MCAS is one of those diagnoses that can make it feel like your body is telling a dozen stories at once—and no one is listening. If you're experiencing GI symptoms alongside flushing, hives, brain fog, fatigue, palpitations, medication sensitivities, or a persistent "fight-or-flight" feeling, this episode is designed to help connect the dots without oversimplifying your experience.

In this episode, we sit down with gastroenterologist Dr. Zachary Spiritos to unpack mast cell activation syndrome (MCAS) and explore the connections between immune activation, the gut-brain axis, and symptoms that can affect nearly every system in the body. We discuss why patients are often dismissed, how stress and hormonal changes can amplify symptoms, and what a realistic, stepwise treatment approach looks like when the evidence base is still evolving.

In this episode, we discuss:

• What mast cells do and why MCAS can affect multiple organ systems
• Why MCAS is often missed in siloed medical care and mislabeled as anxiety
• Barrier dysfunction, environmental triggers, and intestinal permeability as a useful framework
• Histamine as one mediator among many and why antihistamines are not a perfect treatment for all
• Links between MCAS, IBS, visceral hypersensitivity, dysautonomia, and POTS
• Hypermobility, pelvic floor dysfunction, and neck tension as common clinical clues
• Treatment principles including start low and go slow, informed consent, and layered individualized plans
• Dietary approaches patients commonly explore, including low-histamine, low-FODMAP, and gluten-free patterns
• Hormonal influences across the menstrual cycle and during perimenopause
• The role of sleep, nervous system regulation, and stress reduction in decreasing symptom reactivity

If you've ever felt like your symptoms don't fit neatly into a single diagnosis, this episode will help you make sense of the bigger picture and explore what healing can look like when the gut, immune system, and nervous system are all part of the conversation.

References:

Ford AC, Staudacher HM, Talley NJ. Postprandial symptoms in disorders of gut-brain interaction and their potential as a treatment target. Gut. 2024;73(7):1199-1211. Published 2024 Jun 6. doi:10.1136/gutjnl-2023-331833

Walker MM, Warwick A, Ung C, Talley NJ. The role of eosinophils and mast cells in intestinal functional disease. Curr Gastroenterol Rep. 2011;13(4):323-330. doi:10.1007/s11894-011-0197-5

Pasricha PJ, Talley NJ. Functional Dyspepsia. N Engl J Med. 2026;394(2):166-176. doi:10.1056/NEJMcp2501860

Find Dr. Spiritos on IG @drzacspiritos

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Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Part 3 of the Women's Health Series

Bloating, gas, urgency, abdominal pain, and that relentless “what if something happens?” loop can turn sex from a close connection into stress fast.

Digestive symptoms can quietly impact some of the most vulnerable parts of our lives...including intimacy, relationships, and self-esteem. And often, the shame surrounding those experiences feels heavier than the symptoms themselves. If you’ve ever pulled away from connection because your gut felt unpredictable, this conversation is for you. In this episode, we’re opening up an honest and empowering discussion about gut health, confidence, and reclaiming intimacy without fear or embarrassment.

We dive into this topic with our expert guest, Dr. Alyse Bedell, GI psychologist and Certified Sex Therapist, covering:
• Why digestive functions feel taboo in sexual relationships
• How IBS and IBD symptoms can impact desire, relaxation, and satisfaction
• Myth-busting the idea that sex must be spontaneous to be pleasurable
• Scripts and “reset” strategies for handling symptoms in the moment
• Redefining intimacy so closeness does not always imply intercourse
• Flexible planning around meals, energy, triggers, and symptom patterns
• Partner support that reassures without becoming patronizing
• The circular sexual response cycle and starting from sexual neutrality
• Rebuilding sexual self-esteem with stigma work and acting with "as if” confidence

This episode has been sponsored by Ardelyx.

References:

Ballou S, McMahon C, Lee HN, et al. Effects of Irritable Bowel Syndrome on Daily Activities Vary Among Subtypes Based on Results From the IBS in America Survey. Clin Gastroenterol Hepatol. 2019 Nov;17(12):2471-2478.e3.

Fretz KM, Hunker KE, Tripp DA. The Impact of Inflammatory Bowel Disease on Intimacy: A Multimethod Examination of Patients' Sexual Lives and Associated Healthcare Experiences. Inflamm Bowel Dis. 2024 Mar 1;30(3):382-394. doi: 10.1093/ibd/izad106. PMID: 38206426; PMCID: PMC10906359.

Wang J, Varma MG, Creasman JM, et al. Pelvic floor disorders and quality of life in women with self-reported irritable bowel syndrome. Aliment Pharmacol Ther. 2010;31(3):424-431. doi:10.1111/j.1365-2036.2009.04180.x

Dubinsky MC, Potts Bleakman A, Schreiber S, et al.. Impact of moderate-to-severe ulcerative colitis and Crohn's disease on sexual activity: United States and European patient perspectives from the communicating needs and features of IBD experiences (CONFIDE) survey. Curr Med Res Opin. 2025 Jun;41(6):1017-1030. doi: 10.1080/03007995.2025.2530736. Epub 2025 Jul 17. PMID: 40635574.

Come As You Are: Revised and Updated: The Surprising New Science That Will Transform Your Sex Life by Emily Nagoski Ph.D.

Becoming Cliterate: Why Orgasm Equality Matters--And How to Get It by Laurie Mintz

The American Association of Sexuality Educators, Counselors and Therapists (AASECT) (great resources as well as a place to find a certified sex therapist)

Give us a follow us on social media @TheGutHealthPodcast, where we'd love for you to share your thoughts, questions, and experiences.

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Part 2 of the Women's Health Series

Your digestion suddenly feels different, your sleep is falling apart, your mood and patience are all over the place — and you start wondering whether it’s stress, aging, or something bigger. Joined by two extraordinary Mayo Clinic experts, Drs. Chrisandra Shufelt and Jami Kinnucan, we pull back the curtain on perimenopause and menopause, explaining how shifting estrogen and progesterone can ripple through the entire body — from constipation and bloating to metabolic health, cardiovascular risk, and even the gut microbiome. Most importantly, this episode reminds women that these changes are real, common, and worthy of attention.

• Defining perimenopause versus menopause as a life stage and why symptoms vary so much
• Linking estrogen and progesterone changes to motility, constipation, bloating, and visceral sensitivity
• Discussing microbiome shifts, dysbiosis, and how gut health may influence estrogen recycling
• Outlining cardiometabolic changes including central weight gain, lipid changes, blood pressure, and insulin resistance
• Clarifying brain fog, sleep disruption, and increased anxiety and depression risk during perimenopause
• Reviewing SSRIs and SNRIs as options that may also reduce hot flashes
• Covering bone loss timing, hormone therapy limits, and when DEXA scanning makes sense
• Summarizing what is known about IBS symptom severity and what is less clear in IBD
• Debunking hormone panels in perimenopause and pointing to menopause-trained clinicians
• Breaking down soy, supplements, placebo effects, and lifestyle factors like weight loss and exercise snacks
• Detailing vaginal estrogen for dryness, painful sex, and recurrent UTIs, including how to use it correctly

This episode has been sponsored by Ardelyx.

References for this episode:

The 2022 hormone therapy position statement of The North American Menopause Society

The association between metabolic dysfunction-associated steatotic liver disease diagnosis and vasomotor symptoms in midlife women

Impact of Menopause and Clinical Considerations in Patients With Inflammatory Bowel Disease

Understanding the sexual concerns of older women presenting for care to women's health clinics: a cross-sectional study

Find a Menopause Practitioner: Menopause.org

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.