The Liz Moody Podcast - Chronic Disease Is On The Rise. Here’s Why + What We Can Do (MCAS, Long Covid, Autoimmune Disease, & More)

Episode Date: June 18, 2025

If you’ve felt like chronic illnesses are on the rise, you’re right. I’m joined by Michelle Shapiro, an integrative and functional registered dietitian, to dive into why this is happening, what we can do to prevent chronic illnesses and autoimmune diseases, how we can manage symptoms if we are ill with practical steps and tools, and what treatment options we should be exploring. We also discuss the science of exactly what’s happening in our bodies and how our immune system, nervous system, diet, and environment are all connected. In this episode, we get into: The Rise of Chronic Diseases & Autoimmune Diseases Managing Chronic Conditions Treatment Options Practical Advice for Managing Symptoms Handling the “It’s All In Your Head” Skepticism Long COVID, Mast Cell Activation Syndrome (MCAS), POTS, Hashimoto's Disease, Crohn's Disease, Parasites, Mold, SIBO, Candida, Leaky Gut, Hypermobility, & Histamine Issues For more from Michelle Shapiro, find her on Instagram @michelleshapirord or online at https://michelleshapirord.com/. Check out her podcast, Quiet the Diet and her Highly Sensitive Body Hub discussed in the episode. Brain retraining programs for chronic conditions mentioned in this episode from Michelle include the Gupta Program and the Primal Trust Program. Ready to uplevel every part of your life? Order Liz’s book 100 Ways to Change Your Life: The Science of Leveling Up Health, Happiness, Relationships & Success now!  Connect with Liz on Instagram @lizmoody or online at www.lizmoody.com. Subscribe to the substack by visiting https://lizmoody.substack.com/welcome. To join The Liz Moody Podcast Club Facebook group, go to www.facebook.com/groups/thelizmoodypodcast. This episode is brought to you completely free thanks to the following podcast sponsor: LMNT: go to DrinkLMNT.com/LIZMOODY to get a free LMNT sample pack with any order. The Liz Moody Podcast cover art by Zack. The Liz Moody Podcast music by Alex Ruimy. Formerly the Healthier Together Podcast.  This podcast and website represents the opinions of Liz Moody and her guests to the show. The content here should not be taken as medical advice. The content here is for information purposes only, and because each person is so unique, please consult your healthcare professional for any medical questions. The Liz Moody Podcast Episode 339. Learn more about your ad choices. Visit megaphone.fm/adchoices

60% of people at this point have at least one chronic condition, 40% have two or more chronic conditions. Is this because our diagnostics are getting better and better or are rates really just going up? There's a lot of pushback of like, is this step in people's head? Is the focus on it making it worse? What would you say to those people? I think functional medicine doctors got really hot on parasites for a while. I think mold is probably as bad as we think it is. So it's really nice to throw some cold plunging and infrared and all these things on.

But if you don't have that base, you don't have health. Because our bodies are kind of like these operating systems. We just have to crack. And when you crack it, you'll understand exactly what you need. Being told that my brain has that kind of power is like the scariest thing you could tell me. Is this the relation to pot? This is ding, ding, ding. That's why she's Liz Moody, ladies and gentlemen.

Exactly. Hello, friends, and welcome back to the Liz Moody podcast. If you feel like everyone suddenly has a chronic illness, whether it's long COVID, mastel activation syndrome, or autoimmune diseases, you are not wrong. chronic disease is on the rise and there are some very real reasons for it. To unpack the why behind it and more importantly tell us what we can do to both prevent chronic disease and feel better if we have chronic disease, I've brought on my friend Michelle Shapiro.

Michelle is an integrative and functional registered dietitian based in New York City who has helped over 1,000 clients reverse anxiety and heal longstanding gut and immune issues. She hosts the Quiet the Diet podcast where she bridges the gap between body positivity and functional nutrition. And she's also the creator of the highly sensitive body hub, which is an incredible resource for people navigating many of the conditions that we are going to talk about in this episode. In the episode, Michelle and I get into the nitty-gritty of chronic illness,

what it is, how it manifests, and most importantly, how to manage it. This episode is a mix of deep-dive science. We talk about the complex interplay between the immune system, nervous system, and external factors like diet and environmental triggers. and of course, lots of practical action tips that you can use to change your life today. Michelle, welcome back to the podcast. Liz, I'm so freaking excited to be here. You always are freaking.

I feel like you're excited for every part of your life. Yes. You give excited. I am for the things that I like and hang out with you and podcasting with you is one of the things I really like. I love that. Well, I think that you're a great example of one can deal with these health struggles and still live a life that feels really exciting to them every day, which is an element of hope to jump into this conversation with.

I absolutely agree. Yes, I do. And you just have to make your life you and authentically you. And that's how I think you live with chronic illness, the fullest life possible. Okay. So let's zoom out. I look around and it feels like people are just getting sicker and sicker. The data bears that out.

I think 60% of people at this point have at least one chronic condition. 40% have two or more chronic conditions. What is going on here? Is this because our diagnostics are getting better? and better or are rates really just going up? Yeah, it depends on which chronic diseases you're talking about because those would fall into like lifestyle-driven diseases generally or autoimmune conditions. I would say there's a lot of different reasons. Increases in diagnostics would be one of them. And I would say our overall incongruence with our environment and our lifestyle not matching

what the human body wants from us, I think is what's pushing us in these directions. I think a lot of people are assuming it's a hole in one, it's light, it's circadian rhythm, it's blue light, it's phones. I think it's a combination and also a cascade of moving further and further away from being human, honestly, is where we are. And do you think that all of these things are related? Like, do you think that the rise in Hashimoto's and autoimmune conditions is related to the rise in mass cell activation syndrome, et cetera, et cetera, like, are all of these things coming from the same place? So they have different root causes. But, and I'm only the one of the same. triggering myself when I say root causes, by the way. It's interesting how like it went from being like,

oh, yeah, that makes sense to be almost like an overused or like ick word. It did. I think that functional medicine also has moved away from what I truly think functional medicine is into this kind of like supplement abbreviation form of conventional medicine. And so when I hear root cause now I do get icked out because I'm like, oh no, it's like an Instagram phrase now. But in reality, there are only so many different like root causes of disease that then kind of spring up into different things. So I would say this. When the body is in a state of dysfunction, a lot of things happen. So a lot of people's bodies are moving into states of dysfunction, but that doesn't necessarily mean that the conditions show up the same, but the root of dysfunction is often similar. So yes, I think that they're all rising together because of the same

roots of dysfunction. And is there a reason that something would have an effect in a certain person, like why somebody would get long COVID and another person would be completely fine? Long COVID was fascinating because there were some studies that showed that state by state, up to 30% of people who encountered COVID, had long COVID. So it didn't discriminate as much as we thought it would. Although I will say, yes, if you have kind of this baseline of another trigger word, inflammation, if you have this baseline of deficiency, and if you may have been living in what I would call a highly sensitive body, then, yes, your likelihood may have increased.

But there are studies that also show that people encountered long COVID more who were athletes because they had more of like a cytokine storm happening at any given time because your body will release inflammatory compounds after exercise. And the idea that it was metabolically driven is interesting, but we don't necessarily believe that. There's definitely some relationship with muscle. But I would say that overall, with long COVID, it didn't discriminate as much as we thought it would, except for this group of people who I call the highly sensitive body crew. they got slammed, I guess you would say. What is a highly sensitive body? Someone who lives in a highly sensitive body is a body that tends towards immune activation. It's a body that probably tends towards histamine release and massal activation.

And it's basically like that person who is always kind of sick and off. But then they go to like these functional medicine doctors and they're like, maybe you have leaky gut, maybe you have IBS, maybe you have mold. But no one really nails it. And then when they start to do those functional medicine protocols, they seem to get sicker and sicker. And it's this same person. And I just, I am this person, so I know this person. But I see them over and over where their bodies react almost the opposite to functional medicine interventions that someone else's body would. Oh, interesting.

Okay. And if you're listening and you're like, Massel, what? We're going to define all of these things later on. So be confident in that. So would you say some people have this highly sensitive body and we're in this more triggering, environment and that's the combination or what's, I'm thinking about, I have a really good friend who was recently diagnosed with an autoimmune condition with Hashimoto's and they were one of the healthiest people that I've ever met in my life. And yet they just got this diagnosis.

I feel like that's happening more and more. These people who seem really, really, really healthy are getting, am I just getting old? Is that like this? They answered to this. You're like, well, this is what happens as you're getting older. It shouldn't be, by the way. It shouldn't be naturally happening. So a lot of autoimmune disease takes ten. to 20 years to develop. So it's kind of brewing under the surface. And by the time you start to see symptoms or symptoms in your labs, it's like the tip of, you know, the iceberg is like breaking through, basically. It's like breaking through for you to actually see what's going on. But autoimmunity happens under the surface generally with a couple of foundational reasons. It could be stress,

lack of sleep, nutrient deficiencies, chronic stealth infections could be happening. And then there's also, of course, like genetic baseline of something that happens. There could be environmental exposures. But there's kind of like this bucket theory that we think of with all of these conditions. And we don't know that our bucket is getting filled until it seems like there's like this explosion, basically, that happens. So would the reason that these things are going up in some ways just be because there's more things going into the bucket? Yes.

And would I feel like more and more of this is happening, like outside of just long COVID, I feel like more and more of these autoimmune diseases, I'm seeing them since COVID. Is that because COVID was like dropping a big lump of something? into our buckets? Yes. I think we have to establish long COVID's relationship with something called mass cells that I think can we define that? Yeah.

I think it's important for laying this groundwork. Yeah. So we have an immune cell. It's a type of white blood cell called mast cells that exist in all connective tissue in our body. And connective tissue lines are joints, blood vessels, bones, organs. I mean, there's connective tissue in every part of our body. And mass cells are there basically to detect threat. and I kind of think of them as like the guards at the front of the cell.

So they want to make sure if something's going to happen, I'm going to release these compounds to signify the rest of the body. Blood is coming, get blood vessels opening for things to kind of move down like a slide in the body and send immune cells and nutrients to a site of injury, essentially. So mass cells have a very special relationship with COVID, very unfortunately. The way that COVID and mass cells interact is that COVID attacks and attaches to this one type of receptor on the outside of mass cells called the A-C-E-2 receptor.

So when they attach or attack the outside of the cell, mass cells release those compounds. They're like in sacks inside of the cells. And they do something called degranulate, which means that they release those compounds. Histamine is one of those compounds, basically. And then there's 1,200 other chemical messengers that can be released, like tryptases, cytokines,

prostaglandins. A lot of things that can cause symptoms, but we hear the most about histamines, I think, generally. But this relationship between our immune system and, unfortunately, COVID, created this kind of brand new type of sickness that we just really hadn't seen before. And in 2020, the estimated prevalence of MCAS was 17%. And that's pre-COVID. Mass-cell activation syndrome. Okay.

Which means those mass cells constantly keep getting activated and they keep releasing those compounds. The most fascinating and important thing about this picture is not only that our immune system, gets activated, but mass cells have a very intricate relationship with our nervous system. Mass cells release histamines in our hypothalamus. There are mass cells too. So the detection of threat and basically you get really sick and then your body freaks out like what just happened to me because these symptoms are so vast and so huge. And then the cycle starts again because the nervous system kicks off the mass cells too. So it's this immune system and nervous system relationship that I think is at the basis of why we are getting sicker and sick.

We get sick. Our body freaks out that we get sick because it's so abnormal the symptoms we're having. And then that activates our immune system to go again and it becomes this vicious cycle. So is mass cell activation syndrome something that you have and you treat and you get over? Or is it like acquiring a long-term chronic condition? So it's a great question. There's a difference between mass cell activation disease MCAD and MCAS. MCAD is usually more genetic in nature, and it's something that people will have from a young age.

MCAS can happen spontaneously, and it can leave spontaneously. Spoiler alert, it often does not do that. It's hard because do I think that there's like kind of a remission stage of it? Absolutely. But if your body wants to behave in that way, you have to really work hard to make your body not behave in that way. because it's remembering anything from when it comes to our mass cells, environmental triggers, if it's too hot outside, exercising too much, eating anything high in histamines, which could be like tomatoes, like high histamine foods are the healthiest foods in the world. So you would definitely want to be eating them. Any of those things can trigger what I would call a flare, and that flare can kind of reactivate again.

So it's not something where I want clients to constantly be thinking about histamines and MCAS, but it does take some decent management to move you out of the symptomatic state. So it's not a perfect, is there an end to it? But I have seen many, many people have severe reduction in symptoms to where I would say M-CAS is no longer concerned for them. And we'll come back to MCAS in a second. But in general, would you view many chronic conditions in that way? If somebody has an autoimmune disease, would you believe that they could get to a place where they wouldn't have to manage it daily anymore? Yeah.

And this is something that's been known in functional medicine for a long time. So functional medicine doctors weren't joking when they said, like, you can kind of reverse Hashimoto's or you can reverse these gut conditions. Yeah, there's a lot of room. Now, is there certain conditions that there's physical damage to organs and that damage cannot be fixed? Absolutely. Is any pathway to fixing autoimmunity straightforward? No. If anyone tells you that, it's a total lie.

It's not straightforward. It's a lot of, you know, bobbing and weaving and trying to figure out what, you know, what that person's specific body needs. But yes, it is believed, especially in functional medicine and studied, that you can basically reverse at least symptoms and lab symptoms of many autoimmune conditions. And to the point where, though, you don't have to be like, like you give up gluten often when you have Hashimoto's. Yeah.

Because I believe gluten mimics the structure of your thyroid hormone in your body or something, which is what's being attacked. Can you manage these things to the point where you don't have to do those treatment things anymore or if you have these chronic conditions and they're managed successfully in a way, are you signing up to do that stuff forever? I would say the goal of having an autoimmune condition or an immune activation condition is to get your baseline of health so high that those hits aren't as strong. Now, if you had Hashimoto's but you also had celiac disease, no, you cannot include never again

if you have celiac disease, basically. The question is how much is it going to impact you? So I'll give you an example. It's almost like if you are a person who is, I was a catcher in softball. very proudly. And I have gluten sensitivity, but I'm not celiac. If I'm eating gluten on a day where I'm already stressed, my gut is distressed, I'm not taking care of myself, I'm not hydrated, I didn't sleep well. It's almost like someone, I think, of all the gear you wear as a catcher, swinging at my head without a helmet on, right? But if I'm in really good shape, someone swings at my head, but there's a

helmet on, I'm going to be in a lot better of a position, basically. So the goal is like make your baseline and your resilience so high that the hits aren't hits. If you have Hashimoto's eating gluten is always a hit. It's just the question is like, how much can you tolerate the hit and how much are you willing to change your lifestyle to reduce the hits and to protect yourself, basically, from those things. So those things are always going to have an impact. The question is how do we minimize the impact and minimize your bounce back? And again, to the idea that like these things are on the rise, more and more people are feeling more and more unwell because we're just getting hit more and more, essentially, with less protection. 100%. Yeah. It's also interesting because we're

We are in the middle of the biggest rise in wellness culture that's ever existed. The wellness industry is a multi-billion dollar industry. We're doing red light therapy. We're avoiding gluten. We're doing all of these things. But we are getting simultaneously sicker and sicker. So do you think we are doing wellness wrong? I don't associate wellness and health care with each other anymore.

I no longer associate them with each other. If you think about like the pyramid of our needs, even Maslow's hierarchy of needs, we can use that as a reference that every single one of us who took a psych 101 class can immediately, like, come up within our head. But all of those incredible interventions, because I think red light's an incredible intervention. I think cold therapy is incredible are kind of like the tippity top of the pyramid. But if the bottom of your pyramid, if your lifestyle, if your connection to being a human, if the way that you live is not established and you're not doing well, throwing stuff on top is like a sprinkle. And we're missing that bottom of the pyramid, which is really like safety, access to health care, access to community, having like appropriate housing and access to no like environmental toxins.

Like we don't have, most people do not have that base. So it's really nice to throw some coal plunging and infrared and all these things on. But if you don't have that base, you don't have health. What are three things that you think are on the top of the pyramid that we're treating like they're on the bottom of the pyramid? And then what are three things that we really should be paying more attention to when it comes to our health and wellness? That's such a great question. So I would say what I think people are thinking is the top of the pyramid, I am going to put food dyes in. The reason I'm going to put food dyes in the top of the pyramid is because most people who are really health conscious are already not eating Red 40.

So I probably have not consumed a food with Red 40 in 20 years. I can't even imagine the last time I did. So for me, that's not me eliminating Red 40 or someone else eliminating Red 40 is not going to instantly correct all of their health. I would put at the top of the pyramid of Parasite Cleanse as well. I would put parasite cleanse, which I see all over social media at the top of the pyramid. So I think extreme regulation of blood sugar is at the top of the pyramid. I will put real blood sugar regulation at the bottom of the pyramid, but not letting your blood sugar ever go above 140 and being so compulsively monitoring it, I think creates a nervous system response that I think is unfavorable

for most people. So I actually think that extreme regulation of blood sugar would be at the top of my pyramid. Oh, that's interesting. And I mean, it's sort of what happens when like good idea and then capitalism gets to it essentially. Isn't that the whole name of our conversation? Yeah, yeah, yeah. It's all the commoditization of our bodies. That's what all of this is about. And you really can't. If you looked at the bottom of my pyramid, it's going to be all the free stuff. Okay, so what is at the bottom of the pyramid, truly? I think eating regularly, being in community with people that you love and being seen for who you are, creates such a safety inside of your body.

Remember, the body acts in this weird immune way when it's unsafe, because that's the way our immune system helps to keep us alive. It constantly activates to try to save us. All autoimmune disease is a way for our bodies to try to save us. But if we don't need saving and if we have safety, I think the body and the immune system can calm down. because that link between our nervous system and immune system is so tight, which will bring me to also another bottom of the pyramid, top of the pyramid. Top of the pyramid is splashing water on your face vagus nerve exercises.

Bottom of the pyramid is learning to be comfortable inside of your body and learning to be safe inside of your body. That sounds much harder than dunking my face in ice water. Freer but harder. Exactly. It is, exactly. So I think these tools are incredible. And again, I am pro, I even like biohacking.

I've been like in the biohacking world for a long time. I love it. But it's no replacement for that bottom of the pyramid. Like to feel safe and okay inside of your body and to tolerate being inside of your body has nothing to do with splash and water on your face. How do we do that then? What does it have to do with specifically? I think it's a lot of tolerating discomfort, accepting where you are,

tolerating your own thoughts, even when they're uncomfortable. And once you can sit with yourself, and it could be, one minute a day to start with, the body starts to be like, oh, my gosh, she's listening to me. I don't have to freak out and send all these immune signals now because she's here and she's listening to me. So I think it's just about listening to yourself. It's so corny, but I mean that quite literally. And like from a mechanism of action perspective, like there is science behind this. It sounds kind of just like, oh, like listen to yourself and then your body won't be mad at you. Exactly. And it's really, it's really unfair also for me to say that because it's like people are

really struggling with mega symptoms. And imagine being in an emergency symptom state and someone being like, why don't you just chill out? It's not that at all. So our nervous system connects with a specific system of brain structures called our limbic system. And our limbic systems are amygdala, hippocampus and hypothalamus. And they process memory, threat. And they will basically help you in this kind of, in a time of emergency to make sure that you never encounter that situation again. Basically, like, the part of your brain that would tell you don't, you know, touch the hot stove. But our immune system, our limbic system, and our nervous system are all so intricately related that if your limbic system is trying to protect you, sending that thread

response to your nerves, and your nerves are connected to your immune system through the mass cells and through many other pathways, 100%. If your nervous system is constantly activated, your immune system is constantly activated. I think it's hard for people to understand when we say stress, and I hate like just meditate for five minutes. That's, you know, it's like trying to get your body to a state of tolerance almost because when we feel those symptoms or we get a bad lab result, we're completely activated. And then our body goes, let me kick the immune system on and starts the cycle again. So it's really just about finding safety somehow.

What do you have your clients do or what works best for most of your clients? It's funny. When I'm even getting lab results back, I've talked to you about this personally. But when I get lab results back for a client, I have to like contemplate for an hour how I'm pitching the lab results. I'm like, it's so important how we receive information because when we see our own labs sometimes, we're like, oh my goodness, my cholesterol is high. Like I'm done for it. Which like, again, to our point earlier, healthcare providers are not typically doing this. No.

And I don't think a lot of health care providers know how to read labs in context, to be honest with you, which is another thing that I really wish we could change. But I'm thinking about that. And when I'm even going into a session, I'm thinking. about how their body is going to receive the information. And I'll give you like a harder example. I had a client the other day who messaged one of my amazing team nutritionists, my team dietitians, and had said basically like, nothing is working, everything's going wrong, I'm getting sicker and sicker. I looked at their symptom survey. So we measure like people's symptoms. And I'm like, this person's like 75% better than they were. We forget when we're getting better, right? We forget

pain. Thank goodness. We forget pain. I always ask my clients who have given birth. I'm like, you did it again after that? Like, did you forget how hard it was that time? But I think that in that moment I said, and I said to my staff digestion, because I saw her getting really nervous around it. I was like, you got to turn this mindset around. Because I'm like, there's no healing in that mindset because now their brain's searching for threats, searching for things going wrong. There's no way a gut's going to heal, right? Our nervous system will control movement of our gut. So if you're having chronic diarrhea and your guts going like this all the time, you're going to keep having chronic diarrhea. So I said, you know, we have to turn this client's mindset around, basically. And what we did was I basically said,

come, let's do a quick session. Come in. I was like, I'll join the session to tell them, of course, because it was my staff dietitian, Nikki's client. And I basically said, we're going to write down like the five things that are bothering us the most. And then the five things we're going to do about it so that the client feels like, and whoever's listening, feels like they are in the driver's seat of their body, which they are. We have to feel like we're doing something and we're choosing to do something. Wait, the other thing that I want to double click into that you said is, like, we don't recognize how far we've come. Like, I love the action step of like, what am I feeling? What do I want to be feeling the five things? But like, I also love the action step of documenting or

finding a way to notice the 75, your client was 75 percent better. Unbelievable. And I do think I've noticed this in myself so much is it's something I lament almost is I'm like, my work changes all these other people's lives, people will come up to me in the street and be like, you've changed my life. And it's so amazing and I'm so grateful for it. And sometimes I feel like I'm incapable of changing my own life. And I was, I viewed this as almost like a fatal flaw in myself. And my husband was like, you have changed your life so much. He's like, do you remember when you couldn't get out of bed because you're having panic attacks every day? And I was like, true. But like we don't. That's on this health journey, Liz. You've had 20 health journeys. You've like lived 100 lives.

But we don't see it in ourselves. So is there any? Like, how can we recognize the progress that we're making that feels so important? You know what's so weird because I'm so emo. I mean, literally, I listen to emo music all the time. But I will listen to songs or I will look at pictures of times and I'm like, oh my gosh, you were in a neck brace. I'm like looking and I'm like, I take a lot of pictures when I'm sick too so that I can.

I do this so I can remember. That's so smart. There was a time I could barely walk because I had this neck injury and MCAS and all this stuff on long COVID and all the stuff going on. I remember maybe like two years ago, I was like, you know what? Like, am I even better than that? And I looked at pictures and I was like, oh yeah, you couldn't sit up for 15 minutes. I literally would prop myself up during client sessions.

So it's like so nice for me to look back on that. But it's because we are so resilient. Like we are, we baseline to being where we are at the present. And that's like a really beautiful thing. But it's also working against us recognizing our own progress. Yeah. I will tell you, like in the darkest moment of my health, I literally had to lift myself off of a computer chair

and push my computer chair to the bathroom and then basically like fall on the floor intentionally and like crawl to the toilet. It was so bad. This was like I was still seeing clients like eight hours a day. Like unbelievable. That doesn't surprise me. Yeah, exactly.

But I remember looking in the mirror at one point and being like, you know what, Michelle, I just don't think you're going to make it out of this. And I then had like this other part of me that was like, don't ever say that again, basically. Because if you really don't believe that you're ever going to, to make it out of it, your limbic system, your nervous system, and your immune system will follow suit.

It only knows the instructions that we give it from a safety perspective, from a language perspective. So we can't afford to when we're in those moments think like that, which is so hard. Yeah. So like, what do we do? I mean, the way my brain works, yeah. Being told that my brain has that kind of power is like the scariest thing you could tell me. Yeah. You can turn around in one second, though, basically. So first of all, you acknowledge, right? I hear you. I know you got to. really scared and you said that. Now let's offer something new. So there's literally limbic system retraining program. So for MCAS, POTS and long COVID, a lot of the treatment is

actually brain-based treatment, especially something like POTS, which is Postural Orthostatic Tachycardia syndrome, which you guys might have heard for those listening. It's almost like when people stand up and they black out and then their heart starts pounding. Is that also on the rise? It sure is. And it's very related to MCAS. And I could do an entire episode on just the relationship between MCAS and POTS because it's very profound and hypermobility as well. They're a triad, so to speak. Pots, we think of as, well, that's a heart condition, right? Because someone's heart's pounding out of their chest. So it must be related to their heart. It's actually a form of dysautonomia, which means it's a form of dysfunction of the autonomic

nervous system. So POTS is a nervous system disorder because your brain tells your body, well, send blood here, make this muscle work. It starts in the brain. So a lot of the treatment for MCAS, POTS and long COVID is actually brain retraining. What do they do? It's like Gupta program, primal trust, these programs. It's like videos that you're engaging in, you're listening to. There's activities. Like I don't want to give like too much away because these programs are so complex and beautiful.

And I don't want to degrade them by just mentioning. But it could be something like where you say, you have that thought like that and you say stop. And then you kind of picture yourself going in one or two directions. Am I going towards the direction of health? or am I going towards the direction of symptoms, fear, and everything like that? And you kind of consciously take yourself down that path. So it's not as easy as like talk to yourself, but I think start by listening to yourself. It's really profound.

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slash Liz Moody. That's 15% off at Masterclass.com slash Liz Moody. Masterclass.com slash Liz Moody. Is there anything else pragmatically that you would have us do to build that baseline of safety in our body? I would say eating regularly and moving in accordance with what your body is asking you. But I already am so embarrassed that I'm saying this. But like walking is so supportive. No, I saw that post you did that was like the solution to this.

Like what were all the things on the list? I'm embarrassed by this. I think of myself as being so sophisticated. hit it, but I have to tell you, that's how I feel about walking, like a giddy child when I talk about it. But I made a post as like, what's the secret weapon to detox and drainage? What's the secret weapon to weight loss? What's the secret weapon to supporting your mental health? And like every time it was walking. But for me, it was that. And for me, it reconditioned me after my nervous system was so dysregulated, after my, you know, I couldn't walk for so long. So for me, walking, I find to be so

important and so regulating. I would say, again, not skipping meals, having blood sugar regulation in an honest way. That's just consistent meals your body can anticipate and break down appropriately. Eating slowly and mindfully is so important too. I know. I have any, like, yeah, I feel like I've heard a million doctors already say that and I still like eat in front of the TV and I don't chew enough. Give me at least a good posture when you're eating that. Okay. I mean, I probably can't demonstrate it. is like sit up because you're what, you're squashing your digestive system. Yeah, you're squashing your organs. Exactly.

Just give your body a nice pathway down at least. And chew like maybe one more time. Well, it's hard because also taking away the television can be really disregulating for the nervous system. Yeah. Yeah, because we're used to it. Like it's comforted. You know, everything like that. You talk a lot more about dopamine even than I do.

But that's the other thing too. What feels safe for one person is not necessarily going to feel safe for someone else. That's where the authenticity corny piece comes in. I feel safe at like a out of control rock and roll concert. That makes me feel calm and safe and happy because it feels like me and I feel like I'm connecting to that sensitive part of myself. But if I went to like something that would bring other people joy, I'm assuming it would not feel safe for me. Even like the beach doesn't feel that safe for me. I had an interesting thought.

This is like way more out there than I'll normally go. But I wonder if part, a very small part of this rise in chronic conditions that we're seeing is because there's this. this lack of authenticity that's happening right now in our culture because people are just defaulting to this baseline. We're everybody's looking more the same. Everybody's acting more the same. We feel like we're being perceived all the time so we don't show our true, vulnerable, authentic selves. And thus, we very often don't feel safe. And thus we're having this nervous system activation. I'm like, no, it's real. I mean, it's like our soul being mismatched with our bodies. I mean, there's something like, there's something big.

going on from a spiritual standpoint. It's a walk away from authentic humanity. It's like, especially social media, we're not really supposed to know what's going on every part of the world the same time. And these are, again, topics you talk about all the time on your podcast, Liz, but like, it's real. Like you really aren't supposed to be that activated and that empathetic and that in touch at all times. We are losing touch with ourselves and there's this weird pull away from ourselves. Yeah. And then we want to distract because that's so uncomfortable. Yeah.

It really is about being with ourselves. Do most of us spend more than an hour a day, five minutes a day with ourselves? No. Just sitting with ourselves? No. And I sometimes will get viscerally uncomfortable if I'm like in the car and I don't have my phone. I need, I feel the need to distract from being with myself constantly. Yeah.

I think that if you think about people who are probably the most at peace, at balance, it would be like, I don't know, like a Buddhist monk or something. We think about someone who's with themselves. and the universe at all times. And I will say something that I have noticed in my own body is that discomfort will subside if I give it the time to. But often I will reach for the phone, reach for something to comfort myself very quickly. But if I can give it just like two or three, same with when I meditate. If I, at the beginning, all my thoughts are getting stirred up and I'm like, oh, my gosh,

this is so uncomfortable. I hate it. I'm so distracted. I'm not to be able to do this. But like after maybe five minutes that, it's like shaking up a snow globe and the snow globe settles. And then you're just like, oh, it's peaceful here. It's very funny that people think meditation is supposed to feel good.

Oh, my God. When it's like, and we know it's so not supposed to feel good. Of course, you've done these incredible retreats and breathworks and all these things, too. But especially with someone with chronic illness, I want people to understand. I know what I'm asking of people is the hardest thing in the entire world. I'm asking you in a in pain body to tolerate the experience of being with yourself. It's like horrible. I totally completely get that.

It's about titrating it and dosing it in a way that is tolerable. But if we could tolerate and even enjoy being with ourselves, yes, that would trigger immense safety signals because it doesn't feel like your soul's trying to jump out of your body. And I don't want to jump at this too long, but also if you're around people who are making you feel unsafe, if you're in some toxic relationships, like I would say that this would be a sign. Another reason to let go of those as well. 100%. I think friends like, I mean, there's the really extreme toxic where it's like, you know you should get out. But I think too many of us are toxic. Comalerating familial relationships where we feel really unsafe, uncared for.

We're not able to be our authentic selves, friendships, partnerships, all of these things. You mentioned that autoimmune conditions are brewing under the surface for 10 to 20 years before they come out. What are some of the symptoms that we could be looking for? Are there any ways that we could catch it the 10 to 20 years earlier if we know what to look for? So in Hashimoto's, you might see a on-fire immune system first. So you might see like your CRP going up. You might see signs that your immune systems ticked up before the crash happens. So in something like Hashimoto's, yes, you can see that.

I would say in something like Crohn's disease, I mean, it's like you're going to find signs of unwellness or inflammation or in your labs, nutrient deficiencies. it's like a body that's slowly becoming depleted and also on guard. So you can see it in, I guess, inflammatory markers, nutrient deficiency markers. If you ran probably like a Dutch test or a stool test way in advance, you might see some things brewing. The question is like, is your body spiraling into that state? So there's a lot of different things you might pick up on. So if it was, let's say, Crohn's disease, you might have chronic gut conditions before or people who, for the the longest period of time, like feel a little off, they have no appetite. Anything that would signal you're off-kilter for yourself, I would say, but it really depends and not everyone has the

same symptoms. And the way that we generally think of autoimmunity in the functional medicine world is that it's not like you have to have a genetic reason for something like Hashimoto's, but that any autoimmune disease can pop up when the body turns into that protective state, essentially. Interesting. Okay, so the body turning into that protective state is one trigger. Are there other triggers you think we should be paying more attention to when it comes to chronic disease? I think there's already a lot of focus on mold, parasites, environmental toxins. Wait, so you put parasite cleanses at the top of the pyramid. Yeah, I don't think doing a parasite cleanse when you don't have diagnosed parasites and willy-nilly is safe, appropriate, and will probably

defer consequences as well. So I think. But parasites can be a problem. They can be. I don't think they're the root cause. I think functional medicine doctors got really hot on parasites for a while. Yeah. I think mold is probably as bad as we think it is. I think they were really hot on Candida, too. And now people are like, yeah, I feel like Candida was like, it really felt like a trend because it like went through and now people, I kind of feel like Sebo had a similar. Everybody's like everything's Sebo. And now people are like, Sebo was a big leaky gut. Sebo. These were like hot, hot functional medicine things. They're not root causes. That's the reality is that these are side effects. These are the consequence of other root causes. So I think it's not like rudy back enough. It's not the rudiest of the. the root causes. But yes, those were like the ones. But if you have a small intestinal bacterial overgrowth, why? Do you have that? Yeah. Why, what is going on in the environment of your body that is causing that to happen? But you think that the attention being paid to mold right now is legit? Like, do you think mold is a problem for a lot of people? It is. It is a problem. It's also a

problem if people try to rip mold out of their bodies because then they could have terrible symptoms. A lot of my clients with MCAS don't have MCAS because mold was a root cause. They have MCAS because the mold detox they did created such a huge issue inside of their bodies because they weren't able to detox and drain the mold that they were trying to rip out that they ended up in, that was the case for me, by the way, that they ended up in an MCAS state where the immune system's like, oh, God, what are we going to do here? What do we do? What are all these particles? What are we going to do with them? My issue with the mold thing is, I'm like, where are we finding mold-free homes? Like, I, we're not. I think it's over 80% of US homes home. I just am like, I don't feel like

I have enough selection ability, like, unless you're like a billionaire and you're like, I want this home. But like, I just feel like I'll take the home I can get if it fits all of my other qualifications. Which is very hard in the areas we're in. Which is very hard in the areas where I like I just don't feel like I have a lot of options. And then to add mold on top of it and there are all these old houses. And they say like if your house has had water damage at all, it probably has mold. I'm like, find me a house that has not had water damage.

It's impossible. I mean, I literally moved in. So this is like the bane of my existence story is that I moved from Manhattan where I lived my whole adult life. I grew up in Queens. And I had to move to New Jersey recently because I had to live in a brand new building. And I could not find one in Manhattan that was remotely feasible. Because I had to. Because of mold. Do you like recommend we all be trying to hunt down a mold? Like it just, it feels like an insane request to me. So, okay, there's a lot of pretty incredible like TCM providers, Ayurvedic providers and just Eastern medicine providers who have an understanding that

The exact same mold can make one person sick, but not make the other person sick. So the question is, how do we make our constitution so strong that we can, like, defend against the mold ourselves or live with it in congruence? Now, that's really hard, especially in a body that's compromised already from a gut function standpoint, an immune standpoint, nervous system standpoint, nutrient standpoint. It's really hard. But the goal would be to, again, build that resilience where I'll give you an example. I used to go to Miami during COVID years all winter. I would go to Miami, Miami every apartment. I think it's 100% of apartments have molded them.

It's just so damp. Yeah. It's just really hard. And it's like Airbnb's. So people are opening the doors all the time and everything. And I used to go in the beginning in 2020 when I had long COVID. I mean, I would walk in the room and have almost antifalaxis. I could not breathe in the room.

Now I could stay in a moldy place for a month. I don't love it, but I don't get sick from staying there. Interesting. So you have to work both on, yes, trying to eliminate in your environment if you can. and trying to make your body more resilient to it, which is really not straightforward and really, really hard. Is that all the stuff we've been talking about, though? Yeah.

Okay. It's really just about, again, building your gut barrier, building your body's immune capacity and response. Again, it's not like an easy, simple thing, but no, not everyone who encounters mold will get sick from mold. Any other triggers do you think we should be talking about more? I do believe that the circadian rhythm conversation and the light conversation is important, too. The way our body knows, when do we release hormones at this time? When do we do this at this time is through sunlight. So it is very important. And that conversation is now like all over social media too. And it's valid. And there's a real reason for it too. So trying to again align ourselves with nature, be in nature, all the like fun hippie stuff, like real. All right. Let's dive into long COVID a little bit more. How do you treat long COVID in your practice differently than somebody who's seen a conventional doctor might? I've never seen a client with long COVID. COVID who doesn't have MCAS. Never. Seeing a client with long COVID who doesn't have MCAS. A lot of times when patients go to long COVID clinics, they're very focused on the damage that the

disease did. In my opinion, long COVID is not from organ damage. It's from an immune and nervous system response. That would just be COVID damage, right? That would be injury from COVID. Why is it that six months after people have COVID, they're like something, for example, like something like lack of smell. that's like a COVID injury, right? It actually is involved in the nervous system as well, but it is like damage the olfactory nerves probably. Why is it that your body still thinks you're sick when you're not? It's not like there's a nutrient level problem.

It's literally that your body is so scared about what happened during COVID that it keeps those immune systems, that immune system on guard the entire time. And the problem is that that's not a healthy state for the body to be in. That's the issue with the constant immune activation is that there's consequences of having histamines floating around your bloodstream. So I would say I never ever work with someone with long COVID without understanding the histamine and mass cell piece of it. And I've never seen a client with long COVID who doesn't have MCAS. Never. Wait, so you said that histamine is just one of these like thousands of things being released. So why is there so much talk and focus on histamine

versus all these other things? So histamines are fascinatingly troubling because there's so much more than just like seasonal allergies that we think about antihistamine drugs. We think about seasonal allergies. Histamine issues can present as emergency room level issues. So when you have a histamine issue, it can affect your respiratory rate, your heart rate, your blood pressure, fevers, skin rashes, anything you would go to the ER for. So I think the reason why histamines are such a focus is because their impact is so drastic from a symptom standpoint. And also we just feel them, I think, the most. Like cytokines, you might feel like inflammation, but it's not, it's so specific what happens from histamines because of how they act and what they do. And then

you said when you see long COVID, it's always related to massel. They always have MCAS. They always have MCAS. Is there anything else that you're like, they always have MCAS? There's sneaky signs of MCAS. So I've noticed in women specifically that women who have MCAS feel sick during different times of their cycle. So generally people will feel really bad PMS and during their period. Those with MCAS, it's flipped. So they actually feel worse when their estrogen, when estrogen is highest, which is like near ovulation. So at the end of the period, so like, day seven of their cycle, awful when estrogen starts to rise again, and then around day 19, when estrogen starts to bump up a little bit too. So I'm always like, really like, oh,

that's a histamine-y thing, as you would say. If people notice that they're starting to eat healthier, but they feel worse, I'll often look at a histamine thing because high histamine foods are fermented foods, citrus, vinegar, like miso, nato, like some of the healthiest foods you will ever refined spinach, tomatoes, like if I was a gut health doctor, I would say here's the list of the healthiest foods for your gut. They're all really high in histamines, which is just unfortunate. Which is going to trigger the MCAS. Yeah. The higher histamine food you eat, the more histamine symptoms you can get. And also our mass cells do a very frustrating thing. The more histamines that are there, the more histamines they release. I don't know why they do that. Okay. So they're like releasing

these histamines, which is making you not feel well. And then if you're adding in exogenous histamines, And it's like more, more, more, and it's just a vicious cycle. And some of these foods trigger the body to liberate histamines, and then some of them just are high in histamines, basically. Like, aged foods, they're just high in histamine because time has gone on. So they develop more histamine over time. So yes. And then also with our mass cells, again, you have a nervous system thing that happens. Then the foods become more impactful.

So it's definitely a bucket with MCAS. And then the bucket gets overfilled. And is there a test for MCAS? Yes. So you can measure it by just like checking. your serum, your blood for histamine. It's not the best measurement because histamine doesn't live there. It lives in your mass cells inside of your connective tissue, so it's not that helpful. What is a better kind of gold standard test is you can biopsy your gut or you can biopsy your skin and see mass cell

activity. Most doctors do not do this. So whenever I have a client who happens to have gut issues with MCAS, which is very common and histamines can cause a variety of symptoms. And we can talk about the signs of that if you want. But I just have, I'm like, oh, you're in the endoscopy, ascentobiasia a little bit while they're in there already. So it's like if they're already in, even if I have clients who don't have MCAS, I'm like, just ask them to biopsy for mass cells. Why not while we're in there? Yeah.

But so if we can't get that biopsy and the blood test isn't very good, what are we doing? So I have a joke because Olivia Amitrano, Organic Olivia, she did an magazine article like 15 years ago. And she was saying, like, what are your travel essentials? And at the top of her list, she said Benadryl is my biggest travel essential. And I was like, you didn't know you had histamine issues then? like, why would you just bring Benadryl with you everywhere? And she was like, well, you know, in case of an emergency, I'm like, what kind of emergency outside of a histamine emergency would Benadryl help with?

So if you're a person who feels dramatically better when you're taking antihistamines, you probably have a histamine issue, I would say. Which means you have a mass cell activation syndrome, which can contribute to these things like autoimmune conditions, long COVID, etc. Mass cell activation syndrome is different than something called histamine intolerance. Slight variation. Mass cell means the. other mediators are involved, histamine intolerance means it doesn't mean you have too much

histamine. It means your body doesn't like the histamine that's there and is intolerant to that histamine that's there. So you can just have histamine intolerance. I don't think it's as common as people think. I think MCAS is probably more common, but you'll see online a lot about histamine intolerance too. It can be, but it's probably that your mass cells are also doing something interesting.

So the way that mass activation syndrome works with autoimmunity is that autoimmunity is the immune system turning on it. on the body, right? Mass cell activation syndrome is just excess immune system activation, but these conditions often travel together as well. You have immune particles constantly firing off. The immune system is overactive, and some of that activity can turn into auto-on-self activity too. Okay, so in a nutshell, if I said the question I was asking at the top of the episode is all of these chronic diseases are on the rise, what's going on here? One very concrete, big answer you would give me is because more and more people have mass cell activation syndrome.

I would. And long COVID. And long COVID, which is related to a mass cell activation syndrome. Yes. Okay. So it feels like all these things are like long COVID is always correlated with mass cell and mass cell is making long COVID worse. And there's like, it feels like this big tangle of things. And one of the best ways to diagnose this in yourself is you can take an antihistamine and see if you feel better. Kind of. Yeah. And I can't say that's diagnostic. Yeah. Like if you, I feel like a world of difference when I take a Pepsid. Pepsid is actually an antihistamine, by the way, too. Pepsid is an antihistamine of the H2 receptor in our gut. But we often think of it as an acid walking jog, but it's also an antihistamine. So I want to give you a little example of a client I had.

She was on eight psychiatric medications for sleep. Severe insomnia, sleeping one to two hours a night to the point where she had paranoia, hallucinations. It was really tough. Nothing touched it. Trasidone, Ambien. Nothing touched it. And I had this like download about her. This was a long time ago, like maybe five years ago, four or five years ago. And I said, I think this is like a histamine issue because histamines as a part of what their goal is is to keep us alert and to keep us on in case anything happens. So they could also keep you awake, basically. So I said, just do me a favor. Try to take a Pepsid tonight. It has been, I think, over four years and she has not had one troubled night of sleeping. No psychiatric medications. Of course, we weaned off with her doctor,

of course. But point being, if the issue is histamines, you can't turn the signal off by comment your nervous system down. If the histamines are trying to help you and send you a message that you need to be scared, you have to calm them down, basically. So I'm very pro-antihistamine medication usage, not as much Benadryl of them because that does have potential like brain consequences in the long run. But I'm pretty pro those like H-1 drugs, Allegra, Zyrtec, and they're often in pepsid H-2. They're often very necessary in my practice. So we're, I'm a functional dietitian. Was it my goal and dream to have people on over-the-counter medications? No. But if, if, the quality of life difference is someone going to the ER every week to someone feeling good?

Is it worth it to trial them? Absolutely. Okay, we'll come back to antihistamines in a second, but I just want to be abundantly clear for somebody who's like been listening to this whole episode and they're like, okay, I think there's a good chance I have muscle activation syndrome. How do they know if they have it? And like, what should be their first steps that they take? So first, if any of the things that I listed in the beginning of the episode, if you start a mold detox and you feel more sick, if you eat tomatoes, lemons, vinegar. Every time you eat in a restaurant, you feel shaky, dizzy, weird. If you get migraines frequently and migraines medications don't help that much. If you feel weird

during different times of your menstrual cycle, if you just notice you take a supplement that everyone in the world is taking, they're taking colostrum, you feel ill taking it, and your body acts in these ways it doesn't understand. Eat makes you feel sick. You go in the shower and you get red splotches on your legs. You have those hints. You can pursue an allergist office and MCAS diagnosis or like we said, you can trial things at home like antihistamine support or trial taking, maybe playing with some of those foods and saying, oh, every time I eat lemons, I feel like I'm going to die or something like that. Try taking that out of your diet. But what I don't want people to do is self-diagnose and then feel trapped by this lifelong

diagnosis because it's a big, there's so much you can do. And it's not like this permanent diagnose. I don't want people to feel that way. Like you're picking up a new condition. I want it to feel like, oh my gosh, my body has been doing this thing that I never understood. And when I was going to all these functional medicine doctors, I was feeling sicker and sicker. Now I get why. I want people to feel empowered by the information, not stifled by it. And then you said you would rather people take these antihistamines versus go to the emergency room once a week. I feel like where I get stuck in decision making isn't this extreme. It's like I feel a little unwell. Should I take this thing that maybe has long-term consequences to make me feel a little bit better. What would you say to that person?

It's a great question. So, of course, by the way, if you need to go to the ER, please go to the ER. So what we need to establish in each one of our lives is the things that make us feel better. So for me, I know I'm so minute, Liz, with my body, right? So I'm like, okay, I feel a little zingy. And for zingy for me means like I get a little tremory. And then I'm like, great, I need a Pepsid. Because Pepsid also, since it works on the God, I think it has a little vagus nerve impact too, which is interesting. If I'm like, oh, you know what? I feel like, you know what? I feel like I have migraine. I'll go for like a Zyrtec. Let's say just from the medication perspective. I have flare packs for everything. So I'm like, oh, I, you know, I'm hypermobile. I injured my back.

Great. I'm going to put my back brace on. I know where to go, but we have to establish and this takes guinea pigging of our bodies a little bit. We have to say, we got to trial some stuff and say, what made me feel better during that time? Even if it's a panic attack, like I know you've posted about that really cool trick where people have like sour candies or something. Try it. I think it's about trying things and seeing what works and then writing it down and being like, that worked for me last time so that you have that arsenal for yourself to know I can always reach for this. This will always make me feel better because our bodies are kind of like these operating systems. We just have to crack. And when you crack it, you'll understand exactly

what you need and what you should travel with and have with you. And are these antihistamines treating anything at a root cause level? Or are they just treating our symptoms and everything's festering under the surface? It's such a good question. There's a lot of people on social media now who are coming out against antihistamines, basically, which is why I feel like I have to defend them, even though it's like a drug. I don't care. They're like, it's fine.

If your body is having a raging histamine response, it's also having a raging inflammatory response. So to me, anything that lowers that symptom response or lowers that internal inflammatory response is going to help out of root cause, essentially. So treating the symptom can treat the root cause too. It is not fixing the root root root of the MCAS, or anything like that. But if you are in a highly symptomatic state and that symptom state

makes you feel scared and then it creates a new symptom state, well, you are treating the root cause then because the root cause is nervous system disruption, which is very, very, very, very important in MCAS. What else are you doing with clients for MCAS? Oh my gosh. I mean, it really depends. So there are clients, by the way, who are like, oh, this is a gut issue. We have to do some gut work, basically. This is a leaky gut issue, honestly, and we have to do that. It's a lot of, finding those things that make people feel safe, better asymptomatic in the moment, and at the same time, exploring the root causes and exactly what's going on with them. So, I mean, it's so varied.

It's such a combination. The plans that we make for clients are like 20 pages long. There's no MCAS client that the same thing is true for either of them. A lot of them, I have to be honest, I go way into the nervous system side of things. and a lot of it is like rerouting your internal responses when you're having a flare and then immediately kind of jumping on whatever the flare is. So some of my MCAS clients, they have symptoms that are purely anxiety. Like that's just, it's all in their head, like not made up in their head, but their symptoms

are very, very mind focused. I have some MCCAST clients who dizziness, nausea, and vomiting are their symptoms. So we're treating the symptoms. It really depends on what the symptom is. we're always targeting histamines if that's the issue, and we're targeting the nervous system first, and then while we're getting them to a cooler, less symptomatic state, then we're going in and finding out what's driving this in the first place.

But if what's driving it is like COVID, we can't get rid of, like we all had. COVID would never drive something chronically. COVID drives you into a weird body state like MCAS, and then MCAS perpetuates itself. COVID itself is not long COVID. So the reason people are chronically sick from COVID, is a different condition than COVID itself. It's a condition unto itself, basically.

It's that the body is or was in a symptomatic state because of some real damage from this virus, because of some immune activation, and then the immune activation and the nervous system activation stays perpetuating. So you can't really have long COVID without something that keeps it going. In your practice, what do you usually see is like that differentiating factor that starts this cycle and starts.

to perpetuating. You know, it's interesting. I had a client who's actually a friend as well. She was someone who had never been chronically ill. So when she got long COVID, she was so scared and was like, Michelle, I'm so dizzy. I haven't slept in nights. I am freaking out. And it's interesting because a lot of my like people who have been really chronically ill when they got long COVID, they were like, yes, this stinks, but like, is it that much worse than my daily life? So it's almost like the people who got long COVID, there's two different types. The one who's been chronically ill is probably so exhausted and then they have new symptoms. Oh my gosh, I've been fighting Hashimoto's for years now. I have to do this whole new thing. Symptoms are completely different.

Yeah. So I think for them, they were burnt out and I think for people who have never been sick, they don't have that muscle of resilience because chronically ill people are the strongest people you'll ever meet in the entire world to live in pain every day and to keep rocking. They're like the coolest people in the world. That's why I love them as my clients. But for people who are newly sick, and that happened a lot with long COVID, they were like so shocked by how extreme and frightening the symptoms were that it actually created a worse nervous system response because they were like, what is this? Like, you're not someone who, I say in the best way possible, like, it is a good thing. You're not chronically ill, right? Like if you woke up one morning and you literally felt like every time you stepped out of bad, your heart rate was so high that you were so dizzy that you were fainting or blacking out and you felt like you couldn't eat anything without.

having like anaphylaxis, you would be really freaked out. Like, it would be really scary. But for me, I'd be like, this is a pretty bad day. You know, it's the difference. Is there anything we can do if we get COVID to not get long COVID and not get this mastal activation syndrome? Definitely focusing on the mitochondria and definitely focusing on the nervous system and definitely immediately attacking histamines. That's what I would focus on. So like you would take, would you take Pepsid while you had COVID? Yeah. I have my client taking Pepsis. So the reason I even found out about the Pepsid antihistamine thing was because I was looking at COVID studies and I kept seeing Fomodidine, which is the chemical name for, you know, what Pepsid is. And I was like, what the heck are they using

Pepsid for? And there was one study that it showed that 14 out of 16 of the people had an 80% reduction in symptoms with Pepsid as the only intervention. And I was like, this is the craziest thing I've ever seen. I was like, what the heck is this acid reducing drug doing? And that's what really started me on my journey because I couldn't find any information on long COVID. I could not find any support anywhere. I was looking on Reddit, PubMed, anything, like anywhere I could look. Wait, wait. Give me your Michelle Shapiro COVID protocol, like specifically. Like, we don't want to get long COVID. We don't want to get this. We want to prevent it as much as possible. What are we doing? I do megadose vitamin D, 10,000 international units D3. I also am focused on, I would do like

Pepsid and Zyrtec at least one a day. I would probably do two to three Pepsit a day, to be honest with you. I'm taking NAC a lot of, like NAC, NAC, NAC, NAC. I'm taking L-Syne. I'm taking. a lot of that. Why? I'm having clients take a lot of that mitochondrial support too to make sure, because of this inflammatory response. A lot of clients, I'll use zinc. Also, one of the only situations I don't use elderberry anymore because that was proven to actually worsen COVID outcomes in some people. I will use a pretty decent dose of zinc too. If they can tolerate it or they have access, I may do a decent amount of vitamin C as well, a couple of grams. I wouldn't do like 15 grams because you'll probably get a histamine response from that. Someone's first

diagnosed COVID, that's the direction I'm going. Can all of this happen when you get sick from anything or is there something different about COVID? There's something different about COVID. It's the relationship with the mass cells basically. It's the EC2 receptors. Why are that? Like, what's up with that? I think it's lock. I think it's bad luck. I don't know. Some people say it's engineering. I'm kidding. It's definitely not. But I think that it was really bad luck. And that's why you don't get lung flu. You can get like mono symptoms, Epstein bar symptoms for a really long time. But this was like a different thing.

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And is that forever? No, it cannot be forever because you can't miss out on all those amazing foods forever. I literally have clients who can eat a tomato and end up in the hospital. I have clients who can have this much vinegar, a drop of vinegar, and they have diarrhea for six weeks. I mean, I'm absolutely not exaggerating when I say that. Like this is, it is drastic these symptoms. So I would say if that's the case, it might be worth it to, in the short term, cut some of those foods out. But the low histamine diet isn't enough because histamine from food is not the only trigger for MCAS.

So, yes, it's a part of it. It's not the main thing. You have to eliminate basically what is causing your mass cells to activate so much. And then you can also facilitate your body getting rid of histamines as well. There's some supplements like you can take diamine. mean oxidates, a Dow enzyme. It's an enzyme that helps with the liver breakdown of histamines to get them moving out of the body. You can optimize drainage, like doing the, you know, the nice things like lymphatic drainage, dry brushing, those like really top of the pyramid,

nice things. Bottom of the pyramid lymphatic drainage would be like real practitioners doing it. That is real as anything. But us doing like little stuff at home, it's like that can help a little bit. So you can help to get the histamines out of the body as well. That will help. But ultimately, you're trying to break this cycle of this nervous system response. Yes. Okay. And I also, as much as I've never seen a client with long COVID not have MCAS, I've never seen a client get better from MCAS without changing their mindset.

Never. So it is a necessity and I know people are like, I hate that and it's not fair. It just feels the hardest. Like it's much easier for me to like eat a food. Yes. Than it is to change my thoughts. Correct. It's not about changing your thoughts. It's about tolerating your thoughts and providing another option. I am not a naturally joyous person. I'm like a Jew from New York. We're not like, you know, like joyous kind of people. I'm a hypercritical of myself, not of other people and like intense kind of person. But I just channel that intense any other way. So what do I do? I'll listen to like, I won't back down by Tom Petty. And I'm like, all right, if I can't do this, Tom Petty had back issues for like 30 years and he was rocking on his guitar.

And that's what the song I won't back down is about. I was like, all right, if Tom Petty can do this, I'll listen to the song and try to do this. And I'm naturally curmudgeon. Like I am like that I know. But I have to like bring that side out of me in those moments where you're like, Michelle, you can't do this. It's like, well, Tom Petty can do it for me today. So access that, whatever it is. For other people, it might be listening to like Taylor Swift and something that just lights them up and gives them joy.

For me, it has to be like a rebellion thing. That's where you have to know you are language because I would never listen to something poppy and happy and feel like impacted by it. It wouldn't umph me. Like you know, you need that thing that you connect with that makes you, when you don't feel like you have the strength,

you can lean on another part of someone else maybe that can give you that perspective. And you had MCAS. Absolutely. I still do have it, but much really asymptomatic mostly, yeah. Okay. So is that what we're aspiring for?

Is it asymptomatic? Or are we saying, I'm free of MCAS at some point. I'm a person who lives in a highly sensitive body. So I've had weird histamine stuff since I was a kid that I didn't even understand. If I go on an airplane and then I don't move my body for weeks at a time, I know the consequences of that, right? If I went to a sauna for two hours, I'm going to have a histamine response. So I just know what my body is going to do.

And I know sometimes I can accept the consequences and sometimes I don't want to face the consequences. But I make that negotiation with myself, basically. So my body acts in a way that is different than other people. So I learn to accommodate my body and also challenge my body when I need to as well. And to summarize, essentially we're cutting out these histamine stimulators while we're calming our nervous system and then we can potentially add back in these histamine simulators. Can you give me a list of the main histamine stimulators? I know you've said some foods offhand.

Absolutely. I know sauna is like a thing. But like, yeah, can you? Heat is a big one. And especially because, so one of the major actions of histamines, that we have to mention is that it causes something called vasodilation, which is the widening of our blood vessels. Is this the relation to pots?

This is ding, ding, ding. That's why she's Liz Moody, ladies and gentlemen, exactly. Yes, this is one of the main, and the nervous system would be the other one. One of the main reasons why MCAS is related to pots is because of these opening of these blood vessels. So people see this like they're standing in a shower, essentially, and then they look down, they're dizzy, they look down, their legs are really red, and their heart starts pounding, basically.

What happens is if your blood vessels are wide open, which histamines cause this so that immune cells can get places almost like a slide, really open, right? Can kind of get places they need to go. People will be standing in the shower and their blood will drop to their feet. And then because your blood vessels are wide open, you don't have that blood pumping and that constriction that you need to get blood flow back up. So then what does your heart do? Freaks out. Oh, my God, give me blood, right? And that's where the heartbeat, the fast heartbeat's coming from.

Most people think this is a cardiac thing. Oh, God. No, that's, that scare you? No, this whole thing is sounds awful. It's so, I can't even tell you how awful it is. So most people think it's a cardiac thing? Most people think, what do you think? Your heart's pounding out of your chest and you're dizzy?

You want to go to the hospital immediately, which, by the way, again, never restricting anyone. Please go wherever you need to go. But point being, yes, people can feel that a hundred times a day, Liz, with pots. Yeah, pots is brutal, I will say. I hate pots a little bit more than MCAS, but. Are you treating that in the same way? A little different. So when we're working with pots besides the nervous system, because it's a nervous system condition, you have to start at the brain.

With pots, you kind of want to make your body, like I call it a gogert tube. So you wear compression. And you see a lot online about compression, but you'll wear compression around your abdomen. Imagine you squeeze your abdomen, the blood flow can push up then, right? So it's like you're almost creating constriction where your blood vessels are not naturally appropriately constricting, basically. And then they'll wear compression socks and the recommendation for pots is also to enhance vaso-constriction. is to have up to 10 grams of sodium per day. For instance, we all like element, right?

The element-tee electrolyte. Those are one gram of salt per day. Oh, wow. Ten elements? Ten elements a day. Wow. Because you're trying to clean throughout the entire day. Right.

And you're like slowly. Yeah, I sprinkle it in all my water. Yeah. So it's a drastic recommendation to help with basically enhancing blood volume, which will help with blood flow as well so that the blood can get to where it needs to go. So if I have clients who are like MCAS and Pots clients or long COVID, M-CAS and POTs, but then they're having a POTS day. So I'm like, great, throw your legs up on the wall. It really depends on the person and what their symptom is.

Like there are some days where I'm like, oh, I just walked outside and it's like really, I'm having seasonal allergy type symptoms. All right, it's a histamine issue that I'm having. But that's how minute we have to get with ourselves. It's like, what is this a blood flow thing? Is this a pain thing? And we have to see where the symptoms are coming from. Like I can tell my clients are in like a Hashimoto's flare versus an MCAS flare because the symptoms look so different and we can draw where it's coming from. So it takes like intense self-investigation, basically.

Is there anything that you feel like we haven't covered about MCAS, about this rise in chronic conditions, about long COVID that you want to make sure that we mentioned to people here? Yeah. So the just last piece in that triad, MCAS pots and hypermobility. So hypermobility, which like, you know, like people think of it as like you hyper extend. Oh, yeah, you're a little hypermoral. I didn't know. I love that about us. Yes, I have hereditary Ellers-Danlo syndrome.

So Ellers-Danlo syndrome is a collection of genetic connective tissue disorders that people think of as hypermobility. But hypermobility is a connective tissue disorder, especially in Ellers-Danlos. So connective tissue lines are joints, our bones, our organs, our blood vessels. and is essential in those things. So if you have an inability to build that, that's what makes your body bendy. You don't have that, like, structural support, basically. There is a huge connection between MCAS.

Remember, our mass cells live in our connective tissue. So there's that relationship there. So I was noticing during my histamine problems that, like, I was bendier. My neck was having huge problems. My favorite thing to talk about is that there's a common type of hypermobility area, which is our neck, which cause it's something called upper cervical instability, UCI, we call it. So these nerves in your

neck also control your heart rate, right? If Potts is a nerve disorder and from the dysfunction of our autonomic nervous system, our neck is like rich in nerves. Our vagus nerve, we talk about it all the time, right? So the problem is that if you have damage or your ligaments are loose here, it can actually affect your heart pounding and things like that. So that's what I think people aren't getting of how these things are connected, because if you are in the chronic illness, TikTok or Instagram, you'll come across this triad of MCAS, pots, and hypermobility. But it's because connective tissue and the nervous system influence all three of them, basically. We talked at the beginning about what the wellness world is getting wrong. What would you say to somebody who's like,

this stuff's all fake, especially stuff without concrete, like people like blood tests, people like diagnoses, there's been this huge uptick of the stuff and people, all of a sudden, the person who's already, like, you've been watching them limit their gluten forever. And now they're like, oh, I can't eat tomatoes. Tomatoes make me, like, I'm on this antihistamine diet. There's a lot of pushback of like, is this stuff in people's head? Is the focus on it making it worse? What would you say to those people? So the first thing I would say is let's never identify who we are by what our body's experiencing. I almost like saying like, yeah, I have a weird blood flow thing. Like, I don't know. I'll say that to people instead.

I don't like to say I am MCAS and I am Pots. Like, no, this is like the way my body's doing stuff is the way I would view it. So I think a big problem online is over identification with illness. I think that leaves us in a chronically sick state, which is very Western medicine, by the way, to be like, you have MCAS, see ya, like now you have it forever. So that doesn't help either. There's kind of an in-between. I would say if people are like, is this fake? I mean, is it?

Or like, are you guys just sensitive? to like, like, what's the next thing almost? You know what I mean? I think the conversation is changing because now a lot of people are experiencing the symptoms and people like, is this what you guys have experienced this whole time? But is there almost a way? I'm wondering if there's a way to like solicit that empathy

without somebody having to go through it as well. I would never explain the science to people. I would just set boundaries, right? So like my friends, my best friends especially know me, don't invite me to a dinner at 8 p.m. It's so funny, Liz, we were talking about we're going to a show. We're going to dinner at five. Exactly.

And we're going to dinner at five. I'm like, Liz, I would greatly prefer to go to a five o'clock show. I can go to eight o'clock dinner. I'm just not going to eat. Like, it's just my digestion is not doing it at that time. But that's where the ownership of who you are. And that's why you have to know what works for you and what isn't. I am so unafraid to say to someone what I need and people have to do that.

But don't start explaining the science of it because it is overwhelming to be like, well, the mass cells or the white blood cells. Don't go in that direction. It's almost like the no is a full sentence. like I don't eat dinner after 6 p.m. It's a whole sentence. Yeah, exactly. Find out what's your thing. That's what I would say.

Your thing is not a medical condition. Just find out like, again, I use the beach as an example. Like, it's impossible for me to understand that other people like the beach. I can't believe. I hate the beach. I get so much flack for this opinion. I hate the beach. It's hot.

It's sticky. It's sandy. If you are too hot, you go in the ocean, which makes you stickier and sandier. There's like creatures. I mean, it's unbelievable. Go to the pool. The pool is a wonderful place where we've solved every single. problem of the beach. Go to the pool. Exactly how I feel. Yeah. And also like for people with

blood flowy issues and stuff, it's a wide open space. The visual fields very wide. People can feel very dizzy at the beach. It's disorienting. So I'm just like, it's like if I'm going to the beach, I'm going to get an Airbnb that's on the beach and I'll walk outside for 15 minutes. You can look at it from the porch. Look at it. Exactly. But people know these things about me. And it's fine if it's a quirk or whatever it is because there's so many more important things about me. and I want people to really live in their authenticity. And it's like, this is what I need right now. Years ago, again, when I had a neck brace on,

I remember Mother's Day, because Mother's Day is coming up. I went to meet my mother-in-law and my mom at a restaurant. And my heart rate was 160 sitting down. I was so sick and I was like, all right, guys, this is the deal. I need to get up and do weird stretches every five minutes and like, are you happy I'm here because this is what I need to do? Now I could sit, we're going to go to this Broadway show and dinner. I will have the most delightful evening of my life.

there's no problem, but know where you're at and don't judge yourself for being at that point either. Yeah. And then if anyone has anything to say, don't start justifying the science because people do not empathize with science and they'll immediately, you see their eyes going. They're completely lost in it. I will also say every time I've given people the opportunity to be there for me, like I've gone to restaurants and needed to leave because I start having a panic attack or something like that.

And it's something that I would have been so embarrassed about. I would have made up an excuse in my past life and just been like, oh, I got to go, whatever. And I've started being like, I feel like I'm having a panic attack. I need to remove myself from the situation. And people universally, I have not had a single negative experience with it, whether it's with a waiter who has never met me before in their life or whether it's with the person that I'm dining with, anything like that. Like, I would say give people the opportunity to be there for you because I don't think we do that as much as we could. And it's good for them. Like, they enjoy, people enjoy being there for other people. And it's good for us to receive that. A hundred percent. I love

panic attacks as a word, by the way, and also talking about that. But I love it as a word, because it's a more universal experience. It's harder to say, yeah. But I do think you can still say, like, I am feeling this way. This is my need right now. And give people the opportunity to be there for you. Absolutely. And I think they really will want to be. And then you're also, be as vulnerable as you want or as not vulnerable as you want. But you're right. Give people the chance. But don't start by explain. Don't start by justifying or explaining the science. It really doesn't work. It just doesn't, it's not effective. It doesn't work for people. Can Botox trigger mass cell activation syndrome? Yes, it absolutely can. Injections, any foreign bodies that your body says,

what the heck is this? It absolutely can. And I definitely know of many people who Botox, and you know, it's interesting, not even filler, but the dissolving a filler, because then there's like particles that can travel to other places in your lymph, that can be so triggering for MCAS. So anything that your body is like, what do you got there? That can trigger it. So I have seen that a lot. And again, even new skin care products can. Anything that is totally foreign that we're putting in our bodies, because a lot of these, especially like gut supplements, for instance, the point is to trigger an immune response. But we don't want to always activate our immune systems. Yeah, we'll have to have you back on for a longer lecture like you gave me about why I shouldn't get Botox. Yeah, or why I forbid you from it.

It was just, it was just like, it was just like, you were just like, It's a privilege to age. Like, it is a privilege to age. And why wouldn't you want your face to move in the way that your face wants to move? Especially because you are in the career of, like, facial expressions and empathy. And it is, like, you are. But aren't we all if the career is life and life is about relationships? Are we not all in the world?

Like, facial expressions and empathy is why we're here on this planet in some ways. I mean, I think it's the whole bit. I think human connection and feeling connected to other people is literally our whole thing. I don't, I think there is no. know there's like the lay miss quote to love another person is to see the face of God. I think like the whole thing is love. So yeah, I do think the whole thing is love though. I agree with you. So yes, anything that would limit your ability to feel connected to someone else could also put you in a state of unsafe and to not feel understood. And you think Botox is doing

that? A little bit. I don't know. I don't think Botox again is the rudiest of root causes. It's probably at the top of my pyramid of concerns. Like if your buckets are already full. Correct. But if your buckets are empty, that could tip your bucket. But if you feel like you your bucket's full and you feel like you're getting Botox and it's not an issue, would you be like, no, first of all, I have no judgment. Like, I also understand like people are like actors. Yeah, like people like need to look a certain way and accommodating a society makes sense to me and can actually make someone feel more safe to accommodate society. Oh my God.

It's so much to weigh and balance. 100%. So I've zero judgment, but absolutely do I think that it can cause systemic effects, even though it's localized. 100%. Yeah. Can you leave us with one homework assignment for somebody who's been listening to this and suspects they might have. Mass Cell Activation Syndrome and just like wants to know where do I even start with all this. You must start a flare tracker. You have to start a flare tracker. You have to say, what did I do?

What did I eat? What did I experience? How did I feel? Rate that on a scale of one to 10. 10 is I'm close to the ER or I'm in the ER. One is I feel amazing, basically. Start to get to know your symptoms and start to understand the language that your body speaks with you. We have to get to know our bodies, basically. In addition to that, I would just have a stream of consciousness of thoughts. Just to start exposing and acknowledging the thoughts that are coming up, just start writing down the thoughts that you have in your head, start writing down your symptoms, but really, like, get to know that language and get to know what you are reacting to. It's not a perfect science, because sometimes you can react to something 12 hours later or three days later, but you can

pick up on trends really easily when you do that. So, and then I would say for medical appointments, bring that timeline of your health into that medical appointment. Even if they will not accept that document from you, talk through it really quick because then, you know, start to memorize it and talk through it really quick. And would that be the same homework assignment for somebody who has long COVID because of the relationship there? Yeah, I think long COVID be really clear about what your symptoms are. And anyone with long COVID, it's like, again, I'm asking the people who are in the most pain to do the hardest work. And, I'm not silly enough to think that I don't know, you know, I know what I'm asking basically,

but I'm asking you to understand the language with what you're speaking to yourself too. So the homework assignment is like really hone in on what that conversation is like. If you're like, oh my God, these symptoms are so bad, which is normal. It's all normal. Really, really zone in on that and just acknowledge it. Don't try to change the conversation. Just acknowledge it. And then if you're going to the doctor, I would bring up mass solitivation syndrome.

I would bring that up with a doctor, and the doctors I would be seeing for long COVID are usually immunologists. That's who I would be seeing, like allergists. And then for autoimmune conditions, the last kind of class of chronic disease that we talked about in this episode, is there any homework assignment that you would give or way you would think about or approach that differently than you typically see people doing it? I think it's pretty clear online what like the deal is with the root causes of autoimmunity. I think that everyone, all functional medicine doctors agree, many of whom have been in your podcast, obviously. If you went on their pages, they would all say the same thing. Sleep, stress, nutrient deficiencies, mold, environmental exposures. I would start to kind of like write out what you're, I think start with the timeline,

which is what, by the way, all functional medicine and all functional nutrition practitioners should be doing what we call like a functional medicine timeline with you. That's like a requirement that every single one should be doing that, but you can do it with yourself too. Again, with autoimmunity, start to look at the story where you want a tremendous amount of antibiotics as a kid that caused gut damage or something like that, start to write that story for yourself and be prepared in those appointments with that story, essentially, and with where your symptoms are now. So a little bit different in that I think the root causes are a little more clearly defined with autoimmunity, like things that caused inflammation, things that caused, you know,

sleep disruption, trauma, like there's a little bit more clear of that. I would kind of write down in those categories, what do we think happened, potentially? And then you have a lot of resources for people going through these things. Do you want to take a second and talk about some of those? Absolutely. So I'm currently on a break on my podcast, but I do have a podcast with many episodes about this called The Quiet the Diet podcast. I also created a resource center, which is an information center called the highly sensitive body hub. When I was the sickest, I ever was in my life, I was looking online for information about MCAS, POTS, long COVID, and hypermobility. And I could only go to Reddit. There was nowhere else for information for me, because how do you type in, I feel weird on day

nine of my cycle? Why dizzy when shower? Like, it's, nothing comes up. There's no answers, basically. So I create an information center with 14 other practitioners where it's everything about these conditions, basically, and every solution, supplements, herbal approaches, nutrition, meditations, movement, everything like that. And then I have a practice with four other practitioners. There's five of us total, and we all see clients one-on-one. You've dealt with these things. You've dealt with thousands of clients who've dealt with these things. Can you just end us with speaking directly to these people and saying what you wish somebody had said to you? Yes.

So I'm going to use a Harry Potter reference. So in Harry Potter and the prisoner of Ascaband, there's like a scene, especially if we think about the movie, where Harry thinks that his father is going to come back, spoiler alert, and use a patroness to save him. And he's dying actively from Dementors. And then Hermione says, like, nobody's coming, Harry. Nobody's coming. And Harry's like, no, he's coming. Just wait.

And basically, Harry has to save himself. And he's like in the time forward position looking back and he has to save himself. So my answer to everyone is that it's not going to be a doctor. It's not going to be a dietitian who's going to be the hero in the story. It is going to be you. So if you are listening to this, you may not believe it because of what you've experienced, but you are the hero in the story and you can do this. There is no one who can't get themselves out of the hole.

And it could be the most tiny momentary switch in a mindset. It doesn't have to be laborious to change your mindset. You have to like be whimsical and take a chance. But if you are hearing this, you are the hero. There's no one else coming. It is you. But the cool thing is that it is you. And like to have you on your side is the greatest asset in the world.

So if you're listening to this, I'm 100% sure you can turn this around. I don't care how far someone has gone. There's always a chance. and there's always a path. We just can't see it. We always are stuck in one path and there's thousands in front of us. Thank you, Michelle.

Love you. Thank you. I know this episode was a lot, but I really wanted to pack it with as much information as possible. If you know somebody that it might help, please, please send them a link. And if you came here because somebody set you a link,

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