Stronger with Don Saladino – Episode Summary

Episode Title: Why You Still Feel Sick: The Mystery of Histamines, Long COVID & POTS
Host: Don Saladino
Guest: Michelle Shapiro, RD
Date: October 14, 2025

Episode Overview

In this insightful episode, Don Saladino sits down with functional and integrative dietitian Michelle Shapiro for a deep dive into why so many people continue to feel unwell despite healthy behaviors. The conversation centers on the misunderstood roles of histamines, Long COVID, POTS (Postural Orthostatic Tachycardia Syndrome), and hypermobility syndromes. Drawing from Michelle’s clinical expertise and personal health journey, the episode unpacks how immune system dysregulation can manifest as persistent, mysterious symptoms—and how personalized approaches, mindset, and nervous system support are key to real healing.

Key Discussion Points & Insights

1. What Are Histamines? (04:15)

• Definition: Histamines are chemical messengers released from mast cells (immune cells) causing vasodilation, aiding immune response and nutrient delivery.
• Don: “Is it almost like a defense mechanism?”
• Michelle: “Correct. ...Your nervous system or immune system is basically saying, okay, something’s not right. And then your histamine gets released.” (05:10)
• Common Signs: Allergic reactions like sneezing, rashes, vasodilation-induced redness on the skin.

2. Recognizing Histamine Issues – More Than Allergies (06:14)

• Feeling worse with healthy eating, new, persistent gut issues (severe diarrhea, urinary frequency), dizziness, sudden severe insomnia.
• Symptoms linked to post-COVID illness, unexplained anxiety with heart rate changes, poor exercise recovery, and hives/rashes.
• Michelle: “If you notice you felt sicker after COVID for a long period of time, I’d definitely look into a histamine issue.” (06:38)

3. Frustrations with Functional/Conventional Medicine (07:54)

• Many clients are “functional medicine dropouts,” meaning even advanced practitioners have missed the root cause—histamine sensitivity.
• Michelle: “It’s not the SIBO game, it’s not the leaky gut game. It’s a different game.” (07:59)

4. Treatment Realities & Mindset Shifts (09:09)

• Symptom relief often requires “sledgehammer” use of OTC antihistamines (Zyrtec, Allegra, Pepcid) for several months as a first step.
• Key insight: symptoms sometimes resolve immediately after a mindset shift or breakthrough.
• Memorable Quote: “You have to get—start treating the storm down... For some reason, the higher your histamines are, the more your body produces histamines. You just have to take a sledgehammer to it.” (09:23, Michelle)

5. Michelle’s Personal Health Journey: Weight Loss, Anxiety, & Illness (10:45–17:09)

• Grew up overweight, lost nearly 100 lbs. rapidly before college, became chronically ill from severe under-eating and overuse of “healthy” strategies like veganism and energy drinks.
• Developed panic attacks and agoraphobia; sought solutions through massive self-education and, eventually, a naturopathic doctor, discovering severe nutrient deficiencies.
• Quote: “Just because you look skinny doesn’t mean you’re healthy.” (13:11, Don)
• Recovery required addressing both physiological and psychological roots.

6. Food Is Medicine—But Not for Everyone, Always (20:42)

• Michelle highlights that trendy modalities (saunas, cold plunges) are “cherry on the whipped cream”—without safety, stability, and real food, they can’t solve baseline dysregulation.
• Michelle: “People do not feel like they either recognize their bodies or feel safe inside of their bodies. Nothing changes that besides listening to what your body needs...” (21:05)

7. Long COVID, POTS, Mast Cells & Hypermobility—A Troubling Intersection (24:01)

• Michelle’s second health crisis: Long COVID led to constant dizziness, severe heart rate instability (POTS), and the need for a neck brace after minor physical trauma.
• Hypermobility syndromes—like Ehlers-Danlos—often coexist, further destabilizing blood vessels and connective tissue.
• Quote: “There’s a combination of syndromes that travel together: Long COVID, mast cell activation syndrome, POTS, and hypermobility.” (24:35, Michelle)

8. Rehabilitation and the Importance of Muscle Stability (27:43)

• Working with specialized PTs and chiros is essential for hypermobile or POTS patients—a focus on muscle strength over flexibility.
• Many clients “gravitate to what interests them, not what they need.” (29:23, Don)
• Rehab requires patience and strategic support.

9. Mindset & Resilience in Chronic Illness (31:27)

• The lowest point: “There was a moment... I remember looking in the mirror… and was like, ‘Dude, you’re not going to make it through this.’ ...And then another part of me came out—don’t ever say that again. ...You cannot afford to victim yourself.” (32:01–33:41, Michelle)
• Success stories hinge on those who address the mental game head-on.

10. Practical Nutrition Lessons & Histamine Management (34:48)

• Michelle had to drastically shift diet (abandoning veganism) for nutrient repletion.
• Irony: many “healthy” foods (fermented, citrus, avocado, spinach, tomatoes) are high in histamines and can trigger major reactions in sensitive individuals.
• Describes the low-histamine diet as “necessary but not healthy” and always temporary.
• Eventually, many people can reintroduce problematic foods—except, for Michelle, pickles! (38:09)

11. Long COVID—Prevalence, Mechanisms, and Hope (41:44)

• Long COVID can devastate quality of life, even more than cancer, due to its invisible, misunderstood, and persistent symptoms.
• Mast cell activation (release of histamines and other compounds from immune cells) appears central to the syndrome post-infection.
• Quote: “I have never seen someone in my practice who has Long COVID and doesn’t have MCAS [Mast Cell Activation Syndrome]. Never.” (44:24, Michelle)
• Don: “Is it correctable?”
• Michelle: “Absolutely. ...It’s all about increasing the baseline, reducing the flares. ...I don’t get dizziness, I don’t get histamine symptoms... I had a very severe case of Long COVID.” (44:33–45:53)
• Key symptoms: dizziness, heart rate issues, insomnia, severe fatigue, unusual immune responses.

Notable Quotes & Memorable Moments

• Michelle, on Histamine Overflow:
  “If you feel like you get really sick the healthier you eat…that’s a sign to me.” (06:14)

• Michelle, on Mindset Breakthroughs:
  “You can notice symptom reduction in a day, and if you change your mindset—in one second.” (09:54)

• Michelle, on Personal Low Points:
  “I remember looking in the mirror… and was like, ‘Dude, you’re not going to make it through this.’ ...with these conditions... you cannot afford to victim yourself...” (32:01–33:41)

• Don, on Support:
  “The people who make the most change in their lives are the ones that go and attack that mental side of it first.” (33:41)

• Michelle, practical advice:
  “Foods that are high in histamines are very healthy... fermented foods, citrus, avocado, spinach, tomatoes... If your body is high in histamines, eating more can make you sick.” (35:02–36:32)

• Michelle, on Progress:
  “I can eat any high-histamine food now except for pickles, which is painful. As a Jew, it’s painful that I can’t eat pickles.” (37:54)

• On Medical Practices:
  “Most PTs and chiros should be doing a hypermobility assessment on clients. What a hypermobile person needs is not more stretching, but more stability.” (29:23, Michelle)

• Long COVID a Real-Life Crisis:
  “The quality of life for those with Long COVID was often lower than those with stage four cancer...If you have long COVID and you’re like, ‘I have this weird, mysterious condition,’ people are like: you’re faking it.” (41:44, Michelle)

Timestamps for Important Segments

• Intro to Histamines: 04:15
• Histamine Symptoms & Red Flags: 06:14
• Medical System Limitations: 07:54
• Treatment Realities & Mindset: 09:09
• Michelle’s Origin Story/Health Crisis: 10:45–17:09
• Food as Medicine & Real Recovery: 20:42
• Long COVID, POTS, Mast Cells, Hypermobility: 24:01–29:23
• Mindset & Chronic Illness Recovery: 31:27–33:41
• Managing Histamine with Diet: 34:48–39:28
• Long COVID Science and Hope: 41:44–46:04
• Quiz & Resources Mentioned: 47:26

Resources & Closing

• Michelle offers a free quiz: Are You Living in a Highly Sensitive Body?
• Visit Michelle’s Instagram and website for more support on histamine, POTS, long COVID, and personalized “battle plans.”

Final Thoughts

This episode is a must-listen for anyone struggling with mystery symptoms or post-viral illness. Michelle’s practical, compassionate approach empowers listeners to reframe persistent health struggles, focus on well-being over diagnostics, and seek real, customized healing—physically, mentally, and emotionally. Don’s empathetic hosting draws out the human story behind the science and brings today’s most confounding health puzzles into sharp relief.

For those suffering or searching, this episode delivers clarity, validation, and real hope for stronger health.