Is it MCAS or Histamine Intolerance? with Meg Mill, PharmD

Episode 114:

Is it MCAS or Histamine Intolerance? with Meg Mill, PharmD and Evan H. Hirsch, MD

Evan H. Hirsch, MD 0:04

Hey everybody, welcome back to the EnergyMD podcast where we help people resolve

their chronic fatigue MECFS, long COVID and MCASso they can live the life of their

dreams. So really excited today because we're going to be talking to an MCAS expert

among other things. So my friend Meg Mill, so let's learn a little bit about meg. So, Meg

has a doctorate in pharmacy and is a certified functional practitioner. With over two

decades of clinical experience. She is also a best selling author, podcast host summit

hosts and sought after corporate wellness speaker. Her virtual functional practice has

transformed the lives of hundreds of clients worldwide by connecting the dots between

their diverse, unexplained and often overlooked health struggles, such as migraines, gut

issues, chronic fatigue, skin reactions, anxiety or allergies. She uses her eat method EAP

method to uncover and resolve the underlying connections, whether it's histamine

intolerance, hormone imbalances, gut dysfunction, or MCAS, mast cell activation

syndrome, she empowers clients to take back control of their health, so they can regain

the energy, mental clarity and confidence needed to fully show up for their lives again,

she's been seen on lots of TV magazines, blogs, and podcasts. Meg, thanks so much for

joining me today.

Meg Mill, PharmD 1:25

Thank you so much for having me.

Evan H. Hirsch, MD 1:29

So today, we're going to be talking about histamine. And first, before we get started, I

know you've got an event coming up. So I want to make sure we touch on that first,

because that's talking about that's all about MCAS, correct?

Meg Mill, PharmD 1:39

Yes, so we have a summit coming up June 18, through the 24th, where you are one of

our 50 experts. And we have almost 50 hours of education on MACAS and histamine

intolerance. It's called reversing mast cell activation syndrome, and histamine

intolerance. And it's a free educational event, we're really trying to get the word out.

Because, you know, as, as our listeners know, that this is often misunderstood, this is

not something that many of your general practitioners are going to know. And a lot of

the symptoms are overlapping with other symptoms. So we're trying to create

education, clarity and an avenue for people to get help and support and it's all a free

event. So you can I think you're gonna put the link in the show notes right for people to

register. Yep,

Evan H. Hirsch, MD 2:29

we will definitely do that. And so So let's dive into histamine versus MCAS. So I guess

let's get some definitions here first, so that people can kind of understand what MCAS is

and then and then how it relates to histamine. Okay,

Meg Mill, PharmD 2:44

so what what start actually with with histamine because it's the like it's a molecule

within your body. So histamine is a biogenic amine. And so when your immune system

detects an allergy, or an invader histamine is released primarily from your mast cells,

which we'll talk about that and your basal cells as part of your immune response. And

so this molecule is going to increase the permeability of your blood vessels, it's going to

allow your immune cells to reach the affected area more quickly. And, you know, there

are a lot of great purposes with histamine, it just gets a bad rap. I feel like it's kind of like

cortisol now where cortisol has functions in your body, but we often it wreaks havoc.

Again, same with histamine, it has great functions purposes. But when we get it in

excess, that's when we start to see all these symptoms. So it helps with immune

defense to protect us against pathogens, it regulates gastric acid secretion to increase

the breakdown of foods in your digestive system. It can affect neurotransmitter

activities, because there's histamine receptors all over the body, it's part of your allergic

response. And it's actually also part of your inflammatory response. So it recruits

immune cells to the site of infection or injury through increased vascular permeability

and blood flow. So it's really important in that function, except the problem is, when we

have too much histamine, we're getting this constant inflammation, we're getting these

constant problems or we're getting symptoms. So you know, when we're looking at

histamine intolerance and mast cell activation, there is a lot of overlap and symptoms,

but They're two, they're two different things. So it's like this little like kind of triangle of

okay, they can affect one another, but they're also different. So you can, so let's move on

to mast cell activation. So your mast cells are releasing the histamine and when we're

having mast cell activation syndrome, we're having an excess degranulation of the mast

cells. So your body your immune system has your innate immune system and your

adaptive immune system and your innate immune system has the mast cells as part of

that first response, like think of them as those soldiers that are ready to go anything that

comes in we're just going to fire and we're going to protect you, but the problem is when

they start protecting you against things that aren't dangerous. And you're getting

protected against food that you like, or sunlight or air or EMFs, or, you know, different

things that really you shouldn't be reacting to. But these mast cells become over

reactive and they start to granulating. And they start releasing histamine. Now, some

people with mast cell activation syndrome won't have histamine symptoms. That's

pretty rare. I would say, from my personal experience and research, most people that

have mast cell activation will have some symptoms of histamine because when those

mast cells degranulation, they do release histamine, but some people don't. So that's

one thing to note that if you think, Well, I don't have mast cell activation syndrome,

because I don't have the high histamine symptoms. That's not necessarily 100% the

case. Now, you also can have histamine intolerance, without having masala activation

syndrome. So histamine intolerance really comes about when you get this imbalance of

overflow of histamine into the body with the ability to break down histamine. So for this,

I really like to use a bucket analogy with Think of your body as a bucket with holes in the

bottom. So we need to, we're filling the bucket up, it's draining, we're filling the bucket up,

it's draining, and it's flowing, and your body's nice, and you're fine, and you're symptom

free. And then something happens either where the the plugs and the drains get, you

know, the bucket gets plugged, or you're pouring too much in the bucket or both, and you

start to spill over. And that's when you start to have all of these symptoms. So we need

to be able to not have so much histamine coming into the body. And that can be from

mass activation syndrome, that can be foods that can be chemical, you know, chemical

sensitivities, things that are causing allergic reactions, causing this histamine. And then

we also need to be able to metabolize the histamine. And we do that through diamine

oxidase and methylation. And so we need to make sure those pathways are also open.

So we have this nice flow. I know that was a lot of information, but trying to get both

points.

Evan H. Hirsch, MD 7:09

No, that's really helpful. So then, in summary, histamine is produced by the mast cells,

as are mast cells produce histamine, I think histamine is produced in other things in the

body, but mast cells will produce histamine. And that can cause a lot of symptoms that

people are having. Correct?

Meg Mill, PharmD 7:26

Yes, and this is one of the things that I do like to point out here, too, is that these

symptoms can actually happen all over your body because we have four different types

of histamine receptors. So I think when people think of histamine, you're thinking of

allergies, congestions, sneezing, asthma, and those things are symptoms, but we also

see headaches and migraines, fatigue, heart palpitations, vertigo, anxiety, depression,

difficulty concentrating, we can see PMS and irregular periods, we see flushing joint pain

insomnia, we can see higher low blood pressure, and we can see a lot of skin reactions.

So as you can see, these are whole body issues, a lot of digestive where there's so much

more research on digestive symptoms, and how that's actually a histamine or a mast

cell issue, often in IBS. And so I think it's really fascinating that you can when you're

working with histamine, and when you're calming those mast cells down, we start to see

so many different symptoms clear up. So it's one of those, okay, this can often be that

common thread of I have all of these symptoms, which as we can see a lot of these

overlap with other conditions. So it's really trying to figure out, Okay, where is this

coming from, but when we start to work on this through histamine lens I saw off and

see, okay, now my digestive symptoms are better, and my migraines are gone, and I'm

less anxious, and I sleep better. And all these things start to happen, because it is really

a whole body issue.

Evan H. Hirsch, MD 8:52

Yeah, and I think it's important for people to understand that histamine is actually our

friend, you know, you talked about it being that soldier on the front line, like, it's here to

help us. But there's something that's triggering it that is causing it to kind of get out of

control. Right. So maybe we can talk a little bit about that. And you mentioned it a little

bit, but maybe we can go a little bit deeper. What are those things that are triggering

histamine to get out of control?

Meg Mill, PharmD 9:17

So I you know, for me, in my practice, the thing that I see affecting the most is gut

health. So when we talked about how, you know, we have Masel activation syndrome,

and that can definitely be a cause so but when we're looking at just histamine

intolerance in general, we need to be able to break down histamine in the body. And so

there's just so much more research actually, what's what is fascinating is that there are

actually certain bacteria that are histamine producing, and mast cell activating. And so

we're starting to learn more even about the species of our microbes that are even

causing these things. And I have some interesting stuff. worries, one that I really like to

share. Because I think it's, it's I have worked with a man who had total body to carry total

body itching for 20 years, and he was on several different prescription medications

hydroxyzine, which is makes you get exhausted, you know how good he was on these

medications, he was also getting shots he was they were doing everything no one could

ever figure it out. And as soon as the medication would even start to wear off, he'd hate

it would just flare right back up. And he came to me and I said, Well, I want to do a stool

test on you. And he was like, but I have no guts. And I'm like, I've no GI distress, nothing.

There's nothing, no issues that way. And I was like, well, just trust me, we're gonna do

this. And he had high levels of some of those histamine producing bacteria that we're

talking about, one of which is Morganella, he had very high levels of Morganella. And we

did some healing work, some got healing work. And within about four weeks, his itching

was gone. No medications. And I think it's just like, I like that, because it was just such a

dramatic thing that he was like, Okay, there's, this is not even going to be related. There's

no correlation. And it was something more specific, a lot of times, there's a lot more

dynamics, but it was just something that was so specific to him. And no one had ever

looked at that. So we're looking at these particular gut bacteria. Now, we also want to

look at diming oxidase. So that's how we break histamine down in our GI tract. And so

diamine oxidase is an enzyme. So a lot of people are familiar with braid having lactose

intolerant, we need to break down lactose in our body. But we also need to break down

histamine. So if your diamine oxidase is compromised, you may not be breaking

histamine down from your foods. So you may be reacting to foods that are high in

histamine because you can't actually break them down. And so we know that we need

to work on rebalancing your gut bacteria, you know, our diamond oxidase is housed in

the mucosal lining layer of our gut lining. So if that mucosal layer is off, if we have some

dysbiosis going on, we can actually start to see the diamine oxidase not work as well,

we can also start to see intestinal permeability, which can cause more systemic

inflammation. And then we that can further even compromised I mean, oxidase. So we

want to look at how is your you know, are these microbes creating this response? Are

we having trouble breaking it down, that can be creating more inflammation, more

problems. And then we also interesting ly enough need certain nutrients to be absorbed,

to actually facilitate diamine oxidase too. So things like B, six copper, vitamin C, so we

need to make sure that what we eat, we're actually digesting and absorbing. So a lot of

times, that's where I'll start. Because we need to be able to make sure like that we're

getting everything in balance. To make sure we can, you know, break this down. And so

often, like that's one of the main factors that we're looking for when we're looking at

reasons, but there are, there are other things too.

Evan H. Hirsch, MD 13:06

That's great. So then, so how can you tell the difference between histamine intolerance

and MCAS?

Meg Mill, PharmD 13:14

Yeah, so I think it generally, it's kind of that's a good question, because it's not always

easy to unpack. And it's hard to get, not that many people have official M cast diagnosis,

because of the way you know, the testing that you have to do to you know, somebody

could go to a practitioner that does and cast testing tests, tryptase levels, there's, there's

different testing you can do to get an official diagnosis, there is not really as much of an

official diagnosis of histamine intolerance, it's really more symptomatic, and what you're

experiencing. So I tend to see people with em cast more hypersensitive than people with

histamine intolerance. So, you know, often histamine intolerance will be more of a

breakdown issue, you know, we can start to see some of the low histamine, we can get

into the low histamine diet, we start to see that help. But where am cast you're sort of

more like reacting to everything, and you're reacting to more of the supplements, not

that you can't, if you have histamine issues, that it's gray, it's hard to necessarily do

some of this, that we work on the same thing. So I don't know if there's like 100% way to

tell, but I think it's more I would say, for me, it's more symptomatic, and how we're

responding. Yeah,

Evan H. Hirsch, MD 14:36

and I think it's a spectrum. You know, interestingly, you know, like, 1020 years ago, when

we talked about people who are were more sensitive, we talked about MCs, or multiple

chemical sensitivity, right? And essentially, those people have M cast or they're kind of

on the spectrum. You know, I think that sometimes we get so caught up in the

diagnosis, but the reality is, is that if you are more sensitive If your immune system is

hyper reactive, and maybe it's histamine, and maybe it's something else, but oftentimes

the treatment is going to be the same. Would you agree or disagree, agree,

Meg Mill, PharmD 15:10

that's why I think I don't really worry about differentiating, like, Okay, this is this versus

that we're going to work on the same things. So, you know, we're gonna work on gut

health, we're going to, you know, try a low investigate with a low histamine diet, we're

going to do nervous system regulation, because that's really foundational, particularly

for MCAT. I think, if you're working with someone on M casts, you need to be doing that

alongside of any therapy that you're doing.

Evan H. Hirsch, MD 15:38

Yeah, I've seen really amazing things with nervous system regulation, I had somebody in

my program recently, who is, I don't know, 70% better just from doing some brain

retraining. And so and she was M cast and like, couldn't eat anything, and now can eat

like, whatever she wants. And I find that, you know, sometimes doing the nervous

system retraining is like, 10% of the issue with people with M. Cass and other MECFS.

And the other things we work on a lot long, COVID, etc. And sometimes it's like 70%, like,

what are you seeing with your population?

Meg Mill, PharmD 16:14

Yeah, I agree. It depends on all I think that's what's so complicated about some of these

things is it's so individual isn't. It's like, where I'm, where are we putting all of these

pieces together for that individual. But I do find it, like I said, necessary. And I would say

I see it, I see that being a factor for pretty much most people, like you're saying that it

just depends on the spectrum of, of how much that moves the needle, but it is, you

know, even looking back at your trauma, and back at all the things that happened in light,

there was an analogy that I liked that someone use one time, and it's kind of silly, but it

is a good way to think about it, you know, if you are smelling a rose, and you're touching

a hot stove, every time so if someone gives you a rosy of smell, and they're like, Okay,

touch the stove, and you're like, oh, that's uncomfortable. And then you you know, you do

it again, and you do it again. And then they take the stove away, and they're like, now

smell the rose, you're just gonna feel like you hate that smell. It's uncomfortable, it's not

good, it doesn't feel good to you. And so I think that's, you know, that's what's happening

is things that are supposed to be safe for you, your body's reacting to, you feel betrayed

by your body, you feel like you're out of control of that response. And it things that

should feel good, no longer do. So we do need to rewire that response and say, Okay, I

am safe in this body, I do have more control. Another thing I think is working with people

like that will respect that for you. One of the things that I've had people come to me and

say, Okay, I've been to, you know, some of the biggest functional medicine clinics in the

country, I flew there, I did all this testing. And then they threw, like, a ton of supplements

at me and I reacted to everything, and I feel it made me worse. And, and so they're

discouraged. Because they're making the effort. They're trying to do these things.

They're, you know, investing, and now they feel like they can't take anything. So I think

really listening to your body and thinking, Okay, if you can take one granule of a capsule,

and you can tolerate that, that's okay, you know, if you can take a fourth and some of

these capsules, we can open, like, be patient, and listen to your body in your response.

And you will get there. I think that's one of the things that that I see. And I think that

there from what I've, I've heard, I've been doing all of these interviews for for M casts for

all these months. But when I was talking, I believe with Neil Nathe. And he was saying

that there's research that showing that, because he deals with the sensitivities that

people even when you are more sensitive, even though you're taking a lower dose, it

doesn't take as much to actually get the effect from that low dose. So even if you can't

take the full capsule that someone else can, you may be getting more response from

that fourth of a capsule than that someone else is it and you just have to be respectful

of that. And I think that's very interesting, too.

Evan H. Hirsch, MD 19:12

Yeah, I absolutely agree. And I and I, and I feel like that's kind of that's the way that I

think about it, but I don't think everybody thinks about it in that way. I mean, in general,

you know, when we're looking at people who have who are more sensitive, you know,

where sometimes they need a lower dose of something, oftentimes we call it sprinkles

in our program, right? You know, so they, they're just taking a little bit of the capsule, or if

they're doing a tincture, they're doing it topically. And it's really this combination of like,

what is the dose that you're taking? And what is the frequency that you can tolerate?

You know, and so it's kind of like you know, maybe you need it three times a week

because it takes you two days to process out of your body. You know this idea about we

take a certain supplements certain times A day is really based on a 24 hour clock. But

that's not necessarily how our body is processing a certain substance or how long that

substance is in our body. Right? You know, we're making a lot of guesses that, you know,

if you take something every morning, like adrenal support every morning, that that is

actually going to be out of your body by the time you have the next day, and then you

take your next dose, and that gives you the support that you need for that day, right? So

when people are more sensitive, and their detox or drainage pathways aren't working

well, and things are building up more in their bodies, then potentially they don't need

something every day. Is that kind of an accurate representation of what Neil was saying

and what you're saying? Yes,

Meg Mill, PharmD 20:41

yes, I agree. They Exactly. And so they don't in the in the mount that they take, yes, can

be more influential for that smaller amount. And then then someone like they might not

need as even as much of a dose like because they're not detoxing it. But also it can be

effective for them to even at that lower dose. And I don't know about you, too, but I see

also, sometimes whenever people get over, it's like, inching, inching, inching, and then

sometimes you can start, it's like, oh, wow, I'm starting to be able to make a bigger leap.

And then that's like, that's an amazing breakthrough to I think it is like, just seeing some

of the transformations to get to that point where you can do like your body's finally

responding to.

Evan H. Hirsch, MD 21:27

Exactly, yeah. And I feel like so much of that is kind of like opening up the detox or the

drainage pathways. And so I'm kind of curious about how you do that. Can you kind of

talk to us a little bit about that? Because I feel like with people who are m cast, they're

oftentimes they're reacting because, you know, quote, unquote, these pathways are

clogged for a better term.

Meg Mill, PharmD 21:48

Yeah. So I mean, I think we need to start with the base. I know people get like, bored

with basics, but, like, the basic foundational things first, you know, so it's like, Are you

drinking enough water? Like, do you actually drink water? And so that's an important do

you drink water that are you getting as your drinking water? Love it? Yes. So we need to

and so we need to think about that. We also need to make sure that our bowels are

moving. Because if you only go to the bathroom once a week, and you think that's

normal, and you try to do some detoxing, then you're just gonna be reabsorbing things.

So we need to make sure like, are we actually moving the bowels? Then I think doing

you know, we can you move like moving into some other like this, the saunas,

sometimes people are sensitive to heat. So it's like how can and I actually spoke with a

infrared sauna company that was actually saying, even this isn't, I'm not, I don't know,

this is new to me. But they were saying even starting and how it takes about a half hour

for your sauna to really warm up to the temperature, if you can't tolerate that then

actually get in as it's warming up, and the infrared is still helping you. So even if you

can't, if you can't tolerate it to start, they were advising kind of to start that way. So I

found that just interesting to have, you know, so people can try some of those different

modalities. I also like castor oil packs, or people with M cast. So that's another thing

that we will do and start to see if we can get the look, you know, some liver work there

before they can tolerate more. How about how about you?

Evan H. Hirsch, MD 23:30

Yeah, those are all really great tools. You know, like, I think about things that are

exogenous or that are, are outside of the body, you know, because 80% of our immune

system is in the gut, right? So anything you put in the mouth, the immune system can

potentially react to it. Right? So if we can do sauna, which is kind of on the outside, if

you can do something topical, like you know, topical tinctures or a castor oil, or, you

know, sometimes there's coffee enemas, or you're talking about water, I mean, I've

worked with people who are actually sensitive to water. You know, that's definitely more

challenging. But yeah, I think those are, those are really great ideas. I think the sauna

thing is interesting, too, because, you know, sometimes people can only tolerate like five

minutes. And it's hard to know, like, is it the heat? Or is it the, the frequencies, right?

Because, you know, when you look at, you know, a Rife machine or something like that,

where, you know, there are certain frequencies that can kill certain infections. And so

sometimes if you're in a far infrared sauna, or some kind of infrared sauna, that has

certain frequencies, sometimes you may be killing infections and having die off and

consequently, that's why you feel worse, or you're trying to detoxify, and you're not

pooping, you know, or you you're not drinking enough water, you know, whatever it is. So

it's definitely more complicated. But yeah, those are those are great ideas.

Meg Mill, PharmD 24:51

Yes, yeah, I think and I think, again, everybody's a little bit like we're saying everyone's a

little bit different and what they can in this population what they can tell Alright, so if you

just try it, you know, try and see what you can. And if if you can only get in there five

minutes, if you can only get in there as it's eating up, we're going to what you can do just

a little bit, just give that hope of like a little bit more every day and a little bit more. That

eventually you're you're making progress through. Yeah.

Evan H. Hirsch, MD 25:18

And I think people forget, you know, like, we're, we're kind of so focused on the day, and

we forget about the year, right. So, you know, we overestimate the amount we can get

done in a day, and we underestimate the amount we can get done in a year. Right? So

it's, you know, it is it's the long game and and that's so hard for humans to think about.

Okay, if I do something every single day, a year from now, I'm going to look back at this

year, and I'm going to be amazed at what I've accomplished. Do you find that to be the

case, too? Yeah,

Meg Mill, PharmD 25:47

actually, it's funny that you said just about a month ago, I had a call with someone I was

working with, and she was down on herself. And it was she was saying like, Oh, she it

was just an interesting thing, because she had started working with two friends actually

started working with me at the same time. And one of they were just coming from both

actually had histamine issues and mast cell issues, but they were coming from different

places. And then the one friend had lost a lot of had lost weight, just as we weren't

working on weight. But as we were doing things, she had lost weight. And then I'm on

with this other person who was like, kind of at the same spot. She's like, really down on

herself. And I was like, Well, you know, what's wrong? Sick, I'm just not doing as well, you

know, kind of like feeling like she wasn't making the progress that she wanted to make.

And I was like, well, well, why? And she said, Well, you know, I haven't really lost weight.

And I was like, okay, so you just told me that you had your energy as well, that you don't

have any, you know, any GI distress that your anxiety is down that you're not reacting to

things. And she was like, Yeah, and I was like, Well, remember when you came to me,

and you couldn't get off the couch, and you couldn't go out of your house and you were,

you know, overreacting to everything, whatever. She was like, ah, that and she said to

me, actually, thank you for sharing that with me. Because I didn't like and I was being

hard on myself. And I really you're right, like, look at what I've done. And, and it was, you

know, it was appreciation of Yes, exactly what you're saying. Like, we get in that okay,

now I have to do more. Okay, now that now that's now you know, and and so it was just

taking that time and thinking like yes, in a year, what can be different and where you've

come and even if you still have places you want to get to you've you've come so far.

Evan H. Hirsch, MD 27:33

Yeah, such an such an important lesson and perspective. And as humans, we're

incredibly adaptable, right? We keep adapting, and then we forget from whence we

came. Yes, I

Meg Mill, PharmD 27:42

know. I know. It's hard, right? That's where the nervous system work comes into it.

Right? Gotta bring it back. Calm your body. Yeah.

Evan H. Hirsch, MD 27:53

So I want to come back to that. So do you have a favorite Nervous System Program?

What do you like to do for nervous system retraining.

Meg Mill, PharmD 28:03

So I try to do it in three different ways with people that I'm working with. So you know,

we do the bringing our body back into the parasympathetic nervous system with with

breath work with regulating your stress response, I have been trained in something

called Hypno breathwork. So it's a combination of hypnosis, and breath work at the

same time. So when we do that, we actually get into a hypnotic state with our breath.

And then there's prompts that we work through to actually try to rewire norpac neural

pathways. So it's just it's something that I was drawn to and decided, like, this was

something I wanted to get certified and to be able to bring that to people that I work

with. So that's one of the kind of modalities that that we use, and then I do try to do

vagal nerve work, you know, try to do some vagus nerve exercises. And then I also do a

lot of the thought retraining. And you know, I think that limbic system work is important,

and there are programs out there that you can just totally focus on that limbic system

work, but I think that's a also an essential piece to really rewire some of those pathways.

Evan H. Hirsch, MD 29:12

Excellent. Yeah, it's such important work. I feel like the emotional work that we do on

ourselves is probably the most important work that we do in this life, right? There's

obviously career in this then the other thing, but it's like, I've just become more and more

interested in personal growth, and how to continue to improve myself. mentally,

emotionally, physically.

Meg Mill, PharmD 29:37

I agree. I'm doing it with myself too. There isn't time that goes by. We do not and you

know, I think just even bringing that up. So I have a lot of these issues personally, like,

you know, I think your story comes from from personal place. My story comes from a

personal place. And over Christmas, I was reacting to something and my mother said to

me, Oh, you've just always been so sensitive to this war. Roll flick, it was a funny thing

here, like, this is what I do. I'm an adult. But I think just bringing that up, like, we're also

people, we're also doing this work and you want, you know, it can happen where

something gets off, too, but you're bringing yourself back into, okay, what do I need to do

now? What how can I get back to a place where I'm not reacting to everything, or I'm not

having these symptoms? And I think that's a journey for all of us. Yeah.

Evan H. Hirsch, MD 30:24

And I think that that also, it's really nice when you have a partner who's actually been

through it. And, you know, going through it and dealing with a number of these things,

because you know, the tools that have worked for you, you know, you're trying things on

your own, you know, like, like, I think that's, that's really supportive for folks. Because it's

not just them being told, hey, you need to do this thing. And somebody doesn't actually

have that experience. Yes, yeah, absolutely. Yeah.

Unknown Speaker 30:52

So let's get practical

Evan H. Hirsch, MD 30:53

here with the time that we have left, so. So let's talk about so what can so somebody

who is more sensitive, they've got a bunch of the histamine symptoms, or they think

they have MCAS? Where do they start? What should they do in order to start the process

of getting better, is

Meg Mill, PharmD 31:13

one of the things that you can start to do and I like to use this as a discovery tool, like

not as a long term plan, I think people can start a low histamine diet and see if that

makes any difference. Now, I think people can also get very hung up on the low

histamine diet and think this is their path in life and I disagree with that. I think it's a

good tool to say like, okay, are these foods bothering me maybe they can bring down

symptoms that they're having, but it's not something like that's your game plan because

we need to get to the root cause of what's actually happening in your body. But if you're

just listening and you think okay, these symptoms sound familiar, that sounds like me,

you know, you can pull those foods out so and I in the I did put a lien like a guide for you

to give to all the listeners and there is a more complete list of histamine foods. So I have

a list in there that people can reference. But in general, we have you know, high

histamine foods and they can be things like aged cheese's, fermented foods, cured

meats, alcohol, we can have histamine liberating foods like strawberries, tomatoes,

bananas, foods that limit diamine oxidase we can have caffeine can actually be liked. I

mean, oxidase so we have a lot of different foods that you might think, Oh, the, you

know, bananas, or strawberries or even bone broth or fermented foods, like we're, you

know, those are good foods for you, but they could be causing some of your histamine

issues. So it's sort of it's a tool that you can use to start to see, okay, if I bring these

down, does that decrease my symptoms? And see, okay, maybe that's a clue that this is

something you need to maybe look into more and get testing and further investigate.

Evan H. Hirsch, MD 32:59

Excellent. And it sounds like we've kind of talked a little bit about like some of the tools

that people can use, you know, the castor oil packs and so on and stuff like that. Do you

have favorites that really shift the needle, I mean, even if it's bandaid stuff like

antihistamines, whether they're prescription you know, just to kind of get somebody out

of a flare right now somebody's really struggling I

Meg Mill, PharmD 33:24

mean, I think I actually like a lot of the combination natural antihistamines so like the,

you know, the core certain is a great one a lot of people have a lot of benefits with so I'll

often pair that with some rumblings and stinging nettle, some different things where

we're getting a combination of things, even vitamin C can be helpful so we're gonna

we're trying to bring down the reaction stabilize the mast cells will try Dao diamine

oxidase supplements to see if we can take enzymes to help break things down. So we

definitely are working on that while we're working on the root cause so it's kind of like

okay, let's bring down some of your symptoms. Let's work on finding the root cause let's

put nervous system work in here and start to see if we you know, start to see that

change. I think it's when you're putting kind of all these things together, they start to

move the needle.

Evan H. Hirsch, MD 34:15

Excellent. So as we come to the end here, so then where can people find you we've

gotten Meg mil.com. Is that the best place to send people?

Meg Mill, PharmD 34:24

Yes, yes, that's my website. I'm over I have a podcast also caught a little bit healthier. So

if you want to check that out, we talked about all different things with relation to health

and I'm over on Instagram at Dr. Meg mill and and come to the summit if this interest is

you would love to see you there.

Evan H. Hirsch, MD 34:42

Absolutely, yeah, we'll drop the links for that below and then also the link to the free gift,

which is that that histamine document are the essential guide to what does it say

Essential Guide to histamine pre guide?

Meg Mill, PharmD 34:55

Yeah, yeah, it's essential guide to histamine intolerance intolerance.

Evan H. Hirsch, MD 34:58

Yes, yeah. awesome, wonderful. Well, Meg, any last things you want to share with our

audience? Before we adjourn?

Meg Mill, PharmD 35:06

I think they I think we covered a lot of things, just that there's hope. I always like to say

that as a last thing, because I think sometimes when you've been dealing with a chronic

illness for a long time, you you forget that and so it feels like, you know, maybe you're

saying this work, but it will it work for me. And, you know, I think if you can trust yourself,

then you can do the things that heal. So stay positive and hopeful. Absolutely.

Evan H. Hirsch, MD 35:31

And when you're working on the root causes, you're gonna be successful. It's not a

question of if it's a question of when, and it might just take, you know, a long time, but

you're gonna get there and you're gonna improve along the way. So, yeah. Wonderful.

Thank you so much for joining me today, Meg, it's great to see you as well. I'm really

excited about your event. We'll drop all those links below.

Meg Mill, PharmD 35:52

Thank you so much. Thank you for having me.