Histamine Intolerance

Histamine Intolerance: the truth behind hard to heal health issues

Histamine Intolerance Doctor Overland Park KS 

Have you done elimination diets and your symptoms don’t improve? Do you keep running into more foods you are reactive to? Have you been to all the doctors and had all the tests run, but nothing is conclusive? If so, Histamine Intolerance (HIT) may be your issue. HIT is on the rise and is often the reason elimination diets can fail to reduce symptoms or control inflammation. Histamine intolerance can also be a driving force behind autoimmune and gastrointestinal symptoms that flare, move, and persist with seemingly no rhyme or reason despite many interventions- even natural ones. The rise in HIT is likely a combination of patients and practitioners becoming more aware of the issue, as well as an increase in damaged gastrointestinal tracts which is a major player in the development of HIT. It is estimated over 3.2 million have HIT, with over 80% of those being women. The number of people suffering from HIT but undiagnosed is expected to be very high and grossly underestimated when considering the incidence of HIT within the general population.

What Is Histamine Intolerance?

Histamine intolerance is not actually an intolerance like we know food intolerances to be, but rather it is an excess of histamine that the body cannot clear out or manage effectively. Histamine is a chemical your immune system releases…in response to a variety of allergic and toxic exposures.  With these exposures, histamine containing cells basically dump histamine into the bloodstream causing an inflammatory response. This stimulates white blood cells to respond to the perceived injury. This response can happen in almost any system in the body but most often results in a gastrointestinal, neurological, or skin responses. However, a histamine intolerance reaction can be quite unpredictable by not affecting the body the same way consistently. This is one reason it is not often clinically diagnosed and frequently overlooked. More and more practitioners are looking at HIT as a driver of difficult health issues and people are getting well!

Symptoms

Each person will experience the symptoms and combinations thereof differently, but most commonly, these are the issues at play when histamine intolerance is an issue:

Digestive tract

  • Diarrhea
  • Crohn’s Disease/Ulcerative Colitis
  • Chronic constipation
  • Flatulence and feeling of fullness
  • Irritable Bowel Syndrome – (IBS)
  • Stomach cramps/pain
  • Nausea/Vomiting

Head and face

  • Headaches, similar to migraine
  • Runny nose and weepy eyes with no clinical sign of allergies
  • Edema (swellings mostly appearing around eyes and lips, sometimes in the area of the throat)
  • Episodes dizziness
  • Extreme tiredness, feeling knocked out
  • Flushing of face and/or chest

Skin problems

  • Skin rashes, itchiness
  • Eczema,
  • Hives
  • Acne

Chest area

  • Asthma
  • Cardiac arrhythmia, such as a fast beating or irregular heart beat

Women

  • Dysmenorrhoea (severe period pains)
  • HIT symptoms go away during pregnancy and return after birth of child

Other symptoms

  • Chills and shivers
  • Low blood pressure
  • Sudden psychological changes (e.g. aggressiveness, inattentiveness, lack of concentration)
  • Sleep disorder

Causes

HIT is caused by more histamine released from the cells than the body can break down and utilize. This is due to primarily two issues: 1) genetic or acquired deficiencies in enzyme diamine oxidase (DAO) and 2) intestinal (gut) damage. Histamine that is released from histamine-containing cells into the bloodstream is managed by the DAO enzyme. When this enzyme is either lacking from a genetic low production, or poor production from damage in the intestines where it is produced, excess histamine builds up in the bloodstream and affects the body in a multitude of deleterious ways. It is a logical conclusion that the same genetic, lifestyle, and diet related issues that cause damage to the intestines therefore contribute to HIT.

Medications are also a primary cause of HIT since they reduce the DAO enzyme. You are particularly susceptible to HIT if you are or have taken these types of medications which, consequently are often the types of medications prescribed to relieve symptoms of HIT, but without any knowledge that these can worsen the situation:

  • NSAIDs: ibuprofen
  • Antihistamines: Cymbalta, Zoloft, Effexor, Prozac
  • H2 Blockers: Pepcid, Zantac
  • Immune Modulators: Embrel, Humira
  • Antiarrhythmics: Toprol, Metaprolol, Amiodarone

Testing

There are not definitive available for HIT and there are mixed views on what is available. Your conventional medical doctor will likely not have anything to offer in either understanding of, or testing for HIT. Functional medicine practitioners do know how to detect HIT and often rely on testing options. A Zonulin level is a common test when HIT is suspected as it will confirm intestinal permeability or gut damage that occurs with HIT. A leaky gut (intestinal permeability) allows for histamine to move from the gut to the bloodstream causing many of inflammatory reactions. Dunwoody Labs has a DAO/Histamine ratio test which when interpreted correctly can show if the level of DAO enzyme activity is sufficient to address the level of histamine. Interpretation and clinical judgment is key when considering this test since the ratio may be off from DAO deficiency or from excessive histamine levels. Treatment approaches to each will differ slightly depending on the ratio. Most practitioners continue to rely on clinical judgement as there is not one definitive picture or lab test to confirm HIT and exploring the available treatment options when HIT is suspected generally produced favorable results.

Conventional Treatment

There is no standard, conventional treatment for HIT since it is not seen as a medical diagnosis in the United States, nor do many gastroenterologists or primary care physicians know about HIT. You may benefit from ruling out other illnesses that may be the cause of your stubborn symptoms such as Celiac disease, non-celiac gluten sensitivity, Crohn’s disease/Ulcerative colitis or certain types of cancers, but chances are if you are reading this, you have already had many tests done with no specific issues showing up. This is where shifting from the conventional medicine approach to the functional medicine approach is necessary.

A Functional Medicine Approach

As with most complex health issues that functional medicine treats, the solution is multifaceted. With HIT, diet changes, supplementation, and lifestyle modifications all work together to regulate the histamine/DAO systems and get you feeling better. Each practitioner who has experience with HIT will supplement a bit differently since your body will need its own unique support system. In general, these areas will be addressed: low histamine diet, supportive supplements, and lifestyle modifications.

Low Histamine Diet

For many people, 30 days of a low histamine diet can often confirm HIT as symptoms can improve quite quickly for some. This way of eating, admittedly is restrictive, but designed to be temporary to calm things down while other measures are taken to balance the body allowing for foods to be reintroduced. Also, many of these foods are considered “health foods” and for the general population — avocado, fermented foods, and spinach are potent part of a nutrient dense way of eating — but in cases where HIT, these foods need to be avoided, likely only temporarily. Some people will remain sensitive to some high histamine foods but most people can find a very reasonable modified approach that works very well for them.

Foods to Avoid

Histamine IntoleranceThe foods to avoid are broken up into 3 categories, all of equal importance:

1) High Histamine Foods to Avoid

  • Alcohol: champagne, beer, wine (white and red)
  • Aged Cheese: Parmesan, Gouda, Swiss, Cheddar
  • Grains: Wheat
  • Fermented vegetables: kimchi, sauerkraut, tamari, soy sauce
  • Fermented milk products: yogurt, Kefir, buttermilk
  • Fruit: dried, citrus, strawberries
  • Legumes: Chickpeas, soybean
  • Meats: smoked or fermented
  • Vegetables: Tomato, tomato products, spinach, eggplant, avocado
  • Other: cinnamon, chocolate

2)  Histamine Liberators

  • Citrus fruit, banana, dairy products, chocolate, papaya, pineapple, nuts, strawberries, food additives, artificial dyes and preservatives

3) DAO Enzyme Inhibitors

  • Alcohol, black and green tea, mate

Low Histamine Foods to Choose

  • Fresh meats (do not save and eat leftovers)
  • Wild caught fish (no leftovers)
  • Cooked eggs
  • Gluten free grains (rice, quinoa, teff, amaranth)
  • Peanut butter
  • Fruits: mango, pear, watermelon, apple, kiwi, cantaloupe, grapes, papaya
  • Vegetables: all except those on “avoid” list above
  • Dairy alternatives: coconut milk, rice milk, hemp milk, almond milk

Supportive Supplements

Your practitioner will determine based on your unique needs the supportive supplements needed for gut healing, hormone balance, and adrenal restoration. However, these four supplements will likely accompany almost all protocols for HIT

  1. Quercetin and Stinging Nettle
  2. Buffered Vitamin C (ascorbic acid)
  3. Probiotic
  4. DAO enzyme

IV nutrition therapy may also be a good fit based on the level of gut damage, energy depletion, pain and nutrient deficiencies that are occurring. The functional medicine team at LifeWorks Integrative Health can give these struggling systems a boost through IV therapies that can help you feel better much faster while also addressing the more long term balancing that needs to occur.

Lifestyle Modifications

A cornerstone issue with HIT is damage to the gastrointestinal tract, which is also a body system that is quite sensitive to lifestyle issues like poor sleep, high stress, and negative emotions. To many people this treatment category seems optional as if your doctor would with a “wink and a nod” suggest that you decrease stress. When working with the right functional medicine practitioner, lifestyle modification suggestions are just as important as food and supplements. We know you will still have stress, but improving your sleep, stress management skills, and being willing to address underlying emotional/relational issues will help you heal faster. It is now widely accepted that past trauma and unresolved emotional pain contribute to autoimmune conditions. It is important to support and restore all of you, not just add supplements to the underlying issues. You are absolutely worth the effort put in making lifestyle modifications. You are worth being well, whole, and vibrant.

Final Thoughts

Histamine Intolerance (HIT) is a increasingly common condition of which many people are still unaware exists. Additionally, HIT is often the underlying cause of mysterious, undiagnosable conditions that doctors have basically given up on. If you have seen all the doctors, run all the tests, tried all the diets, and still suffer from pain, intestinal issues, headaches, mood issues, painful periods, and nerve pain the team at LifeWorks Integrative Health is here to help. With years of experience finding and treating HIT, we know what to do. For those who have had years of suffering with no answers, it is not uncommon for HIT to be part but not all of the root cause of their chronic, mysterious health issues. We don’t guess, we test which is how we are able to get to the root of most every health issue we see. If you have suffered for years, it is time to get you back to your best.

References

  1. “Histamine and Histamine Intolerance.” AccessScience, doi:10.1036/1097-8542.br10229141.
  2. Maintz, Laura, and Natalija Novak. “Histamine and Histamine Intolerance.” The American Journal of Clinical Nutrition, vol. 85, no. 5, Jan. 2007, pp. 1185–1196., doi:10.1093/ajcn/85.5.1185.
  3. “Symptoms.” Histamine Intolerance, www.histamineintolerance.org.uk/about/symptoms/.
  4. Yacoub, Mona-Rita, et al. “Diamine Oxidase Supplementation in Chronic Spontaneous Urticaria: A Randomized, Double-Blind Placebo-Controlled Study.” International Archives of Allergy and Immunology, 2018, pp. 1–4., doi:10.1159/000488142.

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