Gluten, MTHFR, Mast Cells, and More | Office Hours (Ep 155)

This Office Hours Q&A covers practical ways to approach gluten sensitivity, MTHFR gene results, and mast cell/histamine issues. Dr. Ruscio emphasizes an outcomes-first strategy: unless you have celiac disease, use a time-limited gluten elimination and careful reintroduction to gauge true sensitivity rather than assuming lifelong avoidance. For MTHFR, he cautions against overemphasizing genetic results; most people do best focusing on foundational care—gut health, diet, sleep, stress—before considering targeted methylation support. For mast cell activation/histamine intolerance (symptoms can include flushing, hives, GI upset, headaches, brain fog, palpitations), he suggests a pragmatic, stepwise plan: short-term low-histamine diet, treat gut imbalances/infections, and use evidence-informed supports such as probiotics, vitamin C, quercetin, and, when needed, medications like H1/H2 antihistamines, cromolyn, or ketotifen. He discourages excessive testing when clinical trials of therapy can clarify diagnosis and improve symptoms, and he encourages periodic re-challenges to minimize unnecessary long-term restrictions.