Season 8, Episode 8: Understanding Histamine Intolerance and MCAS with Michelle Shapiro

Evelyne Lambrecht: I am so excited to have you. We’re going to talk about so much. I have so many questions. So, let’s see how many we can get through before we kick it off. What’s lighting you up this week?

Michelle Shapiro: Oh, my goodness. You know, I think it’s like every week. But I am so happy that the weather just came down in New York because my steps have been very inhibited when it’s like a hundred degrees here. So, I’ve been revitalized because I can go get my steps in again because it’s when it’s just too hot, it’s not pleasant for me. So, I’m so excited and pumped that I can walk again.

Evelyne Lambrecht: I love that I noticed on your webinar that you said that you love walking. I love walking too, just long walks. I can walk for a day just because I love it. Magical. It is magical.

Before we continue, I’d love to share a little bit more about you. Michelle Shapiro is an integrative and functional registered dietitian in New York City who has helped over 1,000 clients reverse their anxiety, heal long-standing gut and immune issues, and approach their weight in a loving way. Michelle has a virtual practice of five nutritionists where she and her team work one-on-one towards these goals. She is the host of the Quiet the Diet podcast, where she helps listeners bridge the gap between body positivity and functional nutrition. She’s also the creator of the highly sensitive Body Hub and Information Center for MCAS, POTS, Hypermobility and Long Covid.

So, Michelle, I’d love to start with your personal story. What drew you to specialize, especially as a dietitian in anxiety and then MCAS?

Michelle Shapiro: Yeah, absolutely. So, I had these two healing crises in my life. One came with actually, my anxiety started after a really aggressive weight loss journey that I had gone on. So when I was 17 years old, I had lost 100 pounds in less than a year, which I really don’t recommend. I tremendously don’t recommend. And in the aftermath of that, after having lived always in a larger body and really having no health issues, it was actually after losing weight that I started to have severe and debilitating panic attacks, gut issues. You know, we always treat what we experience. I feel like, as practitioners, that’s very common.

And really the answers I was getting from doctors was, well, why don’t you lose five more pounds? That was their answer to my anxiety. Why don’t you take anxiety medication? I was like, my particular brand of anxiety is that I’m afraid of taking supplements and medication so that wasn’t even a solution for me.

So I really sat down and kind of wrote what I call my first battle plan. Now I make all my client plans. Battle plans. And I just wrote what do we know about anxiety in 2015, what do we know about anxiety? What? How can I target anxiety from a physical, spiritual mental? Any like exercise, supplements? And I just started reading every book on anxiety I could possibly get. And I started to create this plan for myself. How do I target it from all these angles? And I really, then just wanted to help people to also not lose weight in a way that was so aggressive and so put the body in such a state of imbalance and fear, like what just happened to my body and to prevent those like fallout and health and health consequences.

And as well, I wanted to help people with panic attacks. So then I launched my private practice, about 4 to 5 years ago. I ended up getting Covid after I had Covid. I also had a chiropractic injury. And the result of that and the culmination of that was basically like the sickest I ever was in my entire life. I could barely walk. I could barely stand without my heart rate going absolutely out of control high. It was the most frightening time in my life. And honestly, all of my best friends are functional medicine doctors, naturopathic physicians, and functional dietitians, and they just had no idea what was wrong with me. They’re like, why did you go to the chiropractor and leave with your heart rate at 160 while sitting? I don’t understand what happened.

No one really had these answers and no one could understand what happened to me. And so I was really going on Reddit, Evelyne. And I was like, why do I feel weird on day nine of my period and trying to get these answers and pull this information together? And that’s when I started to understand the broader context of this histamine conversation. I had hints, really, from not even my doctor friends, my dietitian friends. You need to look into a histamine issue. And that’s when I started to kind of go down this path. And then I started to put the pieces together of how these symptoms, these really drastic and frightening symptoms I was having were related to histamine in the first place.

And that was what liberated me, honestly, was that self-education. And so I’ve been on a ferocious mission to pull these pieces together for people since, because I really don’t ever want any of my clients to experience what I did. And if they do, I want to have that information available for them.

Evelyne Lambrecht: Well, thank you so much for sharing, and thank you for also sharing so generously online. Like I told you, I watched your almost three-hour webinar that you offered that was so helpful just for understanding. And I think even as a clinician, just to know what people are asking, what people are researching. And I actually think Reddit can be very helpful for that. Even more than Google, even more than chat, even Facebook groups to like to see what patients are struggling with.

So I want to back it up a little bit and start foundationally like what is histamine? What are mast cells, what do they do normally, and what goes wrong in mast cell activation syndrome?

Michelle Shapiro: Absolutely. So mast cells are a form of white blood cells. They’re part of our immune system. And their goal is to detect threats and then to send out these chemical messengers in response to the threats that we experience. These threats can be perceived, or they can be real threats. And our mast cells are, if you can kind of picture like a cell, there are receptors on the outside, something they attach to the receptors on the outside. And then they have these kind of sacs that are filled with granules. And they will release or degranulate up to 1200 chemical messengers when that happens.

Now in normal circumstances, that helps the robust immune response. It helps the nervous system response. It helps with a proper cardiovascular response. Anything your body would need in that time of threat. The issue is, and the reason why we’ve probably been talking about it so much in the past five years is certain triggers can continuously activate those mast cells, and if your mast cells are constantly being activated, or what we know is the syndrome of Mast Cell Activation Syndrome, you’re constantly releasing those mediators.

Now, again, we need these chemical mediators. They really help us to send signals to the body to do certain tasks that would really help us heal or address a threat. The problem is those mediators in excess cause their own symptoms. And that’s what Mast Cell Activation Syndrome looks like. And one of those chemical mediators is histamine. And we often talk the most about histamine because I think probably histamines is one of the ones that you can feel the most.

Everyone listening to this podcast has also heard of cytokines, prostaglandins, interleukins, other features of our immune system that we associate with inflammation generally. But the histamine driven symptoms are very costly from a symptom perspective. So oftentimes we hyper focus on histamines, but there are a lot of other things going on in mass cell activation syndrome as well.

Evelyne Lambrecht: Tell me a little bit more about how histamines affect different parts of the body. Like what are some of the subtle or overlooked signs that would lead someone to suspect histamine intolerance in a patient?

Michelle Shapiro: Absolutely. Yeah. So there’s no person who would have a racing heart and go to an allergist. Right? So the challenging part about histamines is that our mast cells are really in every single part of our body. Our mast cells line our connective tissue. Our connective tissue is a layer of tissue in our bones, joints and organs. We say that mast cells live in all the hollow spaces of our body. They are everywhere. So the symptoms that you can experience can come from any of those organs systems. The tragic part of histamine issues is that because the symptoms can come from anywhere, it’s really hard to know that they’re coming from histamines.

So one of the primary functions of histamines is to cause something called a vasodilation. Vasodilation is the widening of your blood vessels. So it kind of creates like a slide in the body. You open up those blood vessels if you want nutrients, if you want immune cells, if you want any kind of fighters to go out to a site of injury, opening up those blood vessels kind of creates that slide for things to go out.

Here’s the problem. And I’ll give a visual example for someone. Take a person who is in a shower and a lot of people listening and a lot of practitioners listening will say, oh, you know, my clients have experienced this before and I didn’t know what the heck was going on. And basically picture like a client who feels really dizzy in a shower, looks down and sees their legs are really red and then their heart starts pounding. So if our blood vessels are wide open, blood is going to drop down and not be pumped back up, because vasoconstriction will help to basically squeeze and pump, as a result, blood back up to the heart. So when the heart realizes I don’t have enough blood and the brain realizes I don’t have enough blood, the heart starts pounding rapidly to get the blood back up. The redness we see in the legs of someone who either has complex or histamine issues is actually blood literally pooling in their legs.

So histamine issues can look like cardiac issues. They don’t just look like allergies, like most people just think of them as being allergy related. Histamine issues relate to our pain tolerance and our experience of pain. They can increase bladder frequency, like urinary frequency, bladder pain, digestive issues. Again, the point of histamines is to keep us awake, alert, and responding to threat so that can influence the nervous system and muscle contractions as a result, because of this vasodilation, if you have blood pooling in the wrong place, again, this experience of dizziness, migraines, headaches, things like that, a lot of things that influence our brain.

And then, of course, the most and one of the most unfortunate things that because histamines have an alertness or a weakness sensation, insomnia, tremendous panic and anxiety are often very correlated. I have clients describe this experience of histamines. It’s like there’s almost like ants crawling under their skin. And it’s really hard to explain again, like because it’s related to heat intolerance and exercise intolerance, the more that people do things that are healthy for them, the more it can actually exacerbate this mast cell response. Because if you think about things that are healthy in life, we think about soreness, exercise, all of these things also in a positive way can instigate an immune response. So anything that instigates an immune response can instigate a histamine response. And that’s the really tricky part of working with all of this.

Again, if you had a pounding heart and were really dizzy, you would never go to an allergist office. I would tell you to go to the E.R. or cardiologist office. It’s all that histamine has so many vast effects on the immune system and the nervous system that the symptoms can show up in so many different ways.

Evelyne Lambrecht: Yeah. And I think, like you said, one of the most debilitating is the effect on the nervous system. I have some friends who’ve been through it. And just like that, anxiety is so visceral. And just not being able to sleep. So if somebody presents with insomnia, are you going down the list and thinking maybe it’s histamine, even if they don’t have other issues? Do you feel like some of the issues only present in isolation or is it usually a cluster of symptoms?

Michelle Shapiro: It’s really funny because we have a team of now there’s six of us total, five other practitioners on the team, and we have team meetings for every single client that comes to my practice, I meet with every single one of my practitioners, and we have like a really big three-hour meeting every week. And we just go through every client follow-ups, initials, and we just put the symptom survey up on the screen and it’s like, oh, that’s a histamine client. You kind of like see those patterns. So I really am very cautious to not just put everyone in a bucket because once you’ve seen one type of histamine issue, the symptoms can present completely different for every person. And I don’t assume that every person who comes into the practice has a histamine issue, even though of course, it’s more common after Covid. Because Covid is one of the things that actually attaches directly to mast cells on the receptor. So that is why we’ve been talking about this so much more recently, and why the rates of histamine issue have gone up so dramatically, I assume.

But I will say there’s clear patterns, and there are many root causes for insomnia, but there’s a specific type of either, like a hyper adrenergic response that can happen from POTS or a specific type of insomnia that we see with histamine issues. And one of the telltale signs I’ll have for insomnia is, are you not able to treat insomnia with other supplements or medications?

And I often talk about this client I had who was on psychiatric medications, one of my favorite clients of all time. And she herself, actually the psychologist. She’s unbelievable. Was on these psych medication for sleep or for depression, anything. They could maybe take the edge off. She was wide awake. I mean, it was like 21 days straight that she had slept two hours. We were in hallucination, paranoia, severely out of character. And for some reason, I just, this was a really long time ago. This was probably five years ago. I was like, do you want to try an antihistamine and just see, like because the pattern of it and what she would react to and she would get some flushing in the middle of the night.

And she literally took Pepcid, which most people don’t realize is actually an antihistamine as well. We think of it only for its acid blocking properties. And she actually has not had one sleep issue since then. And I started to even put this histamine-Covid-insomnia connection together. I’d seen a study in hospitalized patients, and 14 out of 16 of them got 80% better on 80mg of Modafin and with long Covid symptoms.

And I just remember heavily trying to understand. I was like, what? They had acid reflux? What is the reason that this was helping them so much? And that’s what really prompted me into, again, understanding the connection between these things. So the answer is no, not every client has a histamine issue. But if you do have a histamine issue, it’s really, you have to address this means. There’s no other, she was taking trazodone and Ambien, and it didn’t touch her sleep.

Evelyne Lambrecht: That’s crazy and scary. I want to get back to the medications a little later on, but, how would somebody get diagnosed? And, like, are questionnaires? Like you said, you’re looking at symptoms. Are those enough? Do you look at different labs or do you feel like you have enough information just looking at them?

Michelle Shapiro: Oh, we love when people come in with actual diagnoses, but it’s tremendously hard to get diagnosed. And I’ve actually noticed a new trend where doctors are laughing at clients saying, oh, another histamine thing, because like, it’s like pop. I hope I’m to blame for that. I hope that they blame me for talking about histamine so damn much that their patients are coming to them like that. But I’ve seen that a lot with clients where they’re like, not everything’s a histamine issue and it’s not. But sometimes and a lot of times it really is a histamine issue. I think in 2020, the prevalence of MCAS was like 17% of the population.

Evelyne Lambrecht: Which is already super high.

Michelle Shapiro: Yeah. Yeah, exactly. It’s got to be a lot more now. So, there are lab tests you can do for me. I am not a diagnostician. I’m a dietitian. Just to be clear, I would never diagnose someone with a histamine issue. What I say is histamines might be a play here, so I would never diagnose. I’m not capable of it.

What an allergist can do is they can either run histamine levels in your blood, which is not that reliable, but they can. They can run urine histamine or urine triptans. The reason it’s not reliable is that histamines don’t live in your urine or your blood. They live in your connective tissues or the organs that they’re affecting. So it’s not like there’s a huge amount there, but sometimes my histamines were extremely high in serum, which helped because then I was like, okay, this is like a jackpot. Doesn’t always help.

What is a really gold standard way to diagnose MCAS is, if you’re getting an endoscopy or colonoscopy, just ask them to grab and biopsy a bit. You can biopsy the skin, and you can actually see mass cell presence using that. So that’s kind of our best way of diagnosing. It’s very rare that someone happens to have come to us and their doctor suspects MCAS, and they have an endoscopy scheduled. So it’s not that common. And you’re not going to just go get a skin biopsy, usually. But that is like the best possible way to diagnose. But again, you can measure for some of those chemical mediators in urine, or you can measure in the blood in the serum.

Evelyne Lambrecht: Interesting. So I would love for you to walk us through like a client story or two. You already share the insomnia one, but how you approach the case, I’d love to hear your thought process. How do you set expectations with people? And I assume by the time that they come to you, they already have been to multiple practitioners. Maybe they saw you and they said, okay, I know I have this, I’m going to go to Michelle. So she can get this figured out.

Michelle Shapiro: Totally. Yeah. So back in the day, as you know, Evelyne, because you’ve been in the functional medicine nutrition game for a long time. But functional medicine was the beacon of light for people who were failed by conventional medicine. It was like the place you go when you are failed by conventional medicine. The most frustrating thing about what’s happening right now is that the clients we see are those that have been failed by functional medicine and by failed by functional medicine. It’s not because the doctors don’t care or the dieticians don’t care. It’s because if you’re treating a histamine issue, the body reacts almost opposite of how a normal person’s body reacts.

So like for instance, if someone has a B vitamin deficiency, but they have a histamine issue, and you say, oh my gosh, maybe this is affecting liver detoxification. And that’s actually why they can’t detox. Maybe they need glutathione. Those can create such severe histamine responses that it’s like an unending Herks reaction basically. So people go to these practitioners, they throw them on mold detoxes. You can’t treat the root cause of histamine issues when you have a histamine problem. You have to treat the symptoms first, which is kind of antithetical to how we do functional medicine, right?

Even though comfort is always prioritized and symptom reduction is always prioritized. You really can’t touch the root cause probably for many months. And that’s because once histamines have been released, they can live in your bloodstream for three months. So you have to lower them for three months. You know, usually that’s the minimum it takes.

So if I have a client coming to me, what we can say is we will find a way to reduce symptoms. But I can’t guarantee we’re going to get through a mold detox in your first three months or anything like that. I can never guarantee we can even get to the root cause. But most people, once addressing the actual symptoms, some of those root causes either can correct themselves. And that’s not the case for mold and obviously many other root causes. Or you can gently start to address it. So that’s something that’s really important.

And then I also will say with clients, and we’re really transparent about this, that you have to address the nervous system. So I have clients who come in, and I can hear how reactive they are to symptoms, which by the way, Evelyne, if your heart is pounding out of your chest every time you stand up, and you’re fainting. Yeah. It’s pretty, it’s scary as anything like, I understand why people are reactive. So a lot of the work that we do is also like the mindset around healing, because our nervous system and our immune system are so interconnected and intertwined that anything that influences the immune response is going to trigger the nervous system and the nervous system back.

So what ends up happening is then you have limbic system involvement as well. The brain in MCAS also gets into a vicious cycle of fear. And that fear cycle creates very tangible physical symptoms. So we’re really hard on our clients about that. And it’s really unfair because I’m like, you’re going to have to be tougher than anyone else. It’s not even normal to have these symptoms. And to be as nonreactive as you can to them. So we might say to clients that you have to go through the DNRS, primal trust or group to program while you’re working with us. But we also want clients to be really open with symptoms and for us to find the root cause and everything, but we’re not going to target the root cause in the beginning.

We’re going to do two things. We’re going to lower histamines, and we’re going to address the nervous system that has to be done first. So we’re really not like the fun ones. Like, I feel like you can go to a lot of fun practitioners who are like, all right, we’re going to clean you out and detox. And I’m like, no, we’re going to do really painfully slow work. But your symptoms will come down. That is something that I feel very confident is that we can get people symptoms down using those tools.

So every client process is different. Sometimes I have clients who are extremely resistant to any antihistamine medications as well, which I mean, as a functional dietitian. Was it my dream to be like, you should take Zyrtec? Like, no, I didn’t want to be like recommending over-the-counter medications. That wasn’t my dream in this job. But if it causes such a reduction in symptoms that people are sleeping again, or people are like able to go to their jobs again or something like that, it’s well worth it. So that’s another piece of the conversation too. And that’s within dietitian scope. We may recommend over-the-counter medications as a part of our process. So it looks really different from person to person. But those themes are always going to be the same.

Evelyne Lambrecht: I think it is such a paradigm shift from how we work in functional medicine, which is always like try to go upstream, try to find the root cause. Though at the same time, I think a lot of people do start with some simple symptom reduction, though I think it’s very different in histamine. It’s more complicated. And then the nervous system piece. I have a lot of follow-up questions. I’m trying to figure out where to even start.

So talk to me about vagus nerve training versus limbic system retraining. And you mentioned three programs there. But you did it very quickly. So can you share what those are?

Michelle Shapiro: Yes, absolutely. So the DNRS, Primal Trust and the Gupta program, I have a preference for the Gupta program only because I’ve been through it, but I don’t. It’s a bias. That’s not fair because I haven’t been through the extent of the other two programs. But these are specifically limbic system retraining program. So our limbic system is, three brain structures that communicate with each other our amygdala, our hippocampus and our hypothalamus. And basically they’re going to be involved in memory, threat and how we respond. And the biggest problem with, again, MCAS, POTS, Long Covid and even hypermobility symptoms is that they are so frightening and so unexplainable that we then have this huge nervous system and limbic system response to it. So the brain remembers, oh, when I ate a tomato, I was sick for a week. I’m scared now that that symptom is going to happen. What do I do? So it makes us retreat and retreat and retreat and be so fearful of our own bodies that our lives become so limited on top of the fact that we are having very real reactions.

But the in these limbic system retraining programs, which it’s fascinating, like if you go on any of their websites, they’ll say we treat chronic fatigue syndrome, we treat MCAS, we treat POTS. Well. You would never think again, you have an allergy problem. You’re going to go do a brain retraining program? But the nervous system in the limbic system are so related to the symptoms that we’re having. And also just the knowledge of this is so essential for clients. But the typical approaches to, you can’t vagus nerve trick your way out of unsafety. It’s what I would say because your brain is feeling unsafe. Because it is. So while I do love cold ice on the face and humming and gargling like we’re talking about severe symptoms, and you can’t tell you can’t tell a body that’s unsafe, that it’s safe through doing little activities like that. So I do appreciate vagus nerve work. We do a lot of it in our practice. And those activities especially, and really it will come down to the vagus nerve because the vagus nerve is very related to all the symptoms that we’re talking about as well, the gut symptoms, the cardiovascular symptoms, and certainly the reason that I was so injured in my chiropractic appointment was because my neck was tampered with. And those are those gorgeous nerve endings all here, that were affected, that affect your heart, including the vagus nerve.

So certainly those things are productive. But if your brain literally thinks you’re going to die, gargling a little bit of salt water is not going to give you the information and reassurance that you need. So while those things are important, and I have so many people commenting on my page like people don’t have MCAS, they just have gut health and vagus nerve problems.

And I’m like, you’re talking about like real people, like it’s not what are you going to do, tell someone to, like, put ice on their neck? It’s not this isn’t, even though I do, I recommend that quite a bit, actually. But there has to be a more cellular and biological way to instruct the brain that is safe. And that is what those programs do. And to put us in a state of non-reaction when the symptoms happen to crack into that neuroendocrine immune cycle.

Evelyne Lambrecht: I actually have a question. It’s two questions that go hand in hand from a practitioner of mine who actually works a lot with MCAS. But she said one thing that’s still a mystery to me is how to repair the HP axis when there is still so much or too much shock, quote unquote, in the system from so many insults in terms of toxicity. Yes, I know, limbic retraining, etc. but still.

And the second question that goes along with that is, how can we get people to be in touch with their bodies, but not overly in touch with their bodies and riding that fine line.

Michelle Shapiro: The HPA axis piece. So, it’s so interesting. It’s like it’s like I want to answer it in a different way. It’s a great question. And when she says the HPA axis affected by toxic injury, does she mean like, literal toxins?

Evelyne Lambrecht: Yes, she means like mold, Lyme.

Michelle Shapiro: Environmental toxins and things like that? Some of the symptoms from molds are these like systemic, sneaky, insidious kind of symptoms. And then a lot of the symptoms from mold are histamine symptoms, to be honest with you. And same as in chronic inflammatory response I think that the is like I think a lot of the symptoms are from histamines too. So I still would address the histamines.

Now this is the cool part of addressing histamines is that when you address them, you also address a little bit of the systemic inflammation that’s happening, not in the way of addressing the toxicants, or toxins, but in ways of the body produces more histamines in the presence of histamines, which is a very silly thing of the body. By the way, please stop doing that if I like, if I could ask you to not do that, that’d be awesome.

So if you’re not experiencing them, and if your nervous system is more calm because you’re not experiencing them, because remember, if you’re like this, your nervous system is not going to be calm no matter what you tell your nervous system.

So I would say my answer is still the same because you don’t feel high cortisol. Maybe it’ll wake you up in the middle of the night, but you feel histamines. Very presently. So I would say still addressing the histamines, addressing the nervous system. Anything that can bring the body down. Well then obviously the HP axis is a feedback loop. So it will still impact in a same positive way.

And then you remind me if you start saying the second question, I’ll remember

Evelyne Lambrecht: Riding the line between being in touch with our bodies versus too much.

Michelle Shapiro: Clients so astutely said this on application form yesterday was like, I’m working with a therapist to not care about my symptoms so much. And I’m like, I love that. We also need to know your symptoms because we need to know where they’re coming from. But that is so critical. So it’s what we really want clients to do is become conscious observers to their symptoms instead of engaging with them or noticing them. And oh my gosh, is that hard, right? My heart is pounding. I’m dizzy, I noticed I’m dizzy. I hate that that’s what I will say that out loud to myself. Like, hey, I noticed this feels terrible. I really don’t like it, but noticing the symptoms and reporting them really helps because then you can start to track. Well, you know what? My dizziness was a ten last month at the end of my period. Now it’s only an eight, so in that way it’s good.

But getting hyper fixated or nervous or scared of the symptoms is what we want to avoid. Awareness and consciously observing without reacting or, like intimating their importance because symptoms are not really that important. It’s funny. And I mean, we hate them and they’re so uncomfortable. And I wish none of my clients ever had any symptoms again. I wish all of us didn’t, of course, but they’re really just laying a roadmap for us of what is going on in the body and what the body is trying to communicate with us. So we use them as tools. And the way that we do that, as we bring awareness, consciously observe them and become as nonreactive to them as possible, that’s very difficult.

Evelyne Lambrecht: That’s like it’s so hard.

Michelle Shapiro: I have a personal anecdote that I like to share with clients too, and would like to share with you. Is that at the peak of like my worst moment in my health, I literally was in a neck brace all the time because basically I’m hypermobile and the chiropractor took this tool and any chiropractor listening was like, I know what tool it was. I always forget the name of it, but it’s like this metal thing and was like digging it into my neck, not knowing that I was hypermobile just kind of loosening all the joints there that stabilize the neck. So I walked out with my neck like this. I could not hold my neck up, and I literally I didn’t walk, I crawled to the E.R., I on the cement. I was like, I have my sister in my ear. And she was like, you got to go one more block because no one was around at all. I couldn’t stand up because if I stood up, I was basically almost fainting. And I left and it was like two blocks away. And I was like, all right, I’m going straight to the ER because I was like, this is a mess.

And that was when I learned that I had POTS, was that first time. So and I said to them, I just want you to know, if my heart rate is higher, my blood pressure is high. I have chronically low heart rate and blood pressure. Know that this is atypical. Do not like, tell me I need to have high blood pressure or something like. And so I was communicating that. But during that time it took me about six months before I could walk around the block again. I was seeing clients propped my back up against the wall in a neck brace, and they were like, you look terrible. I’m like, I know, but the only way I could see you do you want to reschedule?

And they’re like, no, let’s do the session. But I’m like, all right, just know, I can’t move my head. And anytime I would move my head, I would get so dizzy. And I just remember one time, I have a bathroom in my office. And I had to literally like, lift myself up on this chair using my arms because if my feet touch the floor, my heart rate would go crazy. And I wheeled myself to the bathroom and then got on the floor, crawled to the toilet like it was. It was brutal. And, I just I got up at some point and I was, I looked in the mirror like holding on to the sink, and I was like Michelle, I just don’t think you’re going to make it through this. Like I can’t, I can’t see it.

And then like, something else inside of me was like, you can never say that sentence again in the rest of your life, because if you say it’s done, it is done. You just can’t afford to talk like that. And it’s so human to feel like that. That’s why would I think I would get better.

But that’s the biggest thing with clients is that it’s so corny, but you have to find that like animal dog in you and just find that way to believe for some reason, somewhere that you’re going to heal, because that is the only message that your brain is getting. And it is so toxic in this situation, like potently toxic to think negatively, which is so human. But you have to not, you can’t afford even for a minute to think like that. And then that was like the lowest of low. And I just was like, you’re done. You’re not allowed to say that ever again. And I just cut myself off from it. Basically, I was like, you can’t.

Evelyne Lambrecht: Wow. And look at you now.

Michelle Shapiro: Yeah, I mean, look at me. Notice me walking 5,000 steps.

Evelyne Lambrecht: Exactly. That’s amazing. And it really just shows the power of recovery and that we can get better and that patients and clients can get better. And I do want to go back to the chiropractor thing, because we do have chiros who listen, we love our chiropractors.

Michelle Shapiro: Yes, I was the person who healed me was a hypermobile specific chiropractor. So Taylor Goldberg shout out, I mean, I love chiropractors, it’s just that they didn’t assess me for hypermobility.

Evelyne Lambrecht: Yeah. And I think that. Yeah, just I wanted to point that out because that is so important. So you shared your view on antihistamines and you got into this a little bit, but I want to dive into a little bit deeper. So I would love to talk through kind of like the risk benefit analysis, especially around cognitive side effects. Because that’s what I hear from some people when we talk about this. Right. Like they ask me like, what supplements do you have for this? And so lately, just based on things I’ve heard, I will say something like, maybe they need a histamine medication. And then it’s like, well, no, I, you know, ran a gut test and we just need to like, address the root cause stuff.

And I think that people can get better. But do you think it maybe depends on how severe somebody case is?

Michelle Shapiro: I’ve never met someone with even moderate histamine issues who did not need at least an aggressive antihistamine supplement protocol. But most clients can’t tolerate histamine supplements in the beginning, some clients do not tolerate medication, by the way, that I want to make that clear. So yeah, the benefits and the risks and the cognitive issues. So when it comes to one specific type of unison and when it comes which has the defenhydrazine, I think it’s called, you can cut that out if I’m wrong by that. Or you can leave it on and even keep me saying that. Okay. And then Benadryl, both of those have been well studied to cause cognitive decline and are, hugely problematic. Less so are the H1 drugs and H2 Pepcid being an H2 drug and H1 being Zyrtec, Claritin, Allegra.

My question is what’s the cognitive consequence of having unchecked inflammation and histamines, causing severe brain fog and severe damage to the nervous system? What’s the consequence of that? If you don’t address that too. So the question is, and what’s the consequence of someone living with such severe symptoms that they can’t walk, that they can’t drink water they can’t get up to drink water and eat food regularly? What is the cost benefit analysis? Because you have to take all those into account, too.

We use antihistamines in our practice all the time. Some people don’t tolerate them. It’s probably like one in 100 don’t tolerate the over the counter ones. But if they don’t, we use other tools. It’s just harder. But there is no person who if you have a histamine issue, it’s not going to show up on a GI map. It’s not going to show up on a gut test. So it’s like, yes, there’s some histamine forming bacteria that can show up, but it doesn’t, it’ll never give you the full scope of the person experiencing them.

So I would say I’m very supportive of any pathway a practitioner takes as long as they address histamines, and you have to address them. So again, Evelyne it wasn’t like my dream. I personally hate over-the-counter medications, by the way. I’m like the person who it took me like months and I had this amazing, naturopathic physician who did catch a histamine issue and I didn’t even know, like I had to learn it myself before I was like, oh yeah, she said that. She said, you need to take three at a time. So if it’s two Zyrtec, one Pepcid, or one, two Pepcid or something like that, you have to take three for three months. She’s like, that’s the deal. She’s like, if you want to lower histamines enough, that’s what you have to do. And for me, that was the magic number.

It’s not often that I need clients to take that much, but we have to leave that as a tool on the table. And from the cognitive perspective, the only ones that have been proven to, and I don’t want to say proven, but there have been really supportive studies that show that cognitive decline, maybe an unintended consequence are Benadryl and that one form of Unisom, not both forms of Unisom, because Unisom is also use in pregnancy regularly. That is not the form that they use. But not the others.

And you really have to think if you’re having a major histamine issue, your body’s in an extreme state of inflammation. What is the consequence of that? So it’s a nuanced answer. But yes versus other, I’m a true blue functional dietitian. I’m as holistic as they come. And I just can’t watch my clients suffer if we have tools that can help.

Evelyne Lambrecht: Absolutely. Let’s talk about supplements a bit. Do you also use like quote unquote natural antihistamines? And also I know you like using well, I call it DAO. You call it Dao.

Michelle Shapiro: Yes.

Evelyne Lambrecht: Yeah. Talk about that a little more.

Michelle Shapiro: We do often use DAO. We will use quercetin nettles. We use a lot of nettle leaf tea. Butter burr, resveratrol PA, really depending on the person again like, I would be more inclined to use PA with someone who presents with more joint pain. I would be more inclined to use someone who has more cardiac involved, like resveratrol, with some with more cardiac involvement.

It really depends on the person. And it’s also so important to really go. I mean, when I say go slow, I’ll use like one supplement at a time, unless someone’s been taking a lot of supplements already. And they’re pretty tolerant because it depends on the person. I’m very intolerant to supplements versus I have histamine clients who are very tolerant to supplements, but they can’t, but they’re reactive to food or they’re reactive to like I, I’ve never had like a rash or cold symptoms from histamine issues, but so I’m not as reactive to like environmental. But if they smell bleach they could be out of work for three days. So it really depends on the person.

But it’s really like I have MCAS, medical doctors who will literally say like one eighth of one supplement to start with. Like, that’s how slow to go, because the body is in this state of alert. Anything you try to change, if you try to detox at all, if you try to do anything that pushes the body in a different direction, you could actually have a paradoxical reaction as well. So it’s just really important to go very, very slow with these clients, use a lot of ginger. There’s like we use a tremendous, and varied, array of histamine approaches depending on their symptomology and what we know they react to, and we just go really slow.

Evelyne Lambrecht: And then you’re also using supplements supportively and carefully, right, to manage some of the other symptoms that are going on. Right, like the GI issues to support the nervous system, etc.?

Michelle Shapiro: Absolutely. Yeah. And again, like if someone does have a B vitamin deficiency and let’s say they have POTS, postural orthostatic tachycardia syndrome, which is very common and concurrent with castes commonly concurrent with MCAS. They may need more blood vessel support or let’s say they have a B12 deficiency. Well, I have to give them one B vitamin at a time to replenish B vitamins because there’s a little bit of a seesaw behavior that happens with B vitamins. So I might give them full-time in which is has actually been shown to be like an independent treatment for POTS as well. First I’ll give you B1, then we do B2 a month later. But we have to build up to it because just giving, again, something that’s going to push detox can be really challenging for people.

So yes, we also have to use supplements to correct the other things that are going on because yeah, if you have tremendously low B12, for instance, you could also have nerve responses, right? You could also have that shaking feeling extreme exhaustion. It can mimic the other things. But I actually I’ve had clients just do injections because they seem to be much better tolerated because they’re not passing through the gut. So it really depends on, again, the context of their overall health. So definitely. And we also use a lot of supplements to help bring down the nervous system in the beginning as well.

So it’ll be, that’s always phase one. And we really phase out our plans. Phase one’s going if you’re an MCAS client, it’s going to be how are we addressing histamines for you? How are we addressing the nervous system?

Evelyne Lambrecht: And I want to go back to the question I originally asked about your thought process through a plan. So you said, sometimes it can take like three months to actually lower those symptoms. And then are you potentially doing a mold detox or things like that with them?

Michelle Shapiro: Totally. Yeah. Well, whatever the root cause is. Yeah. If it’s parasites, if SIBO is also recurrent in an issue, it could really be anything. And yes, that’s where the full breadth of our functional medicine nutrition knowledge comes into play.

But it could be nutrient deficiencies and it could be other sources of inflammation. And it could be something where there’s sluggish bile and there could be so many other root causes. So absolutely. And we’ll try to address them if we can before the three months. But it’s not common.

What we will also address before then is any foundational lifestyle issues as well. So if it isn’t, you know, an exercise intolerance issue, can we get you if you can’t walk one block, can you walk a quarter of a walk? Can we start there? Can we just do calf raises in the morning? If it is a blood flow issue or are we taking our electrolytes? Are we eating regularly? If you can’t prepare meals for yourself, how are we getting you those meals? Because a lot of our clients are, you know, deeply sick. So they may not be able to you know, we have many bed bound clients, to start with. So they may not be able to get those meals. So it’s really about also like reducing that operational load.

And our battle plans. I just wrote the longest battle plan of all time. It was 21 pages, handwritten like not handwritten. I typed, but, I mean, I did not ChatGPT that thing that was like a, it was hard for I think it was like 40 hours or something.

Evelyne Lambrecht: Oh my gosh.

Michelle Shapiro: A really complicated client who came in with 250 pages of medical history. She is the most beautiful mother in the world who, like, if this girl went to the bathroom in 2012, her mom wrote it down like, like I could cry about their relationship. Like her mom is, I think, such a hero and she’s so amazing. But it was 21 pages and it took like literally 40 hours. And because she had been on hundreds of supplements coming in, hundreds of medications they had tried and to sort through all of it, it took a really long time.

But our battle plans are really extensive, and they’ll cover like lifestyle supplement, nutrition, and we put everything into a schedule as well for people. And we also do have like nervous system and specific mindset exercises for the clients. Particularly, I devise meditations and visualizations intentionally for clients as well. Depending on what they need, we will do them in session often. But it’s just an everything’s in a schedule so that it’s not like, oh, you should try, you know, CereVive, like you should try these supplements.

It’s like, no, you’re going to take this exactly at this time you wake up at 5:05, you’re going to take two steps out of your bed, and then you’re going to do this just because when you are not feeling well, the last thing you need is confusion. You just need a streamlined let’s start here plan minute by minute.

Evelyne Lambrecht: So I’m curious in a case like this, and I love how you take such an individualized and very nuanced approach to every person that you see. But then doesn’t that get really overwhelming? I know sometimes people get a plan that’s so like, oh my gosh, this is so much stuff. So how do you work on that with people?

Michelle Shapiro: So everyone is a different personality, right? So when I have clients who spend $100,000 on functional medicine, and that is not uncommon, by the time they come to us, thousands a year, thousands a year, and then they come to us after ten years of being in this game, which should not be a game at all. And, they will say to us, we’ll send them a 16 page plan and they’ll say, I’m doing this already.

And I’m like, you’re not doing everything on these 16 pages. All righty. Okay. And I’ll leave and joke with them about it. I’m like, there’s no freaking why you’re doing everything. But that’s where that schedule comes really into play. I need to explain things to clients, and I need to explain it in writing to clients like this is what’s happened. This is what you told me your goals are. This is what we’re doing. So I’m like, here’s why we’re targeting histamines first. Here’s four phases of this plan. Here’s why we’re doing it this way. Everyone’s phases are different outside of phase one and two is going to be histamines, a nervous system for mixed clients, but the rest of it completely different person to person.

But a lot of it’s explaining and then the action part is so streamlined. Now if we have clients with active eating disorders, if we have clients with diagnoses of OCD, with diagnosis of anxiety will be very, very particular to only certain parts of the plan at a time. And we might titrate it in very slowly. But no matter who gets the plan, we’ll explain why. But more importantly, we’ll say exactly how and what to do, because that is so common to go to functional medicine doctor’s offices and they just they’ll just give like one sheet on glutathione, one sheet on SIBO. Like it doesn’t help because that doesn’t mean anything to anyone.

What does it mean that you want me to do this protocol? Like what does that look like in my real life when I have three kids and I have this job and I have all this?

Evelyne Lambrecht: Yeah, I love that. That’s amazing. I want to go back to diet, which you mentioned briefly, but just what are your thoughts on low histamine diets? Helpful? Not helpful?

Michelle Shapiro: Yeah, they are helpful. They are probably the most unhealthy and restrictive diets we can do, right? If you think of if you think of the healthiest foods in the world, right. If you went to like a gut health on a gut health podcast, right? They would say fermented foods, citrus fruits. They would say, it’s like the breath of histamine foods. It’s like the highest nutrient profile foods that exist, like the best food, like cured proteins, gorgeous foods. The issue is that the body doesn’t perceive them as healthy in the time being. So, if I have a client who and this is quite literal, can eat a tomato or have more so like a little bit of vinegar or something and then have diarrhea for six days straight. Like, is it worth it in the short term to cut those foods out? Yes. Are we really sensitive? Because I also worked in the disordered eating realm for a long time. I have practitioners who are trained in that to not keep that going and not create new food fears around foods that they don’t need to be afraid of. Yes.

So I think a short term history diet is often necessary. Like at this point, I used to not be able to eat anything high histamine. Now the only thing I can’t have is pickles, which is like very painful as a Jewish New Yorker, it’s like it’s a cultural problem. Honestly for me, it’s a big problem. But, and again I would survive, but I would be quite ill after.

But everyone has different triggers. But I would say for a lot of clients addressing the even the heavy hitters, like vinegar, fermented foods, kombucha, bone broth in the beginning can be really important.

Evelyne Lambrecht: And, something else related to diet that I don’t think I had heard before, though I probably have, and I just forgot. But, you talked about how histamine affects blood sugar stability. I feel like I don’t hear a lot about that. Can you share more with us?

Michelle Shapiro: Absolutely. Yeah. So both high and low blood sugar can signal either a state of inflammation or a state of emergency to the body. So those with who can encounter low blood sugar are going to have potential histamine responses as a result, as if the body perceives a state of threat.

We always talk about this in the context of like low blood sugar and cortisol raising in the morning. We have to think about it in ways of low blood sugar signaling, again, that mast cell and histamine response, any state of mental perceived threat or real threat is going to trigger that. So what I often see in people with histamine issues is actually chronically low blood sugar. And this kind of episodic low blood sugar turns into panic. And then I think it’s also because people, you can lose your appetite with MCAS. Again, food preparation can become challenging if you can’t stand for long periods of time. So I think it becomes this, this cycle.

And then being in a state of high blood sugar is can be this kind of, again, insidious state of inflammation. And that can also give that inflammatory feedback loop to your mast cells as well. So it’s really important to regularly, and I would almost never recommend a very low-carb diet for those with histamine issues because it’s just constantly triggering that nervous system response and then that immune system responds to the results.

Evelyne Lambrecht: Interesting. I also want to talk about histamine and the relationship to the menstrual cycle. And it made me think, wait, do you ever see any guys with MCAS?

Michelle Shapiro: Oh, yeah. I have a very rare practice in that we have, it changes all the time, but I feel like 30% of our clients are men, which is very rare in functional nutrition for women because, yes. Totally. It’s probably 70%, 30% now.

Evelyne Lambrecht: Okay. I just found it interesting because we’re mostly talking about women’s health because there is more like immune dysregulation. Right. More nervous system dysregulation. But so the relationship between estrogen and histamine, and I remember the first time this came up on the podcast was when I interviewed Dr. Carrie Jones. And it was like one of our most popular clips on Instagram because a lot of people were like, oh my gosh, like, this is what I feel.

But then it seems like with MCAS, I think you said that people feel sick kind of during random times of their cycle. Can you share more about that?

Michelle Shapiro: Absolutely. Yeah. So we generally think of when people feel bad and especially like the prevalent social media conversation is everyone feels bad during the luteal phase, and it’s like, oh, don’t you know, we have like t-shirts now, like don’t call me during the luteal phase. People with histamine issues often feel much worse during the follicular phase, actually, which is really interesting. So I’m telling you, I used to get so dizzy and sick the day my period would end. Like day seven of my cycle, and I just was like, what the heck is this?

So estrogen and histamine have a direct relationship. Histamine acts on estrogen receptors to release more estrogen when estrogen is released. More histamine is released as a result. So estrogen goes up, histamine goes up. So in gearing up for ovulation your body will start to release estrogen. Obviously it peaks during ovulation, but even people can start to notice the initial creation and release of estrogen. That happens even as their period ends up until ovulation. Now, most people with his ministry will definitely experience symptoms, during ovulation, that is a peak for many people. There’s two times in the cycle where estrogen spikes. It then spikes again on days like 19 to 21 on a 28-day cycle. So seven days after ovulation, generally, there’s another little bump of estrogen. So we don’t feel worse when estrogen is falling. We actually feel worse when estrogen is rising generally.

Evelyne Lambrecht: Interesting. Any like specific things that you do during that time?

Michelle Shapiro: Yeah. So like especially for again myself and my clients, you have to find those days like I have a client and like we’re like, oh, day six. Don’t eat anything high histamine that day. Make sure you’re drinking your nettle leaf tea. Even if my clients are already off antihistamines. Because oftentimes we’ll use them short term, and then they’re off of them. I’m like, maybe take a Zyrtec on a day six prophylactically. We have to track and understand the patterns of the cycle in order for us to make those determinations. But once we do determine, then we’re like, okay, so it’s a nettle leaf tea day. It’s going to be a not high exercise day. We’re not going to go out in the heat as much, but we can accommodate and just make sure we’re not releasing excess histamines on those days. Absolutely.

But this is where cycle tracking becomes so critical, because then you also, I can’t tell you the relief when I used to get a migraine, like day 21 of my cycle every month to look back and see that every single month, it feels like just know it. And I’m sure Dr. Carrie Jones talked about cycle tracking as well. But it’s like to know your cycle is also to know your histamine pattern. So it’s really important for women.

Evelyne Lambrecht: That’s a great pearl too, thank you. I would love to shift just before I ask your signature questions, into a little bit of a business chat. So you mentioned you have multiple nutritionists working with you. And I’m curious, like what the journey has been like for you in building your business over the years, any business pearls that you could share with us?

Michelle Shapiro: Absolutely. Yeah. I think I really lucked out in some ways, my business that I made friends with these people who became like my sisters and my closest friends in the space, and brothers too. And, then they just ended up like having these amazing podcasts and being huge influencers, which is the funniest thing ever. But, for me, the real lesson there is like, I sometimes I’m just like, how did that. It’s so weird. We never would have anticipated that. It’s so weird. But they deserve it.

But for me, the basis of my business has always been connection and friendships. That is how I’ve ever done business. I don’t pay to go on podcasts. I don’t do anything like that. I just have real, actual friends who all of us also take care of each other’s health. We’re there for each other from like a mental and physical perspective and in treating each other with that dignity and respect. We learn so much on how to treat clients as well. And, that is the basis of my business and always has been.

And then I always have like the little flare of, I don’t know, codependency that comes through my work. I joke about it because I will, like my clients know this and my practitioners, anyone I hire know this, like your clients, you have to give way more to them than what they’ve seen before.

And our clients deserve and need more. And I just that has been the premise of the business for a long time. Yes, I think it’s shocking when my dietitians and nutritionists I have non dietitians in my practice as well. Of course, came in and they were like, we’re writing 16-page plans for each client? I think, it’s like a little shocking, but that is just very important to me to like over-provide and just to be like a real point person for our clients as well.

And I think that just like bleeds into everything. If you have those foundations of business, and you have that, hopefully moral integrity, I think it just makes business run very smoothly. And, yeah, it’s just it’s been like a joy. And it’s just really just been a joy. And I looked at our team yesterday because now that we hired someone else. Emily. She’s amazing. She’s actually been training with us for, like, two years, but she just finished her master’s in nutrition. And I’m like, wow, don’t we have, like, the coolest job ever? Like, I can’t believe I’m just like, this is so cool. And the ability to be able to provide jobs for other nutritionists has always been a dream of mine, too. So that feels like almost as important as the client work, because I would like to get as many dietitians out of hospitals that want to leave the hospitals as possible as well.

Evelyne Lambrecht: I love that, I love that, and you providing that mentorship is really incredible.

Michelle Shapiro: That’s the truth. Any client that comes in my practice, I am behind those recommendations. There’s not a client in my practice, and there’s thousands of clients between all of us that I do not know the name and medical history of, there’s not one. Because that’s the promise I made to my practitioners too. You’ll never write a plan without me. You don’t ever have to send a follow-up email if you’re not comfortable. I am behind my practitioners and their clients as well.

Evelyne Lambrecht: And that’s huge, too. And what you mentioned earlier about you guys all having meetings and actually going through each person who walks through the door, I don’t feel like that’s done a lot. Especially when people are like collaborating or even different practitioners. It’s like a rare model. So I absolutely love that because I feel like so many brains are better than one, right? And you can all have input on like how you would approach the case. So I think that’s really incredible.

Michelle Shapiro: Yeah. And even to pair the people with practitioners like from applications I will also pair based on my personality fits too. Where I just feel like there’s a soul connection there too. And it’s just there are different strokes for different folks. So that’s what I love about our practitioners, who every single one of them is so different in personality, but they’re just so out here for their clients honestly.

Evelyne Lambrecht: That’s awesome. And then one more question about that. So you mentioned that you’re working on symptom reduction, and then you’re doing these other things. So when someone comes to you do you usually have them in a program. Is it like a six-month commitment?

Michelle Shapiro: Three months just 3 or 6 months to start with. Again, so we have one practitioner, Nikki, who’s our lead dietician. She’s been with me almost four years. She’s my hero. Nikki also specializes in eating disorders and disordered eating. So if she has a client who has an active eating disorder and MCAS, we will have them do a six-month program, and that will be the minimum requirement. And they will have to meet weekly. So that is a requirement. It depends on what’s going on with someone. We have clients who will do the three-month program to start with, and then they will just add sessions on. I’ve had the same clients, some of them for eight years. So even if we do a check in every two months or something like that, they just have their sessions, they don’t expire. Many practitioners sessions do expire. I haven’t. I’ve had clients come back after like 4 or 5 years and I’m like, all right, just come back and let’s see what’s going on with you. And then they just like doing victory laps about how they’re doing so well. I’m like, all right, just come back. Let’s go.

But it’s very common that people will start with a 3 or 6 month package. And we’ll just let them know, like, honestly, you can start with three months. You might be able to make a huge impact. Okay. We don’t really treat MCAS or work with MCAS. And some we might require a six month to start depending on what’s going on with them.

Evelyne Lambrecht: Yeah, amazing. Thank you for sharing those. So I’d love to close with some of our signature questions. Just rapid fire. So what are your three favorite supplements for yourself?

Michelle Shapiro: I mentioned one, G.I. Revive. We have a lot of clients who do have both gut issues as a root cause and gut symptoms that have to be addressed. So I, on a personal note, I’ll use it like once a year and just take it a liposomal L-theanine and Gaba works very well. We avoid it with those with like commutations, usually Gaba that sometimes can be like excitatory, but generally, I love that supplement as well.

And then usually, I have to tell you I’m very into B1. I’m very into b-thiamin these days too. I’ve seen amazing results with MCAS and POTS clients as well.

Evelyne Lambrecht: Amazing. And what are your favorite health practices that keep you resilient and balanced? I know one of them.

Michelle Shapiro: First, yeah, I can’t. It’s so funny. I’m like, why do I have this five-year degree in nutrition? And all I talk about is walking all the time, like when I make a walking post on Instagram, it is sure to go viral because people feel my passionate about walking. It is just so essential to me.

I eat breakfast within 30 minutes of waking up, I’ll have 30g of protein and 30g of carbs in 30 minutes of waking up. I’m pretty religious with that as well. That for just stabilizing cortisol, stabilizing my blood sugar throughout the day, I very, very low blood sugar. By nature, like my hemoglobin A sees a 4.2, which is like, I’ve never even seen that. And it’s like, am I even alive? I don’t know, but, so I really have to make sure I have carbs frequently throughout the day.

And then I really have been so militant about taking my electrolytes. Also, I have found that especially again with my POTS diagnosis, just having a tremendous amount of sodium particularly works really well for me.

Evelyne Lambrecht: Right. And then what is something, Michelle, that you’ve changed your mind about through all of your years in this field?

Michelle Shapiro: Oh, it’s such a painful conversation. But I came in and I had worked for a kind of like a nutrition private practice that was diet focused, weight loss focused on one of my early, very short period of time, early years as a dietitian. And I was like, body positivity. I think weight loss might be really damaging based on my own experience. I found it very physiologically damaging, mentally damaging. And so I think that I kind of swung in the direction of, I think we can be healthy without weight loss, even if we’re living in a larger body. And over the years, I’ve really found that while the existence of kind of living in a larger body can be inflammatory, it’s not always inflammatory. But fat tissue is proinflammatory muscle tissues and some anti-inflammatory. So I’ve leaned way more into the realm of body neutrality versus body positivity exclusively. Body positivity as a social, political and moral context. I am 100% in support of, unequivocally thought as it comes to a clinical framework. I have moved away from some of those clinical principles. I don’t ever think it should have been a clinical framework, and I don’t know if it was intended to be, or people just ran with it, and led more into this realm of body neutrality while recognizing that body size and body composition, more importantly, does impact health. So I’ve kind of swung back not to the 90s or anything like that, but like somewhere in between where I acknowledge the moral and political consequences and the significance. But I also do not believe that body positivity or health at every size as a clinical framework is appropriate.

Evelyne Lambrecht: Very interesting. Thank you so much for sharing that. That’s a conversation we haven’t had.

Michelle Shapiro: I know it’s a big one, I can come back. I’ll do it with you. That was my first, my practice was built on body neutrality and how I’ve always been the before this, casting, I was the practitioner everyone knew to be like, you go to Michelle when you want to lose weight, you don’t want to develop disordered eating. Michelle was that person. That was what I was known for a very long time. But then the MCAS piece, just people need that help now more it seems like. I think with the GLP-1, people have found other solutions to weight loss, outside of exclusive dietitian work as well.

Evelyne Lambrecht: Yeah. Awesome. Well, Michelle, this has been such a great conversation. Thank you so much. So many clinical pearls, so many business pearls. I just really appreciate you and the work that you’re doing with people. Thank you.

Michelle Shapiro: Thank you so much, Evelyne. You’re a wonderful interviewer and you’ve been in this for over 12 years. So it really shows. And I thank you so much for having me on.

Evelyne Lambrecht: Oh, I’ve been in there since actually. Gosh. Well, 2010 is when I did Integrative Nutrition, but before that I studied kinesiology in college.

Michelle Shapiro: Oh, that’s awesome!

Evelyne Lambrecht: And actually in high school I already knew I wanted to go into the nutrition and health field, so I didn’t go the R.D. route. Like on purpose.

Michelle Shapiro: I’m not I’m like an anti-dietitian. I’m not an anti-diet dietitian, I’m an anti-dietitian dietitian. So, it’s I again I have a FDNP, I have a master’s of nutrition I don’t think anyone needs the dietitian route. I think there are some programs that are better than others, obviously. But no, I’m so with you on that. Proud of you for that. Proud to be talking to a non-RDA neutral.

Evelyne Lambrecht: Oh, you know sometimes I wish I had just like done it right after college. But then I’ve realized like I just don’t need it. But we do need them. Right. Like in hospitals. I know you didn’t do the CNS route just you know, because I’m doing this.

Michelle Shapiro: Yeah. Exactly right. But I think CNS and RD, I think CNS can be a stronger degree in some ways. By the way, I think what is amazing about the RD or CNS certification and degree is that you learn ethics of being a practitioner, which I think is really missing in IN and those programs where like you, you have such legal and ethical responsibility as a practitioner that I think you need that fear a little bit to be a really good practitioner and be like, oh, I could not recommend that. It’s not safe. You know, you understand consequence. And I think that’s missing in some of these, health coaching programs. And so that I do appreciate. But the biological context and what we know about functional nutrition, it’s very antithetical to some of the RG programming for sure.

Evelyne Lambrecht: Yeah. But thankfully we are seeing a shift and there is more like functional nutrition being incorporated.

Michelle Shapiro: Right. And exactly. And there are programs too as well. Like if you got a masters of Functional and Integrative nutrition and then had an RD, I’m like so eager to hire everyone like that. I’m like, yes, that is the coolest thing ever. Totally.

Evelyne Lambrecht: Yeah, I love that. Thank you so much. And thank you for tuning in to Conversations for Health. Check out the show notes for resources from today’s episode. Please share this podcast with your colleagues. Follow, rate, leave a review. And thank you for designing a well world with us.

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