Field Notes From The Clinic
Clinical notes from Dr. Joyce Knieff on MCAS, SIBO, motility, EBV, and the slow work of chronic-illness recovery. Evidence-informed, tempered by practice, written so patients and clinicians can read the same page.
The Library
Why Am I Suddenly Reacting to Fragrance and Chemical Smells? MCAS and Airborne Triggers
If perfume and cleaning products suddenly set you off, MCAS may be the reason. Here is the mechanism behind airborne triggers, and how to lower the load.
Does Your SIBO Breath Test Result Depend on the Lab? What a New Study Found
A 2026 study found the same SIBO breath sample can read positive or negative depending on the cutoff your lab uses. What that means for your result.
What Is Methane SIBO (IMO), and Why Does It Cause Constipation?
Methane SIBO, now called IMO, causes constipation, not diarrhea. Here is why the gas itself slows your gut and what naming it changes.
Why Does My MCAS Get Worse Before My Period?
If your MCAS flares track your menstrual cycle, you're not imagining it. How estrogen and progesterone move your mast cells, and what to do about it.
A New Study Ties Long COVID Brain Fog to Your Own Antibodies. What It Does and Doesn't Prove.
A 2026 Yale/Mount Sinai study links long COVID antibodies to nerve and fatigue symptoms in mice. What it proves, what it doesn't, and what helps now.
Long COVID and Cardiovascular Risk: What the New Mortality Data Means for Your Follow-Up
A 2026 cohort study links long COVID to higher cardiovascular and mortality risk. What the numbers mean, who's most at risk, and what to ask your doctor.
A New Unified Model of ME/CFS: What It Explains, and What It Still Can't
A major 2026 review proposes one mechanistic model for ME/CFS and post-viral illness. What links the symptoms, and why it's not a treatment plan yet.
Is Your Fibromyalgia Actually Histamine Intolerance? What the New DAO Research Suggests
A new review and DAO supplementation trial suggest a treatable histamine-intolerance subtype of fibromyalgia. Here's who actually fits the pattern.
Why Is Going Back to Work After Long COVID So Much Harder Than Expected?
Returning to work with long COVID is harder than expected. A new UK study built a rehab program for the fluctuating, long-term nature of the illness.
Why Does SIBO Keep Coming Back? The Motility Piece Most Relapse Plans Miss
When SIBO returns after antibiotics, the bacteria did not win. Your migrating motor complex stalled. Here is why motility decides long-term outcomes.
Why Are My Food Sensitivities Getting Worse? The Mast Cell Bucket Model
Your safe-food list keeps shrinking even on a clean diet. The bucket model explains why your tolerance is dropping, and how to start unloading.
Is the SIBO Diagnosis Conversation Changing? What a Major New Review Argues
A new critical review questions SIBO breath-test reliability. What the paper actually says, what it doesn't, and what to do with your diagnosis.
Your Gut and Your Blood Sugar: The Microbiome Connection Most Type 2 Plans Skip
A naturopathic look at why the gut microbiome shapes insulin resistance, and why blood sugar plans that skip it tend to plateau.