Ep. 82: Histamine Intolerance, MCAS, and Your Gut: What’s Really Going On with Michelle Shapiro

If you’ve been dealing with reflux, bloating, constipation, or even anxiety and can’t figure out why, histamines might be part of the picture. In this episode, I’m joined by Michelle Shapiro, RD, to break down the connection between histamine intolerance, MCAS, and gut symptoms and why so many people feel worse with standard gut protocols.

Michelle and I discuss: 

• What histamine intolerance really is and how it overlaps with MCAS
• The wide range of symptoms histamine issues can cause (and why they’re often missed)
• How the gut, DAO enzyme, and microbiome influence histamine balance
• Why nervous system support is just as important as gut support
• Practical steps you can take if you suspect histamine intolerance

Michelle also shares her personal journey with histamines, mold exposure, and POTS and how slowing down and supporting safety in the body can be a turning point for healing.

Links Mentioned in the Episode:

• Gupta Program (free 28 day trial with this link)
  
  
• Michelle’s Histamine Essentials Webinar
  
  
• Michelle's Sept 28th Webinar 
  
  
• Michelle’s Website
  
  
• Michelle’s Instagram
  
  

Stay Connected with Dr. Heather:

• Follow on Instagram
  
  
• Visit the Website
  
  

About Michelle: Michelle Shapiro, RD is a functional/ integrative Registered Dietitian who has helped over 3,000 clients transform their health over the past 11 years. As the founder of an NYC-based virtual private practice, Michelle leads a team of six expert nutritionists who specialize in complex cases including histamine issues, gut dysfunction, chronic anxiety, and weight concerns. She is the creator of the viral Histamine Essentials Webinar, which is available now on replay, and the host of the top-rated podcast Quiet the Diet, where she breaks down the science behind chronic illness in a way that actually makes sense and makes you feel seen. Michelle is the go-to expert for people who have tried everything and are ready for a real plan.

Transcript

Dr. Heather Finley: 0:03

Welcome to the Love Your Gut Podcast. I'm your host, Dr. Heather Finley, registered dietitian and gut health specialist. I understand the frustration of dealing with GI issues because I've been there and I spent over two decades searching for answers for my own gut issues of constipation, bloating, and stomach pain. I've dedicated my life to understanding and solving my own gut issues. And now I'm here to guide you. On this podcast, I'll help you identify the true root causes of your discomfort. So you can finally ditch your symptoms for good. My goal is to empower you with the knowledge and tools you need so that you can love your gut and it will love you right back. So if you're ready to learn a lot, gain a deeper understanding of your gut and find lasting relief. You are in the right place. Welcome to the love your gut podcast. Welcome back to the next episode of the Love Your Gut podcast. I'm so excited to be here today with Michelle. I feel like this has been a long time coming. We've been chatting for like 20 minutes Off air should have just pressed record. But Michelle, welcome to the podcast, Dr. Heather. I'm so excited to be here. I'm really excited to be here. Yes. So you spoke in gut practitioner, what was that like a couple months ago and you were a hit, and ever since I'm like, I have to have you on the podcast because histamines and MCAS and all the things is something that I talk about, but not too much. So I figured why not have the actual expert come on here and talk about it. So why don't you just tell us why Histamines MCAS, why does that matter? You and then maybe like what exactly are histamines and why do they matter for gut health? Just for someone listening because they might not know. Um, absolutely. We'll kind of go back to the basics. Yeah. So I live in what I've kind of named a highly sensitive body, and it took a long time for me to understand my highly sensitive body. And it took a lot of going through what I would say is like both conventional medical means and functional medical means. And no matter what I did. Especially in the last five years, it seemed like I was getting sicker and sicker, and it didn't make sense. I would go to the best functional medicine doctors, the best naturopathic physicians, and I would get something like an iv, and then I would have what looked like a flu for a week, or I would go get a massage or lymphatic drainage or go to a sauna. Again, violently ill, I mean, insomnia, tremors, dizziness, um, nausea, gut issues, um, in your domain. Of course, many, many in your domain. And really just could not put the pieces together for myself. And it really took, it was after, um, my first COVID exposure that these symptoms seemed to really skyrocket. I had both a COVID exposure. And a mold exposure. And as, as I was detoxing from the mold, I got much sicker and I was like, wait a second. This mold detox is supposed to make me feel better, not worse. And it really confused me. And so it was my self-discovery from basically being at a point where I couldn't walk. I was in a neck brace and a back brace for over six months. Um, I had to crawl a lot of the time when I needed to do things. Um, I had a chiropractic injury, this mold exposure. Um, and this COVID exposure and that together just created this new level of illness that I had never experienced before. And then I started to see that clients were experiencing this too. So it was like many of us practitioners, it was my eagerness to figure out what the heck is going on in my own body, and if I can figure this out for myself. I hopefully can figure it out for other people as well. Um, so that's what brought me into this specific sphere because I had actually been working with different clients and I still do. Um, and my team still does for many years before. And then I saw after COVID there was this huge increase in this kind of new type of feeling, terrible, um, that I desperately sought answers to, um, for both myself and clients. So interesting. So it was really like, you can pinpoint it was COVID and then mold kind of coupled together that just made you feel so sick. Did you, were you kind of a sick kid or do you feel like you were highly sensitive as a, as a kid with lots of reactions or anything, or, no one's ever asked me that on a podcast. That's so interesting. Oh, I'm a pretty atypical MCAS person. I don't get any. I don't sneeze, I don't get any rashes. I don't have any of what you would think of as like typical allergy symptoms. I really get like nervous system driven symptoms in an extreme way. And gut driven symptoms I like to say about mast cells. And of course we're gonna define what mast cells are, but they really show you your weak spots. They really show you whatever that symptom is that you don't want is the exact symptom you're gonna get. So for me, I hate feeling dizzy. I hate feeling off kilter. Um, that's the symptom that comes up for me. So it really depends on the person. And because mast cells, which are, are a type of immune cell, they're a type of white blood cell, uh, part of our immune system. They are literally in all of our connective tissue and in every single part, connective tissue lines, our joints, our bones, our blood vessels, and also mast cells line all of our organs as well. There's connective tissue in our organ, uh, tissue. Uh, a layer of our organ tissue. So you can really get symptoms from mast cells anywhere in the body and depends on the person. So the answer is actually, I was a kid who like got strep once. I think I was on antibiotics like once. I was never sick. I never had, um, like any sort of rashes, gut issues until I started having really debilitating panic attacks and anxiety, um, in college. And then kind of started feeling like a sick. Person. Um, I also had in high school, lost a hundred pounds going into college. I always occupied a larger body when I was younger. And rapidly lost weight to go to school. Um, I literally was like, oh, people aren't gonna like know me when I go to college. I have to like present differently because I grew up in Queens, New York. It was no problem living in a larger body. I had the most friends, great grades, like beautiful life, a place where all types of body diversity and diversity in general. It was celebrated and I was going to the University of Delaware. Um. A much more homogenous place and I was like, I need to lose weight. And it really was the weight loss part that made me feel sicker. And that's that paradoxical piece of my body. It's not the mold that made me feel sick, it's the mold detox that made me feel sick. It's not carrying extra weight, it's losing weight rapidly. So my body does not respond well to any sort of strong changes. Um, so I didn't really, again, assume that sickness identity until after. The weight loss and, uh, didn't experience. Yeah, no, not as a kid. Uh, wasn't really sick ever. So interesting. It's so crazy how with histamine and MAs cell stuff, it can present so differently. And you kind of alluded to that. So tell us, I guess we often hear histamine intolerance. I feel like that's probably the most common phrase, at least that I hear. Histamine intolerance. How is that different from mast cell activation and like what are the types of symptoms that somebody might experience?'cause. As you know, and we know it could literally be so many different things. Yeah. Yes, absolutely. So our mast cells are these type of white blood cells. And what happens is they have, they're, they're helpful to us in many ways to help us respond to threat or perceived threat inside of the body. They will direct resources, they will direct immune cells, they will direct nutrients and blood flow so that when there is some sort of, again, perceived threat or real threat. We can help the body to recover from it or defend against it. So I think of our mast cells, um, as kind of like if there's a, a watchtower, they're kind of like the guards on the watchtower and they're always looking to see what's happened here inside of our mast cells. There are different types of chemical messengers in kind of like these. Sacks and they will get released when they perceive that threat or that threat is real. So that's when the guards in the watchtower are like, go, go, go. And they start sending everything. Um, in the case of mast cell activation syndrome, those mast cells are constantly, constantly being activated and then they're sending out these 1200 plus chemical messengers. One of those chemical messengers is histamine. And we hear the most about it because I think it creates some of the gnarliest symptoms, unfortunately. Um, so the issue is not that our mast cells are, it's not like you have a, uh, hypoactive immune response. It's not an autoimmune response. It's a hyperimmune. Response in a body that's hypervigilant, essentially. So your body is constantly on and it's constantly sending these signals. So it's not bad that the body does that. The problem is that when you have too many of these mediators floating around, and some other ones that people may have heard of, like cytokines, prostaglandins, interleukin six, these are ones that we associate with inflammation, uh, generally. Um, because being in mast cell activation is a state of inflammation. It's chronic immune activation, which is inflammation. Um. They, it's that these messengers create new symptoms. So you have a bunch of histamine floating around in your bloodstream and that causes these new symptoms. Um, so what happened also with the COVID pandemic specifically, was that COVID has this really special relationship with mast cells. Mast cells have a certain receptor on the outside of them. When something attaches to the receptor, they release the chemical messengers inside. All these communicators and unfortunately, COVID attaches and attacks the ACE two receptor on the outside of mast cells. So that is why so many people had what looked like long COVID or was diagnosed as long COVID, um, I really think of as a combination of MCAS and maybe some other, uh, pieces as well, like pots and hypermobility. But, um, that's what happened in the past few years when we saw the people. Why are we all talking about histamines now? It's because it caused this surge in this histamine response, uh, when those receptors were attached. So histamine's goal in our body is to, again, respond to threat. One of the things that it does, very importantly, is it causes something called vasodilation, which is the opening and widening of our blood vessels, so that it almost creates like a slide in your body. If your blood vessels are wide open, you can just send anything down really quickly, right? If they're squeezed tight, you can't. Push anything through as quick. So it's like kind of like opening up those traffic lanes in the body. That can create a lot of problems if your blood vessels are wide open because you don't get that pumping mechanism that would lead to good blood flow in the brain and heart. So one of the common symptoms we see with histamine issues is. Tech, fast, heart rate, dizziness, um, migraines can be a, a cause, um, can be caused by lack of, uh, appropriate blood flow, um, especially to your brain of course, and a, a lot of body pain as an experience. People have histamines. Job is to kind of keep us alert and aroused and ready for any threats. So also people can experience an extreme amount of anxiety. And I describe that anxiety as being tremendously physical, almost like ants crawling under your skin. Um, you know, that's that heart pounding anxiety. Um, of course that. Thoughts can follow, but it's, it's very physical, this feeling. Um, I had tremors also that would last like all night. Um, and insomnia is really common with histamine issues as well. More common histamine symptoms that we do know about, of course, are what we would take antihistamines for, right? Like seasonal allergies, um, sinus issues. Rashes, um, reactions to food. And then, um, other very common symptoms of histamine issues are chronic, um, urination, feeling of fullness in the bladder, and a, a sensation of inflammation in the bladder. Um, waking up in the middle of the night to pee, uh, waking up at all in the middle of the night because of the insomnia piece, and then a tremendous amount of gut issues. Acid reflux is closely linked to histamine issues as well as I see both a combination of constipation or diarrhea, depending on where you tend. And then. Um, depressive symptoms and anything that can come from, uh, neurotransmitter issues or nervous system issues. It's so interesting because, I mean, I think you kind of already answered this indirectly, but histamine issues are so often missed or misdiagnosed in traditional medical settings. In your experience and in your opinion, do you think it's just because it could be, I mean, literally the symptoms could be all across the board. We just don't know. Great question. I mean, if you, Heather, if your heart was pounding outta your chest, where are you going? Are you going to the immunologist's office? Are you going to the allergist? Right? No. You're probably going to the ER cardiologist. Exactly. There is no world in which if your heart is pounding out of your chest, you are going to be sent to an allergist. And that is the problem with histamine symptoms. They look nothing like what's going on on the inside. They don't look like immune conditions. They look like whatever the symptoms are and a lot of histamine issues'cause they can cause slight variations in in body temperature, certainly heart rate, blood pressure. They look like emergency symptoms. They look like you need to go to the er, right? Those are all, they can change your respiratory rate. They can change your O2 saturation. I mean, these are the exact reasons you would go to the er. This is what any doctor would tell you. Please go to the ER with, and by the way, I invite people, please go to the ER if you have any drastic symptoms. But they're not gonna be able to get to the root cause there, because it's so, it's, it's, so, the way our medical system is lined up is that each body part. Is so fragmented and segmented. You go to the heart doctor for the heart stuff. You go to the this, you know, you go to the neurologist for the headaches. It. There's no one really to put the full picture together, but I think we're getting better at it. But that's why I don't even blame doctors.'cause if I'm a cardiologist, I'm gonna run an EKG, an echocardiogram. I am not going to say, Hmm. Is your heart pounding outta your chest? Because of a histamine issue. Like they're gonna check all their boxes so that they're not missing something major. Yeah, totally. They're gonna look at the organs and how they're functioning. They're not gonna look at what's making those organs act in an interesting or unique or unpleasant way, because it's not what. That their job is, to be honest with you, and I don't blame them for it, their job is to make sure there's nothing emergent happening. Um, and some cardiologists do treat pots, which we're gonna talk about I'm sure as well. But yeah, that's really why, and, and what I'm more nervous about, I would say, is that it's, you know, back in the day it used to be. You go to a conventional medical doctor, conventional medicine fails you. Where do you go? You go to a functional medicine doctor and the promise of a functional medicine doctor is that they're going to be the ones they're if, if all else fails, you go to them. They're the last stop on the train. Most of my clients come from functional medicine doctor's offices. Now, same. They have been harmed, and certainly for you for years, this has been the case. They have been harmed by functional medicine because a lot of the interventions like, Ooh, let's do a gut detox. Let's do a mold detox. Those create very drastic histamine issues because histamines will respond to those changes in the body, and our mast cells are always on alert. So if you create any large change or you try to really dig in. The histamines, the mast cells and histamines will be very reactive. So I'm seeing people get sicker in functional medicine doctor's offices, which again, I don't blame them for,'cause it's like a to, it's like playing four D chess sometimes with our immune system. Well, this is probably a rant for another day. But I often tell clients that, you know, I'm on calls with, they're like, well, how is this different than the functional medicine doctor that I saw? And I asked them, you know, what did they recommend? What did you do? Honestly, what they've done is no different than conventional medicine. They were given like a bag of supplements and like probably told to eliminate a. A ton of foods and that's it. And I'm like, that's apathic medicine. Thats allopathic medicine. Yeah. It's literally no different than conventional medicine where they're just stacking on medications and like true functional medicine is actually looking at like all the pieces of the puzzle, lifestyle, nutrition, like all of it. And yeah, so that's a bone that I have to pick for another day. But I mean, that's an, that's an episode for us. I'm telling you for sure. Because I, I could cry, you know. When I first became like from being a conventional dietician to a functional dietician, like the hope of functional medicine burned inside of me, I was like, this is it. And I still do believe this is it, because functional medicine is not a pill for every ill. Functional medicine is the belief that every single part of our body is. Interconnected that our body's like a seesaw. You push one thing down, the other thing pops up, right? That is every single thing in our spirit, in our connections with other people, everything is part of this big picture, and that's what the real heart of functional medicine is. And it's, and it still should be. And there's still many amazing practitioners and it's really hard. When we've kind of gone into this, again, it's, it's the sa it's just a for-profit system, unfortunately, um, where we're just, again, giving supplements and if you give supplements to a body that's on alert, um, it will react to those supplements and you can get a lot sicker. Um, so a lot of functional medicine doctors are very into IVs, detoxes, really aggressive modalities. And then they say to a client who's getting sicker, oh, you're just having a herx reaction. Mm-hmm. It's just a detox reaction. In the case of histamine issues, if you're getting sicker, you're just getting sicker. They're just get, you're just getting worse and now you have a new problem to deal with basically. So it's something really to notice that if you are working with a functional medicine doctor, you're getting sicker. You're just getting sicker. Mm-hmm. If it's eh, you feel a little off for a week or something, it's very different than if the symptoms are progressing. Totally. So kind of on that note, you know, obviously this podcast is about gut health and we obviously see a lot of things outside of gut health, but of course, what role does the gut play in regulating histamines related to like, of course, DAO microbiome, gut permeability, all of those things? Because to your point. We have seen a lot of people similar where, oh, I did a SIBO protocol, or I did this protocol, and I, I couldn't tolerate it. I felt horrible and they told me to just push through, or I needed to take more binders or, you know, whatever the like recommendation is. But. What role does the gut play? And obviously we have to look outside of the gut and stabilize things there as well. But yeah, hundred percent give kind of some insight there. Oh, there's a lot of areas we can go into here for sure. So one of the first things that I am going to think about is histamines and its relationship to acid reflux. Mm-hmm. And the reason is they have a direct relationship. So the more your body releases histamines, the more your body will release acid. The more your body releases acid, the more your body releases histamines. In functional medicine, we know everyone talks about all acid refluxes from too low of stomach acid. Always Not in the case. Histamines usually, and it's not always exactly. I know it could be 98% of the time. And either way, even if that was what's driving it, if they're symptomatically having acid reflux issues, that then you know you're releasing acid that's creating a new state of inflammation and then your body's going to respond by releasing more histamines. Mast cells do this really frustrating thing. They're more active during inflammation, so it becomes this kind of vicious cycle. So that's one thing that I definitely wanna look out for is, is someone experiencing acid reflux? Very common with histamine issues with SIBO protocols. E, whether it's an herbal protocol or antibiotic protocol, if you are going in and killing a bunch of bacteria. And then your body can't get rid of the bacteria in ways of drainage or detoxification. You're basically gonna recirculate those toxins. And when you recirculate them, your immune system's gonna go, what the heck is that? Let me mount a response on that. I don't like what that is. And then when you have that response mounted, you then have new issues basically,'cause that you'll get symptoms. From the response it's mounting as well. So it's just really important with those protocols. And Sibos very concurrent. It happens a lot with histamine issues, um, because gut motility can be affected because histamines and the nerve, your immune system and nervous system work very closely together. So, um, your basically the, the, just the actual action of. Blood flow going towards the gut. Muscle contraction can be, is controlled by the nervous system. So if your nervous system's on fire, you can have altered gut motility, whether it be like. Really aggressive diarrhea or constipation. And then as we know, and you definitely know Dr. Heather for sure, um, food sitting in our gut and fermenting because we're not moving it through our guts then is going to create new histamine issues as well. Um, so it's, it can be really cyclical in that way. And using really aggressive protocols when you don't have the drainage or detox capacity can lead to brand new issues essentially. So what would you say to someone who's listening to this and going, okay, yes, that's me. I've attempted a SIBO protocol multiple times and I always feel worse. Like where with. Michelle, would you start, like what are you kind of looking at as far as like, okay, let's take a step back and let's like address these things, nervous system, et cetera. Yeah, you basically said it, but yeah, that's the, the rule is if we are addressing anything in the body that's a root cause.'cause SIBO can certainly be a root cause. It also cannot be root cause, uh, as we know. But you can't address the root cause and histamine issues until you've stabilized. Your immune system and you stabilize your nervous system because if your immune system and your nervous system are firing, you know, very fast and and very aggressively, and that threat response is high, anything you throw at it is going to scare your body and create a new response. So I just say it's really important to focus on stabilizing histamines, and that could be, that could be something as easy as eating a lower histamine diet or addressing stress. Really complicated. I know it's like so much easier said than done. Um, and, and then it can be something again, addressing the nervous system as simple as breathing or meditation or as something like taking herbal supplements that help support the nervous system, whatever it takes to get those two steps. A approached first is essential. And I would say if someone's going to approach a root cause protocol. Even again, and I know the SIBO symptoms can be so debilitating, but at least taking a couple weeks to try to calm the body down first before, um, starting and initiating a protocol. And then it's really hard because there's, there's rules and therapeutic doses, especially with herbals and sibo. We have to go as slow as you can. Um, and then it's really silly and really, um, it sounds very corny, but it's very true that when you're like taking these supplements or medications you like, have to work with and communicate with your body and be like, this is for us. This is a nice thing that we're doing. I love you body. This is to help you and like try to create a landscape of healing also, I think is really, really important. We talk to our clients all, all the time. Neuroplasticity is one of the things that we like really emphasize because, and probably similar to your clients, so many of our clients have had so many attempts at feeling better and they have this narrative of,, I can't tolerate X, Y, and Z, or I'll never be able to eat X, y, and z food. And like changing those neuropathways can be so important. But like you said, it's so tricky because. Oftentimes, I think the second that someone hears stress in their nervous system is the root cause. They're like, forget it, you know? Like, I can't quit my job. Totally. I can't do this. So what would you say, if that's kind of the mindset of, you know, kind of the connection between stress and the nervous system and histamine and, and all of that, like Yeah. How it doesn't actually have to be. Meditating on the beach for an hour a day in a fancy outfit. Like, it's not, that's not really what we're getting at. Oh, I have to be, I'm, I'm a Jewish New Yorker born and raised. That's not our style. You know what I mean? It wouldn't, there was not, there's nothing soothing about what you just described to me. I use the word safe, right? We have to do whatever makes us feel safe. For me, it's like blasting emo music. That's what makes me feel safe. It's like blasting rock and roll music. So it has to be what makes you feel familiar and safe. To you. So that's what it means. And the other part of it is, you know, there was a time. During the worst moments of my health where I literally, and I always look, I had a computer chair. I was, I would sit on, I have like a day bed in my office that's like, kind of a couch, kind of a daybed. I would sit there, I would lift myself onto the computer chair.'cause if my feet touch the floor, my heart would start pounding and I would wheel myself to the bathroom. And then I would have to crawl basically to get to the bathroom.'cause I, if, if my feet touched the floor. I was so dizzy. I would be dizzy for days. At that time, I had to recondition so, so substantially, and I remember standing in front of the mirror for a minute. And I was just like so dizzy. And I just said to myself like, I just don't think you're gonna like make it out of this. I just don't. I don't, I'm not seeing it. And then some other like animalistic part of me was like, don't ever say that again. Do not ever say that again. So it doesn't come down to, oh, I have to sit on a beach and meditate or do these things that are like cooling, calming. It's just about finding that part of you that may seem irrational, but believes that there's some chance you can heal. And the reason is with these. Syndromes and conditions particularly, they're extremely nervous system driven and the symptoms come from being in that nervous system state. So I have a lot of my clients, as much as we can to be non-reactive to symptoms. And it's so hard. I mean, who is gonna have diarrhea 15 times a day and excruciating pain and be like, this is fine. You know, but that's really what we have to get to.'cause the second you go, oh my God, this isn't fine, you're actually getting new symptoms. So it really becomes cyclical and then your body anticipates. The discomfort and then releases histamines on top of that. So it's this very weird thing where you have to like believe blindly that you are going to get better, visualize it, and anyone can do that. You don't need time. You just have to be a little silly about it, I think. Mm-hmm. It's like that's not, stress reduction to me isn't like putting ice on your neck, even though it can be really helpful and, and cooling and nice, but it's about finding a way to find that part of you that believes in an irrational sense that you're going to heal. And then finding little pockets of safety wherever it is, whatever that is. I don't care if you're watching tv, you know, I know people are so weird about the, not weird, about like rationally, but so strong about like no blue light at night. Like if you need to watch like old seasons of Sex in the City or something. To like soothe'cause it's familiar and it's, your brain can calm down whatever that thing is for you get and, and find that identity of the person that once wasn't sick. And I think that's really important too. I love that. I think that's such a good way of looking at it. And honestly, I mean, if someone is reaching out to you or me, or even listening to this podcast, there obviously is some piece of them that believes they can get better. Oh yeah. You know? So like, you're already there. Lean into that piece. Yes. Oh yeah, absolutely. You're already there. I wanna circle back to pots, because you mentioned POTS earlier and we see a little bit of pots. Um, I would say when I was seeing a lot more eating disorders, I saw even more pots. Oh yeah. Um, mm-hmm. And you know, now we still see clients with disordered eating, I would say not like active eating disorders, but. You know, the standard treatment for POTS is like, we'll just have three to five grams of sodium a day. Well, it's actually 10 grams, which is, is it 10 now? Okay, 10. Yeah. So, you know, you'll go to your doctor, you'll get like a massive recommendation for salt. And although that can help, like you and I both know, there's a lot more to the story hundred percent when it comes to histamine and, and all these things. So kind of walk us through that. For anybody listening. So we'll walk back even to the point of defining pots. Pots is postural orthostatic tachycardia syndrome. So that means you make a postural change and your heart starts pounding. Okay. I wanna give the example of someone who, and if a client is listening to this or you know, they might identify with this, you're in the shower, you out of nowhere, look down and your legs are really red and you feel really dizzy, and you're like. What's going on a second later, your heart starts pounding really fast. So when histamines are an issue, they cause what we talked about before, vasodilation, the widening of the blood vessels. So what happens is your blood drops down to your feet, and in the case of pots, it may not, your heart may not react to pump the blood back up. The reason you see the redness in your legs is there's. Blood pooling, literally blood that's pooling in your legs, and then your heart and your brain are going, hello, we need the blood flow up here. So your heart starts pounding really fast. So the heart fast, the the fast and hard. Pounding you feel is to get blood flow back up. So often the, and, and often the recommendation for POTS is, is like we said, 10 grams of salt, which you have to picture those little element T like element sodium, that's they're one gram each, so that's 10 element packets a day. This is an extreme amount of salt, which most people don't need that much or can meet that need, but some, some do. So the goal for. That type of approach is that there's different types of pots. One of them is something called hypovolemic pots, and the the deal is your blood volume is too low, that it doesn't have enough to pump and bring the blood flow back up. That's the goal. Now, this is the most interesting thing in the world, and I'm obsessed with this, okay? Pots. Is a form of would, if we were gonna categorize it, we would say, oh, it's probably a cardiac, this has to be a cardiac condition. It's actually a form of dysautonomia. Mm-hmm. It's a form of dysfunction of our autonomic nervous system. It is a nervous system disorder, which makes no sense to people because how could that be? Your nervous system will tell your brain, send blood. Contract this muscle, so it's coming from your brain. So the treatment for POTS that's conventional is, well, let's just add a bunch of salt, make the blood volume bigger so that the blood pumps. More efficiently, or I say it's kinda like making your body like a Go-Gurt tube. You like wear compression socks, you wear an abdominal binder and you squeeze the body. So the pressure goes up. Basically if you think about like squeezing the middle of that Go-Gurt tube and the blood flow will go up, right? Mm-hmm. So that's the goal. Or you lay with your legs on a wall. Basically just anything to help the body's mechanism. Put the blood up please.'cause the body's doing it for you and compensating. But the real ultimate treatment for POTS is you have to address the nervous system, right? Because if the nervous system is in the right, not constantly sympathetic state, and you get in the parasympathetic state, then it'll say, oh. You're supposed to send blood flow here it, this is the muscle that's supposed to contract, and that is the core and crux of it. So a lot of the treatment programs for MCAS and POTS are actually limbic system retraining programs like the Gupta program, primal Trusts, because we know these are brain-based conditions, which is fascinating. Of course, the immune system involved, of course the cardiac system becomes involved, but the root cause of them is a nervous system. Um. You know, condition, which is, I, I, I've always thought fascinating and I think the relationship between MCAS and POTS is in this vasodilation piece is a huge component. It's so interesting. You know, going back to like 2020, I, I think I was like patient X for COVID. I think I had it like right before, like the world shut down. I was sicker than I've ever been. March, 2020. You were, that was it. No, it was like February. Like I, it was like before everything. I like swear that I was one of the first people that had it. I, I could be totally wrong, but I was so sick for like two weeks. I, I've never been sicker in my life. I'm so sorry. It was crazy because several months after that I started having POTS related symptoms, and at the time I was developing the Gut Together program. Mm-hmm. And the Gupta program is like a big recommendation that we give to our clients and something that I did. Symptoms gone, so I know. It's so cool. Yeah, I, first of all, he's so cool. The creator, Ash Gupta had him on my podcast. He was like, so cool. Love that. And the program's incredible. I have a little bit of a preference because I've been through it, but I've only seen parts of Primal Trust, um, and DNRS. I've only seen parts, but yeah, it's. It's really incredible and the idea that you're treating this immune condition that shows up like a heart condition by treating the brain. It's so fascinating. And, and then once you get it, you get it. And it wasn't until that all those symptoms I was describing were really pot symptoms, right. When I, when I would stand up mm-hmm. The blood changes and the dizziness, they only got better when I started working with my limbic and nervous system. It's so true. I mean, my husband was, would get so worried because I'd stand up and I'd be like, so dizzy, blacking out, like holding onto something so I didn't fall over. And he's like, you need to go to a cardiologist. Like I'm really worried. Hundred percent. And I mean, I was so close to being like, is there a problem? And then it just. Like slowly started getting better and I'm like, that's the only thing that was different. It's wild to me. And then when I dealt with mold, same thing. Like the limbic system is such a big piece. So Yeah. And our limbic system that I know we've mentioned, and I'll walk back to is three brain structures, our amygdala, our hippocampus, and our hypothalamus. And they will process threat, same thing. And they will also prepare your body using memory. If this happens, we don't want it to happen again. Let's prepare. Your limbic system communicates directly with your nervous system and your immune system. Um, histamines can also be released from and created in your hypothalamus. Um, so that is why you get that extra alertness anxiety that can happen. Uh, this link between you having. A COVID virus and that turning into this pots, you don't know how long it took all of us to figure this all out because it was so, it so doesn't make sense.'cause it didn't happen with other viruses. It never'cause the, the flu doesn't attach to mast cells, you know, and in the same way, like the seasonal flu, right. I'm sure it does in some capacity, but certainly not to this level. So. For me, it was like figuring out, I literally would just type into, I would just type into like Google, like pre pre-chat GPT. I was like, why dizzy on day nine cycle? Like I just, and what's the answer you get from that? Right? Like, I had to go on Reddit and be like, what the heck is going on it? It really was when I saw a study. About long COVID patients, and the study was studying 16 long COVID patients and they had severe fatigue symptoms and they gave them 80 milligrams of Famotidine, Pepcid. And I was like, and then 80% of their symptoms resolved. And I was like, what? I was like, why is this acid blocking drug helping with fatigue symptoms? And then I. Oh wait, Pepcid also an antihistamine. Wait, wait, wait. I didn't even realize that at the time. No one would realize that, of course, at the time. And it took me like, I was like, oh, there's a thread and the thread is histamines and, and it took me tying so many different things together and really a lot of self-discovery because how do you get from point A to point B, right? It's like impossible. And I don't blame even again, practitioners for not getting there. But now, after five years of COVID, I we're starting to see these predictable patterns, and I've really never seen someone with p. Who do not have M Cs. It's very rare. There's a couple like people who were maybe had a history of eating disorders and were childhood athletes who I've seen with POTS that don't really have histamine issues. But in the COVID context, I've never seen someone with POTS who doesn't have histamine issues. And again, if you went to a neurologist for pots, they're still not gonna look at histamines because of the fragmentation of our healthcare system. So you bring up two points and things that I wanted to mention. Histamines and hormones. You mentioned day nine, and then also Pepcid and antihistamines, Zyrtec, et cetera. So when you spoke in gut practitioner, you talked about kind of like this, like trial you could have clients do, like try Pepcid for, I think you said, three days or something, and see if your symptoms resolve. Um. Talk us through that. And then also maybe we can bring in like the hormone connection as well. Yes. And something I have to mention is, of course, this is not medical advice. This is not medical recommendations. Yes. In any capacity. And everyone will have a different reaction to every single over the counter medication, every single supplement, especially in this population. So know that you can get these over the counter. It does not mean that you will react the same way as anyone else. And that's just something I have to mention. Um, so. Again, why did I become a functional dietician so I could be talking about over the counter medications? No way. I never thought I would be talking about over the counter medications, you know? Um. It's really interesting. I have a friend who a lot of people know on Instagram is organic, Olivia, but she mm-hmm. You know, I'll, I'll, of course I'll call her Olivia. Olivia wrote an article a long time for her company, and they said in the article like, well, what is your ultimate travel emergency, you know, pack? And she said, I always have Benadryl in there because Benadryl helps with everything. I said, Olivia, the fact that you didn't know you had a histamine issue. When you wrote this article, I was like, Benadryl doesn't help anyone with anything unless you have a histamine issue. Like, she's like, this is the thing that will cure every ailment in my body. I'm like, yeah,'cause your, if your ailment iss a histamine issue, it'll, it'll help. So if you have a histamine issue and you respond really well to antihistamines. You know, you'll, you'll get an understanding that potentially this is what's going on, and I'm getting some relief from this. A lot of clients are very hesitant to take over the counter medications, especially if they've been in like the natural world, the holistic world, the functional world for a long time. Um, but I've seen that some people really do. Need them. Um, and from a hormone perspective, and I'm doing a histamine hormone webinar at, on September 28th. Okay. I'll put the, I'll put the link in the show notes. Yes. With Amanda Montalvo, who people know on Instagram is the Hormone healing Rd. It's gonna be nuts. I'll be there. Yeah, exactly. Yeah. It's gonna be a little nuts. I have to be honest, like this is, this is like heavy hitters. I'm very, very excited. She's the most brilliant person I know, so I'm so excited. Um, for me, again, I was looking like. Why do I feel so bad the day my bleeding stops? Like normally people, if you look online, what do they say? The luteal phase. Everything's the luteal phase. You feel so bad during, I was like, I feel amazing during the luteal phase. It's the follicular phase I feel terrible in. And that's because estrogen and histamine also have a direct relationship. So as your body starts to release estrogen in, uh, preparation for ovulation, where it will peak in estrogen, of course that's when people start to notice symptoms. And that'll start usually by the, you know, days. Seven or eight in a 28 day cycle. Um, some people a little earlier, and that's where those histamine symptoms start coming up. So if clients have any kind of histamine driven symptoms, that's where they can trial. Oh, this three day period is the most symptomatic for me. This is where I might wanna trial either natural antihistamines or over the counter antihistamines, whatever that looks like for them. But the most important thing you can ever do when it comes to histamines is track. Especially as a woman, tracking your cycle.'cause then you can see, oh, day 10 every month to not feel crazy. When I would I, I just, it made me feel so sane when I would look at my calendar and be like. Day 20. I got a headache last three months in a row. Okay, day 20 is a headache day. I need to understand and prepare for that. Okay, day nine's a dizzy day. I need to prepare for that. So just understanding and tracking your cycle is important. And I know we can sometimes get hypervigilant about it and I wouldn't recommend that as much we can avoid, but the validation of like, I know my body and I know what to expect is so helpful. And then you can say, oh, I need to up antihistamines, whatever form again. Natural or not. Um, and then, or I need to, you know, take it easier these days, or I need to drink extra water if it's gonna be a headache day, whatever it is. What about pregnancy? So we've had clients who feel a lot better during pregnancy and then we have some, you know, maybe no change or maybe feel a little bit worse. Yeah. So walk us through how pregnancy would affect histamines. Absolutely. So the first cool thing about pregnancy is you do produce more Dao, which does help break down histamine in the gut, which is the placenta actually produces more Dao, which is DAO Oh, diamine. Oxidate. So cool to me. Like how it's just so cool. Yeah, it's, yeah, it's immaculate. I had this brilliant naturopathic physician who I was working with, and she also described that like when your immune system is so busy, like building new life and like creating an immune system and using your own, it kind of like diverts its efforts into growing the child as opposed to. Being hyperactive to all the symptoms and things around you. So it can happen where MCAS sometimes it can be worse in pregnancy just because your estrogen's really high in pregnancy too. So it's not stabilizing. Progesterone is supposed to be mast cell stabilizing. The other problem is, I mean, the other reason why pregnancy may be positive, there's other people who have more problems with it, and I'll talk about that, but is because your blood volume increases by 50%. So that's really nice for pots. If you have hypovolemic pots. That's really, really nice so people can feel a lot better. So I notice pot symptoms get. Often a lot better. Um, but then you're also generally people are a lot more inactive and that can lead to deconditioning and that can, it really depends. Um, also you can become very, your blood sugar's much more erratic. Um, oftentimes it can be in pregnancy and actually in the first trimester, your, your insulin's more sensitive. If you already tend towards low blood sugar, that can create more low blood sugar episodes. So I've seen people with MCAS have worse acid reflux, worse morning sickness as well. Um, but I've also seen like the crazier huge MCAS symptoms get better, like we said, because your immune system has a new job to do as opposed to just being dramatic like my immune system is, you know? Yeah. Mine's pretty dramatic too, so I get it. I think the best people's are. Yeah, I think that's the truth. there was this joke growing up, like my family would always joke that like, I could look at something and get a rash, and I'm like, I mean, it's funny, but like, it's also true. So, you know, I think that's me with like, um, empathy, physical pain. Like, I, I can't, I couldn't, that was the truth. I may not have been by a lot like a hype hypersensitive from a body perspective, but I was highly sensitive as a person and everything. Everything mattered to me at all times in my life. Everything was so important. Everyone else, everyone else was feeling I needed like a shield. Even as a kid it was like I couldn't even like go on the soccer field. My dad had to hold my hand, which is so funny'cause I am very extroverted and like love public speaking in front of thousands of people and have no problem with it. But my dad had like hold my hand on the soccer field.'cause I was like, I don't know what the other kids are thinking or feeling. And he's like, okay, that's not, you have to just kick the ball. We're here to play soccer ball. Yeah, exactly. Just take the ball around. Oh, I get it. It's so hard. So we've talked about a lot of things and someone might be thinking, well, would like a low histamine diet just fix all these problems? Walk us through that. They already, they already know. No, by the way, if they're here, they already know the, they've already tried that. Yeah. However, I will say this, the more high histamine foods we eat, the more our body produces histamines. It's a very backwards, silly thing about our body, by the way. I'm like. No, you have enough. You don't need to make more. But our body does this very frustrating thing. So there are clients I have who could eat a tomato and end up in the hospital. There are clients I have who could eat two bites of vinegar and they're stomach sick for three weeks. It is often necessary to trial a lower histamine diet for some period of time, but. Highest mean foods are the healthiest foods that we know of, right? If you went to a gut health doctor or you went to Dr. Heather 10 years ago, you would've been like, have some fermented foods, have citrus fruits? Mm-hmm. Have like nato, Tempe, miso, bone broth, right? Vinegar, like they are all the things, some of the healthiest foods. Tomatoes, avocados, bananas, spinach, you could not create healthier foods than the high histamine foods. So it's just that it's causing this kind of sideways, odd reaction. But they're not actually unhealthy in any capacity. These foods, they just create unhealthy symptoms within us. So it's often necessary for people to, yes, sometimes trial, low histamine diet. But if that's not your root cause, I have some clients who are huge histamine clients and they can crush vinegar and there's no problem with it. I have some clients though, who go into a room and has a chemical smell. They're sick for weeks. Mm-hmm. So you, you really have to know your own triggers. But often in the beginning when the body's hyperreactive, it's going to be hyperreactive to foods as well. And the goal is to just lower the bucket, all of the histamine load, lower it as much as you possibly can for in the beginning. So on that note, if someone is listening and they suspect histamine intolerance or Ma MCAS, or maybe they already know they have that, what would you suggest as like a first kind of practical step to start feeling better? Yeah, the first thing I would do is get to know your symptoms. So track them, notice them. When I eat this, I notice I feel this way and it's not gonna be the same every time. So don't expect the pattern's gonna be perfect if you are a woman. What's going on with your cycle? What are you noticing? The first thing is getting to know your symptoms and getting to know where maybe there's a pattern you could recognize. It's not about one-time reactions, but where we can pick up on patterns. That would be the first thing. The next is I would just start to assess. What makes me feel safe, what makes me feel unsafe, and start to understand again, what are your personal triggers, whether it's food, whether it's stress, whatever those things are. You don't have to do anything about them, but just inventory those things in your life. That act of getting to know yourself is extremely soothing to your nervous system because when we can understand we can calm. Mm-hmm. It's when we don't understand what's going on in our bodies and we say, oh my God, my heart is pounding and it's so freaking scary. That is when we start to freak out and that's when the symptoms get much grander, which is so normal and human of course, to feel that way. But when we understand ourselves, we start to heal. So the first step is understand yourself and understand. Start to get to know your triggers. Then you can trial at home a little bit of a lower histamine diet if you wanted to. It's safe to do, but not in the long term. Um, so just trialing. Do I feel a little bit better? It will take more than a couple days for you to, to notice that. And then again, anything that drives safety, anything at all that drives safety for you. I would also probably discontinue all supplements, you know, for the time being, especially if your reactions are really great. And if you are trialing new supplements, you do one or one eighth of one for a week, and then you add in another one. Mm-hmm. Okay. Very, very slow. Yes. Slow is. Is the key for all of this. It it really is, yes. Slowness in every way. Slowness in how you live, slowness in how you approach things. It is MCAS makes us feel like we're on fire and we need to do everything we can to slow. Yes. So what gives you hope in working with clients who struggle with histamines mast cell? What gives you hope? Oh, I've ne I've never felt more hopeful. Than I do now, which is the best feeling ever. Um, watching myself, watching all of our clients getting better. Um, I've, I've seen people heal from just attending a freaking pod, watching let's do a podcast or watching a webinar. I think the really exciting thing is we really get it now, like we're really starting to understand how, what's this landscape of our immune system and our nervous system, and I just have so much faith in the human spirit, and I have so much faith in our ability to heal and that our bodies want to heal and they don't. They don't want to stay sick. And I just have so much faith in us, and I've seen what looks like miracles every single day. But it's not miracles. It's because we get it now, and that's the truth. So the more and more information we have, the more we can empower ourselves and the more success that we see other people experiencing, I think the better. Um, I, I just, I've never felt more hopeful. I'm like, we so got this. I mean, there's really no level of sick someone can come to with me and I'm like, we're good. We'll, we'll figure it out no matter what. I love that. Yeah. Okay. Well this has been amazing and so much good information. So tell everybody where they can find you, work with you, podcasts, like all the things. Absolutely. Um, it was my joy and I'm so glad that we got to hang out before too, by the way. Um, so you can listen to older episodes of Quiet The Diet, which is my podcast. I haven't recorded in a bit because I've been working on these, the, a lot of the histamine webinars and everything like that. Um. I'm on. It's really easy to find me everywhere. I'm on Instagram, Michelle Shapiro Rd. My website Michelle Shapiro Rd. Um, we have an upcoming, um, histamine webinar with Amanda Montalvo, the Hormone Healing rd. Oh my God, I'm so excited. We're gonna do P-M-S-P-M-D-D, endometriosis, PCOS, pre-pregnancy, during pregnancy, post-pregnancy, perimenopause and menopause. And it's all gonna be, it's gonna be like eight hours long. The last one was three and it was just me. So I am concerned. Yes, I am. Yes. It's scary. It's scary. I can't wait. What we're gonna do. Exactly. Yeah. It's gonna be really fun. It's gonna be really fun. Um, and the last one was literally just a histamine essentials webinar. People can buy the replay of if they want to. That was an almost three hour webinar and it was, it was so much fun and it was so much information. And I have a team of, now there are seven of us, um, practitioners, if people wanna work with people one-on-one. Okay, so amazing. I'll put all those links in the show notes. I'm definitely planning to be at the webinar. Can't wait. And thanks so much for joining today. Thank you so much.