Key Topics & Timestamps
0:00 - Introduction to MCAS and Autoimmunity in Menopause
5:30 - Dr. Tania Dempsey's Background and Journey into MCAS
12:15 - Understanding MCAS: Symptoms and Prevalence
18:45 - The Connection Between Hormones and Mast Cells
25:20 - Triggers and Environmental Factors
32:10 - Case Study: Post-COVID MCAS Reactivation
39:40 - Natural and Pharmaceutical Treatment Approaches
47:25 - Ozone Therapy for MCAS Management
54:30 - Plasmapheresis: The Future of MCAS Treatment
62:15 - EMF Sensitivity and Environmental Triggers
68:45 - Dietary Recommendations and Enzyme Support
75:20 - How to Connect with Dr. Dempsey
As a physician who has been practicing for over 30 years, I can tell you that something fundamental has shifted in women's health—particularly regarding autoimmunity and inflammatory conditions. What I'm seeing in my practice today looks dramatically different from what I encountered even five years ago. The prevalence of mast cell activation syndrome (MCAS), histamine reactions, and complex autoimmune conditions has exploded, especially among women navigating perimenopause and menopause.
This is why I was so excited to have Dr. Tania Dempsey on The Girlfriend Doctor Show. As one of the world's leading experts in MCAS and complex multisystem diseases, she's been at the forefront of understanding and treating these challenging conditions that often leave women "circling the drain" looking for answers.
Understanding MCAS: The Hidden Epidemic
Dr. Dempsey's journey into MCAS began somewhat by accident in 2014 when she encountered a patient who simply wouldn't get better despite all conventional approaches. After extensive research, she discovered mast cell activation syndrome—and it changed everything.
"I think greater than ninety percent of my patients have this condition," Dr. Dempsey shared, referring to her practice before COVID. Even more staggering, she estimates that more than 17% of the population has MCAS—and those numbers have likely increased significantly post-COVID and post-vaccination.
But what exactly is MCAS? As Dr. Dempsey explains, "This is a multisystem inflammatory condition. And inflammation is really one of the hallmark features of it." The key characteristics include:
Inflammation (the primary feature)
Allergic phenomena (though not always present)
Growth and development issues (affecting wound healing, causing cysts, fibroids, thyroid nodules, endometriosis)
The Symptom Spectrum: When Your Body Turns Against Itself
What makes MCAS so challenging to diagnose is that mast cells exist in every organ and tissue in the body. When they become dysfunctional, they essentially "explode," releasing over 1,200 different chemicals and mediators—histamine being just one of them.
The symptoms can manifest anywhere:
Skin: Rashes, hives, flushing
Respiratory: Shortness of breath, wheezing
Cardiovascular: Tachycardia, POTS (postural orthostatic tachycardia syndrome)
Gastrointestinal: Abdominal pain, nausea, vomiting, SIBO
Neurological: Brain fog, fatigue (often the most common symptom)
Reproductive: Endometriosis, irregular cycles
"Literally, like, almost every disease process that we see could be tied back or in some way to the mast cell," Dr. Dempsey notes. This is why so many women struggle for years before getting a proper diagnosis and treatment.
The Menopause Connection: Why Women Are Particularly Vulnerable
One of the most crucial insights from our conversation was understanding why women—especially those in perimenopause and menopause—are disproportionately affected by MCAS.
As Dr. Dempsey explains, "We generally have a different immune system. And because of our fluctuations in our hormones over the course of most of our lives until menopause, we know that these hormones, particularly estrogen, is very interrelated, is very connected to the immune system."
Here's the critical piece: mast cells have hormone receptors. They have estrogen receptors, progesterone receptors, and testosterone receptors on their surface. When hormone levels shift—which happens dramatically during perimenopause and menopause—the mast cells interpret this as a threat.
"They particularly are very sensitive to changes in the hormones," Dr. Dempsey notes. "And so when you see those shifts, that's when they are more likely to release their mediators and they're most likely to cause inflammation."
The Perfect Storm: Key Life Stages for MCAS
Dr. Dempsey identified several critical windows when women are most vulnerable:
Puberty : When estrogen levels begin rising
Post-pregnancy : When the immune system "rebounds" after being suppressed during pregnancy
Perimenopause : The most significant time due to dramatic hormonal fluctuations
Menopause : When hormone levels stabilize at lower levels
"Perimenopause is a really significant time," she emphasized. "How many perimenopausal women are feeling inflamed? Gaining weight, feeling yucky, no libido. Their vagina is dry. Like, everything starts to go crazy. And the mast cells are involved in this process."
A Real-World Case: Post-COVID MCAS Reactivation
During our conversation, I shared a complex case that perfectly illustrates how MCAS can be triggered and reactivated. My patient, a vibrant woman in her mid-40s, had received five COVID vaccines while living in South America, then contracted COVID twice. After the second infection, she became bedridden for almost a year.
We successfully treated her long COVID symptoms, optimized her hormones, and she was thriving—until suddenly, she began experiencing severe histamine reactions. First to steak, then fish, until she could only tolerate chicken. Despite having normal inflammatory markers (CRP below 1), she was experiencing profound fatigue, joint pain, hair loss, and tinnitus.
Dr. Dempsey's analysis was illuminating: "I have some questions. Did she have another vaccine since?" When I confirmed she hadn't, she continued: "So what I think is really important is really to identify a trigger... What shifted? Was she exposed to another virus?"
Indeed, about two weeks before her symptoms began, family members had been ill with flu or cold. Dr. Dempsey explained: "Her immune system thought, wow, I gotta really fight this. And so she may not have gotten sick, but her immune system recognized that there was something they had to fight. And the mast cells... really are that first line of defense."
Treatment Approaches: From Natural to Advanced Therapies
The good news is that MCAS, while challenging, is treatable. Dr. Dempsey outlined a comprehensive approach that includes:
Natural Antihistamines and Mast Cell Stabilizers
Vitamin C: Natural antihistamine and mast cell stabilizer
Quercetin: Powerful natural antihistamine
Luteolin: Another natural option for mast cell stabilization
Progesterone: Acts as a mast cell stabilizer, especially when given as steady hormone replacement
Pharmaceutical Options
When natural approaches aren't sufficient:
H1 antihistamines: Claritin, Zyrtec, Allegra, Benadryl
H2 blockers: Pepcid (particularly helpful for GI symptoms)
Cromolyn sodium: Specifically helpful for gut-related mast cell issues
Low-dose naltrexone: Helps modulate immune function
Advanced Therapies
Ozone Therapy: Dr. Dempsey uses ozone therapy, particularly when infections are driving MCAS. "Ozone's interesting because it has a couple of interesting properties. It's a disinfectant, so it does kill viruses and bacteria... But at the same time, what ozone does is it's sort of like super oxygen... it oxygenates tissue."
Plasmapheresis: Perhaps the most exciting future treatment, plasmapheresis (therapeutic plasma exchange) removes inflammatory cytokines and mediators from the blood. "What we're hoping to do is actually run a study on mast cell patients," Dr. Dempsey shared. "I think we're gonna be able to pull out some of the bad mast cells and maybe be able to reset."
Environmental Triggers: The Hidden Culprits
One of the most eye-opening parts of our conversation was discussing environmental triggers that can activate mast cells:
EMF Sensitivity
"I have patients who cannot have any electromagnetic devices in the room with them. They are that sensitive. Literally causes them to be almost anaphylactic," Dr. Dempsey revealed. While not everyone with MCAS is EMF-sensitive, for those who are, it can be a significant trigger.
Mold Exposure
Often underlying EMF sensitivity is mold exposure. "What I find is that for some of those patients... I think a lot of those patients actually have mold. They're exposed to mold. And so their mast cells are already at a very heightened state."
Other Environmental Factors
New medications
Hidden infections (Epstein-Barr, Lyme, other viruses)
Chemical exposures
Stress (physical and emotional)
Dietary Strategies: Healing from the Inside Out
Nutrition plays a crucial role in managing MCAS. Dr. Dempsey's recommendations include:
Protein Priority
"Generally speaking, let's try to get as much protein in... even if it's just chicken. Because protein is so important. You need it for your muscles and you need it for your overall health."
Enzyme Support
For those struggling with food sensitivities:
DAO (diamine oxidase): Helps break down histamine
Digestive enzymes: Tailored to individual sensitivities (fat, carbohydrate, or protein digestion)
FODMAP enzymes: For those sensitive to specific carbohydrates
Individualized Approach
"Every patient is so different. And we try to figure out how we can get them to absorb their nutrients, digest their food, and not feel sick every time they eat."
The Hope Factor: There Is Always a Solution
What I love most about Dr. Dempsey's approach is her unwavering optimism. "I always say the solution's there. We might just have to hunt it down a little bit for you, but it's there."
While MCAS cannot currently be "cured," it can be controlled, suppressed, and put into remission. The key is understanding that this is often a journey requiring patience, detective work, and a willingness to try different approaches.
As I always tell my patients, "If I can heal the cell, I can heal the patient." This means focusing on:
Healing cell membranes
Removing toxins
Reducing inflammation
Supporting mitochondrial function
Addressing root causes rather than just symptoms
The Future of MCAS Treatment
Dr. Dempsey is actively working to advance our understanding of MCAS through research, education, and clinical innovation. She recently became the first physician to lecture first-year medical students about MCAS—a crucial step since most medical professionals receive no training on this condition despite its high prevalence.
Her mission extends beyond her practice: "I just wanna educate... the reality is that I can't see everybody. I wish I could. I wish I could help the world, but I'm gonna help the world one patient at a time by giving them this information so they can help themselves."
Taking Action: Your Next Steps
If you recognize yourself in these symptoms and stories, don't despair. Here's what you can do:
Find a knowledgeable practitioner who understands MCAS and functional medicine
Track your symptoms and potential triggers
Consider basic lab work, including DAO levels and inflammatory markers
Start with natural antihistamines under professional guidance
Address underlying infections or environmental triggers
Optimize your hormones if you're in perimenopause or menopause
Remember, as Dr. Dempsey emphasizes, "Patients have to be their own advocates right now." The medical establishment is still catching up to understanding MCAS, so education and self-advocacy are crucial.
Beyond Symptoms: Reclaiming Your Life
What gives me the most hope in treating complex conditions like MCAS is seeing women reclaim their lives. When we address the root causes—whether it's healing the gut, balancing hormones, reducing toxic load, or calming the immune system—transformation is possible.
The woman I mentioned earlier? We're working through her current flare with the tools Dr. Dempsey discussed, and I'm optimistic about her recovery. Because that's what this work is about—not just managing symptoms, but helping women thrive again.
Ready to dive deeper into this crucial conversation about MCAS, hormones, and healing? Listen to the full podcast episode to hear all the details of Dr. Dempsey's insights, treatment protocols, and the hope she offers to women struggling with these complex conditions.
Frequently Asked Questions
Q: How do I know if I have MCAS versus just regular allergies?
A: MCAS is a multisystem condition affecting multiple organs, not just typical allergy symptoms. You might experience fatigue, GI issues, heart palpitations, brain fog, and skin problems all together. Regular allergies are usually more localized and predictable.
Q: Can MCAS be cured, or is it a lifelong condition?
A: Currently, MCAS cannot be cured, but it can be controlled, suppressed, and put into remission. With proper treatment, many people live symptom-free for extended periods. The key is identifying and managing triggers while supporting the immune system.
Q: Why are women in menopause more susceptible to MCAS?
A: Mast cells have hormone receptors and are particularly sensitive to hormonal changes. The dramatic fluctuations during perimenopause and the hormonal shifts of menopause can trigger mast cell activation, leading to increased inflammation and symptoms.
Q: What's the connection between COVID and MCAS?
A: Both COVID infection and vaccination can trigger immune dysregulation in some people, potentially activating mast cells. The spike protein and immune response may create the perfect storm for developing or exacerbating MCAS, especially in those already predisposed.
Q: Are there specific tests to diagnose MCAS?
A: MCAS diagnosis is primarily clinical, based on symptoms and response to treatment. Some helpful tests include DAO levels, tryptase levels, and specialized urine tests for mast cell mediators, but normal results don't rule out MCAS.
