicker. So we know that the autonomic nervous system does go to your thymus gland, it does go to your spleen, it goes to your bone and your bone marrow. So there is controls that we have in our body that can create homeostasis within your immune system. Now, I would say that I’m not an expert on those controls, but we’re studying it more and those do exist. So by getting your nervous system healthy after either a real bad infection or after a trauma, whether it’s emotional, physical or mental, we know that a stronger nervous system will control your immune system better.
16:16
Dr. Joe Schneider
Your immune reactivity, it will also control your digestive tract better and for overall healthier response to your environment and to your world. Now what does that end up doing? It ends up having you get back to your life. You know, if you’re a child, you know, it’s important you do well in school. It’s important that you can go to school. It’s important that you can participate in extracurricular activities, have a good social life, and really kind of enjoy your life again. So this is Dr. Joe Schneider saying goodbye for now and looking forward to doing our next podcast. And we’ll see you then. Thank you. Thank you for joining us on my POTS podcast.
17:09
Dr. Joe Schneider
If you’re looking for more support, Visit us at hopeprayingcenter.com or follow our journey on TikTok where we share daily insights and inspiration. Remember, healing is cost. I’m living proof.
17:24
Dr. Joe Schneider
I’m Dr. Joseph Schneider and I’ll see you next time as we continue exploring paths to recovery.
