Wellness Protocol
without medication

• Favour: fresh foods cooked the same day, cooked vegetables (courgette, green beans, sweet potato, broccoli), fresh meats (no deli meats), rice, quinoa, apples, pears, grapes, fresh herbs (basil, chives).
• Avoid: fermented foods (aged cheeses, yoghurt, sauerkraut, vinegar), alcohol, tomatoes, spinach, aubergine, nuts, canned fish, reheated leftovers.
• Storage tip: freeze meat and fish immediately after purchase. Cold prevents bacterial histamine formation.
• Keep a food diary for 2 weeks to identify personal triggers. Everyone has their own threshold.
• Cook with olive oil, fresh herbs, lemon (moderate) to maintain a flavourful diet without triggers.

• Light walking: 15 to 30 min/day at conversational pace. Why: improves lymphatic drainage, reduces cortisol and stabilises blood sugar without triggering mast cell degranulation. The only aerobic exercise safe at all stages of the PMCHS terrain.
• Gentle or yin yoga: 20 min, 3×/week. Why: held positions activate the parasympathetic system via joint baroreceptors — directly reducing mast cell activation. Particularly beneficial for EDS (proprioception). Free YouTube channels: Yoga with Adriene, Tara Stiles.
• Aqua gym or gentle swimming: Why: hydrostatic pressure promotes venous and lymphatic return (crucial for lipedema). Water supports body weight and reduces load on hypermobile joints. Gentle water thermoregulation soothes the autonomic nervous system.
• Rebounding (mini-trampoline): 5 to 10 min/day. Why: rebounding stimulates lymphatic drainage via rhythmic muscle contractions without joint impact. Also increases vagal tone through vestibular stimulation — doubly beneficial on a PMCHS terrain.
• Golden rule: stop before fatigue, not after. Why: muscular exhaustion releases pro-inflammatory cytokines (IL-6, TNF-α) that can trigger reactive degranulation. In case of post-exertion malaise, halve the intensity.

• Cardiac coherence 3-6-5: 3 times/day, 6 breaths/minute, 5 minutes. Free app: RespiRelax. Why: synchronises heart rate with breathing, increasing heart rate variability (HRV) — a direct marker of vagal tone. High vagal tone inhibits CRH release and reduces mast cell activation. Best practised before meals.
• 4-7-8 breathing: inhale 4 sec, hold 7 sec, exhale 8 sec. 4 cycles. Why: prolonged retention raises blood CO₂, directly activating the vagus nerve and triggering parasympathetic vasodilation — short-circuiting the adrenaline → degranulation cascade. Powerful during mild histamine reactions.
• Vagus nerve stimulation: cold water gargles (30 sec), humming, singing, laughing. Why: these actions activate the auricular and pharyngeal branches of the vagus nerve via the pharynx and larynx muscles — direct access points to the parasympathetic system without medication. Cold also activates vagal pathways via cervical thermoreceptors.
• Warm bath or shower (36-37°C, not hot): Why: intense hot water (>39°C) triggers systemic vasodilation and releases histamine from cutaneous mast cells. Warm temperature instead stimulates mild cold receptors, activating the parasympathetic system and reducing inflammation.
• Nature contact (earthing): walk barefoot 15 min/day if possible. Why: direct earth contact enables free electron transfer that neutralises pro-inflammatory free radicals — documented antioxidant effect with measurable reduction in cortisol and inflammatory markers.

• Regular bedtime: same time every day, including weekends. Why: the circadian rhythm programmes mast cell activity — their density and activation threshold vary by hour. Irregular sleep-wake cycles disrupt the immune clock and increase nocturnal inflammatory reactivity.
• Cool and dark room: 18-19°C, total darkness. Why: melatonin — inhibited by blue light and heat — is also a mast cell stabiliser. A melatonin deficit increases nocturnal intestinal permeability and amplifies histamine peaks at 2-4am.
• Screens off 1h before bed: Why: screen blue light suppresses melatonin and keeps the sympathetic system activated — incompatible with nocturnal mast cell regulation. Replace with reading, gentle stretching, journalling.
• Light, low-histamine dinner: at least 2h before bedtime. Why: nocturnal digestion of fermented foods generates an intestinal histamine peak absorbed around midnight — responsible for 2-4am wake-ups with hot flushes, itching or palpitations. Avoid: alcohol, cheese, tomatoes, reheated leftovers in the evening.
• Evening herbal tea: chamomile, lemon balm, linden. Why: chamomile contains apigenin (a mast cell-stabilising flavonoid), lemon balm inhibits GABA breakdown, and linden activates GABA-A receptors — triple calming action with no risk. Avoid valerian if ADHD (may have the reverse effect).

Level 2a — Mast cell stabilisation

• Quercétine : 500 mg, 2×/day with meals. Mast cell stabiliser, degranulation inhibitor, intestinal GLP-1 stimulant. Choose phytosomal form or with bromelain for better absorption.
• Lutéoline : 100–400 mg/day. Potent inhibitor of mast cell cytokine release. Often combined with quercetin.
• Lysine : 500–1000 mg/day. Mast cell stabiliser, L-carnitine precursor, supports oligodendrocytes (myelin-producing cells).
• NAC (N-acétylcystéine) : 600 mg/day. Glutathione precursor, potent antioxidant. Reduces oxidative stress associated with mast cell activation and protects myelin.
• Magnésium (glycinate ou malate) : 300–400 mg in the evening. Reduces neural hyperreactivity, improves sleep, particularly useful with associated ADHD.

Level 2b — Neuroprotection & remyelination

• Oméga-3 DHA/EPA : 2–3 g/day with a fatty meal. Direct structural component of myelin membranes, anti-inflammatory via leukotrienes, GLP-1 stimulant. Prefer triglyceride form, wild fish oil or algae. Increased dose for documented neuroprotective effect.
• L-Carnitine : 500–1000 mg/day in the morning. Transports fatty acids into oligodendrocyte mitochondria for the energy production necessary for myelination. Particularly relevant on PMCHS terrain with compromised mitochondria.
• Vitamine E (tocophérol) : 200–400 IU/day. Neurological antioxidant, protects myelin membranes from chronic oxidative stress.
• Vitamine B12 (méthylcobalamine) : 1000 µg/day. Myelin protection — a deficit progressively demyelinates. Prefer methylcobalamin form, better absorbed than cyanocobalamin.
• Vitamine D3 + K2 : D3 2000–4000 IU/day with K2 (MK-7) 100–200 µg/day, with a fatty meal. Why together: D3 promotes calcium absorption and immunomodulation; K2 directs calcium to bones rather than arteries — an essential combination on PMCHS terrain where vascular calcification risk is increased. D3 deficiency is near-universal in these profiles.

Antihistamines

• Antihistaminiques H1 (cetirizine, loratadine, fexofenadine…): block H1 receptors, reducing histamine-mediated symptoms — urticaria, pruritus, rhinitis, brain fog. The choice of molecule and timing (morning vs evening) can make a significant difference depending on your dominant phenotype.
• Antihistaminiques H2 (famotidine, ranitidine…): block gastrointestinal H2 receptors. Documented to reduce digestive symptoms and potentiate H1 effect. Often prescribed alongside H1 blockers in MCAS.

Mast cell stabilisers and modifiers

• Cromoglycate de sodium (oral Nalcrom): direct mast cell stabiliser, inhibits degranulation. Documented in oral MCAS, particularly for gastrointestinal symptoms. Local intestinal action, low systemic absorption.
• Montélukast (Singulair): leukotriene receptor inhibitor. Particularly relevant for the leukotriene-dominant phenotype (respiratory symptoms, chemical sensitivity, cognitive fatigue). Also documented for bronchial hyperreactivity and some ADHD profiles.
• Aspirine faible dose (under strict medical supervision): inhibits prostaglandin synthesis via COX-1/COX-2. Relevant for the prostaglandin phenotype (dysmenorrhoea, proctalgia, hypersomnia). Contraindicated in NSAID intolerance or haemorrhagic tendency.

Autonomic nervous system modulators

• Guanfacine (Intuniv, Tenex): α2A adrenergic agonist, reduces prefrontal noradrenaline. Documented for ADHD, hypervigilance and chronic anxiety — particularly relevant on PMCHS terrain as it reduces locus coeruleus activation and noradrenergic mast cell hyperreactivity.
• Agonistes GLP-1 — microdosés (semaglutide/Ozempic, liraglutide… at sub-therapeutic doses, off-label): at very low doses, distinct from those used for diabetes or obesity, documented for anti-inflammatory effect via NF-κB inhibition, reduction of mast cell activation and improvement of vagal tone. Exploratory use on PMCHS terrain — to be discussed with your doctor, microdosing protocol to be defined together.
• Naltrexone faible dose (LDN) : 1.5–4.5 mg/day (off-label). Immunomodulator via immune cell opioid receptors. Documented in fibromyalgia, ME/CFS and certain chronic mast cell activation profiles. Requires a prescription and follow-up.

This list is not exhaustive and sensitivity varies greatly between individuals. Never stop an ongoing treatment without medical advice.

📄 Download the full, sourced list