Exclusive Dr. Hyman+ Ask Mark Anything: Histamine Intolerance And Adrenal Fatigue

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Okay, here we go.

Hey everyone and thank you so much for tuning in to the newest episode of Dr. Hyman Plus exclusive Ask Mark Anything. My name is Darcy and I'm one of the producers of the Longevity Roadmap Docu-Series and I'm joined by the one and only our Dr. Hyman Plus Community Manager Herschel Perrot. This is an episode where we collect all of your questions to be answered by our resident expert Dr. Mark Hyman and is only available exclusively to you, our Dr. Hyman Plus community. We've collected some of your top questions for Dr. Hyman in this month's Ask Mark Anything, and we're excited to get the answers from the expert himself. So let's go ahead and get started with that first question. And I'm just gonna hop right into it. Dr. Hyman, this is actually one of the questions that I've been really curious about myself personally. And it's all about histamine sensitivity. Or even histamine intolerance. So the question from our community member, she wants to know if somebody has a problem, they know that they have a problem breaking down histamine, can they ever reverse that completely? And of course, if you could maybe elaborate for our community what histamine intolerance is, where everything about histamine intolerance.

Well, this could go on for a couple of hours. Hey, everybody, it's great to see you all and I'm excited to share you a little bit of what I know. about a lot of the amazing questions we have today for Ask Me Anything community. The histamine issue is quite a big one. It's really mostly undiagnosed. It causes a whole host of miserable symptoms for people that seem related to other things and doctors often confuse for other diseases but actually are driven off of histamine. I'll just tell you a quick story of a patient and then I'll sort of dive into what it is. But histamine essentially is this molecule that's in food that is in our bodies and that's released by our white blood cells and so forth. It's necessary for regulating our immune system and inflammation and so forth. And we know if we, you know, for example, get a bee sting or a, you know, peanut allergy, that's a histamine response to the extreme where the body releases huge amounts of histamine. It leads to food retention and, you know, can ultimately lead to anaphylaxis and death. And it's It's pretty uncommon to have those level of reactions, but that doesn't mean that histamine, if it's in a level that sort of overcomes people's natural ability to break it down in the body, that it doesn't cause a lot of symptoms. And it really does. This one guy, you know, had been sick for years and years. His immune system was not working. He was always about 30, 40 pounds overweight. It was almost all fluid. He had all these weird sores and rashes all over his body. And there's a lot of vague symptoms and we put him on a histamine free diet and a number of other supplements and things that help regulate histamine. And he was able to completely drop the weight and reduce all these chronic infections to feel better and really, really recover. So it's something that takes a lot of work and detective work, but it's really important for people to understand that if they've got weird vague symptoms, they might want to think about it. So first of all, so, you know, what is histamine intolerance? Well, it's, it's basically. a buildup of histamine in the body because of medications, various medical conditions, nutritional deficiencies, environmental toxins, our diet, all these can lead to a dysregulation of our ability to break down histamine. And so what you see is the decrease in function or effectiveness of a particular enzyme in the gut called DAO or diamine oxidase, which is the enzyme that breaks down the histamine that's in your food because there's naturally occurring histamine in food. And there's another enzyme called the HNMT also that's involved. And really severe reactions are pretty rare, like probably 1%, as I mentioned, but a lot of food and drinks have histamine and a lot of factors can interfere with this enzyme DAO or HMNT, which means you build up a lot of extra histamine. And there are a lot of medications, for example, airway medications like theophylline, heart medications, antibiotics, antidepressants, antipsychotic medications, muscle relaxants, pain meds, GI meds, nausea meds, even over-the-counter drugs like Advil, aspirin, and indomethacin, and Voltaren, and naproxen, all these things you can get over-the-counter. And then of course, other things that are part of our life, like alcohol, intestinal problems that may affect the gut, so having gut issues, which is a big factor in functional medicine, various liver problems, B vitamin deficiency, like B6, copper, zinc, vitamin C's, stress, trauma, injury, various temperature extremes. All these things can screw up your ability to break down histamine. And then you get this hypersensitivity and you get all kinds of symptoms that make it really hard to figure out. And it can be really weird stuff like digestive stuff like diarrhea, flushing, you can get dermatographia where you scratch on your skin and you'll see little welts. You literally write your name on your chest, flushing, headaches, ingestion, red, itchy eyes. And we know, you know, when you get allergies, that's a typical histamine reaction. That's why we take antihistamines like Benadryl, right? Or, or Zyrtec or Claritin. These are antihistamines that block some of these histamine reactions that come from environmental factors. But it can also be other things that you can get from this lot of skin issues, itchy skin, hives, burning bumps, weird things. You can get cramps in the stomach, anxiety, constipation, nausea, vomiting, gas bloating, a lot of digestive stuff, fatigue, patchy, dry skin, like eczema, regular heartbeats, menstrual cramps that are pretty bad. So all these things can happen. You can even have worse symptoms. So diet plays a big role. There's a lot of foods that have high level of histamine. So if you have those symptoms, sometimes doing a histamine-free or a low histamine diet can really help. Most foods contain some level of histamine. And the more aged food is, the more sort of fermented food is, the more likely this to be a problem. So like blue cheese or moldy stuff, those are probably not great. The most sort of rich foods in Istamina are things like alcohol, cheeses, which are kind of aged, canned pickled fermented foods, smoked products like sausage or bacon, sorry, certain beans like soybeans, chickpeas, lentils, vinegar, lots of prepared food, yogurt, salty snacks, sweets with preservatives, chocolate, sorry, Green tea, pineapple, canned fish, peanuts, spinach, tomatoes, eggplant, all these things really have problems. And things that often can increase the release of histamine, so even if there, for example, isn't in the food, you might, if you eat citrus food or chocolate or tomatoes or various beans or nuts, these can cause the body to release histamine, even though they may not have histamine in them. And then there are a lot of foods that interfere with this enzyme, DAO, alcohol, energy drinks, green tea, black tea, mate, egg whites, yogurts, depending on the bacteria, and that can interfere with that enzyme. So this causes a lot of problems. So what you need to do is sort of eat a low histamine diet. And what does that look like? Well, getting rid of some of the histamine food. So chicken, but no skin, fresh. Everything has to be fresh, right? No, nothing, no leftovers, basically fresh food. Egg yolks are fine. Frozen meat, fish is fine. Most vegetables except tomatoes and eggplants are fine. Most fruits fine and berries are fine except citrus, strawberries and cherries. Most cold dairy products are okay if they're fresh. Certain things like coconut rice milk are okay. Butter is okay. Certain teas are okay that are herbal that are not green, black or mate. Leafy greens are okay except spinach. Most oils are okay. So you can construct a diet. It's a little bit restricted, but sometimes it's worth it for two or three weeks to see if you can get into trouble. So a lot of vitamins can be helpful. B6, it helps break down histamine, which helps that enzyme DAO, break down histamine, vitamin C lowers histamine levels and helps the break down the histamine. Copper also can help raise the levels of this DAO and breaks down histamine, magnesium can reduce allergic responses. Manganese can also help zinc, calcium B1, 12 and folic acid. These are all really important. And of course, as we'll use medications, if we do eliminate the sources of it and we optimize ask people's nutrition, try to get the enzymes working, we get rid of alcohol and all that. We might need to give them antihistamines. It could be things like Zantac or Zyrtec. Zantac is an antihistamine, even though it's a gut drug. There are DAO enzyme supplements that we prescribe. Get them to get off the medications. It could be a problem and avoid using sort of the anti-inflammatory medications like Advil and pain drugs, unfortunately. So that can really, really help if you focus on it. Now, testing for it is, is tricky. You know, you kind of have to rule out other causes. You might, you know, really look at, at other factors that, that could be driving it. But, but, you know, keeping a food diary and serum really works. Skin prick tests can, can be helpful, but not really, really that reliable. You can measure histamine levels as well. So, I mean, histamine intolerance is a real thing. And if you have weird if you have weird symptoms that aren't being explained by other factors, it's something to think about and even seeing someone who can help evaluate histamine sensitivity. Hopefully that answers your question. It's a long answer.

Yeah, for sure. Well, I actually have one follow-up question about that. A lot of the foods that you just listed that are really high in histamine levels are also healthy foods. Why is it that some people can have this reaction to high histamine foods and that others just aren't affected by histamines like that.

Well, I think that's what I mentioned too, and as I was going through it all, there are certain factors that actually drive histamine intolerance. And those are the medications that I talked about. There are the nutritional deficiencies I talked about, alcohol, chronic stress, trauma, temperature extremes. These all can kind of set people up to be in trouble. And also, I find often it goes along with leaky gut and other things. So it's kind of often associated with a lot of other problems as well.

Yeah, yeah, that makes sense. I feel like somebody's explained it once to me that it's kind of like a cup where you can fill it up with some histamine and it's okay, but once you fill it up with too much and it kind of spills over, it can cause some of these issues.

Exactly.

Okay, great. Well, thank you so much for that answer. I think that's really helps to summarize this. That's something that a lot of people aren't particularly familiar with. And so I'll hand it off to Herschel for our next question.

Hi.

So the next topic is something that's, I think, ignored in conventional medicine and it's sort of a driver of chronic disease. And it's something that comes up, especially right now during the pandemic when everybody's sort of stressed out and busy and that's adrenal fatigue. so can you talk a little bit about adrenal fatigue, what causes it, and why it's not something that's usually brought up in your regular doctor's office?

Well, you know, I joke and often say to people, you know, listen, if you go to the doctor and you're having all these weird symptoms and they do all the tests and they examine you and they say, well, your exam is fine, your tests are fine, everything's fine. And then probably next sentence is you probably are depressed and need Prozac. But what usually is the case is, you know, either the doctor's missing something or you're crazy, and I I don't usually assume my patients are crazy. And if they're complaining, there's usually something going on. And just because traditional approaches don't think about it or can't find it doesn't mean it's not real. And, and we often in medicine think about things as on or off. You either have it or you don't. Right. You're, you're alive or you're dead, you're diabetic or you're not. You have high blood pressure, you don't. Right. This is nonsense. The body is a, as a, as a, as a sort of an ecosystem, and there's imbalances that occur all the way from sort of mild changes to very severe changes. So in adrenal issues, we think, oh, you either have Cushing's disease, which is where have a tumor that makes too much cortisol, or you have Addison's disease, which is where you have an autoimmune disease that nukes your adrenal glands, so you can't make all the adrenal hormones, so you get adrenal exhaustion. And aside from that, everything's fine. But it's just not the case. And we know from work of Bruce Lipton and others, when you look at the pattern of chronic stress, like we're really, we burn out over time. And, and the, you know, there's a great book by Robert Sapolsky called why Zebras Don't Get Ulcers, which basically explains the fact that, Zebu are out there chewing their grass and hanging around. And then the lion comes along and they all chase and they all run like crazy. It catches one of them and then the rest of them just go back to eating their lunch while the lion's having his lunch just right next door. And nobody's upset or stressed. The problem with Western societies is we're just chronically stressed. We don't have the acute stress where we run like crazy, burn off the stress hormones, and then react to doing our normal thing. We're chronically stressed. And what initially happens is you get a cortisol response, which is a stress hormone. You'll get this high spiking cortisol, which makes you feel a little revved up. And it's a good thing in response to stress. You don't want to be struggling with not being able to respond to a very powerful stressor. So it's a good thing. But then when you have this chronic stress, the cortisol will cause ongoing damage. It'll cause muscle loss, it'll cause you to be hypertensive, diabetic, it'll cause you to be hungry, crave sugar, carbs, be depressed. I mean, it just increases, you know, damage your skin and all kinds of things. It solves your bones. You just don't want that. And the, the truth is that, that when you, when you stay in that state for a while, your body can kind of compensate. And then what happens is you start to decrease the function. So you're just like beating a dead horse. Your pancreas, I mean, your adrenal glands can't keep up anymore producing the adrenal hormones that you need in order to respond to stress. then you get a burnout phase. So you go from like high cortisol and you're sort of this normal stress response to basically this flattened response until like it's a flat line. Well, I hope you enjoy that teaser.

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