This is a very good thread and indeed, there needs to be a unifying theory for all of the improvements seen in this forum and elsewhere.
I think there are at least a three things that we all can agree on: neurotransmitters, mast cells and gut.
Let's take an example - matcha.
https://poiscenter.com/forums/index.php?topic=3746.0;topicseenMatcha will increase enpinephrine and norepinephrine, which by itself may be significant enough, because of its action on the vascular tone, etc, but increased epinephrine will also help to inhibit mast cells. In addition to that, green tea has an effect on H2S producing species - Desulfovibrio and Fusobacterium, which are involved in H2S SIBO, which leads us to... Bismuth. There's also a thread on Pepto bismol, which contains bismuth and bismuth is known tk suppress H2S production and bacteria. Of course, bismuth has a lot of other modes of action, so there can be other explanations, like its protection of GI mucosa, which leads us to diets that have been reported to be helpful, Candida and fluconazole and so on...
This is just an example of how all of these treatments interconnect and aren't really targeting completely different things. I admit the H2S is a bit of a leap, because the thread author gets immediate benefits and it probably wouldn't work so fast to reduce H2S, but that's not the point.
As Muon said, I agree that it probably boils down to mast cells mainly and I think the recent Omalizumab case study supports that. However, we have to ask ourselves why the mast cells are too reactive? One of the explanations is that it's the gut barrier and the infiltration of pathogenic, or perhaps even normal bacterial flora that shouldn't be there. It should be in the mucus layer, slightly seperated from the epithelial cells, but it is eitherperiodically or continuously invading the mucosa and triggerint immune response and by extension mast cells, causing oxidative stress, which then destroys BH4 and reduces neurotransmitters, which then contributes to even more mast cell activation, hemodynamic instability, etc etc... Also, the aforementioned acetaldehyde and other bacterial toxins, like LPS, etc, which also could be related to taurine as a number of members reported (me included), which as it turns out hells wiyh ALDH and acetaldehyde:
https://pubmed.ncbi.nlm.nih.gov/10821139/ as well as some studies point to reduction of allergy symptoms..
I think it's also possible that there is an overexaggerated vasoconstrictive response, caused by low norepinephrine and perhaps mast cells, which also contributes to the POIS symptoms by causing a transient gut injury (due to vasoconstriction and hypoxia) releasing bacteria and bacterial toxins into the blood until it heals again, which is when the POIS symptoms mostly stop.
There are a few other questions. If someone has candida or sibo or whatever, you have to ask why? E.g. genetic issues can cause yeast overgrowth:
https://pubmed.ncbi.nlm.nih.gov/9764646/ I believe it's wrong that some people, at least historically (maybe that changed) used to to view this illnees as something that happens only after orgasm. That lead to theories like sperm allergy, etc, which are very unlikely, perhaps in very few cases, but not in general. I'm more of the opinion that everyone with this syndrome is not in optimal health and has issues that need to be fixed. Those issues may not be apparent if you lived like that all your life, btw. Of course, it's good to have prevention measures that work 'on demand', but ultimately, there are things that need to be addressed. Those include: nutritional deficiencies, pathogens or overgrowths in the gut and elsewhere, possible metabolic issues due to genetic mutations. This may not always be easy, but it can be done, especially since this population isn't too sick. I myself have MECFS in addition to POIS and it makes it extremely challenging as I don't tolerate a lot of supplements, etc.
We have to understand that all of these issues are cycles that feed into one another. It's not just e.g. candida or SIBO causes leaky gut and MCAS, but also they will contribute to nutritional deficiencies, etc. All the cycles connect to one another, so ideally, everything needs to be addressed more or less at the same time.
If you want to dive deeper, I recommend two resources. For nutritional deficiencies and genetic mutations I recommend looking into Chris Masterjohn.
You may also want to look into BornFree and Joshua's protocol. Some of the things I have said are taken from his work. I don't subscribe to everything he says, I think it has flaws and the protocol may be dangerous for sick people, but the framework is useful and can help open your eyes to some possibilities. I think his view on POIS is a overly simplistic, but it doesn't really change anything much, because it all revolves around same pillars and mostly same interventions. He doesn't "believe" in genetic mutations and their impact or doesn't think they're important, that's why I mentioned Masterjohn, because he does and he's also very scientific and honest and doesn't really go beyond evidence, while Joshua does.
Be careful and don't buy into the hype of this being the end all be all, if you decide to go this way..
https://bornfree.life/understanding-the-model/6/updated-disease-model-wip/45I've seen that Muon has posted a few links to BornFree in the past, but I think the model has become more developed since then and may be worth a look.
Anyway... enough for today.
