s5 e21: The Root Cause of Reflux with Michelle Shapiro, RD

The Root Cause of Reflux with Michelle Shapiro, RD

The Root Cause of Reflux with Michelle Shapiro, RD

In this episode, I am interviewing Michelle Shapiro, an integrative functional registered dietitian who’s going to unravel the confusion that often surrounds reflux treatment. We’ll explore why conventional medicine’s approach to reflux may not always be in your stomach’s best interest, and why you may sometimes need to fuel the fire. Michelle helps us understand the contributing factors of reflux symptoms – ranging from a burning throat and chest pain to that nagging feeling of hunger paired with nausea. Michelle also cautions about supplements and touches on the complex relationship between pregnancy, hiatal hernias, and how managing stress and histamine levels plays a vital role in your health.

If you’ve ever wondered about the connection between stress, your thyroid, and the importance of listening to your body – you won’t want to miss this episode. We also have a special Q&A waiting for you over at patreon.com/hormonehealingrd.

As always, this episode is for informational purposes only. Please talk with your healthcare provider to figure out what’s best for you.

This episode covers:

  • Common symptoms of acid reflux
  • Causes of high and low stomach acid levels
  • Connection between histamines, stomach acid, and acid-reducing drugs
  • The impact of pregnancy on reflux and histamine intolerance
  • Strategies for reflux relief and dietary management

Thyroid Mineral Training

Connect with Michelle:


Website: https://michelleshapirord.com/

Quiet The Diet Podcast: https://podcasts.apple.com/us/podcast/quiet-the-diet/id1663088026


Master Your Minerals Course
My Favorite Paleovalley Products

Free Resources:

Free Healthy Period Starter Guide
Mineral Imbalance Quiz
Mineral Training
Thyroid Mineral Training
Feminine Periodical (monthly newsletter)


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Amanda Montalvo [00:00:01]:

Welcome to the are you menstrual? Podcast, where we dive deep into all things women’s health to support you on your healing journey. I’m Amanda Montalbo functional and integrative dietitian, also known as the hormone healing Rd. If you enjoyed this podcast and you want to keep learning, check out the.

Amanda Montalvo [00:00:16]:

Podcast Patreon, where I share a bonus.

Amanda Montalvo [00:00:19]:

Episode with additional downloadable resources each week. You can go to Patreon.com forward slash Hormone Healing Rd or check out the.

Amanda Montalvo [00:00:27]:

Link in the show. Notes I have an amazing episode for you today with my very good friend and colleague Michelle Shapiro. She has been on the podcast before. We did a really great episode on anxiety in the past, and today we’re talking about reflux. It’s an important one. I cannot tell you how many questions I get about reflux. It is a very prevalent issue. We talk about how a lot of reflux, not all.

Amanda Montalvo [00:00:53]:

We go through all the different types with the nuance around it. We talk about like high versus low stomach acid versus stomach acid getting displaced, which is a very important concept to understand if you are someone that is struggling with reflux. I think that it’s very confusing because if you look at the conventional medicine world, they talk about having too much stomach acid and they’re constantly trying to lower it. If you look at the functional medicine world, they’re talking about how most reflux is because of low stomach acid and trying to raise it, and it’s kind of like, well, what do I do? Maybe you’ve tried more functional strategies and they make your reflux worse, and you’re like, but I thought I’m supposed to increase my stomach acid. There’s a lot of nuance there. That’s what we get into in the episode. I think it’s an important one. There’s a lot more we could have gone into.

Amanda Montalvo [00:01:36]:

I will absolutely have Michelle back. I think we’re going to do a whole episode on histamines and mast cell activation because that is a huge root of reflux for a lot of people, and I think it’s a big part of reflux in pregnancy as well. We discussed this more in the episode, but I hope you enjoy this one. If you have never met Michelle, if you didn’t listen to the other episode. She is an integrative functional registered dietitian in New York City. She’s helped over a thousand clients reverse their anxiety, heal long standing gut issues, and approach their weight in a loving way. She has a virtual private practice where she helps clients work one on one towards these goals. She’s also the host of a really good podcast.

Amanda Montalvo [00:02:13]:

I had been trying to get Michelle to do a podcast for years. I was like, you need to do a podcast. She’s an amazing speaker. I’m like, you’re the person that needs a podcast. So she finally started one. It’s called quiet. The diet podcast. Highly recommend it.

Amanda Montalvo [00:02:28]:

I will link it in the description below and the main focus there is she’s helping listeners bridge the gap between body positivity and functional nutrition, heal their anxiety and panic attacks, and approach all health in a nuanced and compassionate way. And there is no one more compassionate than Michelle. I love her. I know that you will love her, and I really hope that you enjoy this episode. All right, so let’s just get right into defining what acid reflux is, since that’s going to be the main focus today.

Michelle Shapiro [00:03:00]:

What is the main focus today? And Amanda, not only have we had so many professional conversations about this, we’ve had so many personal conversations about this, too, which we can totally touch on. So in ways of reflux, what we are classically thinking of as acid reflux is acid spilling from the stomach into the esophagus. So when we think of acid reflux in a kind of conventional allopathic medicine sense, we always think of it as having too much stomach acid. So we think of taking PPIs and drugs that either reduce the total amount of acid produced or acid output. So that is kind of the classical definition of what we think of when we think of acid reflux. What we’ve seen a lot, I think, in the functional medicine world, very correctly in some ways and other ways, we’re going to nitpick a little bit is that acid reflux as we know it is actually generally driven by too low of stomach acid and not having enough stomach acid. And we can talk, of course, on this podcast mechanistically about what that looks like. But there’s kind of a world in between where sometimes it’s too much stomach acid that’s causing you symptoms, and sometimes.

Amanda Montalvo [00:04:06]:

It’S too little, because that’s something that we got a lot of questions about was like, oh, but when I try to from a functional perspective, when I try to increase my stomach acid, it makes my reflux worse. So is it really low? Is it really high? What’s kind of going on here? Let’s go through some of the symptoms. That was the other thing I had. A few people will answer the questions in my patreon, but they were asking about like, oh, I didn’t know that this hunger kind of pain feeling is reflux. I didn’t know that nausea could be reflux. So can you go through some of the different symptoms of reflux?

Michelle Shapiro [00:04:43]:

Yes. And I also want to add to my definition, by the way, I have to tell you, I’m so excited about this, that I’m kind of getting reflux talking I’m so excited about talking about reflux that I’m burning up inside. I can’t wait. And we could also talk about how excitement or anxiety can cause reflux.

Amanda Montalvo [00:04:59]:

We are going to talk about anxiety and reflux.

Michelle Shapiro [00:05:02]:

Too exactly. But I’m just burning up. Talk to you anytime. Sanda obviously. Too so the other thing I want people to have is kind of this visual of the stomach as being this VAT of acid. So if we picture our gut being a VAT of acid different things, different hormones, different interactions with the body, different food types when they go into our stomach, think of it almost like if it’s half full and you throw a hamburger not chewed up into that acid. It’s just going to really sit there because there’s nothing corrosive enough to burn it up. So then what will happen is bacteria will come and feed off of the leftover food that’s there and ferment, and that can cause that gas.

Michelle Shapiro [00:05:41]:

And ultimately that gas can push the walls of your stomach out, which then makes that distension and then pushes up because it has nowhere else to go. And then that’s when the acid starts pouring out. When you think of, again, acid reflux, we often think of, oh, is it that it’s too much acid spilling everywhere? Maybe. And often we think of it being either too much or too little acid. But what we want to start to think about is where is that acid going? Because that’s what’s going to cause the symptoms. And that’s the reason I kind of draw this visual for us is whatever is driving the reflux is what’s going to be showing up as a symptom. So if someone could have kind of these really random and weird symptoms from reflux, it’s a great pretender acid reflux because it can look like a lot of different things. The most classic symptoms we think of are a literal burning in the throat.

Michelle Shapiro [00:06:31]:

And I can just tell you from professional experience, I have no clients who even get that right. Like it’s so rare.

Amanda Montalvo [00:06:38]:

I would say pregnant clients. It’s usually because your belly is so big and everything’s being squished. And like you’re saying it’s more that it’s getting displaced than anything.

Michelle Shapiro [00:06:46]:

Exactly. And it’s getting pushed up into your throat. So we literally think of that. And then another thing that we hear a lot is that raspy voice from people and that experience of I have a lot of clients who get a lot of chest pain from reflux too. And then this very distinct symptom I talk about all the time, which is it almost feels like there’s a little elf inside of your stomach who’s trying to claw its way out and it’s like gnawing at you. So the word gnawing really comes to mind. Have you seen that with your clients?

Amanda Montalvo [00:07:11]:

Too that almost like a hunger. It’s almost like a hunger feeling. And that’s like when I hear that and especially pair with nausea, I’m like that’s reflux.

Michelle Shapiro [00:07:22]:

That’s most likely reflux 100%. The nausea is a huge symptom. Too so there’s a couple of reasons why the nausea happens. Too a, because acid is touching the nerve endings and that just causes like a real nervous system response, a real emergency response. Too emily Fletcher, who created the Ziva method of meditation, actually in her book, writes about how if we were running from a tiger. One method that our body has to deal with that stress is to acidify our body. So to push acid out, so that when a tiger takes a bite out of us, they’re going to think we don’t taste very good and then I want to take a second bite. So it’s really interesting from this evolutionary perspective too, but a lot of the symptoms we’re seeing is the displacement of that acid.

Michelle Shapiro [00:08:05]:

So again, nausea is a really common symptom distension. I have clients who get back pain too. Again, where does that acid end up is always the question. Upper back pain, chest pain, shortness of breath is very common too. And again, it’s that the acid is either going somewhere it’s not supposed to and burning there, and then a lot of mucus comes to the site. So people get a lot of sinus issues when they have reflux, too. That’s really common. And then that hunger thing is really interesting, Amanda, because again, it’s touching those nerve endings, which is really uncomfortable.

Michelle Shapiro [00:08:37]:

And then what happens is when there’s an empty stomach and it’s inflamed with acid touching it, what we want to do really badly is cool it off. And I think eating gets things to start moving along. I’ll notice people have reflux if they find that they eat really large meals and then they feel hungry almost immediately after. Yeah, and then I’ll also notice if people are really aversive to protein, that’s when I start to think maybe they don’t have enough stomach acid. Because protein requires quite a bit of stomach acid to break down and it’s the primary site of protein digestion in the body versus a lot of other digestion happens in our small intestine proteins. And the stomach is a big place and we really need that acid to denature those proteins and break them into smaller chains to go into the next stage of digestion. So all of these can be symptoms and they all could seem totally random, but after working with thousands of clients that we both have, we’re like, oh, that’s not like a parasite that’s reflux. It kind of rings true, even though they’re all different symptoms.

Amanda Montalvo [00:09:37]:

And that’s why I want you to go through it, because it’s so much more than the burning in your chest. I do think that cough, that consistent little dry cough thing, is really common. Even having a sore throat and not really knowing what it’s from, I’ve seen that a lot in pregnant clients where they may not necessarily have the burning sensation, but they wake up and they’re like, I feel like I’m sick every morning, like I have a sore throat. I’m like, it’s probably reflux.

Michelle Shapiro [00:10:01]:

It is. And it then also starts to alter potentially immune function. And again, you can be getting more colds or feeling more sick. And we’ll talk about another kind of what the primary focuses of our stomach acid are, why we need this corrosive stomach acid in our gut too. But I also notice people when they have a very poor appetite in the morning, that could often be from reflux. Again, you’re pouring acid out in the night, it’s irritating, it’s nauseating. And people often will then crave, like carby or sweeter foods in the morning to kind of cool it off, I guess is the way I would say it, from like I know that’s not as scientific to say, but it’s like a feeling of you want to soothe it and you want to move things along, basically.

Amanda Montalvo [00:10:42]:

So let’s talk about this low versus high stomach acid thing. You did a great job explaining of how it gets displaced. Right. Which I think people are going to find very interesting and probably connect with, oh, I do get that sort of a feeling, and I didn’t realize that it was reflux. Or maybe they had like a lot of people have a feeling it might be, but they can’t get the diagnosis or they’re just told that it’s not. Let’s talk about what causes high stomach acid since we know that that can actually be an issue for some people.

Michelle Shapiro [00:11:15]:

Absolutely. Yeah. So high stomach acid is going to happen. Intake of food is going to be important in why our body would be overproducing high stomach acid. If you’re eating dense and high fat foods, your body produces stomach acid in anticipation of food. So a lot of times people experience this where they’ve been vegan for a really long time. I was vegan for over ten years in my starting to eat protein. I first of all had a huge aversion to protein and then was like, I really don’t want it.

Michelle Shapiro [00:11:43]:

But your body will produce excess acid when you’re eating meat consistently and eating higher fat foods consistently to help move those foods along. If you are eating a kind of low fat vegetarian diet, your body actually is very efficient, so it will produce less acid over time, and then your body will kind of kick it into high gear when you reintroduce those foods. Another common reason I see for high stomach acid is having any sort of histamine intolerance, because histamine will act on the parietal cells in the epithelial lining of our gut, which release stomach acid and produce stomach acid, and it will actually signal them to produce more stomach acid as a result. So I do often see, and I know we’ll do a different section on histamine intolerance, but that’s another reason I.

Amanda Montalvo [00:12:24]:

Think so many people with reflux is it’s histamine.

Michelle Shapiro [00:12:30]:

You and I could just talk histamines all day, because I just really do tend to agree. And that is a very common symptom of histamine intolerance for people. And that is a case of overproduction of stomach acid, very likely. Also, again, just in the overproduction category or high stomach acid. It could just also be that your stomach is if you’re overeating or binging very frequently. Again, your gut is overfilled, generally, and your body, to try to move things along, will release acid, which will start to initiate that part of the digestive process, too. Stress also can cause mostly low stomach acid, but it can also cause overproduction of stomach acid, too, because it can.

Amanda Montalvo [00:13:11]:

Cause a histamine response. Exactly.

Michelle Shapiro [00:13:15]:

And then the histamines will hit back on the parietal cells and hit back and recause that again. So those would be my I don’t know. Am I missing one for high stomach acid causes?

Amanda Montalvo [00:13:23]:

No, I feel like that’s primarily. I think sometimes people can feel like they are overproducers of stomach acid if they’re very inflamed, but it’s not technically causing high stomach acid. But it’s very easy to think you fall into this category if you have a lot of inflammation or gastritis or something like that. That’s like, of course, even having a small amount of stomach acid could feel like it’s a lot if you’re incredibly.

Michelle Shapiro [00:13:49]:

Inflammated, and it’s going to get displaced more likely if it’s too high. Also, I think the premise behind PPI drugs was like, when we think of acid lowering reducing drugs, I think the premise was smart because it was like, oh, people are noticing there’s acid in their throat and it’s burning them. That must be from too much. But I think we really learned over time how essential stomach acid is and how we don’t want to just reduce it all the time. But I also need to just give a huge amount of empathy to people who have been on PPIs for a long time and aren’t sure what moves to make if they want to get off of them. Because there is rebound reflux, which is that once you stop suppressing the stomach acid from being produced, people often get a very high amount of reflux when they go off those medications because your body starts naturally producing on its own, and it’s not being suppressed anymore. So start running wild and free, and.

Amanda Montalvo [00:14:41]:

Then you’re in that hard place of like, well, what do I do? Especially if you don’t have anyone supporting you, it’s like, okay, well, do I go back on it? We’ll talk about PPIs though. Okay, so that’s primarily high stomach acid, and we’ll get into histamines a little bit more. Let’s talk about what causes low stomach acid. I do think a lot of people fall into this category. Me too. But it’s not everyone. So can you go into what can cause low stomach acid?

Michelle Shapiro [00:15:07]:

100%? Yeah. Chronic stress is going to be one of the first things I think of. And then, Amanda, it’s your podcast. We have to say it. Mineral deficiencies are going to cause low stomach acid too, because your body requires potassium and zinc and sodium. Sodium. I’m like my brain right now. I’m like NA.

Michelle Shapiro [00:15:27]:

This is my brain. Of course, NaCl. Right. We think about hydrochloric acid. We need that chloride from it, too. We need those to even produce stomach acid. And again, stomach acid, much like if we think about our HPA axis, it’s something that the more you need it, the more it gets depleted. And it’s kind of like this vicious cycle.

Michelle Shapiro [00:15:49]:

So we often think we need to reacidify because it’s very easy to anytime your body also has a huge bacterial fight on its hand. It’s going to use excess stomach acid to get that fight going because it might be the first line of action for a food based toxic ant or something like that too, because that’s one of the functions of our stomach acid, is to neutralize bacteria. It’s also, again, to denature those proteins, to move them into the next stage of digestion. A lot of our nutrient absorption happens in our gut, too. So if your body’s working overtime in any capacity, it’s very likely that you could end up with low stomach acid. A lot of medications deplete stomach acid, too. Not only those medications, but antibiotics, PPIs, and anything that really damages your gut or your gut bacteria can also deplete that stomach acid as well.

Amanda Montalvo [00:16:36]:

And then I think, though, because I work in the women’s health base, hypothyroidism, having a sluggish thyroid, I say hypothyroidism. I don’t think you have to have a diagnosis in order to not have a thyroid that’s functioning optimally. That’s going to set the metabolic pace of your body. And so, especially if you are super stressed, eventually you have that kind of downstream effect from that stress response. Cortisol will blunt that TSH production, which is what tells your thyroid to make more thyroid hormone in the first place. And eventually it leads to this place where you’re in and everything has slowed down, which includes digestion. And that’s why a lot of people your appetite decreases because you’re not burning as much energy. Your body’s reserving that your metabolism has tried to preserve that energy and digestion it takes a huge hit.

Amanda Montalvo [00:17:26]:

And then, of course, like you mentioned, it’s so important for breaking down and getting that food moving. When we don’t have enough stomach acid, it ferments. And then that’s when we have bacteria that can overgrow it’s moving slower through our intestines. A lot of people can struggle with SIBO and everything, and that’s why supporting digestion can be so helpful for SIBO. But we always want to go back to that. Is your thyroid, how is your metabolism functioning? What’s going on there? Chronic stress, all that stuff, because I think that is a huge effect. But those are the people that I see where they often have either histamine issues where they’re overproducing, or it’s definitely being displaced, because if they try to conversation, if they try to increase it, it usually makes them feel worse. And then h polari, of course, h polari can very I think if you.

Michelle Shapiro [00:18:13]:

Go to the doctor, one of the major causes of low stomach acid would be H pylori. Absolutely.

Amanda Montalvo [00:18:17]:

And it’s very common. I don’t think everyone needs to eradicate H pylori. If you see it on a stool test, unless you’re obviously having symptoms, then that would probably be smart. But you can have normal levels of it, and if you don’t have a lot of other stress and inflammation, your gut, like, you could totally be okay. But that is another one. So let’s talk about histamine, because everyone in the Q A pretty much I’m like histamine.

Michelle Shapiro [00:18:45]:

I want to walk us back to something that’s going to bring us back to histamines. Okay, now everyone listening is mad at us, amanda because at this point, you’re like, why are they mad at us? Michelle because, Amanda, at this point, we’ve talked about how low stomach acid or stomach acid can drive the exact same symptoms. So it’s not commonly known if you’re going to have there’s no intuition around this if it’s high or too low. So what ends up happening is that when people see a functional medicine doctor or they learn online about hypochloridia, right, they’re like, okay, now I need to pour acid on it. What we need to think about in our bodies is what is like the current state of the fire, I would say. Right? So if you are feeling burning in your throat, I’m not going to tell you to drink lemon water right away, right? Because you’re going to be pouring if a fire is already burning outside of your stomach, we want the stomach to be burning hot fire, right? We want acid. It’s beautiful. The lining of our gut is perfectly designed to store this corrosive acid.

Michelle Shapiro [00:19:44]:

But when that acid goes in other places in the body that’s not meant to go, that becomes a problem. So what really we need to focus on also is, and something we didn’t mention is there’s a sphincter between our esophagus and our stomach called the lower esophageal sphincter. We might call it the les for this conversation. Right. And there are certain things that strengthen that, because if it gets floppy, that’s when the acid pushes up, right. And that’s when things can go out and into the wrong places. If there’s already acid and a fire burning outside of your gut, which you do not want, you can’t pour more fuel on the fire. Now, if there’s no acid burning at all because you have too low of stomach acid, that’s when you can start to play a little bit.

Michelle Shapiro [00:20:20]:

So I would say first rule of this game is you can’t pour fuel on a fire. So if you’re going to even a functional medicine doctor who’s saying, great, let’s take HCL, let’s take betane HCL supplements, right? Exactly. For people who are listening instead of watching. Exactly. It’s a very scary thing to be pouring fire when your body is also not secure in holding on to that acid and that is not strengthened the lower esophageal sphincter. So before we even have this histamine conversation, I just want to say that the recommendation across the board to either increase stomach acid or decrease stomach acid is not you really have to know where’s my fire burning and is it safe to introduce that. So this is the trickiest thing about histamines ever, right? Because like we said, histamines are going to cause more of a stomach acid release. And the reason for that is because it’s again, the body signaling like we need a little bit more fire to fight whatever is going on.

Michelle Shapiro [00:21:17]:

Probably it’s just part of this response. And also because it again directs the H two receptors on the parietal cells to release histamines and vice versa and acid and back and forth. So this was so fascinating, Amanda, with people who had long COVID. Sounds like it’s way out of left field. I’m talking about long COVID in this context, right? So they gave so many different interventions for people with long COVID. They didn’t know what was causing all these random crazy symptoms that people were so unexplainable. And ultimately they ended up doing a trial where they gave people 80 milligrams of Pepsid per day and a majority of the people had a huge reduction in long COVID symptoms. Like, wait a second, why is this acid drug that we see over the counter causing help for people in neurological symptoms for COVID? It seems like so crazy, right? And that’s because there’s histamine receptors in all of the bone marrow of our body, right? There’s histamine receptors, and I mean mass cell receptors all over our body which release histamines.

Michelle Shapiro [00:22:13]:

So it’s very interesting that an acid reducing drug could help with all these long COVID symptoms. And the reason was because it’s actually, in addition to being an acid reducing drug, it’s also an antihistamine. Phomodine is an antihistamine. So the Pepsid drug itself is an antihistamine. So in the case of histamines here’s, the problem is that low stomach acid is going to cause more digestive issues, which is going to cause a histamine response. But at the same time, if you’re busting out a lot of acid and busting out a lot of histamines, you got to lower it somehow. So I leave kind of pepsin on the table, I would say with clients for a very short period of time because that rebound reflux, if your stomach acid gets too low, is really strong. But that relationship between histamines and acid is so you have to be so gentle with it because if you get too low in stomach acid, you also get those reflux symptoms really quickly.

Michelle Shapiro [00:23:06]:

So you can’t lower it too much.

Amanda Montalvo [00:23:09]:

It’s tricky. And I have a whole podcast episode I’m going to link on histamine intolerance 101 where I just kind of go it’s just helpful because I feel like everyone talks about histamines now. A lot of people since the pandemic have all of a sudden do you not feel like the last three years. Everyone has histamine issues.

Michelle Shapiro [00:23:28]:

I feel like all my clients who never had a histamine issue in their life have histamine issues now. Absolutely. Reflux too.

Amanda Montalvo [00:23:35]:

Yeah, I think reflux is and that’s why I think a lot of it goes back to histamine and having intolerance histamine symptoms. It doesn’t have to be reflux just for those listening that are like, I thought I had these other maybe you have skin stuff, maybe you have really painful periods if you feel like you react to every supplement that you take. We have histamine receptors literally everywhere. So you could have a histamine symptom that’s reflux one day and then headaches the next day.

Michelle Shapiro [00:24:04]:

We have them in our brain and we have them in our gut. It affects our nerve uterus tremors exactly everywhere.

Amanda Montalvo [00:24:12]:

Like you said, bone marrow. I mean, it can affect so many different things. So that’s something where we’re kind of talking the context of reflux. But of course histamine is very broad. So I’m going to link that podcast episode so everyone knows and it is really important. Like you were talking about that les, right? That lower esophageal sphincter. That can be an issue for a lot of people with reflux when it’s not working properly. Because if stomach acid is too low, it also doesn’t work well.

Amanda Montalvo [00:24:39]:

It gets really lazy when you’re pregnant and your progesterone increases, it also typically gets a little lazy so it’s not staying nice and closed. And then that’s when a lot of pregnant women experience like the burning and stuff. Which is why it can be helpful to lower their stomach acid actually, at least in the short term, so that they can have symptom relief. I mean, how many pregnant people do you know that have been on PPIs? Like so many, because they’re like I don’t know what else to do because.

Michelle Shapiro [00:25:07]:

I have this really bad, so painful and so uncomfortable. Some people just need that relief too. And I can tell you that if there was a pregnant woman who and Amanda, if we talk about reflux also, and I know we’re going to have a bigger conversation about this from like a spiritual perspective, it’s like too much, right? Like it’s just so much heat in the body. Thinking about pouring on the most energy demanding process the body can possibly do. The most heat generating process is pregnancy. Right? This is a very fiery time for people and it’s so much going on in the body. Imagine like pouring acid onto a body that’s burning like that already and people are wondering who is it too low, stomach acid. You’re right.

Michelle Shapiro [00:25:45]:

In pregnancy. No, there’s not a lot of space left, especially towards the end of pregnancy. And it’s a very hot time. I think that’s the only phrase I could use. It’s an energy and the hormonal shift.

Amanda Montalvo [00:25:58]:

You want that increase in progesterone. But I do think because of the immune system. Changes that we experience during pregnancy. That’s what led to all my histamine issues. Like your immune system shifts all of a sudden. I had eczema. I had reflux in the very nontraditional sense, where I had to eat small meals. I had that gnawing feeling, nausea, I think a lot of morning sicknesses reflux, to be completely honest.

Michelle Shapiro [00:26:25]:

Oh, absolutely.

Amanda Montalvo [00:26:26]:

And that’s something where it’s like when you talk about sodium bicarbonate or even like I was using a lot of magnesium bicarbonate between meals, like in my adrenal cocktails or just taking a sip, and that bicarbonate because it neutralizes the stomach acid. So then I found out, okay, I don’t have to eat every 2 hours. I don’t have reflux this time, thank god. But a lot of what happens is I think the immune system shifts. So many things happen. I think I have so many clients that eczema comes back only during pregnancy. They don’t experience it outside of pregnancy because your body is shifting, your immune system is adapting because you’re growing a life. So I think that pops up for a lot of people.

Amanda Montalvo [00:27:15]:

But I think that hyperemesis is actually histamine and mass.

Michelle Shapiro [00:27:20]:

I think it’s histamine and reflux, I think.

Amanda Montalvo [00:27:23]:


Michelle Shapiro [00:27:24]:

You know, it’s so funny, Amanda, because I have been a person who is like you’ve been by many means in a very positive way, like super healthy and strong a lot of your life. And I’m like, not I lost like a hundred pounds. I had anxiety, I had digestive issues. I had all this stuff going on. And for you, it was your hormonal stuff that led you into the beautiful place you are in your career. For me, reflux is a huge part of my life. So when you were pregnant and you were telling me, you were like, michelle, what is scientifically new? But, you know, experiencing it, of course, is different. I was like, oh, Amanda, now you have to eat, like I used to have to eat now.

Michelle Shapiro [00:27:59]:

All right, amanda, are you having your snack every 2 hours? Because also what happens with reflux, too, is if you get too hungry, your body anticipates that there’s food coming, so you release acid, and when you eat, it makes acid move along. It pushes things down the process. So what happens is then you just have acid sitting there with nowhere to go. So, again, if you have not a lot of space left, and you have very on fire nerve endings, and your lower esophageal sphincter is looser or flappier because of the progesterone, you might need to eat more frequently or something like that during pregnancy. And for you, it was, like, so weird because you’d never did that experience that yeah, it was so weird. You’re such a meal girly. I’m a snack girly.

Amanda Montalvo [00:28:38]:

You’re a meal person.

Amanda Montalvo [00:28:40]:

Thyroid health is essential for healthy hormones, digestion energy, and more. Our thyroid is so important because it sets the metabolic pace of our body, which controls how every single system functions. Whether you think you may have some thyroid dysfunction going on based on symptoms you may have or have a confirmed diagnosis, chances are you haven’t been given the best tools to address your thyroid health. I’ve been there. Thyroid is a big part of my health journey and something I’ve been optimizing for the last decade. I’m very passionate about this topic, which is why I created a free thyroid training that walks you through how to assess thyroid health. All the labs I do cover blood work and what the optimal ranges are. I just want to say that I think we have to look beyond blood work when it comes to assessing our thyroid health.

Amanda Montalvo [00:29:23]:

That’s why I also cover hair mineral testing, urine testing, and then basal body temperature, which is a measurement you can do at home to assess your thyroid health. I’ve had so many people reach out and say they can’t believe that this training is free. I promise you won’t be disappointed. I also cover nutrition tips for optimizing thyroid health. You can head to the link in the show Notes or to my website, Hormonehealingrd.com to watch the training. There’s just so much lacking when it comes to helpful info on thyroid health. So I’m really hoping that this training helps you and fills that gap.

Amanda Montalvo [00:29:58]:

But I think a lot that’s very normalized in pregnancy, having to eat every couple of hours. And I think in the first trimester, it’s kind of like your body’s doing so much work, your hormones are increasing so fast. Having some nausea, I think is pretty normal. But I think when it’s debilitating, when you can’t eat I lost a lot of weight my first trimester of my first pregnancy and I’m like, this is not good. It kind of freaked me out. And then I figured out how to manage it. You were like, Bicarbonate, do the baking soda. Also, we’ll talk about this, but very teeny, like an 8th of a teaspoon.

Amanda Montalvo [00:30:33]:

But that is very helpful. And I think for people with histamine issues, like you said, it’s a double edged sword. If you have too low stomach acid, it leads to poor digestion, which can your body can then see those foods, tag them, want to get rid of them because they’re these unidentified proteins, so it can lead to histamine issues. But I think there’s a way to find a happy medium and ultimately supporting your digestion in the long term. And we’ll talk about strategies and stuff at the end, but the other piece with histamine is stress and the nervous system. We cannot forget this. And I think we can talk about circadian rhythm because histamine has a circadian release.

Michelle Shapiro [00:31:14]:

Of course we can. Exactly. Yeah. When I joke that Mass Cell Activation Syndrome, which is what people commonly associate as I histamine intolerance, I think of it as being having an allergy distress. That’s how I joke that it is, which means that the body that’s so good exactly. It’s like your body is on constant high alert from something that’s happened, from a deficiency, from an attack, from something that’s happened. And your body is constantly assessing for those threats and trying to do the absolute best it can from that state of that preservation mode, basically. So a body that is experiencing histamine intolerance is not going to act anything like a body that is not.

Michelle Shapiro [00:31:56]:

And the most frustrating part about histamines and reflux is that what your body needs the most is what it’s going to potentially resist the most. Which means that if you again need stomach acid, because you’ve low stomach acid, your body might produce an insanely high output of stomach acid from that, and it might not feel very good when you’re doing it or something. Again, with histamines, like oftentimes people with histamine intolerance really require vitamin C and B vitamins and all these things for liver detoxification, which will help, right. And ultimately, when you take them, they can cause massive responses. Yeah, histamine responses. So it’s like our body does this very funny thing where the thing that we need might not feel good. And I think this is really important to talk about with reflux because even if you’re having low stomach acid and you need acid, it might not feel okay to take that acid in. And that’s not what we’re hearing from functional medicine doctors, I think.

Michelle Shapiro [00:32:49]:

I think what we’re hearing a lot on social media is like low stomach acid. Take some acid. And I’m like, but if you’re burning up and your throat’s killing you, don’t do that because you need to cool it off first, like you said with the bicarbonate. So certainly histamine reactions beget histamine reactions. And so you have to really with everything with reflux and histamines, you need to go so dramatically slower than you think you need to go with any.

Amanda Montalvo [00:33:13]:

It’S annoying doing, but it’s the only way I truly feel. It’s the only way. Otherwise, I’ve had clients that they try a supplement to support their immune system because it’s usually completely depleted at that point. Right. By the time you get to that point where you’re like histamine symptoms constantly mass cell activation, your nervous system is responding to every you’re so sensitive to everything around you. You can’t just take a bunch of supplements and follow some mass cell protocol, which I see people do, oh my God, all the time, and they feel terrible. And I’m like, it doesn’t mean that those things aren’t going to work for you eventually, but it means that you have to take very teeny, tiny baby steps and not be afraid to be like, okay, this is really not working. It’s affecting my day to day.

Amanda Montalvo [00:34:01]:

I’m going to try to move on to this next thing. Honestly, I think most people with histamine issues have to work on how they’re living on a day to day basis, their stress and their nervous system first before they do anything. Because if you look at what causes mass cell activation has been released, it’s like temperature shifts, like mental emotional stress, certain stressors. Yeah, literally like any physical or mental emotional stressor could cause that activation. And that means your body has no resiliency left. Like you said, you’re allergic to stress, which I will forever be using that I will credit you. But it’s truly like so how can we look at this? I think people want like what do I do if I have histamine related reflux? That’s like the number one, the first thing. And then I have a tidbit on light exposure because we’ll talk about their circadian release.

Michelle Shapiro [00:34:57]:

Yeah, I really want to talk about that too.

Amanda Montalvo [00:34:58]:

Oh my gosh, it’s so interesting.

Michelle Shapiro [00:35:05]:

I think that I have a very special piece of my heart for reflux sufferers or histamine intolerance people, obviously because I’ve been that person, but also because there’s a very special type of person who usually encounters these things. And I feel like I’m not stereotyping, but I have seen a lot where it’s the type of person who really bears a lot of responsibility for the world on their shoulders. And there are very likely people who have done so much for others and are constantly so protective, I guess is the word I would say. And it ends up just like you hold stuff in you and then anything that’s coming at you is like too much is kind of what it feels like. It’s like a feeling of too muchness. So our inclination is like when I first got diagnosed with mass cell activation syndrome, I was like, I’m going to get an IV of 10,000 grams, milligrams of vitamin C, 10 grams of vitamin C. I was like, I’m going to get B vitamins. And by the way, I did it and whoo did it flare me.

Michelle Shapiro [00:36:02]:

And I was like, I’m going to just get it over with. That’s kind of the opposite approach I would recommend for people with reflux or for histamine intolerance because it’s really about bringing your body back to that state of balance and that really means creating like it’s so silly to say, but like, peace within your body. So you kind of have to baby your body in both of these situations, which is really frustrating for these type of very high energy, hot headed, I’m like not hot headed in anger way, but we carry the heat in our body. Passionate people who are passionate about protecting others that’s what they want to do is just kind of bulldoze things and it calls for us to kind of eat like a baby bird. Like, you eat a little bit here, then eat a little bit there, and you kind of have to eat slower, and you kind of have to pay attention to how you feel. And it forces people to do what’s the hardest thing in the entire world, which is really like, slow down and look inwards, which anytime you’re doing either of those, you’re impacting your nervous system, which is then affecting your release of stomach acid, affecting your output of histamines. I really think the whole name of the game is always in our world, the nervous system. For you, it’s the nervous system and minerals.

Michelle Shapiro [00:37:14]:

But the nervous system and minerals are so interrelated as you talk about on most episodes in your podcast, of course, anyway. But I think it’s really a call in both of these cases to slow down and introduce things that once didn’t feel foreign to your body, but for some reason right now, it feels foreign to your body, which could be food, as simple as that.

Amanda Montalvo [00:37:34]:

And to prioritize yourself. I have a lot of moms that are clients that have mass cell, like severe mass cell issues. And reflux is always a symptom, usually paired with constipation and having to take supplements upon supplements upon supplements for years just to have regular bowel movements. Because of course, low stomach acid is also going to have a huge impact on bowel movements and constipation and everything when they start to prioritize themselves. One, it’s incredibly difficult. Foreign, right? It didn’t used to be, but it is now because they have multiple kids. But they really are they’re like the nicest, sweetest, most caring people you’ll ever meet.

Michelle Shapiro [00:38:22]:

It’s a refusal on our part to take care of ourselves. It’s a refusal. It’s like, I have to focus on the baby. I have to focus on all these things. It’s the people who are relentless in their pursuit of helping others, to be honest with you, who are going to end up with the worst cases of these.

Amanda Montalvo [00:38:36]:

Oh, my gosh. I know I have a special place.

Michelle Shapiro [00:38:38]:

In my heart for them because I think it’s very protective people. And I think a lot of people associate anger with reflux, which is like chakra wise, like, kind of makes sense. Our solar plexus, right? We associate. But it’s really for me, it’s like holding things in and holding things really passionately, I think is where people end up with reflux. And that would follow from a biological perspective, too, by the way, that actually makes sense. And then if we just think also when it comes to reflux or histamines, think about our posture and our musculature, right? Reflux. We’re so used to eating. We eat hunched over and we’re shoving food in our mouth, especially those people who are too generous, right? And I know people listening are like, shush, Michelle, okay, leave me alone.

Amanda Montalvo [00:39:20]:


Michelle Shapiro [00:39:20]:

The people who are focused on other people, you eat head down, scrunched over, your acid’s going to be pouring into your throat, you’re smushing your stomach together and all of that acid is coming up. So we have to think about physical positioning. And also, again, that position where we’re hunched over very protective position, right. We think about opening up our arms and opening up our hearts a little bit and to ourselves really. And then it becomes a little bit better. So reflux without a question and histamine intolerance. The first thing I’m going to ask people is what is your posture and speed of eating? Because we can’t force this process. And we think also about our digestion as being like almost like a river.

Michelle Shapiro [00:39:57]:

Like things go from the top and then they go down and through. It’s a very complicated process but anything like you said that stops the flow is going to stop other parts of digestion and that’s where we get into the constipation and pieces of digestion like that too. So what’s happening in our brain is where digestion really is going to start and we think of it in the mouth, I think of it in the brain and then how things move downwards from there.

Amanda Montalvo [00:40:19]:

I love that. And we’ll get into more strategies. We’re going to have to go so fast through some of this stuff so we can do the Q and really quickly. So last thing on histamines there is a circadian release of histamines. So like around five to six in the morning, around one P, mish twelve 01:00 p.m.. And then around 07:00 p.m.. And when I share this with clients they’re often like, oh yeah, my symptoms are often worse around those times. I also think for histamine people, they tend to wake up at like three or four in the morning and a lot of people associate with liver, which of course people with histamine issues have liver issues, of course.

Michelle Shapiro [00:40:59]:

But the primary site, yeah, I think.

Amanda Montalvo [00:41:01]:

Primarily they’re waking up because their circadian rhythm of their histamine release is off and so light exposure and I have a whole episode coming with Carrie Bennett, you guys are going to love it. And she’s the one that I learned about the circadian rhythm of histamine release from. I was like, whoa, this makes too much sense. It hurts my head. Because then you think back of all your clients I think of back of when I was pregnant and I would wake up at three or four or even postpartum before I did all that gut work because I had a newborn. I was like, I’m not working on my gut right now. That was like when my hispine issues hit like a peak and I was waking up and I’m like, I don’t wake up at night, this is not cool. And it was like my nose was running.

Amanda Montalvo [00:41:48]:

I was congested. I definitely still had some reflux stuff, which is probably why I had sinus stuff. So it’s just like very interesting when you start to think about that release too and how okay, if your circadian rhythm of your histamine releases off, how is the rest of your circadian rhythm, how is your biological clock? And then that’s where light exposure comes in and what that looks like for, like, anyone that has reflux issues, you think it might be histamine related. Make sure you listen to my next episode with carrie, because that histamine one.

Michelle Shapiro [00:42:18]:

On one episode, which is fantastic, by the way. I’ve heard a million times that’s, like.

Amanda Montalvo [00:42:23]:

A one where I’m like, we have to cover this because so many people talk about histamines and they don’t really understand it. Okay.

Michelle Shapiro [00:42:28]:

And then I want to mention really quickly on that, too, because, damn, we still have so much to go through. I got to say the word mucilaginous yet? Amanda oh, yeah. We have so much to go through. I notice very much in my reflux clients, with or without histamine intolerance, that 05:00 a.m. Is like ultimate gnawing hunger time. That’s when people are noticing that the most, and that will then lead to what they’re not realizing is if they’re having a lack of appetite in the morning or they’re having only a preference for sweet foods in the morning or nausea in the morning. It’s almost always reflux in those cases. And I definitely notice 05:00 a.m.

Michelle Shapiro [00:43:06]:

Is like, that gnawing time. 05:00 a.m. Is that gnawing time?

Amanda Montalvo [00:43:10]:

Because I think people are going to be like, how do I know if it’s histamine related? I would think about that. Do you have specific times of the day when your reflux symptoms are worse? And if it kind of lines up with what I just went through, I would say that’s probably.

Michelle Shapiro [00:43:24]:

On that. If you’re wondering if there’s maybe histamine involvement, I would look for other symptoms outside of the ones we named. Like, if there’s a dizziness, if there’s any kind of disorientation, if there’s any kind of numbness leg signaling, heart rate changes. Those kind of things are usually not only reflux related. And I think a second place I might look is histamines there, too.

Amanda Montalvo [00:43:47]:

Yeah. Oh, definitely. Because, again, nervous system. It’s like literally nervous system reacting. Okay. I feel like we talked plenty about pregnancy heightal hernias. I’m like, how do we not mention it?

Michelle Shapiro [00:44:01]:

So can we do that quickly reflux stuff we have to talk about? Yeah. So, again, a hiatal hernia is a functional disorder that would happen where you’re wrapped around your diaphragm. There’s, like a little loop, and that will also push acid up. One thing I say for people, this is absolutely not medical or nutrition advice or diagnostic. But if you do notice a tenderness when you press on your rib cage anywhere, I would just see a doctor about that and make sure just to rule out if it’s a heightal hernia or not, Because that’s one of the most common causes of reflux, where if amanda, if someone’s dealing with their histamine issues and someone is dealing with their reflux issues, stomach acid issues, and they’re still not getting any better, it might be a physical function issue, too. It might be the shape of the stomach and that little knot that’s created.

Amanda Montalvo [00:44:46]:

Yeah. And it just messes with that sphincter, that les. And so that’s when you can have those issues. It’s like my dad had reflux forever. Forever. And again, we tried all the things. I was like, I know he has low stomach acid from forever. And I think that he probably did.

Amanda Montalvo [00:45:02]:

But he was one of those people that it didn’t matter what we did. It was definitely a hiatal hernia. And his chiropractor was like, here’s how.

Michelle Shapiro [00:45:10]:

To I know a chiropractor corrected mine too. A chiropractor literally got in there with his two fingers and untwisted it in my body. It was crazy.

Amanda Montalvo [00:45:18]:

So it’s one of those things where see a doctor. If you have your chiropractor, they definitely know what they are, something to consider.

Michelle Shapiro [00:45:26]:

They may also need a specialty in it, by the way, that’s the only thing is don’t let anyone poke around your stomach unless they have a specialty in Heidal hernias. But some of them do have actual specific courses they take in it, and they can correct it manually, which is unbelievable instead of surgery.

Amanda Montalvo [00:45:38]:

Yeah. And I feel like in the south, a lot of them do because the population is older, and so they have no other option. It’s really common, I feel like, in the older population, but I’ve seen it in a lot of clients, too, honestly, like young clients. So let’s get into symptom relief, some of these strategies. We talked a little bit about eating smaller meals, right. And how that can be kind of hard mentally sometimes for people, but it can be very helpful. So what do we think? If someone is struggling with reflux, what strategies would you have them experiment with?

Michelle Shapiro [00:46:11]:

Absolutely. Yeah. So, first of all, again, let’s divide the strategies for a second into what we’ve historically seen. Allopathic conventional nutritionists, not even doctors, will tell you to not eat spicy foods, eat really slow, small meals, not eat high fat foods. And basically the goal of allopathic nutrition is to not annoy your gut and create reflux. That’s kind of the main goal. How do we do that in functional medicine? Of course, in functional nutrition, we’re always seeking to fix kind of the root cause. Where I think, again, we’re falling short is that we have to address symptoms when they come up, too.

Michelle Shapiro [00:46:43]:

So when I think of, again, cooling, what I was yelling at Amanda about is I’m like, give me a little bit of baking. So because something like baking soda, which is very alkaline, obviously is going to kind of cool that reaction. Now, if you continue to have baking soda or you continue to have bicarbonate or things that are more alkaline, it could then cause too low of stomach acid eventually. So I’d say as a very short term strategy, I sometimes have clients take a quarter of a teaspoon of baking soda in one, like 8oz of lukewarm water that can just really be very soothing for the short term if you’re experiencing symptoms. If low stomach acid is a problem.

Amanda Montalvo [00:47:18]:

Not near a meal, guys, not near a meal. Because remember, if we lower stomach acid.

Michelle Shapiro [00:47:22]:

Not for your supplements either. Too exactly. We actually need that acid to break down our vitamins and minerals too. So that is a mineral.

Amanda Montalvo [00:47:30]:

And you could do magnesium bicarbonate if you’re not comfortable with baking soda. I find that a lot of people.

Michelle Shapiro [00:47:36]:

Already have that and magnesium actually helps with the structure of the lower esophageal sphincter, too. So you kind of get a double benefit from doing magnesium bicarbonate, too. And by the way, as far as I’m concerned, baking soda is safe for many different conditions. But please check also specifically for yourself with your doctor, of course. So that’s one thing I would say. Another thing which is really popular is actually supplementing with mucilaginous agents. Yes, we get to say mucilaginous, which is basically mucus forming protective agents that you can take slippery elm, marshmallow root, I think a lot of people have heard of. And these you take in supplement form or powder form or DGL people have heard of a lot.

Michelle Shapiro [00:48:15]:

And these will actually form a protective barrier anywhere where the acid is going to the wrong place. But mostly when we think of it, it’s along our esophagus and throat. So that will help with a lot of symptoms. Too when you have that protective layer, also, it will help acid to move more efficiently throughout your system also. So that kind of helps in two ways for symptom relief. And then also, I think, again, eating very slowly in a really good posture is a good chewing. It’s a protect and chewing your food basically pretend that your body is down for the count. Treat your body like it needs your help because it does and make things really easy for your body.

Michelle Shapiro [00:48:54]:

And then also, I think eating and drinking at different times can be really helpful for people when they’re in an episode or in a flare. Just because if we’re eating and drinking at the same time, the sheer volume of food and liquid in our stomach is going to make it push out and potentially push up. And then also anything that’s really supporting your liver and bile production, which know you’re going to get that information from so many of your episodes. Amanda they know where to live for that, too. Yeah, because that’s going to really help. I like carrot juice that is the most amanda the raw carrot is the Amanda Montal special. But I think anything that’s really supportive in that way will help. And then also just making sure again, what you’re eating at meals, if you are eating spicy foods, just make sure it’s matching how spicy your body feels, right? Like if you feel like the gnawing feeling but you’re not feeling the burning and you’re like, okay, I want to see if I add a little bit of heat, if this will help.

Michelle Shapiro [00:49:49]:

So doing things like taking ginger, doing things like that, introduce heat. Lemon water can be really helpful for that low stomach acid, just not when you’re currently actively inflamed and flared.

Amanda Montalvo [00:50:00]:

Yeah, and I think that’s like the easiest way because it’s like, okay, well, what do I do if I want to support improving my low stomach acid in the long term? Like you said, all being mindful, the chronic stress, figuring out what caused that low stomach acid in the first place. I mean, minerals are going to be huge, right? Especially if you’re worried about thyroid health, metabolism. Minerals are going to be a huge driver for that. Do you have deficiencies? But we can never ignore the stress piece. That’s typically what has gotten most people there in the first place. But I think it can be this beautiful combination of like, okay, I’m supporting my body for the long term in these ways, but I can still support reducing symptoms in the short term. I think it’s okay and honestly essential with reflux to do that because there can be detrimental long term effects of struggling with that reflux. And then really quick, because you mentioned the I know people are going to ask about slippery elm and marshmallow and DGL.

Amanda Montalvo [00:50:55]:

Are they safe during pregnancy? DGL is safe, and that’s typically the one that I would recommend during pregnancy. If you have low potassium, be careful with licorice. That’s like the only thing I’ll say. So if you have measure whether that blood pressure too, via blood work, yeah, and if you’re someone like I get a lot of people in my course that they already have low blood pressure and then they get pregnant and it gets lower, do not take DGL then. And again, this is why you have to talk with your doctor. People will just order herbal supplements online. And I’m like, if you’re on a medication, if you have any health history, you really shouldn’t do that because herbs are powerful, they do work, so you just want to respect them and make sure it’s like a good fit for you. Okay, let’s talk about the HCL piece.

Amanda Montalvo [00:51:44]:

How come it works for some people and how come it doesn’t work for others?

Michelle Shapiro [00:51:47]:

Yeah, again, this is on the functional medicine.

Amanda Montalvo [00:51:50]:

Bitters or apple cider vinegar? Because I feel like everyone tries that too.

Michelle Shapiro [00:51:54]:

Exactly. So also bitters and apple cider vinegar are going to work a little bit differently than if you’re basically we’ll have people take betane HCL with pet absence, so they’ll have enzymes already in it. One thing we didn’t mention is that there’s little if we think of like, pacman that swim inside of the acid. And these are enzymes and they will help to do the action of whatever we need them to do. Denaturing the protein, breaking down bacteria, whatever that is. If we don’t have proper stomach. Acid, those enzymes won’t work. So oftentimes people take digestive enzymes to help with reflux.

Michelle Shapiro [00:52:24]:

And I’m like, if you don’t have stomach acid, they don’t swim in anything, they’re not active, they become activated by the stomach acid itself. That’s how they exist only. So I think people will take betane HCL supplements. And again, if you are already in a flare, it is going to kind of pour fuel on that fire and it is not going to help. And you are going to be quite symptomatic from taking it, too. So you have to be really careful with taking those acid supplements specifically. And sometimes, again, like you said, Amanda, if it’s not treating the root cause anyway, if the root cause of your low, the root cause of your low stomach acid is probably not just having low stomach acid, there has to be a reason why your stomach acid was low in the first place. So learning and understanding why, again, if the lining of your gut is not solid, it can really be quite corrosive and can cause some issues for people.

Michelle Shapiro [00:53:14]:

But I still use it in my practice. I still think it’s fantastic. BT and HCL. And then also people take bitters. Bitters can instigate the production of stomach acid and also create for that fiery environment for the enzymes to live, basically. But again, if you just think about eating a bunch of ginger when your throat’s hurting, it can help, but it also could burn on the way down, essentially. So it’s just being sensible about that and going extremely, tremendously, ridiculously slow with every single intervention you have. I think that’s really what’s important here.

Michelle Shapiro [00:53:46]:

And as you’re trying things, noticing how you’re feeling, especially with histamine intolerance combined with this reflux, there’s a recommendation, I think, for histamine intolerance that if you’re trying a new supplement and the dose is like three pills, you should try to open it up and do one 8th of one pill to start with. That’s how slow you should go with these things. And reflux and histamine intolerance are both calling for slowness. They’re calling for detail, attention, compassion and kindness. So just eating slower, thinking slower, doing everything you can to slow down will really help all of this. And slowing down can then also help you to pick things up as your body garners the energy to do these things and get the proper nutrients from the breakdown of all the food that you’re getting.

Amanda Montalvo [00:54:31]:

And I’m trying to think, I’m like, did we cover PPIs enough? I mean, you talked about how they’re acid blocking medications, which is an issue because it can help in the short term, but in the long term, we need stomach acid because it gets digestion going, it activates enzymes. It’s incredibly important for digesting and absorbing our food well in keeping our gut healthy.

Michelle Shapiro [00:54:53]:

We can’t cleave vitamin B Twelve because of the intrinsic factor issue. Also, a lot of the vitamins and minerals we have are from directly or indirectly as a result of our stomach part of digestion. When we think of our gut, by the way, people are off talking about our small intestine, by the way, they’re not actually talking about our stomach, but our stomach does a lot of really important things too. Or when we think about this obsession people have, which is pretty rational with glutathione and our mitochondria, our glutathione is made from three different unique amino acids which have to be broken down properly. And if basically you don’t have good stomach acid and you can’t break down the proteins into smaller structures and lines of amino acid, it’s going to go into your small intestine and those longer chains and then your body’s like, what the heck is that? And that can actually cause autoimmune responses because your body is like, this shouldn’t be here, basically. So again, another reason why, especially when you’re having high protein foods, you have to take it really slow when you have reflux because it is energy dependent and it’s acid dependent, digesting protein foods. So it’s so silly. Again, when your body needs glutathione the most, our body doesn’t have enough stomach acid to get it.

Michelle Shapiro [00:56:05]:

So that eating protein can be irritating to our reflux. But I think, again, higher protein foods, as essential as they are, and let me tell you, they are essential, even if your body’s telling you it doesn’t want them because of reflux, try to very slowly introduce them. And my hack for people eating protein when they have reflux is try to eat cold versions of it. So I mean eat like literally, if you think about rotisserie chicken even, or like deli meats, which I know people are like, oh, they’re not organic, whatever. Everyone has their own level of what they think is acceptable to eat, but they seem much less nauseating than like a beef stew. Like, imagine being nauseous and having reflux and then pouring a beef stew into your body. It’s so hot. So choosing proteins even like a whey protein shake or something like that, that are colder and cooler might be easier to get in while you’re trying to build your protein up.

Michelle Shapiro [00:56:53]:

If you have no appetite for protein.

Amanda Montalvo [00:56:55]:

When you have reflux yeah, I think the other two is like perfectionism. Because I talk about the importance of protein and blood sugar balance and all that. Yes, of course. But we can’t let perfectionism be what is it be the enemy of good or whatever.

Michelle Shapiro [00:57:10]:

It’s like you have to at least.

Amanda Montalvo [00:57:12]:

Get it done right. You have to at least take even if it’s a few bites. And that’s what I tell women in pregnancy that have protein aversions. They usually also have reflux and they probably have some sort of mass cell histamine issue going on. And I’m like, even if it’s a few bites, it doesn’t matter. It’s a few bytes, right? And that’s where you begin and then you can work on that further from there. And then last thing, we kind of covered it. Stress and the mental health impact on reflux.

Michelle Shapiro [00:57:40]:

I mean, our vagus nerve, which we know connects our brain to our heart to our gut and all these vital organs in our body sets the pace for how much acid to produce and sets the pace for where that acid goes and sets the pace for how long or short it takes food to get into our gut. So, again, we can’t think of digestion as starting even in the mouth. It almost starts higher than the mouth because the second we see food, digestion really even starts. Right. So that cephalic phase of digestion right, which is in our brain, essentially. So anything that is impacting our stress is going to directly impact our digestion. And I made a comment on Instagram recently, or a post, I think, and it was like, by the time you’re asking, hey, is it stress that’s bothering my gut, the answer is, so yes, don’t even think about it. By the time you’re thinking about it, it is so that but it will literally direct the timing and motion of food as it moves through our digestive tract.

Michelle Shapiro [00:58:38]:

So every single part of stress influences every single aspect of our digestion. So there’s literally nothing. The gut bacteria we produce is influenced by the stress that we have and which gut bacteria are going to do what and eat what is impacted by it. So every single part of digestion really is impacted by our brain and our nervous system. And of course, if we were in the most evolutionary biological way, which we always talk about evolutionary biology at least five times at every episode, of course, if we think about if we were running kind of from that tiger we were talking about, the last thing your body is going to be interested in doing is going to the bathroom. So your body will stop or initiate digestion based on the resource and need of the rest of your body. So where does my blood flow need to go? Where does my brain energy need to go? Where do my resources need to go? And in times of mineral scarcity, in times of other types of scarcity, I think that we really find that digestion is an easy way for our body to divert resources outwards as opposed to inwards. And that’s where the resources need to go, to running or fighting or all those trauma responses.

Amanda Montalvo [00:59:47]:

And do you find, because you work a lot with clients with anxiety, that the majority of them also struggle with reflux?

Michelle Shapiro [00:59:56]:

Yeah. Oh, my God, I can’t believe we didn’t talk about my trifecta. Amanda, my trifecta is blood sugar reflux anxiety. Yes. Reflux specifically because it can influence your blood sugar. You can get this starving, fearful, gnawing pain that definitely instigates anxiety. And also, by the way, when acid is in the wrong place. That’s going to stimulate your vagus nerve in a way that’s going to make you very anxious.

Michelle Shapiro [01:00:21]:

It’s going to downplay the action of your parasympathetic nervous system for sure, and hype up that sympathetic nervous system. What I’ve learned in my ten years of clients, Amanda, is that a majority of the anxiety we experience comes from our reaction to symptoms. And I’ll tell you another just really quick thing about reflux is that when we get really distended like that and our weight kind of goes up on the scale, it’s one of the most triggering symptoms that can exist for people because you feel like, oh my God, I’m gaining weight. Oh my God, something’s horribly wrong. Oh my God, I don’t know what to do to fix this. I’m already taking a PPI. So just knowing that when you experience that reflux, just say, hey, these symptoms are really weird and I really don’t like them, but they’ll pass. I think that’s really important with reflux because it’s very scary for people and absolutely can cause anxiety on its own.

Michelle Shapiro [01:01:12]:

And anxiety can then cause reflux. And then we get into the fun low blood sugar reflux anxiety cycle, which we all love to be in.

Amanda Montalvo [01:01:18]:

It’s so enjoyable and I just don’t think people understand anxiety is stress. Is your body in fight or flight? So that’s what Michelle means when she like, anxiety can cause reflux. It’s that whole scenario that you just went through with how stress leads to reflux. I just wanted to point that out because for us it’s very obvious because we’re working with clients and we’re in this space, but I think sometimes it can surprise people. Like they feel like they’re two separate things. It’s like no anxiety and stress.

Michelle Shapiro [01:01:50]:

Yeah, anxiety. I think of anxiety as being a higher level of stress or something, but generalized anxiety is just little stress all the time.

Amanda Montalvo [01:01:59]:

It is a stress response.

Michelle Shapiro [01:02:01]:

I would put them in the category of stress and anxiety being the same and panic being a little more. Yeah, that’s what I would say. And I also really, again, am calling people to I think reflux and histamine intolerance are calls back home from the body to say, I really need you to cool off. It’s just cooling off in the metaphysical way and in the physical way. We got to cool it down. It’s too much for right now in whatever way. And also, by the way, I’m speaking of one little tiny thing, which is that posturally and stress wise, exercise can cause reflux and can also cause histamine intolerance. Histamine intolerance symptoms.

Michelle Shapiro [01:02:42]:

Not doesn’t cause either of these things, but in the short term, too. Just watch how your body’s moving again, if you’re in a state of stress and you’re hunched over, you’re stressed about something, think about what your body is doing right. You put added stress in your body and then you’re smooshing your digestion together. Same thing when we’re doing AB workouts or we’re doing other things where we’re moving around that area a lot, especially if you have a hernia or something like that. Just be mindful of your posture and mindful of your movement when it comes to both reflux and histamine intolerance, too.

Amanda Montalvo [01:03:12]:

I’m like, Are we going to bring this episode to fascia? Because that’s where I feel like it’s going.

Michelle Shapiro [01:03:16]:

We have to talk about the form, Amanda. We have to talk about our form and then our posture.

Amanda Montalvo [01:03:22]:

It’s a pattern for your body and we’ll end it here because we have to do the Q and A. It creates a pattern for your body. And we have this fascia, this connective tissue that layers over that posture. So the longer that you’re in that you’re hunched over, we’re all at our computers, like, looking down at our phones, or you get that forward neck posture when we are on computers all the time at a desk, all the like, then that layers on that connective tissue, and then it’s even harder to get out of those postures.

Michelle Shapiro [01:03:57]:

But Amanda, we have to say it, oh, God, you shouldn’t have brought this up because now we’re going into a whole different thing where’s our vagus nerve, amanda right. Running through our course. Exactly. So you’re also pressing on it when your neck is pressing forward and that will send signals for your body to do things. Listen, in total summation, from the top to the bottom, your body is working altogether. So anything that influences your brain is going to influence your digestion. Right. You never have to ask if stress is a part of it.

Michelle Shapiro [01:04:25]:

It is. Factually, it is. It will always be a part of it, no matter what. It is a constant battle of all of ours, the battle of the stress, that is always a big thing. And I think again when I think of all of these things, you have to think of the interconnectedness. And then I just want to tell people, because histamine intolerance and reflux are two of the scariest symptom sets you can have. Their bark is so much worse than their bite. I promise you these are not long term dangerous.

Michelle Shapiro [01:04:48]:

Don’t be so scared by the symptoms. And I promise for anyone listening that no matter how bad it seems in either way, there’s always hope and there’s always something you can do. So to like 100 things you can do, but there’s probably 1000 things you can do. So I just want people to know that even if you’ve been to doctors and they said, no, you can only take acid reducing drugs, no, I can only help you with mass cell in this way. There’s always more. And the answer is always going to come back to just listening to yourself and taking it slow.

Amanda Montalvo [01:05:15]:

I love that. So we’re going to end it there. If you guys want to get access to the Q A, we’re going to answer a bunch of our patrons questions in the bonus episode, you can go to patreon.com slash hormonehealingrd. But thank you so much for being here.

Michelle Shapiro [01:05:28]:

Michelle love you.

Amanda Montalvo [01:05:30]:

Thank you for listening to this episode of the Are You Menstrual?

Amanda Montalvo [01:05:34]:

Podcast. If you want to support my work.

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Please leave a review and let me.

Amanda Montalvo [01:05:37]:

Know how you like the episode.

Amanda Montalvo [01:05:38]:

This lets me know what you guys want more of less of.

Amanda Montalvo [01:05:41]:

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Amanda Montalvo [01:05:44]:

Appreciate them more than you know.

Amanda Montalvo [01:05:46]:

If you want to keep learning, you can get access to the bonus episode.

Amanda Montalvo [01:05:49]:

And additional resources on Patreon.com Hormonehealingrd. I’d love to have you in there. Thanks again and I will see you in the next episode.

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

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