Chronic-Symptoms-Secretly-Caused-by-MCAS-POTS-and-Histamine-Intolerance-Michelle-Shapiro
If you've ever felt dismissed by medical professionals or if you've struggled with confusing symptoms like dizziness, racing heart, or fatigue without clear answers, this conversation is for you. >> Histamine is one of,200 plus chemical messengers that come out of mass cells. >> In this episode of the Dr. Gabrielle Lion Show, I interview Michelle Shapiro, registered dietician. clients who eat tomatoes and citrus fruits and fermented foods. If you went to a gut health doctor, these would be the healthiest foods on the list. They would say, "You have to eat these foods." And they would be the exact foods that would sicken those with histamine issues. We're tackling a widely misunderstood and illdefined health issue. histamine and its related conditions like mass cell activation syndrome, postural orthostatic tacocardia or POTS and she shares her personal and professional journey navigating these challenging conditions. It's impossible to believe that something that's healthy for someone can create severe symptoms. It's not logical almost, right? Why would someone drinking lemon water make them violently ill for a week? It almost it's like defies our understanding of the human body almost because it acts in this very odd way basically. We'll explore why traditional medicine often misses the mark on diagnosing and treating them and discuss how these conditions intersect. We break down practical strategies to reclaim your health, calm your nervous system and build resilience. Michelle Shapiro, registered dietician, also one of my dearest friends. welcome to the show. >> I'm already emotional. Thank you so much for having me here. >> This is so happy to be here. >> Unbelievable. >> It's unbelievable. >> One of the reasons why I wanted to have you on is typically when we see a patient in the practice that has all these strange symptoms like dizziness, heart rate variability, uh they are reacting to foods, to sun, to things that we couldn't even imagine. It seems as if mass cell activation syndrome >> is something that plays a role and it being related to nutrition. You certainly are an expert and have seen many patients with mass cell activation syndrome. But what is it? >> Yeah. So we'll first define what mass cells are. I think that's really important. So much of the conversation online right now is about histamines. So we're going to use that word a lot. But I think to even define histamines, we have to talk about where they come from. Mass cells are a part of our immune system. They're a type of white blood cell. And I really think of them as being the guards to our body. So what their job is is to assess for threat and then send messengers out to the rest of our body instructing them on what do we do in this situation. And I really think of mass cells as being this not only um they not only help with the healing in times of a threat, but they are always anticipating threats as well. So what happens is something will attach to the outside of a mass cell and then the inside there's these sacks where they will release these granules that have these chemical messengers in them. One of them is histamine. So this is why this histamine conversation becomes so important. Mass cell activation syndrome is when those mass cells are constantly activated and releasing these chemical messengers. And it's really important to state histamine is one of,200 plus chemical messengers that come out of mass cells. So >> wow. and we really have kind of honed in on histamines. Just out of curiosity, why do you think that is? >> I think histamines create the most um emergency like symptoms and I think that's why we focus so much on them because histamines are the most I guess the loudest you could say of a lot of them. There's elastes, tryases, cytoines. There's so many different compounds that come out of our mass cells, but the ones that we can actually see and feel come from histamines usually. >> For anyone who's interested in research, I wanted to pull um some of the new existing data and this is a 2024 paper. It's the world journal of clinical pediatrics and it's mass cell activation an up-to-date review of the literature and again it talks about mass cells as this again what you had said a type of white blood cell that is involved in the immune system and they create a common list of symptoms flushing hypotension itchiness swollen tongue headache vomiting diarrhea and it seems seems as if there's a lot of outstanding questions. Uh, I'd love for you to talk about a little bit about what these symptoms are. Is it system dependent? And how is that going to happen? I can't believe how excited I am to talk about this. I'm like, this is so great. Thank you for asking me that question. So, when we think of histamines, we often think of medications like antihistamines. >> Think of this as a benadryil deficiency, >> right? It's like you just need a Zerek, right? Which in some cases, by the way, you do need a Zerek. We can talk about the medication component of it. Um, but histamines are so much more than just these compounds that cause mucus and coughing and this type of um classic cold symptomology. So mass cells are in our connective tissue and our connective tissue lines every organ in our body, our joints, our bones. Um really anywhere where there they say like there's a dark hollow space in your body, there are mass cells. So that means that the symptoms from histamines can come from anywhere in your body. So it's really weird because if people can get tachi cardia or low or high blood pressure from histamines, they would actually think maybe I'll go to a cardiologist. Um but in reality because the symptoms are coming from this type of chemical compound, it's really hard to trace kind of their place of origin. And other symptoms that people experience with histamine issues are flushing and those classic allergy symptoms that we think of cold symptoms. But then also people can experience extreme urgency in their digestive system, extreme urgency in their urinary tract, feeling like their bladder is constantly full and irritated, feeling um extreme anxiety because one of the roles of histamine is to keep us awake and alert. Uh so people have insomnia, anxiety that's really prevalent, depression or depressive symptoms. Um because we can't say there's only one root cause of any uh of these conditions or syndromes. Histamine issues can cause joint pain. Um and our perception of pain can be increased from them as well. And then a lot just again a lot of digestive issues. People are seeing uh rapid diarrhea also constipation which is weird. It depends on the person. Um and a lot of nervous system involvement too. And that's really tricky because it's almost a catch-all phrase. >> You're not feeling well. It could be mass cell activation syndrome, which is not common. I think that this is a case. When I say it's not common, it's not very common in the literature. It's also not common from a diagnosis perspective. And it reminds me of when mold and environmental toxins were never thought of. I remember when I was living in New York City. I mean, we've known each other now. It's going to be almost a decade. It'll be going on a decade. And when I was living in New York City, >> I'm gonna start crying right now. >> So sweet. Um before both babies and uh before Shane, >> literally before Shane. >> Aren't you so glad we don't have to listen to uh Bud's class 234 like we were on repeat last night? But anyway, >> 10 p.m. >> the when I was living in New New York City, I got really sick living in my apartment. >> I went to multiple doctors and I had already been a physician, right? So, I'd been a physician seeing patients and it turned out I went to probably five different doctors and I didn't get any answers. I couldn't explain word finding difficulties, vision changes, and just terrible fatigue. I mean, I could barely get out of bed. >> Sorry. And it ended up being mold. I was exposed to stockbatricus in the apartment that I was living in. But at the time, people would think that was crazy. >> Now, everybody is talking about mold. It's really become more of a prevalent disease just just like lime. >> Absolutely. >> Mass cell activation, I think, is the next thing. >> Yeah. And mold, by the way, can be a very like clear root cause to mass cell activation syndrome, by the way, because of this inflammatory cascade that happens as a result. Because anything that triggers your immune system to be in that constant state of threat or activation or needing to detox all the time, anything like that, if you don't have proper drainage, can create this immune system need to constantly put out these messengers and constantly um fight. That is very interesting because it gives us a root cause approach and that is something that you really focus a lot on. >> Yeah. >> How does someone know what would be the process of trying to figure out if someone had massel activation syndrome and I'm thinking of one patient I have and he would go into his house and immediately he would get a histamine reaction. >> Yeah. So first of all you can have that histamine reaction to these environmental toxicants. So when I think of we'll talk about the diagnostic piece but also when I think of this histamine problem usually it's a composite of different uh different factors. So histamine issues are not just from one thing. So it's not that you ate a tomato and then you were sick after. I think of histamines much like we think of autoimmunity kind of like a bucket theory. So you could have a little bit of environmental toxicant that puts your immune system on guard, a little bit of mold, and then you have a stressful conversation with a family member, and then you eat a bunch of tomatoes, and then you drink a little bit of alcohol, and then that turns into this, >> and then and then you watch Navy Seal documentaries at 900 p.m., which is way past my bedtime with the children. Um, yeah, exactly. But it's it's a composite of these things that then puts your body into this state of activation. So, it really is not just usually one event. However, I will say a lot of times if there is one event, it is usually from a very strong detox protocol. So, I often see clients coming to me after they've been to functional medicine doctors on these incredible parasite cleanses, mold detoxes. They're correct, but their immune system is too reactive basically. >> And what I'm hearing you say is you're describing what people would probably pin on a Herk reaction. >> Exa, that is exactly right. And so usually if you're working with a fabulous functional medicine doctor, they'll titrate down or they'll say, "We kind of have to push through, right? We have to push through this herks." The problem is with histamine issues is you have a new problem. If you have if you have mass activation syndrome while you're going through a mold detox, you now have to deal with the mass cell activation syndrome because your immune system in that state of constant searching and fighting is going to create new problems for you. >> That just sounds really challenging. Yeah. When someone is thinking, okay, I might have mass cell activation, >> how would they then go through kind of a a diagnosis criteria or um is there a criteria for diagnosis? >> Sure. Yeah. So, this can be done in an immunologist's office. This can be done in a primary care office, a functional medicine doctor's office. So, you can measure the actual mediators. You can measure serum, tripase, serum, histamine in in your actual like at a lab with a lab test. You can also measure through a urine test. The reason why these can be very limiting is because histamines aren't don't live in our blood for very long. And if you're not in an active flare, you might not be able to see um what is circulating basically. And and and I so it's really important that if people are using that mode of diagnosis that they actually go during a flare. I would say it's really important and you have to be off of antihistamines to be tested for it. um a kind of more accurate measurement and another way that we can diagnose uh not myself but that doctors can diagnose is through biopsy. So you can get a skin biopsy or if you happen to be going in for an endoscopy or colonoscopy you can you can biopsy the cells and see mass cell activity through that as well. The standard laboratory diagnostic markers of MCCAST according to this up-to-date review for MCCAST is serum tripase with a normal level defined between 0 and It also exactly what you said studies have shown that the sample should be taken within 1 to four hours of the beginning of symptoms and that that basil level should be evaluated in advance during a symptom-free period at least 24 to 48 hours after complete recovery. As one could imagine, this is not easy to do and some studies suggest that even a normal tripase level that that does not diagnostically rule out MCCAS. you had mentioned and I'll just this is for the providers listening and and if you are someone who is testing in your urine or urinary metabolites that other mediators such as histamine prostaglandins lucatryines other urinary metabolites of histamines it says that they are not as well known in terms of diagnostic criteria. >> Yep. What else would be a way to tell? Is this a diagnosis of exclusion? >> It can be. And while of course as a dietitian I'm not diagnosing anything, um I will say this. Um I tell the story about a mutual friend of ours, Olivia Amatrono, uh who you introduced us. >> That's right. I'm responsible for the friendship. >> You are very responsible and I'm giving you full accountability and responsibility. Um, Olivia wrote an article a long time about what her number one travel tips were and what she has to pack with her when she's traveling. And in that article, she said, "I always bring benadryil with me because you never know when you'll need it." And I said, "You'll only need benadryil if you have a histamine issue. So that's a good way to know. If you take Claritin or you took a Zerek or you took a Pepsid and you felt immeasurably better, that would tell you, you know what, maybe this is this is something and maybe this is a direction to look in because for people who do not have histamine issues, you would not feel better taking those medications. So sometimes there's a little bit of a trial and error as well. I would also say that after working with probably at this point in my practice a thousand clients between myself and my practitioners, there's very clear patterns that we can see when it comes to histamine issues. So clients who eat tomatoes and citrus fruits and fermented foods, if you went to a gut health doctor, these would be the healthiest foods on the list. They would say, "You have to eat these foods." And they would be the exact foods that would sicken those with histamine issues. So when I see clients come in with a list and I say, "What foods do you react to?" And they say, "Vine, tomatoes, spinach, avocado." That leads me in a direction of, "Okay, this is not a regular gut issue like leaky gut or something." They're not reacting to fiber particles. they're reacting to one specific component of the food. So, it's it is a little bit of um by exclusion and also by pattern recognition, I would say. 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So, go to onkin.co, that's nei.co, and use the code dr lion for 15% off. What? That made me think about that list. It also made me think about small intestinal bacteria overgrowth. >> Yes. >> Which is exactly what it sounds like. Small intestinal bacteria overgrowth. There is a disproportionate amount of bacteria that would be less than ideal for the gut. People get a lot of bloating. When you see a patient with histamine, do we call it histamine intolerance? How do we differentiate between histamine intolerance and massel activation syndrome? >> Yeah, so massel activation syndrome will probably involve those other mediators. Histamine intolerance can be you have actually a normal amount of histamine circulating. You just don't feel well when you're having that amount. So it's an intolerance to existing histamine that you're experiencing. Um pretty hard diagnostically to differentiate. However, if someone has histamine intolerance, I'm always wondering if there's mass cell involvement as well. Um, and there is mass cell involvement because that's where histamine is released from. Would it be safe to say that if somebody has a histamine reaction repeatedly that they should be checked for massel activation syndrome? >> Absolutely. Is there a list of symptoms a validated list of symptoms that they would say okay you go to your cardiologist because they see tacoc cardia or POTS which I'd love for you to talk a little bit about is there a checklist to determine cuz I I haven't seen one >> I have never seen a validated checklist although again I think immunologists probably have access to something that's pretty again this clear pattern recognition. Um it is not there would not be a diagnosis based on that list that I'm aware of. I could be wrong by the way and I'm open to >> No, I I haven't seen it but you for example in low testosterone there are questionnaires for sleep apnea. There are questionnaires for narcolepsy for all of these many of challenges physical challenges. There seems to be a a questionnaire. this would make sense that guys if no one has done this we should go do it >> go get on this right away because it would be really really helpful. >> Yes. So this this part of the conversation I think is the most important part because the philosophical question we have is whose responsibility is it to treat MCCAST and what can each person do? What is the role of each provider? What's the scope? Because this information around MCCAST is exploding very recently. The first practice paper I believe was only in 2017 maybe 2019. So um it's all very new and we've also seen an explosion of MCCAST with long co. So the question is where's each of our roles I think and it's really really important because if someone again if someone has a pounding heart when they stand up and their heart rate's jumping up severe tacky cardio which is a frightening experience you think you're having a heart attack. You don't know what's going on. You're so dizzy you can't move. People can't walk when that reaction is happening. Where would you go Gabrielle? You'd go to your the ER. You go to a cardiologist's office, but there's no cardiologist who's pulling out a list of histamine intolerance checklist. When someone's coming in, they're going to do an EKG. They're going to do what they need to do to make sure that their heart as a muscle is functioning. The issue is that histamines, one of their main functions is to um cause vasoddilation, which we'll go into more deeply, but it's not that the heart itself is not functioning. It's that the brain is signaling and the mass cells, the immune system is signaling for the body to operate in a different way. So, it's really challenging for doctors because that's not in their inclination and it shouldn't be. They want to make sure that muscle is working, that the organ is working. So, it's really challenging when clients go to the ER because you can get any emergency sign you can think of, respiratory rate changes, fevers, um obviously any uh visible signs and things like that, heart rate. So, the question is what is each of our role I think because it's really tricky and it it really conceals itself as other conditions as well. What would the diet look like? Is it fair to say that there is a diet to help modify these symptoms in the short term? And then I'm curious as to treatments in the long term. Absolutely. Yeah. So, let's say someone let's say we have identified a root cause for MCCAST. Let's say we know someone's living in a moldy home. Let's say actually someone has SIBO because SIBO is actually one of the syndromes or conditions that we say travels with MCCAST. So they they often have um overlapping ed like symptomology as well. So if someone has these symptoms in the short term or we've even identified the root cause, you still have to treat the symptoms first. This is very different than other conditions because if you know that mold is an issue, usually you treat the mold, right? If you know that parasites are an issue, you treat parasites because histamines are so um react our immune cells or man cells are so reactive to any type of detoxification including a vitamin C supplement. I had a oneweek reaction with fevers because I got a vitamin C IV. Wow. This I this really brings me back to remember u my New York practice. >> Of course, >> we had a patient that reacted to vitamin C. This was before I was even thinking about mass cell activation syndrome and we were thinking to ourselves how we don't believe this. We do not believe that she is reacting to vitamin C. Tell me more. >> Yeah. So it's really funny because those patients are my only clients. So that's I only see the people who have those reactions and those reactions have exploded since co by the way. So it's impossible to believe that something that's healthy for someone can create severe symptoms. It's not logical almost right. Why would someone drinking lemon water make them violently ill for a week? It almost it's like defies our understanding of the human body almost because it acts in this very odd way basically. So vitamin C is powerfully supportive for our immune system. In mass cell activation syndrome your immune system is not hypoactive and it's not autoimmune, it's hyperactive. So it's constantly turned on essentially. So anything that enhances an immune response can also enhance a mass cell response as well. The other issue is if you are not draining or detoxing properly, you can have recirculation of toxins. >> What what does that mean? Does that mean liver removal? Yes. Does that mean going to the bathroom, >> gutt removal, liver removal? So any if any step in the detox and drainage process is inhibited, you can have recirculation of toxins basically. So in SIBO is a great example. you have this bacterial overgrowth and your body is like let me mount an immune response to help you to get rid of this and to move this through but you don't you you cannot handle the added immune and detoxification response. So it is a body that is in a state of turned on too much. So anything that enhances the detox response that could help you you actually can't do which is really really frustrating in treatment. >> That would be really again very challenging. Here I'm just going to read this. This is the relationship between SIBO and MCCAST is as follows. SIBO and this is for my science nerds in there. Dad, I hope you're listening. SIBO causes the activation of mass cells and increase in Tlymphosytes. Tlymphosytes in turn secrete microparticles that again activate mass cells. Activated mass cells and Tlymphosytes release cytoines. This increases intestinal permeability and leads to this vicious cycle. friends. Why this is so important is because when you hear mass cell activation or when you hear SIBO, you must have a mechanism of action. >> Absolutely. >> When we don't have mechanism of action and the way that I would think about this is red meat causes cancer, colon cancer or red meat causes cancer. What is the mechanism of action? This has a clear mechanism of action. How do we begin treatment? >> Because obviously >> people would think, oh well, I'm going to take vitamin C. I'm not feeling well. >> But before, actually before we go to treatment, give me some other >> items that people would take. You said vinegar, >> avocado, any of the foods that seem to exacerbate small intestinal bacteria overgrowth. I did a a episode with Ken Brown, Dr. Ken Brown. He was amazing. If you guys want to learn more about SIBO, we should link to that episode here. Vitamin C. What else? >> Yeah. So, from a histamine food perspective and the original question, yeah, absolutely. The original question you had was like, what is the diet the deal with the diet piece of it and we will talk about that of course. So, the foods that are high in histamines or can cause the body to release histamines are vinegar, citrus fruits, spinach, avocado, tomatoes, especially like aged um foods. Unfortunately, pickles for me, it's a major loss. Um it's actually the only high histamine food I can't eat. Chocolate, everyone's mad at me for saying that one. Alcohol, anything that's aged, the the food itself can build histamines over time, basically because histadine gets converted to histamine in the aging process. fermented foods, those gut healthy foods, miso, natto, um fermented vegetables, like these foods that again are so objectively healthy, they have a high histamine content or they cause the body to release histamines. Um bananas are another one. Um spinach. So would these reactions happen immediately? >> Depends. It's a great question. Yeah. >> Or is it over time? For example, the person who eats a ton of bananas one day can't tolerate bananas. or I used to eat um you know like Matt my producer chugging vinegar he maybe could do it and then all of a sudden he can't do it anymore. >> Absolutely. Yeah. So it depends on where you are in that bucket theory right. Have you had a lot of other environmental toxicants? Stress. Have you been exercising too hard? And exercise is something we have to talk about because sad here. It's not sad because exercise is essential for POTS especially and MCCAST, but everything's about titration and everything's about creating safety in the body first and you have to do things in a certain order. So the answer is this. Does a low histamine diet treat the root cause of MCCAST? A little bit, but not totally. The way that it does a little bit is because unfortunately our body has this very odd mechanism where the more histamines that are present in serum the more body the more the body creates histamines which I'm like don't do that we have enough clearly. So the problem is if you eat high histamine foods it enhances this cycle that continues as well and can cause drastic symptoms. And when I say drastic symptoms I mean violent digestive issues for days at a time. Could be all the way up to vomiting. It could be migraines. I mean these are really really intense symptoms. Not just that little rash that people think of which is also a common histamine symptom of course as well but these symptoms are so drastic and it is hard because you can have a reaction within minutes or the reaction can be delayed like 12 hours later. >> That was my that was going to be my next question. Does someone have an immediate reaction? And if we're thinking about diet obviously you're removing those things. Is that the first step? >> Yes. So I would say in any protocol, so this is the same thing with supplements and when we were talking about supplements, vitamin C, vitamin B, especially glutathione, anything that's enhancing that detoxification or immune system response. Um, but really people with mass cell activation syndromes, I think of our bodies as these highly sensitive bodies as bodies that are on guard. So anything that's perceived as a change to the system um can be really challenging. So, it's it's those supplements that enhance the immune response, mitochondrial response or detoxification or anything that's new to your body, unfortunately. And it really depends on the state because I can eat if I took a flight and my my mass cells are already irritated, I might not be able to tolerate them. So, it is really challenging to kind of chase. But in the beginning, you have to stabilize two things of any mass cell journey. You have to stabilize your histamines and you must stabilize your nervous system because our nervous system and our immune system are intricately connected. And in mass cell activation syndrome, there is no way that your mass cells can be calm if your nervous system is hyperactive because that's the number one signal for our mass cells to to activate and they literally communicate with each other. Mass cells are also considered neurotransmitters and are released by our hypothalamus as well. Hm. >> With histamine stabilization and nervous system stabilization. Can you give me a sample type protocol? And we've actually worked on >> a few quite a few patients together. And there's this one patient that I'm thinking about and this was uh she had long co and we should talk about longcoid longcoid ACE receptors and this uh MCAST connection. >> We started her on pepsid. We gave her a handful of items and it seemed to really improve her symptoms. So, let's start with that. >> Yeah. And I I I'm going to actually mention a case study with a different client and why Pepsid even came up to me and why I even started thinking about Pepsid. Um I had a client who was on eight psychiatric medications. Uh actually she had a fantastic psychiatrist and it was well for insomnia. She had untreatable insomnia. She was sleeping 1 to two hours a night. Then maybe like the third night she would get like five or six hours. But it led to the point where she had like paranoia and hallucinations. Her insomnia was so severe. In my emails to stay up to date, I always get these medical lectures. And I recently listened to a lecture from an academic MDPhD about magnesium. I have to tell you it completely changed my perspective from a scientific point of view on magnesium. One of the most common causes of headaches, you won't believe it, is a magnesium or could be a magnesium deficiency. And you can test for this in the blood. There are hundreds of biological processes that magnesium is responsible for. And the absorption in our diet is not great. And after listening to this lecture, I am more convinced than ever that taking magnesium can be helpful. Also, 75% of Americans are deficient. That means three out of four of you listening to this podcast may be deficient. And that's where Melo Magnesium comes in. It's a daily super blend that contains the three most bioavailable and nutrient-dense forms of chelated magnesium and not to mention over 70 trace minerals. Full transparency, Ned shares all of its third-party lab reports. So, you know that the product that you are ingesting, it has what it says it has. So, if you are someone like one of the 75% of Americans who are magnesium deficient, go to hellned.com. That's h e l.com/dlion. And they have amazing amazing small travel packs of this magnesium, mellow magnesium. You will love it. And at some point, I started noticing she had other histamine reactions. So I said why don't we try Pepsid which is actually an antihistamine. The reason I even thought of Pepsi is because I had seen a study. Um they studied 16 people out of who were inatient in a hospital and they found that 14 out of 16 of them had an intervention of 80 milligrams of fotodine which is Pepsid. And I was so shocked because I was like what the heck does Pepsid have to do with longcoid symptoms? Why would that make a difference? And it's actually because Pepsid is an antihistamine, which most people don't know. And I think this is a little speculatory, but I think because it works on the gut, I notice it helps with a lot of neurological symptoms for people um and nervous like uh numbness, tingling, that zingy feeling because I think it's the Vegas nerve impact. Um so it works even better than some of those H1 receptor medications. So she took Pepsid and it's been 5 years. She's never had trouble sleeping since. Um obviously she worked on the rest of her medication protocol with her doctor. dietitians actually can recommend over-the-c counter medications and um we worked on that together and she is sleep she has not said the word sleep to me in five years. >> So weird. >> Yeah, >> that's wild. >> Someone listening to this and they wanted to take matters into their own hands. Obviously we always suggest we don't give medical advice here but this is for educational purposes only. You start a lot of your patients on Pepsid that have this. Do you take them off of supplementation? And I know that you use a lot we both use a lot of electrolytes. >> Yes, absolutely. >> Tell me a little more and why what it is that we are using. >> So the first round for us is always those two things. Histamines, nervous system. The deal with histamines and the MCAST is that you have to kind of radically drop those histamines down because if you're in that symptomatic state, your nervous system is going to be so active and it becomes this cyclical um state of existence. And unfortunately for people, again, Gabrielle, we're really talking about people who are mostly many of them are unable to work because if they walk into an office where they recently used bleach, they're having a potentially asthmatic reaction to it, right? They're having um such a severe reaction to environmental triggers or having going out to dinner with friends and having something that's super healthy and ending up again violently ill. So in the beginning I will often even as a dietitian recommend overthe-counter medications a combination of H1 receptor medications like Claritin Allegra or Zerek and then probably a combination of Pepsid as well. The the question that's going to come up in your amazing medical community is well Pepsid lowers stomach acid and low stomach acid is a huge problem Michelle. So in this population it's interesting because they actually may have higher stomach acid because stomach acid and um mass cells releasing histamine it's a direct relationship higher the stomach acid higher the histamine release higher the histamine release higher the stomach acid this all happens on the parietal cells H2 receptors um are very again there's this cycle that happens so what you have to do in the beginning is whether it's overthe-counter medications or supplements like we use pearlla extract pea queretin Um, again, we can't use vitamin C in the beginning usually, but we will take people off of the supplements they're on most likely because we don't know what they're reacting to, and we will just focus on supplements that'll help the nervous system, mindset work that helps the nervous system, and then also anything related to histamines to bring down that response. >> When you focus on their diet, is it mostly proteins? What kind of foods do you typically have them eat? Yeah, fresh protein because leftover foods can also again the older a food is uh the the the more it can develop that histamine response. So fresh meats, many vegetables outside of the ones I named are fantastic. Fruits usually are fine outside of those citrus um and raspberries unfortunately and strawberries. Um but there's and tomatoes as we talked about, but there's basically most whole foods. Most carb foods are low in histamines as well. So you can eat a whole foods diet. It's just being selective with those foods. So, we will go on a probably um an 8 to research about low oxalate diets as well. I haven't seen as much positive response. It's really hard because people can still have histamine issues while they're on the low histamine diet because I don't know, they have uh an abusive partner and that's the reason that their mass cells are activated. So, it's hard to know the exact reason, but you can see some really tremendous symptom improvement from that low histamine diet. And it's still so essential to eat those whole foods during the time. And very possible, right? >> 8 to so 8 to 12 weeks on a low histamine diet, whole foods, taking some form of a typically an H2 blocker >> and H1, a combination of H1, H2. Yeah, >> H1 H2 blocker. That's one side of the equation. Mhm. >> Is there something to directly work on the nervous system? Would that be meditation? Are there other obviously you're probably they're not seeing doctors and going on SSRIs? How are we stabilizing the nervous system? >> By the way, that's a really good point, too, because a lot of medications can cause drastic reactions. So, it's really hard for people to find out which medications help or hurt as well. So, when it comes to the nervous system and mass cells, I have this visual for mass cells. I almost, and I feel really silly saying it here, and I hope Shane doesn't um think this is extra silly, but I kind of think of mass cells as like the guards on the watchtowwer of a battle that just happened. They're kind of like looking to make sure they're witnessing the battle and then they're deploying resource resources after to help clean up the debris and also to prevent that from happening again. So the problem is that people with extremely uncomfortable and frightening symptoms get really scared when those symptoms happen. And this is what keeps mass cell activation going. It's really challenging for me to look at someone who's been sick with painful, frightening symptoms that no doctor has been able to help them with and say, "I need you to be calm when these symptoms come up and I need you to find a way to be non-reactive to these symptoms." So there are actually brain retraining programs that help retrain our lybic system which is our hypothalamus, hippocampus and amydala which will process our um threat response, memory and basically again is deeply integrated with um this mass cell response. So it's really interesting because these brain retraining programs are one of the top ways to support MCCast the Gupta program DNRs primal trust and it starts in the brain. So we often think oh maybe mass cell stabilizing medications like promolin sodium ketoyphen um but in reality starting in the brain is the most important thing at home I'm not asking people to meditate and do things like that even though it's essential because the symptoms are so loud that sitting in them can be really challenging. So, what I invite people to do is to just ask themselves questions and get really curious about their symptoms and just ask yourself, I have people just tap their heart and say, "What do I need? What do I need in this moment?" And really, just at home, again, this is temporary. I know how horrible this is. I've personally experienced these symptoms to an extreme degree. So, I understand. Um, but anything we can do to become non-reactive really, really helps in the long-term treatment of these conditions. And our mutual client, I had that. It's a hard conversation to have because I'm like, it's not your fault that your nervous system is so reactive, but we have to find a way to feel safe again. >> And what is fascinating about it is this is not something where individuals are usually very reactive and they're having these experiences in their body that are real and they are coming from white blood cells and and other portions of the body that are really pushing up anxiety. I was reading one thing about migraines. They believe that mass cell activation seems to play a significant role in the pathophysiology of migraines. >> I'm I'm bursting at the seams to talk about this. Yes. >> Go burst. Don't one one thing about one of the functions of histamines is to cause vasoddilation. Okay. The widening of our blood vessels. And this is you have such an intelligent audience. They're going to be like Michelle, please don't explain vasoddilation to me. So, I want someone to think of a scenario where they've had this experience where they're in the shower and suddenly they feel really dizzy when they're in a hot shower and they look down, they see their legs are red and their heart rate is pounding. Why does this happen? Right? So, what's happening in that situation is that heat and histamines both cause vasoddilation. So, if our blood vessels are wide open, we're standing in the shower, it's steamy, our body's standing up straight, gravity plus vasoddilation will pull blood down and blood will pull down. So blood pooling is a big component of both mass cell activation syndrome and POTS postural orthostatic ticardia syndrome. So when the blood pools in our feet and legs you see it on the surface that's the the opening of those blood vessels. You see all that redness and then what's happening is your heart and your brain don't have blood flow going to them. Now of course they have some blood flow going to them but there's limited. So what happens is your body starts pounding your heart to get the blood flow back up to your heart and your brain. The dizziness comes because you're not having blood flow to your brain and your heart starts to pound because it's not getting that blood flow. So in a histamine response again, what you can see is blood that's pooling in your extremities dropping down because you're constantly having that vasoddilation. All right, this is my big moment. Okay, migraine medications are what? They're vasoc constrictors, right? We think of eedran migraine that has caffeine in it. We think of what helps people with migraines. There's this very popular trend that's happening online where it's like have a diet coke and French fries. I'm like don't. I'm like there's other ways. There's other ways. Um we think of electrolytes that help people with migraines. We think of cold compresses that help you with migraines. All of these have vasoc constrictive properties. Migraines we've known for a long time are vasoddilation issues. And histamines are potent vasoddilators. So I believe that the root cause of many people's migraines. There's many root causes of migraines can be histamine issues because of this vasoddilative feature which is um I think one of the roles of histamine that creates the most havoc in the body symptom-wise. I have had many patients explain that scenario to me. Doc, I was in the shower and I don't know what happened but I started getting red and lightaded. How do we treat them in that moment? Is that a pre-treatment with H1 and H2 or is there a different way? What what are your thoughts on that? >> It's the it's the exact right question. So, this scenario is very common in people with this um syndrome postural orthot orthostatic tachicardia syndrome >> which we did not really dive into and I'd love for you to talk about. That'll take us into that because this is one way where those two are very related. And I have a joke about POTS. The way that we treat POTS in conventional medicine is we kind of create a go-gurt tube through your body. So, we compress your stomach. We wear an abdominal binder. You squeeze it. It helps the blood flow go up. We wear compression socks. We kind of squeeze your body like a go-gurt tube and just bring the blood flow back up. Right? And you know this from all of your extensive years in practice and training, but um if someone has like low, you know, blood pressure, you might have them put their legs up on the wall. Basically, the goal is to get blood flowing back up. Now, POTS we think of as maybe that's a cardiac condition, right? It has to do with how fast your heart rate is jumping when you make a postural change. When in reality, POTS is a form of disordia. Wait a second. It's a nervous system disorder. It's a dysfunction of your autonomic nervous system. So, that means that treating POTS is not about treating your heart. In most cases, there's different types of POTS. Three. One is hypoalmic POTS which is that you just have low blood volume. When you don't have enough blood volume, you don't have that pump and then your again your heart will start pounding faster. We often think of POTS um we're like why are people's part hearts pounding so much? They get put on propanol, metiprolol like anything that beta blockers to help bring the heart rate down and stabilize it. Um in the case of hypoalmic pots the treatment is also to have not only this compression but to have 10 grams of sodium per day additional. So we drink element right element that's one gram of sodium. We're talking about 10 element packets and again it's to enhance vasoc constriction and increase that blood volume essentially and to help um so that there is that blood flow and that blood volume will help to enhance the blood flow. The second type of POTS is hyperadinuric POTS which is you're having this hyperadrenaline response. These people do not have low blood volume necessarily. They're having an adrenaline response that is causing their heart rate to go really high. Very related to mass cell both of them again in this feature of mass cell activation syndrome enhancing that vasoddilation causing leakier blood vessels. POTS and MCCAST are connected right there and it's really important. And then um idiopathic POTS, which is there's actually some sort of blood vessel damage that's causing it. >> How long does it take to treat POTS? Would you treat POTS or MCAST first? Because >> they're almost as if so POTS is this downstream effect of MCCAST. However, it seems that what I'm hearing you say is for the treatment of MCCAST, number one, regardless of what is causing it, you have to stabilize both histamine and nervous system. But histamine is kind of a catch-all term for the multiple other responses. It could be right. It could be prostaglandins, it could be lucatryins, it could be >> it's inflammation, right? In some level, it's the immune system. And then the also you need to block the histamine symptoms on some level because people are unable to work and live their lives. Um it's it's really excruciating. There was one study out of the University of College London that stated that those with long CO which if you ask me I think it's a composite of MCCAST and POTS in almost every single scenario um had worse quality of life and more fatigue than those with stage 4 cancer and stage because the symptoms are so drastic and so intense and no one knows how to help them essentially. So I think that if you have a POTS issue, and I've I've never seen someone with POTS who doesn't have MCAST. I have to tell you, it is such an honor to have beef sponsor this podcast episode. As you know, beef is more than a delicious, satisfying protein. It is a nutrient powerhouse that supports strength, energy, and vitality at every stage of life. It is packed with high quality protein, iron, zinc, B vitamins, and healthpromoting bioactive compounds like creatine. Beef is a whole food source that helps fuel your body. And whether you are trying to build muscle, support metabolic health, or simply aim to feel your best, beef delivers the nutrition to your body to thrive. Beef is what'sfordinner.com is one of my go-to resources to gain valuable insight on how beef is raised, grown. You'll find recipes. I am so honored that they are helping to support this podcast and your journey to be forever strong. The beef nutrition team at the NCBA is made up of dedicated nutrition scientists and registered dieticians who are passionate about sharing accurate science-based information. Go to beef is what'sfor.com. But you said something Gabrielle that's going to be Dr. Gabriel line that is going to be so profound for people. You said pots is a downstream effect of MCCAST. No one says that just so you know that's not common in the conversation. I believe that to be true. I have never seen a POTS client who doesn't have MCCAST. So the question is how do we stabilize him histamines to stabilize symptoms? And then with POTS you must recondition. You have to because it's blood flow, right? That's a huge piece of it and you have to you have to have a tremendous amount of electrolytes and you have to hydrate really really well. >> That brings us to exercise. >> How does that happen? How can we manage exercise dealing with POTS or MCCAST? And I've had patients with POTS who probably have MCCAST, but the major presenting symptom is this exercise intolerance and heart rate changes. >> Yes. >> And those symptoms I I don't think we can overstate how absolutely terrifying those symptoms are. By the way, it's not just like, oh, my heart is fluttering. You can't People feel like they can't see. It's excruciatingly anxietyinducing and the anxiety around pots, especially hyperaginuric pots. You have this it's like a I I can only describe it as a very full body anxiety where you feel like there's ants crawling under your skin and you're >> had it have I had >> people don't know your personal story. You have had >> absolutely >> POTS >> MCCAST >> MCCAST >> hypermobility and long >> which we should talk about the connection between hypermobility and MCAST but after you >> finish telling us how we are going to exercise cuz this crew they want to train they want >> us and it's the most devastating for this crew because first of all >> being unable to exercise doesn't make exercise less healthy for us. So, it's like we know the information. You have you have told us this information yourself for you've devoted your life to telling us this information and it doesn't change the information. It just means that we might have to build our tolerance to it. We, you know, I've had so many clients, Gabrielle, where they're at the point where they can't walk 10 steps. So, what do you have to do? >> What do they do when they walk 10 steps? They just feel out of breath or >> Yeah. So, um so dizzy that they might actually faint. Um some that POTS there's a huge fainting component to many. Not every single person has that symptom. Um their heart rate is is so rapid again that they could immediately have this like feeling when they stand up so dizzy the heart pounding so profound it just basically like pulls you back to sit down. And those episodes from just standing up once can leave you with that anxiety and that adrenaline response for days. So it really makes people feel so frightened. And it's actually with mass activation syndrome, you can also have pretty profound exercise intolerance and they would actually get full body rashes and then what feels like a flu basically. So the answer is how do we titrate it specifically? Something else that's very very important with POTS is something called upper cervical instability which happens in hypermobility that I know we're going to talk about. Really with POTS, it's about protecting your neck because if there are if there's any instability in your neck, all the nerves that control your heart rate are in your neck, right? They're running down. We we talk about the vagus nerve all the time in ways of digestion and ways of anxiety. But think about the fact that the these nerves are going to control that heart response and it's a it's a nervous system condition. It's a nerve condition, right? >> So, it's really important. There's actually a type of exercise protocol called the Chop Lavine protocol. It's a free PDF they have online. Um, it was developed for people with POTS to increase their exercise tolerance. All of the workouts are very specific to not be you're not doing standing up exercise to start with, right? You might be doing recumbent because you don't want that blood flow dropping down, not getting the blood flow back up to your heart. And then also they're really mindful of neck as well. Is there one modality of exercise? When I say one modality, is it easier to tolerate resistance type training than it would be walking or cardiovascular activity? >> It's an excellent question. I think it depends on the person. I think people can probably tolerate lowweight resistance training easier than cardiovascular to start with. I it would make sense because again we share a few patients together and when those patients do a lot of walking with weights they they feel terrible >> and it's and these are regular exercisers. Typically we have a handful of patients who have had long COVID and that seems to be their response if we don't titrate it really really slow. How fast do you think and again I understand that this is individual. How fast do you think someone could titrate up movement? It really depends on the person. It depends on their exercise capacity before and it depends on how much can you control those histamines. Honestly, >> what about the hypermobility part? You had mentioned earlier that >> there is um >> connective tissue potentially bone joint involvement in this. Talk to me about that. So our connective tissue lines all of our joints, bones, and organs in our body and our blood vessels most importantly too, which is what will come into play with how POTS and hypermobility are related. Hypermobility as I'm talking about it is probably a collection of conditions that are connective tissue disorders called Ellers's Danlo syndrome, EDS. I have HEDS, hyper mobile Eller's Danlo syndrome. Ellers's Danlo syndrome. >> Wait, did you just say you have? >> Yeah, I sure do. >> I exactly >> I remember. Do you remember when you called me and you were like, Gabrielle, you do you remember? You won't believe it. Can you just share because this really plays into this Eller's Danlo? >> Absolutely. >> And just share a little bit about what you were going through. >> Yes, absolutely. So, I had moved to I'm so so embarrassingly for me, I had moved to New Jersey from Manhattan, but I was right over the bridge, but I needed a car basically when I got there. I had gone through a mold detox in my apartment in Manhattan. I moved to New Jersey because I had such a severe and profound mold. I mean, there was mold. It was It was such a good apartment. Otherwise, it was very hard. >> You did not You did not want to leave. How long were you there? >> I was there for 2 years. You >> were there for 2 years. >> So, I was not planning to leave. And then I walked into my bedroom of that apartment and I saw my husband. It was like the movie Interstellar. Like, he was coughing up along and I'm like, "Are we in a dust storm in here?" I'm like, "We have to leave this apartment." Like, I know I have weird reactions. And I was having symptoms that were again dizziness. I was like, "Maybe this is a thyroid thing." I was like, "Oh, you know, I'm having gut conditions. I'm going to get a GI map. Let me see what's going on." Nothing was really showing up. I was like, "Oh, now I know it's mold related." So, I went on a mold detox in that apartment was like the sickest I ever was in my life. And I just I I mean, Herk's reaction, those symptoms where you feel like your body is going through such a you're in a flu state, dizziness, anxiety, insomnia. So I left that apartment and when I moved I had to start driving and when I started driving I started getting a lot of dizziness when I was driving and I was like I thought these symptoms were gone. I then had COVID again and then I went to a chiropractor and the chiropractor did an adjustment and he said oh my you know I've never felt a neck this tight in my life. So I took this like metal tool and chiropractors who are listening are gonna be like I know the name of the tool and I don't. I'm sorry. dug into my neck, did not assess me for hypermobility, and basically on a very small level loosened the joints in my neck. I walked out of there, and I don't I actually don't mean I walked I crawled out of that appointment, and I crawled directly to the ER. Um, I could not stand up without my heart rate going up to 160. I mean, I I was sitting it was the phone with my sister crawling on the cement in an urban place, crawling to the ER. I said, "What just happened to me?" Um, I it took me a long time to understand how mass activation syndrome and because I kind of knew there was a histamine thing. I kind of knew that something was going on, but to pull this all together. Wait, it was this when you >> I think I would I I wanted you to come to something and you were going to come but you weren't sure because I have and then you were wearing a neck brace. Was this during that time? >> Do you know that I would risk my life to do a talk with you by the way? So, this is the funniest thing you were doing. We were It was for your book. We did a Q&A for your book and you invited me and it was one of like the biggest like like the biggest joys of my life. And I was like, "All right, Gabrielle, I cannot fly to come see you, but I will I will film in Manhattan. You will film there. I came in a neck brace. My tolerance for even sitting up because my the hyper mobility situation was so rough. And again, he had the chiropractor had loosened all the joints in my neck. My nerves were so inflamed from that. And your brain has to send the signal to your heart to pump. That's what I think people don't understand about POTS. It's not a heart condition. It's a brain condition. Your brain says, "Send blood flow here. Activate this muscle. Do this." In hypermobility, which is a connective tissue disorder, that relationship is not there. And we also don't have the structural support because connective tissue holds us up and it gives that structural support. So, if you don't have proper connective tissue development and someone goes like this with your neck, what's holding your neck up? So, I went to that I went to that Q&A with you and in between takes I would take off my neck brace. I was literally I I we can show people the video. I was like this. I was like, don't tell me about Forever Strong. I was like, and you were like, great job, but >> we didn't use it. >> We did not end up using that. You still did a great job. >> Yeah. >> But you didn't know you had Eller's downloads. And I want to talk a little bit about it's a it's a group it's a genetic disorder and it's mixed connective tissue. >> It is is it uncommon? I think there are degrees to it. >> So it the amount of women who are hyper mobile but don't you can be hyper mobile and just have um basically like just different joints in your body are hyper mobile but not have Ellis Danlo. The numbers are over 60% I believe of women are hyper mobile. Hypermobility is not necessarily a connective tissue disorder. The rates of hypermobility are very high though. Um, and people also need to work out differently when they're hyper mobile, which many amazing chiropractors, personal trainers know. And I actually have a a personal trainer who specifically works with hypermobility. Shout out to Taylor Goldberg. She's the best. Um, and shout out to Taylor Goldberg. You know, you've got uh Michelle Shapiro. I said, Michelle, do you want to come train with us this morning? She goes, uh, no. I am going to stay at the hotel gym and I'm going to lift my 15 pound weight. Ex. >> That's exactly right. >> Um, >> yeah. >> And Taylor tells me what to do. She's one of the only people I let bully me besides you. >> Taylor, you're fired. But, uh, okay. Well, I guess >> you also threatened me and said to go on the ice plunge. I'm like, you got to give me a break. >> I am really actually glad you brought that up. I do want to talk about other modalities >> first. So, I'm going to write this down. Ice plunge. >> Yes. >> And and for Yes. How can someone assess for Ellers's Danlos and what is the relationship between Eller's Danlos and the association with MCCAST? >> Yes. So, Ellers's Danlo syndrome, there's 13 different types of EDS. Hyper mobile EDS is one of them. You there are genetic tests for almost every other type of EDS besides hyper mobile that's done through assessment basically. Um, there's some genetic markers that lean towards it like Cole 5A1. There's some that we know. There's one type of Ellers Danlo syndrome that's really important for us to talk about because it requires additional testing. Um, and that's vascular EDS, which means that again your blood vessels can become leaky. And this is if someone has vascular EDS, they could die in pregnancy. It's a very it's a profoundly important thing that we anyone who has Eller Stan syndrome gets an echo cardiogram not an EKG an echo cardiogram because you have to make sure um that there's not going to be you know even like a rupture um of those blood vessels. So just understanding how important our connective tissue is. Uh there's assessments that you can be done and also genetic uh diagnostic features uh for EDS as well. So if our mass cells live in our connective tissue and you have taught us this more than anyone Dr. Y is our connective tissue like our muscle is endocrine facing. It's immune facing. It doesn't just sit there. And if we don't have the structural support from connective tissue and if there's connective tissue dysfunction and our mass cells live in our connective tissue, there's going to be communication errors that happen and that is going to activate mass cells. And the same thing with POTS. You have constant mass activation syndrome that can lead to leaky blood vessels as well with the constant inflammation and the vasoddilation pushing outwards and then you have this kind of cluster of what we call the triad which is symptoms from any direction. Now hydration isn't just about drinking Coke Zero or sugar-free Red Bull. I'm saying that for a friend or even drinking just more water. It's about keeping the right balance of electrolytes and fluids during life's most demanding season that matters even more than ever. So, for example, if you are pregnant or postpartum, your body is going through massive changes, blood volume, hormone shifts, breastfeeding dem demands, I don't know, crying kids, all of it. And this is a place where you need electrolytes like sodium, magnesium, potassium. element was formulated to replenish what you actually use without sugar fillers or junk. It's a clean, effective way to stay hydrated. For example, through pregnancy, postpartum, and for men, hey, this isn't just for ladies. It's not just about hydration. It is about performance, recovery, mental clarity, and yes, energy. Whether you are hitting the gym, chasing your kids, or grinding through another workday, dehydration can quietly sabotage your focus. Element helps you stay sharp, strong, and ready. We use Element because it works and it tastes great. You can get a free sample pack with any purchase. That's eight flavors. Go to drink d r i n k lm nt.com/dlion. That's drinklm nt.com/dlion. Stay hydrated. Stay strong. The biggest challenge is well, are you having a hyper mobile symptom day or are you having a mass cell symptom day? Because there's different symptoms for each one of these. Um, so it can be challenging, but I know my client's body so well where I'm like, "All right, it's a hyper mobile day. ice up. And something I need to mention because it's your podcast of all people is that one of the most important things we can do as hyper mobile people is build muscle because we do not have the structural stability from our connective tissue. Something's got to hold us together, right? muscle will put those bricks, those building blocks in your body to hold you together and get that proper blood flow because there's this severance of this brain blood flow connection that happens in hypermobility and you have to have muscle to reestablish it and to structurally hold you together. It is the only like it is the most important thing we can do. >> What I'm hearing you say is that muscle is the organ of longevity and the most important >> structure in our body. I I really have to say it absolutely is and it's 100% the thing we can control. It helps with POTS. It helps with hypermobility and because it has this anti-inflammatory effect, it also helps with MCAST. This makes me think about a sport injury for example. You know, I I'm not sure the amount of mass cells that live in any portion of the tissue. For example, in your connective tissue, your tendons, do they live in tendons and ligaments as well? >> Just connective tissue. >> Just connective tissue. >> If someone injures their connective tissue in some kind of sporting injury, would that cause a cascade of mass cell activation? >> 100%. Absolutely. Yes. Especially because it's in your joints, too. And there's, you know, there's kind of this like echo reaction that happens. Our entire body is so intricately connected. We like to think that if we have anxiety, it's in our head. We like to think if we have an injury in our leg. There's systemic communication between injury and also injury is going to stimulate your immune system as well. So, absolutely the sauna and cold plunge. I I've been trying to get you to do that. I use those all the time. the massel activation. Obviously, there's different phenotypes for lack of a better word. Whether you are massel activation with small intestinal bacteria overgrowth, whether you have pots and mass activation or you have eller stanlos and mass activation, >> are there adjunct therapies that are more beneficial for one group than the other? >> Yeah, absolutely. Um, I think cold therapy in ways of cold compresses on your neck is really powerful for POTS again like vag nerve support. So, we talked about step one and step two with MCCAST. What do we do? Stabilize histamine, stabilize the nervous system. Well, what's the rest, right? What do we get to what fun do we get to have after? Once you have your immune system and your nervous system stabilized, that's when you get to have fun because that's when you can say, "Let's go for a mold detox. Let's use infrared sauna. Let's >> That's how you're defining fun. We we we can't. >> Wait a second. That's how you define fun. Are you kidding me? I came here to visit your family. >> I was thinking there was rocks and >> Yeah, exactly. But for you, more intense exercise is fun. And it's true because then you can start to dig at the root cause after. So you can do all of those root cause things. It just takes more time. You have to stabilize first. So infrared is tremendously supportive from a detoxification perspective, from a um nervous system perspective in, you know, innumerable ways that Dr. Dr. Alexis Cowen um has told us about so many times, but it really can be so helpful for those with MCCAST and it can be really soothing for people as well, but infrared is a huge bucket filler for MCCAST in the beginning. So when you are still stabilizing histamines or stabilizing your nervous system, we cannot push detoxification and we cannot push um heat changes because much like exercise intolerance, heat intolerance and cold intolerance and temperature changes um can can trigger these these symptoms. >> Okay, I cannot validate some of these items on here, but I want to talk about them. Okay. >> And that is a histamine estrogen connection. >> Women with histamine issues from what I'm reading often feel sick days 6 to 11 days 19 to 21 rather than when they have menration itself. Is this validated? >> Yes. >> Okay. Yes. >> Yes. Totally validated. Histamine and estrogen have a direct relationship. It's a well-known well-established relationship. So, when you have clients coming to you, any of us have clients coming to us with um regular PMS symptoms, PMDD, there's a very targeted window that we assume that symptoms are going to happen. They're going to happen the week before someone's period comes. In those with histamine issues or POTS, their symptoms generally start about day seven of their cycle. It could even be as early as day six and then up until ovulation. So, when estrogen starts getting released, that's when the histamine reaction starts. So, it's not even at the peak necessarily that people experience it, but on the way to ovulation and then there's a second estrogen spike in the middle of our ludial phase and people will notice around 19 to 21 another set of histamine symptoms. This was one of the hardest things personally for me to figure out. I was on Reddit like why feel sick when period end? Like what where are you getting that information? like to establish this connection and it's so exciting for me to talk about because just knowing information about histamines can be healing and that's not the same for leaky gut that's not the same for other conditions understanding okay I need to maybe slow it down in ways of like my vinegar intake during days you know 6 to 14 and just be mindful of that or I need to take my antihistamines on those days cuz you can then understand what is going on in your body imagine you just feel really weird weird every day seven of your cycle like no everyone's like what is this? So it's a clear and established connection and um it gives people a lot of relief to understand why their body might be operating on a different system. >> Another thing that I'm reading here is that increase in estrogen increases histamine release. What about those on for example an estrogen patch? I have, but in our practice at Strong Medical, I have very rarely seen patients go on an estrogen patch and say they feel worse. Maybe they don't notice it. Is there is this true? Is this something that you see, but they're also on progesterone? We never give unopposed estrogen. And maybe it's the progesterone that helps regulate it. >> The ratio is important as well of estrogen to progesterone. So I would say in all of my clients who are on HRT and have MCCAST, they do notice a reaction with estrogen. They also notice a reaction with progesterone. Even though progesterone is actually massel stabilizing, um it can create issues because progesterone causes laxity in our joints. So that can cause hyper mobile symptoms for people. So it's like a catch 22 a little bit. However, if someone needs hormone replacement therapy, we have to find a way to reduce the symptomology to to have them tolerate the medication that's essential for them. >> Do you find similar symptoms? For example, someone who is using an estrogen patch and the subsequent histamine release. >> Yes, I do. >> What is it? >> So, it's the same reaction. Whatever their I I say mass cells show you the symptom you want the least. For me, I hate insomnia. I hate dizziness. So that's I my my nervous system gets reactive, right? Versus someone else, they hate having cold symptoms or a rash that scares them. You know, it's like histamines will get your attention in the way they need to. So depending on what your symptoms are, digestive, nervous system, urinary, um, rashes or otherwise, that's what will show up for you and your flare state. >> Also, reflux is not just a stomach issue. >> Absolutely. >> Often a histamine response. >> Absolutely. Would that happen in general or just after being provoked, meaning after they ingest something? >> Uh, so it can be that you just have this hyperactivation and this the parietal cells releasing too much stomach acid and being signaled again because the H2 receptor. So it can be that someone with mass cell activation syndrome just has a lot of acid reflux. And I this is a really little hack is that baking soda both stabilizes mass cells and helps with acid reflux. So, it's like a really eighth of a teaspoon in water. Like little hack that people can do, especially if they don't tolerate Pepsid. Um, but I don't use Pepsid for acid reflux, by the way. I use it for histamine issues, which is really funny because that's how people usually think. >> And you use baking soda for acid reflux. >> Yeah, exactly. It's like the It's like totally flipped. Exactly. Um, but >> and we will say it tastes disgusting. >> It's horrible. It's salty. It's not like salty in a fun element way. It's like a salty in a bad way. >> Tastes like armpits or something. Not that I taste armpits, but >> but it I will say and there's also tri salts um which can be really helpful for people as well. But a lot of reflux what I'm focusing on is how do we soothe? So it might be slippery al marshmallow root um herbs that can be supportive but a lot of the reducing the inflammatory histamine response is also just about reducing that inflammation not only reducing the acid output. >> Are there supplements that could be beneficial? meaning fish oil or other items that seem to taper it that we haven't really talked about >> for MCCAST specifically. >> Yeah. Yeah. I think rveratrol is incredible. Queretin, pilla extract, pea. Um I so I think most people with histamine issues have a major omega-3 issue, but most do not tolerate fish oil. Still too reactive. Um >> they take it and then they might get itchy or whatever their histamine reaction is. And also um people with because in Ellers's Danlo syndrome, you're going to have junctions and joints and flaps that are going to move slower. Your digestive tract is going to move slower. Um things are looser along the way. You're going to have a different slew of digestive issues. So a lot of people who take fish oil may experience bile reflux and reflux um as it's harder to digest things. Really interestingly, a feature of digestion that actually links POTS and hypermobility together is that people feel really dizzy after they eat when they have POTS. Um, and this because blood pools in your digestion away from your brain. So, I will have people literally wear a little abdominal binder, like an ace bandage around their waist when they're eating and the dizziness goes away. >> That is I mean I I don't think I've ever heard that before, but it makes sense. Is an individual hopeful for a full recovery or is this something that they live with always? If you are not hopeful for a full recovery, you're not going to recover in my opinion. So, absolutely. I would say that like for myself, for instance, I took an antihistamine cuz I've got on an airplane to come down here. Woohoo. Um, other than that, I I go months without taking them. I can eat every food except for pickles. I can exercise in my way. Dr. Gabrielle Lion. Exactly. But um absolutely and the I think the language around all of this is that you can never these are s massivation syndrome and pots are syndromes right they are not intended to necessarily be lifelong conditions. Is it something that people may have to manage? Yes. Do I have hope for almost every single person that they can live a life without having to think about it um and kind of live a life that's really custom and cater to them? Absolutely. And because our mass cells and our nervous system are so related and because POTS is a condition of our nervous system, you must think like that. That is the number one difference between those who heal and those who don't is they believe they can heal. I couldn't agree more. I typically, you know, when we see patients, >> it's if those patients believe and it does sound um >> I don't want to say woo woo, but there >> corny or something like that, but there is something in the inherent belief of a person >> who gets better, you're right, >> versus a patient who doesn't. >> This is the what makes these conditions so unique is that they are nervous system related disorders. So it's it is directly responsible for the symptoms you have. Now how do I look at someone and say you have to find a way to not react to these symptoms because I'd say half of the symptoms we see are from the actual reaction itself and then half are from how our mental state reacts to those like you must find a way. So story about myself is that after that chiropractic incident um I the insomnia was so profound I could not move my head an inch and I more importantly could not sit up. So, I was still seeing clients and I would prop myself up against the wall and I'm like, "Do you want to see me like this or you want to wait 3 weeks?" And they're like, "No, no, I'll take you like this. It's fine." I'm like, "I'm just going to keep seeing I'm I'm going to a talk in the city." Oh my god. The Uber to that talk. I I wore a neck brace, a back brace. I held on basically any movement was triggering my heart rate to go up really high. Um, >> and is that what someone with POTS would experience? >> Yes. Someone with POTS and uh upper cervical instability combined, basically. >> How long did it take you to get diagnosed? So with um I I ran a genetic test for hyper mobile ellers syndrome and so >> by yourself >> you can do yeah that you can order them yourself online but I had I had an ND and MD review them. So POTS >> but I'm what I guess what I'm getting at is that's very forward thinking >> where >> I had to figure a lot of it out myself. It's it's hard. It's true. So MCCAST my serum histamine serum tripase were exceptionally high. So that and that was um with a functional medicine doctor and that was that was like four years ago. So that was the first hint and they ran that and that really helped me to understand the connection. Um POTS and POTS when I was in the ER and the doctor was didn't even have to do a tilt table test. He was like stand up again, sit down again and and I said I have no I'm just telling you my heart rate is normally very low. My blood pressure is normally very low and I'm telling you that because this is abnormal and that's really important when people go because often doctors will say you have high blood pressure. That's what's going on here. You have high heart rate. And I was like I need you to know this is atypical. But the doctor was like, "Stand up, sit down." And I and he was like, "Okay, you need to look into POTS and you need to see someone for POTS." Um, >> and you went to the cardiologist. >> Um, I went to an interventional cardiologist who is someone who can diagnose POTS. Did the tilt table test and got that diagnosis. And then I I ran the genetic testing and had it reviewed by an ND for um, Ellers Danlo syndrome. And all along the way was trying to figure this all out because I'm telling you, it was me, a neck brace, and Reddit. And I was like, why leave chiropractor can't walk? Like what h I was like, did he did he sever something? Like what h it was so frightening. The anxiety was so excruciating. The symptoms were so intense all the time. And I just I remember I had to literally It's so embarrassing. I don't care. But I had it's like I don't I I just you know you know me I'll literally say anything but I would I had to lift myself up by my arms and push myself onto a computer chair to go to the bathroom because I if I put my feet on the ground my heart rate was 160 and that I'm like I don't want to do a dizzy and fainting and all of this. So I'm like I would just lift myself up as long as my feet didn't touch the ground, wheel myself to the bathroom. And I remember there was one time I was in my neck brace looking in the mirror, just made it to the bathroom, and I just said, "You know what, Michelle? I just I don't think you're going to make it out of this." And then some other part of me was like, "You better never say that again." Because if your nervous system and your limbic system believe that you're not going to heal, you truly, this is one of the only conditions where it is tangible that you won't heal. So you have to find that, I don't know, that dog in you. You got to find that Dr. Gabrielle line in you. got to find that Shane in you and you have to find a way to believe you can heal and you know I had a very serious conversation with a client the other day who um she's bedbound with symptoms and um she was talking about her health history. She was talking about the different co- infections she had and I said I love you so much and I just heard you say I felt good for a couple days but it always happens like that and it's not going to happen again. And I said you can't even say that out loud. I said your body is listening to you. Don't even think it. Don't even say it. It's that precious and that important. The mindset, the resilience piece, which you you've changed my life in so many ways in that department, too. I mean, everyone's lives, but personally, too. Like, you have to find that dog in you. I don't know what to say. You have to find it. >> Well, Michelle Shapiro, I'm so grateful that you came from is it New Jersey now? >> It's so hurtful. Queens, New York City. I I just to know if we're calling it if we're here in New York, but you are a wealth of information and just again for those of you guys who don't know Michelle Shapiro, >> watch for her. She is a superstar. I have been telling her this and telling everybody I know for a really long time and I believe that you are the person to watch. >> Thank you. You You are the person I watch and that we all watch. Thank you. I love you so much. >> You're really good at taking compliments, but that's okay. Michelle Shapiro, thank you again for really getting into the dark and dirty and shedding some light on MCCAST POTS Eller Stanlos. You know, you've been through a lot and I would say that those individuals are the best providers. >> Absolutely. Yeah. The word you used is right, shedding the light on it because the light, the information is the tool here. The knowledge is the tool and the resilience is the tool. I could talk about anti-histamines, the lowhistamine diet, but you have to shine the light on yourself. And I'm telling anyone who's listening who's dealing with I don't care how far those symptoms are. You there's always a way back from them. I have more hope for this community than I've ever had in my entire life. Well said. Well said, my friend. I love you so much. Thank you. Thanks for tuning in to another episode of the Dr. Gabrielle Lion Show. Remember, healing is possible. It's about improving your baseline, regaining function, and cultivating resilience. When equipped with education and the right approach, these conditions don't have to define your life. If today's episode resonated with you, please share it with someone who needs to hear it. And don't forget to subscribe and leave a review. It helps us reach more people who need answers and hope. Until next time, friends, stay strong, stay informed, and remember, you are in control of your own health. [Music]
Episode-61-Michelle-Shapiro-RD-Unpacks-Histamine-Intolerance-Nervous-System-Healing
Are you the friend who's always being asked for health advice? Now imagine turning that passion into a fulfilling career with our become a nutrition coach program. Step into a world where your enthusiasm for wellness becomes the heart of your own thriving business. With me as your professor and guide and coach on our userfriendly digital platform, you can learn from anywhere at your very own pace. It's perfect for your busy life. Envision empowering others to live their healthiest lives, all while growing a career you love. You're not just gaining a certification here. You're joining a community of like-minded professionals ready to support and celebrate with you every step of the way. So, what are you waiting for? It's time to nourish your future and help change lives, including your own. Head over to [Music] nutritiouslife.com/bnc for a free class and a sneak peek of the program. Your journey to becoming a nutrition coach begins now. Buckle up, friends, because today may be gamechanging for some of you. Welcome. I'm Carrie Glassman, your host of Living a Nutritious Life. And on today's episode of the podcast, I sat down with my friend, the brilliant Michelle Shapiro. Michelle is an integrative functional registered dietician in NYC who has helped thousands of clients reverse their anxiety, heal long-standing gut and immune issues, and approaches their weight and weight loss in a truly loving way. In today's episode, Michelle shares her personal journey from drastic weight loss and health crisis to becoming a leading functional dietician. What I really wanted to tackle today was histamine intolerance because it seems that people are struggling with this more and more. And I wanted to know what Michelle was seeing and how she's treating these clients. We talked about mass cell activation syndrome, histamines, long co, why rapid weight loss often is not healthy, and how understanding your highly sensitive body can be a superpower. Michelle has a unique way of delivering info and supporting clients in a straight shooter kind of way that is also extraordinarily supportive and nurturing. You're going to want to learn from her. So, keep on listening. And as always, please rate, review, and share if you love the episode. Let's do this. Welcome to Living a Nutritious Life. I'm Carrie Glassman, a celebrity registered dietician nutritionist. Join me every Tuesday on YouTube and your favorite podcast platforms as I bring in some heavy hitters to share the latest in nutrition and wellness science. We dive deep into food, sleep, stress, relationships, and so much more. Your weekly guide to a happier, healthier, more nutritious life. Michelle Shapiro, welcome, welcome, welcome. I am so excited. As I just said in my intro, one of my absolute most most favorite and loved and adored people in this space. I am so excit I'm always excited to see you. I'm always excited to chat with you. I mean, you know, you and I, we could just talk for hours upon hours, but to do it today on my podcast, I feel so grateful and honored for you to be here. So, thank you. Thank you. Thank you for being here today. I am so excited to chat with you. How are you doing? I'm doing amazing because I'm here with you and I need to say that I feel exactly the same way. We from the minute we connected have been like soul sisters and we're always on the same vibe and have easy conversations, easy friendship, hard conversations and like I love that about us and you're just one of the most curious amazing people. So being interviewed by you is a joy to me. So I'm very excited to be here. A thank you. All the love. all the love. I love it. But it's so true. We do. From the minute we connected, it was just like this like such a nice easy friendship. I totally agree. Like that just like just But aside from just loving and adoring you, you are brilliant. You are an absolutely brilliant registered dietitian nutritionist and I am so excited to share your wisdom with our listeners today. So before we dive into the topic at hand today, I want to ask you about your personal journey. you have a really interesting story and I want you to share if you can um a little bit about your health journey and how it influenced the work you do today. Absolutely. Yeah. I kind of define my health journey as having two different parts. The first part is this major weight loss experience that I had. So going into college um I had been I had grown up in Queens, New York, one of the most diverse high schools in the entire world. Arguably the most diverse high school in the entire world. Wow. Yes, actually Flushing, New York, where my mom is from and I'm from Queens also. Queens represent um is the most diverse like by per square foot place in the entire world. And my high school is on the border of Flushing, so potentially. And there's 5,000 students in my high school actually. Um we Oh, wait. What high school was it? Cardoozo High School. Oh, okay. Okay. Someone everyone knows someone from there because there was 5,000 kids in Well, I'm just wondering because my son went to Brooklyn Tech and I always thought of that as being the biggest high school in the country. So, I think go to Brooklyn. I think there was 55. He was there a few years ago. Yeah. I mean, it's it's a lot. It was like a college. Yeah. It's insane. Um, so growing up there, I had always grown up in a larger body and then I was going to the University of Delaware for college and realized, oh, I might have to lose weight to kind of fit in because I grew up in Queens. My weight never was an issue in my social life. Didn't really feel it in my health because I'm 17 years old. Um, I had great grades, great friends. I was class clown of my entire high school. Um, no really my weight didn't get in the way, but I knew going to college in a much more homogeneous place, I was going to have to lose weight in order for people to understand me, accept me, and that's just the way society is, you know, unfortunately. But that's real life. So, I lost close to 100 pounds in the time before going away to school. And in like from graduation to going away to school, I think it was between like maybe like six to nine months like uh Wow. But that's still really fast. It was way fast. And that resulted in my first health crisis. The weight itself was not the health crisis for me. That rapid weight loss left me sick all of college. I had panic attacks, IBS diagnosis, hypothyroidism, acid reflux, like all of these different things kept popping up. And doctors were like, "Why don't you lose a little more weight?" And that was like their answer to everything. And it really was. Now, how did you lose all that weight, though? A a very calorierestricted vegan diet. Extremely calorie restricted. And I kind of used veganism to like hide that there was an eating disorder going on. Um, for sure it was right. It was more just like major restriction. Exactly. And then I got so much validation from that obviously too that you want to keep going. So, but I started going to doctors for these panic attacks because they were so profound. I was having several panic attacks a day. Um, I was And you'd never had this before until all this weight loss. I mean, I'm a Jew from New York, so yeah, obviously I had anxiety growing up, but um, I did not have panic attacks before. remember the first ones were like that summer going into college right when I had right after that weight loss happened and what I ultimately realized was that that weight loss put my body into what I would think is a toxin overloaded state that also is a very nutrient-deprived state so as you lose weight your you know your body will spill toxins from your fat cells your fat cells will spill toxins and I didn't have any nutrients because I was on a calorie restricted vegan diet to help clear detox and drain those toxins so I think that was part of it also of starving myself. So starving yourself, low blood sugar and it really was naturopathic medicine and functional medicine and seeing practitioners that brought me back to life. And that's where I said I'm not just going to be a dietitian. I'm going to be a functional dietician because I said there is something so powerful about this practitioner in front of me sitting with me for two hours. It just kind of changed and blew my entire mind. Um and that was kind of the first part of my health journey. And the second part came about four years ago when I encountered COVID um at exposure and I had a chiropractic injury that led me into um what I would call this very highly sensitive body state. Um and it's been clawing my way back from that that has kind of defined this next leg of my work journey, health journey which for all of us is like usually intertwined obviously. Um yeah absolutely we do. Well, first of all, the just going to the weight loss part of the story. It's so interesting because I think so many people do not think of that happening with weight loss. They think weight loss, oh, you improve your health. Weight loss, you reduce your risk of diabetes. Weight loss, you reduce your risk of cancer. Weight loss, you feel better, you're more you have more energy, right? they do not think of all of what actually happens when you lose weight and why losing weight so fast and being on such a severely restricted diet can be so detrimental. So I think like just you even putting that out there and and sharing that is super helpful to to people because again I don't think people consider that. And for any coaches and practitioners listening, it's like it's also really helpful because sometimes you see someone that's lost a lot of weight, that's like, okay, like your numbers should be good and you should be feeling better and they're not necessarily thinking about this other layer of weight loss and what what's going on. So, absolutely really really important. Okay, so let's let's talk a little bit about like what you just said, this sort of your second the second part of your journey when you got COVID and and all of that. I know that since then you've had you've gone on again like this whole other part of your journey. Can you dive like a little bit deeper into what's gone on there, what you've discovered, what you've learned because I know there's been a lot that's happened there. Absolutely. Yeah. So, I'm a storyteller, Carrie, and you know that. So, the story for me was I again from the time that I was in college, I really healed from panic disorder. I really healed from anxiety and I had never really had anxiety in between those 10 years in between basically. Um I really mastered and I I do this with clients all the time and I really worked with clients on how do we lose weight in a body positive way? How do we not end up in toxin overload when we're losing weight? How do we safely approach weight loss? And how do we um heal from anxiety because I think it's totally possible. It was only a couple years ago that I started to feel really off and it started with some dizziness. Um, and I started to explore root causes. Well, what's wrong with me? I had a COVID exposure like we all did in 20 like many of us did in 2020. And then at the same time, I found mold in my apartment. It was an amazing apartment and it was so painful because I really didn't want to leave. And the quick story I'll tell is that I was like, it was like right near Bryant Park, right on Fifth Avenue. It was just such a good apartment. And it's so hard to lose a good apartment in New York. And remember being like, you know what, this mold is kind of killing me. I had severe dizziness, um, really severe digestive issues. I was nauseous all the time, reflux, again, all these symptoms, but way higher. And then I walked into my bedroom and I saw my husband literally coughing up a lung like he was in the movie Interstellar. And I'm like, "Oh, he's in a mold dust storm. I have to get him out of it." Like, this is like really unhealthy at this point. So I then started going to these functional medicine doctors, naturopathic physicians again and their recommendations were let's get put you a mega dose of IVs binders let's get rid of this mold and they were very aggressive kill protocols binding protocols and Carrie when I started that I would leave an IV and I would text my friend who's the practitioner who would give me the IV because I all my friends are the ones who give me these treatments and I said to my friend like am I supposed to feel like I'm having like a heart attack. Am I supposed to feel like I'm having fevers? Like my fever jumped up and he was he was like, "That's kind of abnormal." Like, and I had full body flushing and then the night after the IV, I had full body tremors and I was just shaking all night. And I was like, "I don't think this is how it's supposed to go." And he was like, "Maybe it's too much vitamin C." And then I started to notice again, my body wouldn't react to these functional medicine treatments like other people's would. And I'm like, "My body does something." Wait, what were the treatments exactly? Like what exactly were you getting IVs for? Mold. So, I was getting mega doses of vitamin C, glutathione, okay, vitamins. I I couldn't take one B vitamin orally without having a full body reaction essentially. So, there was no supplements I was taking and I had notable B vitamin deficiencies. And so, I didn't understand how is it possible that I'm feeling worse and worse when I'm taking these vitamins. Um, and everything. I mean, I we did I did infrared sauna, I did cold plunging, I did IVs, I did like anything. And you were reacting poorly to all of it. Everything. Everything. Yeah. Wow. Anything that was supposed to make me feel better in the long term, like you said before, this is the interesting thing. It doesn't really matter if something makes us feel better in the long term or it's good for longevity. If it makes us feel awful right now. Absolutely. It doesn't matter. If it makes you feel awful right now, that's what actually matters. So, my symptoms were getting worse and worse till ultimately um I did see a chiropractor because I was dizzy all the time. and he took this like metal tool and was kind of digging it into my neck. And this is my message to everyone listening to this podcast. Don't let anyone touch your neck under any circumstances unless they assess you for hyper mobility and they assess you for any upper cervical instability. I crawled out of that appointment and crawled to the ER. I mean, I was on cement floor crawling. I couldn't walk. My heart rate was 160 while I was sitting. Wow. Because the nerves in my neck were affected from the treatment. The nerves in your neck control your heart rate. So Wow. It was like and what did he what did the chiropractor say? Like what h like what was too and I and I kind of messaged him after like you you there's something because I didn't know I didn't have the language for what happened to me yet. So that's what really I went to the ER and I said maybe this is like a POTS thing um because I realized it was in near my neck so maybe this is a postural orthostatic tachicardia thing and yeah actually will you just wait just for anyone that doesn't know what that is again will you just will you say that again? POTS. Maybe you thought it was a have to define all these terms for sure. Yeah. So POTS is a syndrome called postural orthostatic tachic cardio syndrome which is basically when you make postural changes your heart rate jumps up tachicardia essentially. So I was like maybe this is related to POTS or something because I knew I did I have very low blood pressure generally. So my blood pressure was high my heart rate was high um and I could not understand what's going on. I was in a neck brace and a back brace for like a year after that. Um it was really challenging and I remember seeing you during that time. Yeah, I remember where were we and you were like you look so you're like are you okay and I'm like literally no it was I remember I have Yeah, we were at a we were at like a a dinner for a brand I believe right the first times that I could even go to something was how bad it was honestly. Um, and then I kind of in that then I was having these tremors again, dizziness, extreme frightening, go to the ER kind of symptoms and I had no explanation for them, Carrie. I was going to all of my practitioners. So frustrating and it's so frustrating and so many people right or people that have been in similar situations where like you have all these things going on and you don't know what's why you're not getting any answers. you're and you are someone that's a so knowledgeable but b also has access to all of these incredible people around you and everything that's supposed to help is making you worse. I mean that is that had to be not only I mean frustrating but upsetting, horrifying, scary. I mean so many things it was and I really am the type person where I'm like if I can't figure it out how the heck is someone else going to figure this out? And that's so I basically was like I'm gonna have I'm going to have to figure this out essentially. Um, I at some point in time, uh, realized that my COVID and all these things were kind of connected and I drew my own timeline of my life and I kind of pulled these all together. And before I go into that, one thing I want to mention is with people with bodies like mine, something that I call a highly sensitive body, an HSV, living in a highly sensitive body, you know, these are people who, like you said, back in the day, Carrie, the deal was we would go to fun, we would go to functional medicine doctors when conventional medicine doctors failed us, right? Then we would say functional medicine is the beacon of light. It's the one that's going to save us because conventional medicine is is not able to help us. And it was that. It really was. Right now I'm seeing clients who are injured from functional medicine. Essentially they have gone to conventional medicine doctors. Forget it. They've been to every functional medicine doctor and now they're in my office cuz they are the people whose bodies respond terribly to functional medicine treatments. Okay. Interesting. And and why why do you think that they're too like you said highly sensitive to like Yeah. Yeah. It's a it's it's the right question. Functional medicine aims to treat the root cause. And sometimes that means that they are not looking at symptoms as well. And either way, if you have a highly sensitive body, a doctor's office might not be the place to go. You actually might need a nutritionist or a dietitian or a life coach or a health coach or someone like that because you need someone monitoring your reactions to things. You need someone helping you through those dark moments. So just going to a doctor's office, even if it's a 90-minute visit, but they're not following your case and checking your food journals, your stool journals, they're not going to pick up on the essential information. So people who are in highly sensitive bodies, what may be happening that I suspect is a histamine like reaction or a literal reaction, a specific immune response that is not found in every single person. Because some people do mold protocols, they feel kind of crappy, but they don't stay sick after that. People in house do. Okay. So, you just said the big question, the big not question, the big word of the day, histamines, which is what I wanted to talk to you about, which is why I called you and said, Michelle, you got to come on my podcast and talk about histamines. There's so much histamine talk right now. And I know you're talking about histamines a lot. we got to talk about them because I have never seen so so much histamine conversation and obviously I think most people I think when they think of histamines they think antihistamines and they think allergies and taking an antihistamine but that's where a lot of people's knowledge ends so talk to us about histamines and how and and what does that how does that even connect to what you were just telling us about 100% yeah so we have a type of immune cell in our body called mast cells mast mast cells They're a type of white blood cell. Their job is to detect threat and help to send immune cells and resources to different parts of the body when something happens. Our mass cells I kind of view as like the guards on the tower of the body. So overlooking everything. They're saying, "What's going on here?" And they're very they're very hyperaroused and they want to make sure everything's okay. Mhm. The way that they work is something they have an outside of them with receptors all around and then they have kind of these like sacks on the inside we'll call them. On the outside when something attaches to the outside or attacks the outside they will release compounds from the inside. They they do something called degranulate which means they release those compounds. There are 1,200 different compounds that mass cells release and histamine is one of them. The reason we talk so much about histamine is because having too much histamine in the body or an inability to remove histamine from the body can create system like symptoms in every system of your body. There are mass cells in every organ of your body in your joints and your bone in your blood vessels. Every single part of your body has mass cells. So they can respond and create symptoms in any of those areas. Okay. So why when you were having all of these different symptoms and things happening, why is it so challenging? Because it sounds like no one was getting to the bottom of all of this and what was going on with you. And so why is it so challenging to get a diagnosis or to get proper support for mass cell activation syndrome as you I know you you talk a lot about um in our current system like why is it so difficult? I mean for you again, you were in this, this is what you do for a living. You have access to all these amazing people. You were working with all these people, but why did it take so long? And actually, then I want to hear because we kind of I kind of feel like I jumped ahead a little bit. I want to go back to like when you figured that out, what what happened there, but let's stick with this for a second. Why is it so hard to Yeah. to address that and to diagnose that and to support that? Yeah. So, first of all, testing for it is hard and we'll talk about that. But more importantly, weirdest thing in the world about histamines because they can cause symptoms like a racing heart, a fever, a rash, diarrhea. If you car if you had a racing heart, would you go to an immunologist or you would go to a cardiologist? Right. A cardiologist. Absolutely. Right. The problem is that where the symptoms come from is not their organ of origin. So you have heart issues, but they're coming from the brain. They're coming from the immune system. So the problem is if you go to any doctor, what they're going to do is run an EKG, run an echo cardiogram, and they're going to say, "It looks gorgeous. I don't know what's going on." And that's because our nervous system controls where our body sends blood, how our heart sounds, it's coming from the brain essentially. It's coming from the nervous system. So you're not going to go to a neurologist with a beating heart. You're not going to go to an immunologist. Right. Really like the first major practice paper on in the like American Journal of Allergy, it's like the AAI journal came out in like 2019 on mass cells. It's in its of understanding. We knew mass cells existed. We knew they were a part of the immune system. But again, no idea that they could wreak so much havoc. And the reason they have is if you want me to talk about I think it's fascinating. Yeah. Relationship between mass cells and co. Yeah. Yeah. So we had this explosion in conversation around histamines I think because very annoyingly mass cells one of the receptors they have is something called the ACC2 receptor and CO is perfect match with the AC2 receptor. So what long COVID looks like is not like people having a flu and then feeling kind of like crap for 10 days. These are people who have felt sick sicker for longer than three months after having a virus. It's unheard of. And the reason is because the outside of like Epstein bar like mono you can you can feel that way for a longer time but it's because our mass cells are so on guard after that co that keep pumping out histamine and these other compounds and you don't want to have too much histamine floating around your body because then it can create a lot of these symptoms all those other symptoms that people right feel. Okay. So actually though one of can you go through some of those symptoms because I'm thinking like when people are having like allergic type reaction symptoms but like what what what do you think of as the most common symptoms there or someone like that's having long COVID like that. It's funny because I wouldn't even think of um allergies as being a common histamine symptom which is so it's really funny because most of my clients don't really have allergy symptoms they have it shows up in other areas of the body which is interesting. I think there's a spiritual explanation for that I can talk about later. But um common symptoms I see with histamine intolerance or mass cell activation syndrome are severe physical biological anxiety that can happen, tremors, tingling, numbness, um feeling when it comes to mood, people feel like there's almost this black cloud covering their eyes like this brain fog, this depressive type feeling. Something called coat hanger pain is really common with histamine issues in POTS, which is like if you took a like a upside down triangle and put it behind your back from here in your shoulders going down right in the back of your neck. Um people experience increased urinary frequency, diarrhea, that's really profound, body pain, muscle pain, joint pain, um migraines are really common, menstrual cycle disturbances, so you know MS, um endometriosis and MCAST have a very strong link as well. um really any symptom you can imagine that is when your body is in a very heightened aroused state um when you're very up and I have to tell you about this one client that I had um I'll call her Kay so Kay came to me and she was on eight psychiatric medications for insomnia nothing ambientone Xanax nothing they tried every type of medication you can imagine to get her to sleep when she came to me she was having rashes before bed. And in conversation, I said, "Why don't we try an antihistamine and just see if it makes a difference?" So, we tried Pepsid. Pepsid is actually an antihistamine, which is an interesting um Wow. thing that most people don't know, and it works on the gut specifically, but I find it helps with sleep. She tried it. She's been sleeping eight hours a night for 4 years. Pepsid for sleep. I never would have thought of that. Exactly. Never. Exactly. So the reason I thought of it was because I saw this what started this whole histamine journey for me is I saw a study when they were treating longco and the only intervention it was 16 people was giving pepsid for fatigue and I was like what why are they giving pepsid I was like is it a stomach acid problem? Histamine and stomach acid have a direct relationship by the way as well. So acid goes up histamine goes up also. So that makes sense. Yeah. Yeah. Exactly. and the uh histamine attaches to the the H2 receptors on the parietal cells of the gut and so it'll make you pump out more acid. But I was like I could not understand why this acid drug I didn't know it was an antihistamine at the time was helping and then I started to learn more about histamine. So when I saw that study and it was like 14 out of 16 of the people in the study had an 80% improvement in symptoms from Pepsid and I was like what the heck is going on with this? So that's what actually started me in my whole understanding. Why are they treating long co with this acid drug and that's what kept me going on this journey. Yeah. Okay. Wait, go back to K though because I'm really fascinated by that. So she's on eight different types of drugs to try to get her to sleep. She has horrible insomnia and you put her on Pepsid and then she starts sleeping sleeping literally. This is absolutely not an exaggeration. Eight hours a night. And you have to understand something her insomnia was so profound. She would sleep 1 to two hours a night. three nights in a row, then she would sleep like five hours. She had paranoia as a result of it because she was like seeing things like she was not I mean, you can't live like that. That's that's horrific. It's so dangerous. The reason is histamine's job and our mass cell's job is to keep us alert and awake. So, they can be very like I don't know jumpy, arousing, arising. So if your histamines are that high, doesn't matter if you try to calm your nervous system because your immune system is like stay up and stay awake. So it keeps that looping either way. Wait, so she I I mean would would like like what what did she say? How did she react to that? She must have just been like obviously beyond thrilled, but then what was the next step? So then you said, "Okay, this is a histamine issue." So then where did you go from there? Yeah. So then you can start at some point. Antihistamines are often important and that many people do need them in an MCCAST journey. So, it's not my dream as a functional dietician to give everyone antihistamine medications over the Sometimes there's a there's a time and a there's a time and a place and a and a value there. Yeah. So, then we started to see what foods she might be reacting to. Um started to support a little bit more of whatever nutrients she was deficient in, but really slowly to help ultimately with detox. But then also we just had to address the histamine elephant in the room. So we did a lot of supplements in the beginning that also address um histamine either helping them break down, helping with an inflammatory response because all of this is an inflammatory response. It's a hyperimmune response. Um so we did quite a bit of different herbs and supplements, but really Carrie the number one thing is worked on the nervous system. Um and really Yeah. Well, then she was probably able to work on her nervous system because if you're sleepd deprived like that, you can't even work on your nervous system. But once she started getting sleep, you were probably able to then a work on the nutrition like you said in the supplementation, but also work on her work on her nervous system because she was at least in a much better place because just I mean going from not sleeping at all to then sleeping. I mean that is just such a huge massive jump in her overall health and then her ability to deal with other things that I'm just imagining this person like coming in and literally like lying on the ground and kissing your feet being like you have saved me. I mean that is like people like she is and it's I will tell you that I had read this Pepsi study. It was in the back of my head somewhere and I I'm only saying this on your podcast but I did have like a weird like almost a spiritual download with her and I was like Pepsi. I was like try this four or five years. No, I love this. But by the way, hey listeners, didn't I tell you Michelle was brilliant? Didn't I tell you? I said it. I said the brilliant Michelle a little bit of a freak. A little bit of a spiritual. But I, you know, I had to flags fly. Let them let them go. I love it. I love it. You have to in order to heal. You have to be yourself. Exactly. Well, you also have to No, you know what you did? And and I want to give you a lot of I mean, you deserve so much credit in so many ways, but you were open-minded. You're open-minded to all the different possibilities that could be going on with her. And that's like what you need in your team that's helping you heal. You need people that are open-minded and going to look for all the different why, how, and instead of just, you know, going to someone them saying, "Oh, well, it can't be this and it can't be that, so you must have this." I mean, you have to be able to be open-minded and and see things and discover. And it's like you talk about peeling back the layers and getting in there and figuring it out and being, you know, an investigator. I mean, you wow, that is that blows my mind that story. I love it so much. Just because I know cuz from working with people over the years, too. Like you see people struggle with so many different things and go to so many different doctors and so many different types of practitioners and not figure things out. So when I'm just like imagining this person coming to you and then you figuring this out for them, it's really beautiful. Yeah. And you know, Carrie, and I know you feel this way too, but like I really do thank God, the universe that I had the experience I had because you can't know the terror of these symptoms honestly, unless you've experienced it. So not everyone on my team has histamine issues by any means. And by the way, not every client has histamine issues. Yeah, like everyone listening is like, "Oh, that's me." But sometimes it is you and sometimes it isn't. Um, and but I was very grateful to have that because I had never experienced anything like it in my life. And you know, there's actually one study uh and I'll before I even say the study long co and MCCAST mass cell activation syndrome when those mass cells are constantly pumping are very interconnected. I would say they are interchangeable in some. I think that long co and mass I was gonna say the way it sounds like to me is that long co is mcast feel that way but I can't really say that because it's not okay not and I kind of feel like long co's a combination of mcasts hypermobility it's kind of like the cluster we call it the triad mcast and hypermobility the triad because they travel together these drums basically um and there's a couple reasons why but um I lost my train of thought point being I was very grateful to have experienced it because if you have to have symptoms that extreme without any explanation, Carrie, I was on Reddit looking for answers. I literally was like, "Why do I feel dizzy after whatever, like walking? Why I feel and I just I was like, why do I feel weird on day nine of my cycle after my period ends, but I don't feel bad during PMS?" Like, there's no there's no Reddit for that. There's no answer. So, this is like the body's operating on a different system than what we know. And in functional medicine, it's all leaky gut, IBS, and those things are lovely, but you you will not and they're important like and real diagnoses obviously, but you can't address the root cause in someone with histamine issues without addressing the symptoms. You have to address the symptoms first. Yeah. So interesting, right? And it's right. So it's it's and and so many people, right, they go from traditional western medicine to then they go, you know, functional medicine. Let's get to the root. And like that's not always the place to go. Exactly. And sometimes it's dangerous to address the root first. This is the study I wanted to mention quickly. They did one study. First of all, stateby-state survey to see on average like how many people by state had long COVID. And they found that up to 30% in each state of people had long COVID 3 months after having COVID. So this issue is mega profound. We're talking millions and tens of millions and maybe even a hundred million people in America who are experiencing this. And that was about two years ago. I'm sure it's expanded since then. And the and the other thing I want to mention about long co that's just so important is that um they did one study and found that the quality of life of those experiencing long COVID on average was a lower quality of life than those with stage four cancer on medication. Wow. And that's because the fatigue was so profound that they could not work. Fatigue is a major um symptom in all these conditions as well in in addition to insomnia. They couldn't work. The things they could do in their life was less. And also people don't get community support, Carrie, because people don't believe you when you say you have long COVID. They believe when you say you have cancer. And by the way, not from a prognosis standpoint. We're not talking about from a prognosis. We're talking about quality of life. Right. Right. And you know, Right. No. So, okay. So, let's just say there's someone listening right now and they say, "Yeah, I think I have long COVID. I I feel, you know, and I feel kind of crappy and whatever." What what's what do they do? Would they wake up tomorrow? What do they do? Who do they call? What should they ask about? What do they consider? Yeah. The first thing I would do is it for yourself before even going to a provider, start inventorying your symptoms. Yeah. So, make a little diagram head to toe, little stick figure. It doesn't have to be fancy. and symptoms from head to toe. Top of your body to bottom. Anxiety goes in the head. Headaches go in the head. And then prioritize which of these symptoms are most impactful for me. And then find out when when do those symptoms happen. Do you get migraines around a certain time of the month? When you eat food, when you eat a certain type of restaurant, you talk to a certain friend who talks too fast like me? whatever it is, find out what those symptoms are for you and where they're from because you're going to walk into an integrative nutrition professional's office or a functional medicine doctor's office and I want you to come in with that information. So, the first thing is get to know your body and get to know the language of your body and how your body's communicating with you, right? I would say like do a little self assessment and yeah, food and and food journaling too like you did mention that like with with the food side of it too, but like really really as much detail as possible. I always say the more information you can go into someone's office with, the more you're going to get out of that appointment and you can start to like move things along because not only do you forget things in the moment, but also it's like just all down on paper. You put together such a better story and it it helps you actually put it together. Not just like, oh, my stomach hurts after this or I get a racing heart after that or that like you you can develop the story yourself before you go in. So anyway, I know you just said that. I'm just sort of reiterating because I think it is so valuable and I think people always think like I make an appointment and then they feel better like okay, I'm going to that appointment. Hopefully I'll feel better after I go there. They don't think about starting to do that work on their own. And as much as like yes, you hopefully you'll go to an amazing practitioner like like Kay went to you and you gave her, you know, Pepsid, but hopefully you'll have an experience that is that impactful, but the more work you can do beforehand because no one knows you and your body like yourself. And I think sometimes people do they they like to, you know, people do they feel better the minute they make an appointment. People are like, "Oh, I feel better. I've made an appointment to go and do this. I'm fixing it. I'm going to work on this." But no one is going to know your body like you. And I always remind people of that. And and any good practitioner should tell you like, "I don't know your body as well as you." And if they're not saying that to you, that's also, by the way, a red flag. If they're like, "Nope, it can't be this cuz that's not true. You shouldn't be feeling this because of this. You're only feeling this because of that." Like if anybody's saying that to you too, like that is not a great practitioner because because it's not Yeah, exactly. That is like a big to me a red flag. Um, okay. Let's talk about the histamine estrogen connection because I know this is a big I know this is a big deal for a lot of women also in pmenopause. Absolutely. So, what's the connection there and I know we have a lot of listeners that are in that pmenopause menopause stage. though I'm sure they're they're chomping at the bit right now. So we genuinely we generally consider progesterone to be mass cell stabilizing. So a positive effect, less histamine potentially and we think of estrogen to be mass cell stimulating. So estrogen and histamines much like stomach acid have a direct relationship. They attach to each other's receptors. Interesting. Yeah. So interest because progesterone we know helps like for most people calm calm and stabilizes the immune system. It's involved response. Um, absolutely. And so here's the deal that we know happens in pmenopause. First, progesterone will drop, right? Already can be a potential histamine issue, and then you have not lower estrogen necessarily, but swings. So, it can be very high estrogen some months, very low estrogen some months. So, this is where it's really weird, Terry, but if the simp if the hormones are lower, like a lot of my MCAST clients unfortunately feel so much better in menopause because you don't have the constant like high estrogen cycling. Um, where clients with histamine issues feel worse generally is when estrogen starts rising. So, the day their period ends, they stop bleeding, really weird day. They start having migraines, they start having anxiety, they feel really weird often then. And then there's kind of that's like the start obviously estrogen will rise for ovulation midcycle and there's a second kind of rise in estrogen around in a 28 day cycle like day 19 to 21 and notice that as well. So the issue with pmenopause is unfortunately all over the place. All over the place. Yeah. So you just have to kind of be consistent and preventative with stabilizing mass cells and with supporting estrogen detox appropriately in case it's one of those swing high months basically. Okay. How do we support the the MCAST? Absolutely. So, I would say um if from the lowest level standpoint, if you want to use like teas, like I love nettle leaf tea. I find that incredibly supportive. Um there's a tremendous amount of supplements as well, but supporting your nervous system, eating regularly to support your nervous system and blood sugar. The, you know, Carrie essentials that I know you've mentioned in every single podcast, your your principles have to be addressed. And then when it comes to histamines, you can do things like besides taking medication, there's certain supplements like there's a DAO supplement which is the enzyme that helps to break down histamine in the gut. You can take that before a meal. Ginger is really helpful. Pilla extract. There's loads of herbs and supplements. Queretin, although I find some people react to it. Um, but you really want to start on a histamine journey. Vitamin C, vitamin C, right? The problem is vitamin C helps with Dowo production, but it's very histaminey because it boosts your immune system. You don't want anything pushing your immune system. Basically, you want to calm your immune system. Okay? So, before doing any other detox, anything like that, the first two things you have to do is address histamines and address your nervous system. So, that could be also having calming herbs like uh el like uh supplements and herbs. Atheonine, an amino acid, GABA, a neurotransmitter. Um I like passion flour, things that calm and cool you. And then things that will cool and calm the histamines as well. So address the histamines and the nervous system first through lifestyle supplements. Um really essential and then you can start to address if there's a specific gut issue that's a root cause if there's a mold issue but first in any stage in life that's what we have to address. So good. Wow. Thank you. And it makes so much sense that like during pmenopause where everything it's all those fluctuations that make it all harder to manage. Yes. I do have a hot take on permenopause though and I want I want I want your hot take. I have no right cuz I'm not in parmenopause but but I have I want your hot take. You have all the right in the world. Tell us. So the reason only because of my clients the reason the hot take I have is that pmenopause is not a medical diagnosis. Okay. We talk and hear about pmenopause online like pmenopause is and of itself a diagnosible medical condition. Perry menopause is a period of time and it's different for every single person. So I can tell you Carrie, I have MCCAST clients, highly sensitive clients who feel so much better during pmenopause because their hormones start to calm down. So they actually feel better. They might need to go on HRT and menopause of course, but right the the experience of pmenopause is so individual. And when we think of when I think of permenopause, I kind of think of premenopausal, you're at the top of the slide. P menopause, you're somewhere on that slide and then menopause bottom of the slide. We don't know where we are. So, it's more important than ever during pmenopause to not get into the mindset of, oh, I just feel awful because of my permenopause and right, of course, I'm writing off these you would never, but some people do that. I'm writing off these years because I feel awful because I am parmenopause. I'm diagnosed with parmenopause. You're still you and you. It's actually a time to pay more attention to your symptoms and give more support as opposed to just saying, "Let me write this off because it's permenopause." Which I see online every day. I see that online. Right. No. And I and I totally understand what you're saying because I mean I joke all the time with like, you know, brain fog and this and I'm like, "Oh, parmenopause. I don't remember what I was just saying again." And I No, no, no. I know how you're saying it though. No, no, I know what you're saying, though. But it's like labeling yourself, right? Like you don't want to label yourself. It's like it's it's it's even like people label themselves all the time. It's like when you have a client that comes in and says, "I eat sweets every night after dinner." And you're like, "Well, if you keep telling yourself that," you're definitely going to do that every single night, right? But if you tell yourself, "I love tea every night after dinner." What are you going to do? You're going to start having tea every night after dinner. It's like it's like, you know, it's like and that's like a silly simple example, but it is the same thing. It it's like what you're saying though that people label themselves like, "I'm in pmenopause, so I'm going to gain weight. I'm in p menopause so I'm going to feel crappy and irritable all the time. No, I absolutely agree with you. I mean there there I agree with you that you don't say I feel like you're also a person who often feels good. So you're actually a very good example. Like I feel like you feel pretty good much I feel good a lot because I work on it but I also no I am oh I tell people when I haven't slept well I am irritable as f. I mean I am moody. I am moody because I think because you know you know me like I'm I I have yes I have a lot of happy energy. I have a lot of positive energy but I also have a lot of lows. I'm an emotion I'm very like emotional and so I have lots of ups downs all around. Your deep your personality and sensitivity. Absolutely right. Right. So so I do have a lot of different and I and I absolutely feel things more right now in this pmenopausal phase of life. Okay. the actual things that are going on in the body are so freaking real. I just want Evan and not anticipate agony. And I 100% I 100% understand what you're saying and also sort of like make it again sort of label it and make it like a thing like you are able to address it and deal with it. doesn't have to become like your this is it throw away these years this is what's happening to meact with it also but is by the way the metabolic changes that happen during pmenopause the biochemical they're all so real it's not even it is so irrefutable how real those changes are um but your experience is also the most but I know yeah I know exactly how you were saying it though like that people do they like make it like oh it's my because of my hormones this is happening or that's happening so what I say to people it's similar I Like what you were saying is that I always say like during this time you just have to dial in a little bit close a little bit more to all of those things that you really should have been doing for all these years. So it's sort of I again the term I always say is like you need to double down like double down on your on your on managing your stress. So like you would, you know, managing that nervous system, double down on that. Double down on like making sure that you're getting your quality sleep or what whatever you have to do to get that. And so if you if you dial in on those things during this time of life, you are like you're going to get through it a lot better and feel like yourself. You just can't, you know, when you're in your 20s if you don't have some sort of an illness and if you don't have something going on. I never felt good in my 20. I'm like, I was going to say, yeah, you didn't feel good in your 20s. I But I'm saying for someone that, let's say, felt like pretty good in their 20s and then, you know, maybe was sick or or gained some weight or had something happen, they snap back. They snap back very fast. Like, you just aren't Exactly. Your body's a little more resilient like that where because of the hormonal imbalances, you have to be a little more dialed into everything or everything starts to fall apart. Yeah. You know, I I started this diet tribe because I was at a a menopause talk um with some colleagues and one of the people there who was speaking is like a profoundly brilliant, incredible menopause expert. I mean, she is beyond brilliant, an amazing amazing woman. And she said like, you know, I knew I was in menopause because I uh started being really, you know, my husband was like, "You're acting really bitchy." And I was like, "This this is not the this is not the dialogue for me. I'm way too much of a feminist." I'm like, imagine my husband said that to me. Like I I was like, this is not this is not the dialogue for me. But I think it was it we can get into that dismissing woman's symptoms as opposed to through it, you know what I mean? And writing ourselves off. And I just want people to know it's not a medical diagnosis, but it's medically real, by the way, the realest. And there's just so much we can do to make ourselves feel better. I have I have so much hope that we can feel so good. Yeah. I listen, I like your hot take. I'll take any hot takes any day. So, I'm all here for the hot takes. I love it. Controversial. Exactly. But it's not woman's experience. It's to empower individual experience. Absolutely. Yeah. Okay. So, I have a couple more questions for you because I know I could talk to you forever and ever, but um I will let you go at some point. So, um one more histamine question for you. Yeah. Because you know, I think you know that I get migraines. Um, I no longer drink at all because I get migraines um, very easily from triggered from alcohol and other things too. But anyway, histamine migraine connection. Talk to me about it. I have to tell you, my heart's pounding out of my chest out of excitement that you just asked this question. It's my It's literally my favorite thing to talk about. Okay. One of the most So glad I asked. I think I'm going to blow your mind, Carrie. I literally think I'm going to blow your mind. Okay. First of all, I have to tell you, I went to a neurologist recently and I was I went for not recently. I guess it was also like four years ago for headaches and the neurologist said to me, um, do you also get seasonal allergies? And the first thing he recommended was an antihistamine, which I'm like, that's very cool and we'll talk about it. So, one of the main things that histamines do is cause something called vasoddilation in our body. So, that means they open up our blood vessels. So, I want us all to picture that kind of experience, and if anyone listening's experienced this, where you're standing in the shower and then you feel really dizzy all of a sudden. You look down, your legs look really red. People like start holding on to the wall if the shower is too hot and then your heart starts pounding basically. So heat is also a vasoddilator. So what's happening in this scenario? You're standing up. Gravity naturally in general pulls blood to your feet and then your heart pumps the blood back up and your blood vessels will squeeze and pump blood back up. If your blood vessels are always wide open, they don't pump that blood back to your heart. So what happens? Your heart goes, "Oh my gosh, I don't have enough blood here. Pump, pump, pump." And then you have that excessive heart rate to get the blood back up. So, okay, this is it, Carrie. All right. The number one thing that migraine medications do is cause vasoc constriction. So, they work exactly against what histamines do. Now, if you even think about it, something like caffeine, we know caffeine makes our heart pump and constricts our blood vessels, right? Eedin migraine. What's the difference between Eedin migraine and a regular Tylenol or Eedin is the caffeine component. We always hear about migraine cures being oh diet coke and uh you know salty uh French fries those are all vasoc constriction. Those all cause vasoc constriction. So we think that possibly excessive vasoddilation causes blood pooling in the brain. Too much blood not too much blood and not enough blood flow. So constriction can either help some of the blood to leave the brain or it can also help with um just getting that pump going again or and that constriction can cause the blood pressure to go up which will then cause the pump again to happen. So it is the biggest relationship and it comes down to this vasoddilation piece which is also where why we see skin rashes. It's literally blood pooling on the surface. Wow. Wow. No, it's amazing. No, it's amazing and I think for so many people like out there too just to understand that and what is going on there but that yeah wow that migraine histamine connection it is it's fascinating I would also want to cause vasoc constriction in the time of a migraine so I would put ice on my head I would put I cold vasoc constricts heat vasoddilates ice on your neck ice on your head and we already know to do that right all the migraine cats have ice it's all about the vasoc constriction that's Every single remedy for migraines is for vasoc constriction and histamines are the biggest vasoddilators. Wow. And no wonder people, you know, are affected by things like wine that are high histamine foods that can cause the or migraine triggers, right? Exact. A lot of the migraine triggers you'll see excessive heat like all the atmosphere changes. A lot of those things can trigger a mass cell histamine response. Absolutely. Such a good So glad you asked that. I'm like migraine. And I'm like, I get to say vasoddilation now. We get excited about these types of things. I get it. I hear you. I get excited about those types of words, too. Um, amazing. Okay, last question for you. How do you live your most nutritious life on a daily basis? What ignites your nutritious life when each day? So, you know, I I kind of mentioned this before. When I was really sick, I realized if it's not going to be me who's going to figure this all out and figure out how to feel okay in a body that seems determined to not feel okay, who is it going to be? Um, so what fuels me is I need to set the example for myself and I can't afford to not live a nutritious life. I have to live a nutritious life. Um, other people have a little more wiggle room than me. I do not. my body is um I can't have those deviations like you said the sleep eating regularly um balancing my blood sugar like I I can't afford it because I can my body can slip into this immune state can slip into these things so and then I won't be able to show other people that it's possible and I think healing has to be mirrored um so that's what fuels me to love oh my gosh that's so beautiful right for you to help others you need to do it for yourself I love that oh you're so good concept We do. We need to know that it's possible. Yeah. Yeah. You're so amazing. I love that. Um I love you. That is beautiful and amazing. And you are so focused on doing what you need to do to help yourself so that you can help others, which is just awesome and beautiful. And you are so brilliant. And I could talk to you for hours and hours. So I might just have to ask you to come back. Okay. I'll be there. Okay. Are we filming again? All right. All right, I'm ready. Um, all right. You're amazing. I love you, Michelle. Thank you so much. Thank you so much for having me. Can't wait for this to come out. Thank you all for listening. Where can listeners find you? And do you have anything any big projects going on that you want anyone to know about? So, if you go to my website by this point that this comes out, I'm really hopeful it'll be there, and it will be, um, you can watch I have a histamine essentials webinar. It's available for purchase. It's a threehour everything you need to know either as a practitioner or someone just looking to improve your own health. It is very comprehensive um on my website. I'll give you the link for that. Um I have a podcast, Quiet the Diet, um if you want to listen. And I have a private practice where I have um it's myself and four other practitioners working with people one-on-one. You are incredible. And I'm going to put links to all of that in the show notes. Thank you so much. [Music]