Navigating MCAS, COVID & Chronic Fatigue Complexities

Introduction and Guest Background 0:00

Welcome back to our reversing mast cell activation syndrome and histamine intolerance summit. I'm your host, Dr. Meg Mill And today I'm joined by Dr. Evan Hirsch, who's also known as the EnergyMD. Dr. Hirsch is a world renowned energy expert, bestselling author, and professional speaker, and he is the creator of the Energy MD method, which is a science backed and clinically proven four step process to resolve chronic fatigue and long Covid naturally. So we're going to have a great conversation today because we are clearly seeing MCAS go up after Covid and we're getting really strong data and there's so many connections.

So I'm excited to dive into this and give all of this information to you. So thank you so much for joining us. Evan. Thanks so much for having me on. So excited to get started. So before we get into how Covid is affecting MCAS and all the connections, could you just give us a little bit of background on, you know, how you got to where you are today and focusing on this? Sure. So, I had a very successful functional medicine practice and, and so and then I got chronic fatigue. and actually, I'll back up a little bit because my first experience with chronic fatigue was my older sister, after college.

But I didn't really understand what was going on at that time. And then I met my wife, and about three months after we got together, she had chronic fatigue. but then I had it, and it lasted for about five years, and it just about destroyed everything. My relationship with my wife, she was coming out of her fatigue, and I couldn't help with the dishes at home. We had a new baby. I couldn't play with her. I couldn't help out. I could barely keep things together at work. I was napping underneath my desk, and I was still.

I was practicing functional medicine, and I was. And the first thing was that I wasn't practicing on myself so that I wasn't, I wasn't replacing a lot of the deficiencies that I had learned about. And so I started doing that. But then I still could only get so much better. It was really only when I started looking at environmental medicine, and I went on this journey of finding all of the potential causes. And now I'm up to 30 plus different causes that I work on with people. But it was only when I started looking at the heavy metals, the chemicals, the molds, the infections, and then more recently, the trauma that I realized how much of those were playing a role in my life.

And as I dissected those, addressed them and got rid of them out of my body, that's really when I was able to, resolve my chronic fatigue. Yeah, I know is we all have a personal journey. I think that it's really enlightening because I like how you said that.

Covid, MCAS, and Chronic Fatigue Connections 2:53

Because I can feel that, too, where sometimes you're giving all the advice. But are you taking it and doing it for yourself and and really putting that mirror up and saying, okay, what do I need to change? And, and then once you start to see the results, you can pass all the information that you've learned on to your patients to just broadens your perspective. So thank you for sharing that with us. Now, you know, let's start. And we can jump into some chronic fatigue things too, because that, you know, a lot of the same things that you're talking about with chronic fatigue are also the same triggers that we're seeing for MCAS.

And it's just people are expressing it differently. So, but talking about Covid to start out with, you know, we see have seen this really go up since we've had the pandemic. And I actually it's interesting and I'm curious if you've seen this, we'll see people get through Covid sometimes just fine and feel like, oh, it was not a problem for me. And then the symptoms start. So it's like they're thinking, okay, so we see people having trouble with Covid and starting to get long. How were they made it through.

And then everything falls apart. So you know, I let's get started on just kind of the interplay of what's going on. Yeah. And actually people are more likely to get long Covid or persistent symptoms of Covid if they have a more mild experience. So if they have five symptoms that are more mild, they're significantly more likely to get long Covid, which is counterintuitive and different than what we think about in terms of acute Covid and people ending up in the hospital, in the ICU. So what ends up happening?

You want me to go into kind of Covid and MCAS and that interplay? Let's start. Yep. Let's start there. Okay. So in terms of MCAS mast cell activation syndrome, as I'm sure has been talked about ad nauseam, on your beautiful summit, you know, it's the immune system, dysfunction and the reaction of the immune system and more specifically, the mast cells in terms of what it's reacting to in the body. And Covid is just another one of those things. And the reality is, is that the causes of MCAS are the same thing as the causes of long Covid, and it's the same thing as the causes of chronic fatigue.

So it really is a combination of these three plus different causes with really the big ones. What I call the toxic five are heavy metals, chemicals, molds, infections and trauma. And in this case with long Covid, Covid is just another infection. And these are all things that get inside the body and they're not supposed to be there. And so the immune system's job, its whole job is to get rid of things out of the body that really that aren't supposed to be there. And so when it's looking around and it sees these things, it starts reacting, and then it starts becoming more sensitive to everything that it comes into contact with, whether it's perfumes, whether it's food that you're putting in your body, whatever it is, the immune system is now hyperactive and it's only going to quiet down if you dampen that response with what I call Band-Aids or natural Band-Aids.

If we're using things that are like more horrible or you're removing these root causes of this toxic vibe that we're talking about. Yeah. I like how you said that natural Band-Aids because I think that's, that's a big point where a lot of talking about antihistamines are mast cell Stabilizers or things like that. But if we're not addressing the root causes we're not going to actually get better. And you know, when you're looking at mast cell activation, when you're looking at long Covid and you're looking at chronic fatigue, there are overlapping symptoms.

So how do you unpack that when someone's presenting to you. Yeah. And so about 75% of these different causes can be determined by symptoms alone. You know. And there are you know, I'm talking about these 30 different causes. But I only mentioned like the toxic five. When I'm looking at these different causes, I'm looking at deficiencies. I categorize them as deficiencies. These are things that are not in the body that are supposed to be there. And there's toxicities. These are things that are in the body that aren't supposed to be there.

And it just so happens that about 75% of these can be determined by symptoms alone. So this is looking at deficiencies in hormones, you know, your adrenals or your thyroid or your sex hormones or your mitochondrial function, which produces 70 to 90% of our energy in the body, or, different vitamins or minerals or lifestyle habits. So some of the things. Well, yeah. And then in terms of the toxicities, it's the toxic five. Like I mentioned, it's food allergies. those are kind of the big ones. And so when you're taking a look and determining, you know, what somebody has or how we tease them out, you know, in terms of the toxic five with heavy metals and chemicals and molds and infections, the heavy metals, chemicals and molds, you really need labs in order to determine how much of these toxins that people have.

Now I'm saying how much, because the reality is, is that the people that I work with will have chronic fatigue who have long Covid. It's generally not a question of if they have these things. It's a question of how much do they have? So you can do the test now. But the reality is, is that we need to remove those things out of the body. And with people who have mcas who are more sensitive, it's more of a question about how do you remove the things out of the body and what is how do you take these layers off the liver, off the immune system,

Identifying Root Causes and the Toxic Five 8:14

so that you can become less reactive in terms of a number of the infections? Fortunately, a lot of those can be determined by your symptoms. You know, if you have pain on the bottom of your feet, muscle cramps, and a hard time sleeping, you may have an infection called Bartonella that kind of runs with lyme or Borrelia. You know, if you have symptoms that move around the body, whether it's joint pain, muscle pain or nerve pain and symptoms that come and go, you may have Borrelia, which is another name for lime, if you have if you feel hot all the time or you're having kind of hot flashes but you're not menopausal, maybe you're having some shortness of breath.

Maybe you're having awful insomnia, anxiety to the point of panic attacks or depression to the point of suicidal thoughts. You could be having babesia, which is another co-infection that runs with Lyme. if you have, chronic sore throat, large lymph nodes and general malaise, that could be Epstein-Barr or HHV6 or cytomegalovirus or one of these other viruses. Now, the interesting thing about Covid is depending on where it goes in the body, it can mimic any one of these. And so sometimes we don't know whether or not it's Covid or whether or not it's one of these infections, because, you know, with Covid you can have over 250 different symptoms.

But in general, people will know that they got sick after a particular viral illness that happened after 2019. So that's generally the criteria that I look at is, you know, did you have a viral illness after 2019 and did your symptoms start after that? And maybe they weren't exactly after that. Maybe they you got rid of the virus or you think you got rid of the virus. And then a month or two later, all of a sudden you got some sort of really weird mystery symptom that often can be due to Covid. And so the question about whether or not it's Covid or whether or not it's one of these other infections really has to do with where the Covid is located, but also whether or not Covid is acting as a biofilm disruptor or basically it's it's releasing some of these infections out of their hiding places, or it's distracting the immune system and allowing some of these infections to become opportunistic.

So there is that interplay between Covid and the infections. And sometimes we don't know until we treat as oftentimes by treating things specifically, you can get some data around whether or not it's Covid or whether or not it's some other infection. So if someone came in to you and they have, you know, answered, I do actually also ask everyone now, have you had Covid and what was the date? Because, you know, we want to and most people have at this point, but some still haven't. But if you're coming in, they answer, they have had the virus they're mimicking like where where do you start?

So, as Julie Andrews says in The Sound of Music, we're going to start at the very beginning, right? It's a wonderful place, a great place to start. So I have a four step process that I take people through. And so the first step is to determine which of these causes do they have. And like I said, they're going to know 75% of their causes just by, you know, if they're going through our group program or our course, they're going to know just from going through the workbook and the checklist. And the first part of the workbook, 75% of those causes.

And then they may need some labs in order to determine some of the other 25% that we talked about. If they're seeing me generally, I'm going to know about 90% of their causes by the end of the first appointment that we have and then create a plan. And so the the next steps are pretty much all about fixing your matching up the cause that somebody has. And we're working with right now about 38 different causes. And everybody really that we work with has a combination of about 20 of those causes, combinations of deficiencies plus toxicities, with the most important things being that toxic.

Five that I talked about, the heavy metals, the chemicals, the molds, the infections and the trauma. And so then in step two, we replace the deficiencies. Because in general this is going to help people feel better faster. And this is why when you've seen your natural path or your integrative doctor or your functional medicine doc, and they start giving you support for your adrenals or your mitochondria or your thyroid or your B12 or your vitamin D or are working on your lifestyle habits, why you start to feel better, you know, and oftentimes we see people who've kind of been working on that stuff or working on their gut for years, and they plateau and they just can't get any better.

It's because you have to you have to get to removing the toxins. This is kind of the missing thing. And if you're looking at if you're not looking at these 38 different causes, and you're not looking at the 20 causes or so that you have in you, let's say you're focused on ten of those. You have another ten that you're not focused on. You're going to miss getting better. You have to address all of those causes that you actually have. It's like having 20 nails in the bottom of your foot. If you remove ten of them, it still hurts to walk, right.

So step two is replacing the deficiencies to make people feel more robust. the big three is supporting the adrenals, which manages your stress. And the mitochondria, like I said, which, supports your energy and produces about 70, 90% of your energy in the thyroid. I call that the big three, because that's a real big needle mover. When people have fatigue, it increases their energy significantly. And we want you to be as energized and robust and resilient as possible to make sure that you can continue through the next, couple of steps in the process.

And so then step three is opening up the drainage pathways, the kidney, the liver, the lymph, the neural lymph in the brain, the intestines, the gallbladder, to make sure that you've got an exit strategy for these toxins. So if you're trying to remove toxins, heavy metals, chemicals, molds, infections of the past, and you haven't felt well, it's because there wasn't enough time spent in what I call step three and opening up these drainage pathways so that then you can go into step four and you can remove these toxins.

Stepwise Healing: Deficiencies, Drainage, and Detox 14:22

and that's a huge point because I think we hear detox a lot. Now, there's a lot of people out there talking about detoxing and how you need to detox. And, and that information is getting out there. But if you don't have the pathways open, if you're not making sure you have those drainage pathways open, then you're just causing more symptoms. And I think people try to do that sometimes when they're doing it on their own and then start to feel worse. Yeah. And you know, with people who have tests, sometimes we do have to pivot.

So sometimes we have to do step three before step four. Or do step three before step two. Because sometimes, you know, because you can, you know, if the if the real cause is removing these toxicities and somebody can't really tolerate a lot of different supplements, we have to say, okay, well what's the biggest bang for the buck here. And it really is about okay. Well how do we start to open these pathways even just a little bit to make sure that we can start removing these toxins. and so we have some strategies also, which I'm happy to get into about how we help people with more tolerate more of their supplements.

Yeah. Let's let's move on. That's a great one because I know there sensitivity is a huge issue. Yeah. And so, you know, 80% of the immune system is in the gut. So anything that you put in the mouth potentially you have an opportunity to react to. So oftentimes with people with mixed we're trying to give them things topically. And so we work a lot with tinctures and so herbal tinctures. And so you figuring out what herbal tinctures will work for folks and having them use them topically rubbed into the hands, rubbed in sort of ramping up on that oftentimes will give you a percent of that tincture.

So you're absorbing about 20, 25% when you're using it topically, that decreases the amount that people are exposed to. Plus also then you're not using them orally. And so the immune system is they're less responsive to that. And so that's one way that we like to, to work with it. Or sometimes we're using some of the acne patches, the LifeWay patches that are out there now. but these are just some techniques. Sometimes we're using foot baths, sometimes we're using saunas. There's some of these different or coffee enemas, some of these different techniques that we use in order to make sure that people aren't going to react to things by putting them in orally.

So and then, you know, small and small and, steady wins the race, the body like small changes. And we always want to see how somebody is reacting to something. So, you know, every seven days or so for people with mass, we will have them make a change in their protocol so that we can actually see how they're reacting to something. And then the ramp up becomes, slow and steady. And before they know it, they're they're ramped up to full doses or whatever dose they need. that's going to be appropriate for them.

And then we can kind of move on to step four and start to remove some of these toxins. I know and it really it does take more time sometimes, but it's so valuable when you can finally tolerate things. So I think just taking it I think that slow and steady wins the race is really important when it comes to people with Marcus, because if you can even just get like a tiny bit in and then it's like, you know, I've have people that will call me or like so excited because they've gotten the full caps on and we're there.

And then, you know, I can start to think, wow, the value of that, whenever you're reacting to everything, it can be really valuable. Yeah. And I think that a lot of this is setting up expectation like you mentioned, you know, like slow and steady wins the race. All of our programs are 12 months, you know, and it's like, because we know that we're going to be working with people for at least 12 months. You know, with mixed folks, oftentimes it takes longer than that. It really depends on the number of causes that people have.

The severity of each of those causes, their ability to tolerate supplements, their reaction to treatment, how many bumps they have in the way because there's always bumps. But we're there to hold their hand, you know? So that's why it's so important to, you know, have this big picture and make sure that they have those expectations because, you know, you're not going to be better in three months. You know, that's just kind of unfortunately part of the process. You didn't get sick in a day. And it's going to take a period of time.

You've been accumulating these toxins ever since you've been in the womb, you know? And so a lot of people forget that, that you come out already having, a number of toxins from mom through the placenta, and then you just accumulate throughout your life, and then the immune system and the body says, okay, I'm done with this. I'm going to start reacting to everything, and then you're stuck in that position. And so you have to remove these that are at a rate that the body can tolerate. And it needs to be slow.

Do you see any any issue with people who already have Marcus when they get Covid 19. Are you seeing any correlation there. If they've already been someone who's already sensitive and then get the virus after. Absolutely. So what's interesting is that sometimes they you know they'll have a strong reaction to Covid. Sometimes they won't. and sometimes they'll have worsening symptoms after they get the Covid and sometimes they won't. And a lot of this has to do with what their immune system is already distracted with. But yes, absolutely.

This is it. Most of the time, I would say 80% of the time when somebody has Marcus and they get Covid, they can end up with persistent symptoms. Because if your in order to get rid of an infection out of the body, you have to have a somewhat intact and attentive immune system. So the immune system has to be able to focus on that infection. You can't get rid of it just with antivirals and antimicrobials. And so if the immune system is often left field, dealing with the toxic five, it's not going to be able to help to get rid of that particular infection.

interestingly enough, I was speaking to somebody who had Marcus and she was saying, you know, I haven't gotten a cold in 5 or 10 years. And it's like, well, that's not necessarily a good thing, because when you get a cold, it's the immune system getting rid of of the virus or the infection out of the body that's not supposed to be there. And so general, if you haven't been getting colds, it's

Supporting Sensitive Patients and Slow Ramp-Up 20:38

because the immune system has been distracted and the infection has come into the body and has started to is taken up shop, essentially. Yeah. That's yeah. That's interesting. I know that's a good point because you're thing she did you burst her bubble Unfortunately I, I try not to I try to be supportive like yes that's great. And this is probably why that's happening. So let's talk about a little bit about chronic fatigue too, because I know that's your another one of your specialties and your history.

And why do you find it's so hard to to treat chronic fatigue. So the challenge is that there's so many different causes. Everybody kind of wants the magic bullet. You know, they're like, my cause is like, my cause is mold. My cause is Epstein-Barr, my cause is adrenal fatigue, my cause is Hashimoto's or a thyroid issue. my cause is a sleep issue. The reality is, is that your causes are all of those things. And, and it just doesn't it's not the unifying principles that we kind of learned about in medical school.

And so, it's really important to remember that you have all of these different causes, and that does feel overwhelming. But when you break it down and you realize that your goal is just to figure out the causes that you have, and then you match them up with the treatment, and then you take those for 6 to 12 to 18 to 24 months. You're going to be good and you're going to get better along the way. It it ends up making, making sense to folks. Do you find that people, when you're telling them that, you know, when you're saying 18 to 24 months, do you find resistance there of people accepting or you're able to see the value?

I mean, I know because I know it's hard. It's it's hard when you're talking about chronic fatigue, when you're talking about mixed it, you will get better. So you we know that you will get better. But it does take time. And in this world of instant gratification, sometimes that's hard to wrap your head around. Yeah, absolutely. Yeah. And you know, everybody wants to be better yesterday. I want to be better yesterday. And often people come to me and they're like, you know, I've been on this journey for ten years.

And when we look at all the causes that they've looked at, they haven't looked at half of the causes. It's like, I totally get that you've been on this journey and I want to validate that for you. And you have been struggling and you have been working really hard. And the reality is, is that you haven't been looking at the right causes or all the causes, you know. And so the thing is, is that when you're looking at all the causes, you know, I know I'm looking at like 95% of the causes. And I find and I know that if I leave no stone unturned, that I'm going to be more successful.

So that that I know that eventually, like you said, we're going to get there, you know? So it's just making people understand that commitment. And the other thing is that we talk a lot about mindset. You know, we have a force, that mindset practice that people work through because there are frustrations that come up because you're frustrated that it's taken so long, even though you know that it's going to take at least 12 months. You may be at six months and you're frustrated. And so it's important to have gratitude.

It's important to have a vision for what your life is going to look like, your health and all the other components. It's important to look at any of the disempowering beliefs that you have. Like, you know, I'm never going to get better. Well, that's not really going to help you in this process. So you have to flip that into, I'm going to get better. It's just going to take some time. I'm getting better every single day. And then we have to ask ourself more empowering questions. We can't be asking ourselves like, why me and all that?

Because the brain is a goal achieving machine. It's going to give you answers that you're not going to want to, that aren't going to be supportive for you. And so you have to remember to ask a better question, like,

Chronic Fatigue, Mindset, and Trauma Work 24:18

what can I do today to love myself even more, right? What can I do today to advance my health even more? You know what? You know what is on my protocol that I'm supposed to increase. That's the only thing that you need to focus on is is working on. And when people can take the time off and they can really, you know, support themselves by going through a program like this, then, it's even that much more, supportive. But they have to have that expectation and they have to work through some of the mindset blocks.

Yeah. It's really a huge factor I think I know and I have seen people that haven't been able to make any progress until we work through that. So I've had to take a step back and say okay you know what, we can't really do anything else until we get through this piece. And then once we got through mindset, then everything starts to fall into place because their energy is changed. And and you also mentioned you know, another thing that I'm always working with is the nervous system regulation. And you mentioned that and trauma.

And that's a huge factor here. So can we dive a little bit into that piece to. Absolutely. So we don't have a trauma curriculum, but we partner with some of these other trauma programs. whether it's the Gupta program or DNS or, Doctor Amy Higgins program or other somatic, programs, or even now we're getting into more of the, the plant medicine, you know, whether it's, Doctor Maya, she treats quantum drops or psilocybin or ayahuasca. so there's a number of these things that we take a look at in order to support people through their trauma journey.

and oftentimes we don't know whether it's going to be 10% of the solution or 50% of the solution. But, you know, it's always, it's always significant. It's always supportive. and it's always a complement to kind of this other work that we do. I haven't really found anybody where doing the trauma work is going to be 100% of their work, because oftentimes the trauma and the stress of that ends up opening you up to a number of these other things. So you'll you'll have these heavy metals, chemicals, molds and infections that still need to be removed from the body.

But the complement of those two is incredibly supportive. Yes. Well so so if someone's listening you've given us such helpful information. So if someone's listening and they feel they have mixed they have have had Covid they're like okay I'm wondering if there can be a connection. I'm having all of these symptoms. Where do you recommend they start? I know that that's a hard place because we you know, we've covered a lot. But like if just someone's here listening and thinking, okay, well, what can I start doing right now to start helping myself?

So I think that, you know, the cheapest thing that people can do is they can start working on their mindset. yeah. And working on their lifestyle habits, you know, so that's especially if they're like, you know, reacting to all of these different things and they're, you know, they, and they're not sure what to do next. That's always a good opportunity to start working on those things. Maybe do one of those trauma programs like the Gupta program. And we see a lot of success with, and so that they can that can start to remove a layer off of their nervous system and their immune system and their liver, and so that then they can start, tolerating things a little bit better.

They can maybe get some energy back, you know, and so that's, that's usually a good place to start if you're finding that you can't tolerate supplements. And while you're still researching to figure out who's going to be the right practitioner for you, because, you know, it just takes time, you know, it's going to take some work. It's going to take, you know, significant investment of of time. and working on those trauma aspects for, you know, three, six, 12 months. So there'll be times when I'll be on a meet and greet call with somebody to see whether we're a good fit to work together.

And I'll say, you know, really not right now because you need to do more of this other work. and then come back and, you know, talk to me in 3 or 6 months once you've kind of laid that foundation. So, so that's always something that people can start to do is the lifestyle habits, the trauma work, the mindset work. and while they're researching and figuring out who to work with next. Yeah, that's those are great points because you have to be ready to be on this journey. And while it's a really valuable journey, you have to be, like we're saying, have that mindset and really believe that you can heal.

I mean, I always even bring up the placebo effect more, and I know it's extreme, but there is a placebo effect. So some people do heal from water pills because they believe they're they're healing and the mind is very powerful. And then really getting to the bottom of all of these. Do you have specific I know that maybe sharing some specific testing. I think when it comes to to Lyme, there's confusion a lot of times around the testing and people struggle with thinking that they don't have Lyme when really they do have underlying tick borne illness.

Testing, Lyme, and Finding the Right Practitioner 29:28

And I think that's a real big problem right now. So could you tell us that just talk a little bit to that? Yeah. So please that you mentioned that because that is such a big issue where people are like, yeah, I did a test and it said that I didn't have line, so I don't have line and I'm not going to address it. And so then that's once again, that's a cause that you have that hasn't been addressed. you know, even the centers for Disease Control and Lana say that Lyme and it's co-infections are clinical diagnoses.

The you know, it's not the Western blot test or the Eliza test. It says that those are for epidemiologic studies only, but it's really based off of your history and your symptoms. Kind of like how I mentioned with all of the different symptoms that you can have. and sometimes and sometimes it looks different for different people. And so sometimes these infections need to be treated even though you're not fitting into a box. And amazing things happen for, for those folks. So it's really important to realize that it is complex.

There's a lot to there's a lot that kind of goes into it and it's really important to realize that all labs testing is imperfect. I'm going to say that again, all lab testing is imperfect. And so you really need to combine your history plus your symptoms, plus any lab testing plus reaction to treatment. You know, if you take something that's more specific for Epstein-Barr and you have a herxheimer a reaction, you feel better, you feel worse. And we know that that's probably a cause. And then also muscle testing, this is something that I've come to late in the game, but I've seen it really be helpful for folks.

And so we teach people a little bit about sway testing or pendulum testing, and it can really provide some excellent data. And so and so when you're looking at a number of imperfect data, we combine each one of those components in order to get the best data that we possibly can, in order to support people and make sure that we're addressing all of the causes so that we're not missing anything, and that when bumps pop up as they always do, that we're able to address them in an expeditious manner and allow people to get back on track.

Well, thank you so much. You've given us such great, helpful information today. Can you share with us where we can find you. So people can head to our website EnergyMDmethod.com. They want to click on the little button that it's in the bottom right corner. You can text me directly, ask me questions. You can get on a free call with me for 20 minutes to see if we're a good fit to work together, and then you can also, check me out at other social media outlets. And we do have a podcast as well. Well, thank you so much.

Thanks for being here with us today, Evan. Thanks for having me on. And have a great day. Everyone.