What Is Histamine Intolerance & How To Get Fast Relief? | Dr. Elizabeth Boham

Coming up on this episode of the Doctor's Pharmacy.

One thing I always say to people is, you know, this is not a lifelong condition, right? This is not like, you're not like histamine intolerant forever and ever, right? It's not like, oh, you've got this condition, it's never gonna go away. We've gotta ask that question, why, right? What is triggering this for this person?

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Discussions with other experts in the field. So let's just jump right in.

Welcome, Liz. Great to have you back on the podcast today.

Thank you, Mark. It's so great to be with you again. Thank you.

So as you heard from the introduction, Liz has been a longtime colleague of mine for I don't even know how many decades now. It's a little scary. At least two and a half, I think, decades. It's all good. You know, Liz doesn't age a bit. I don't know what she's doing, but we have been working together deep in the world of functional medicine to try to really help people who are struggling with conditions that are often not getting good solutions through traditional medicine and dealing with people with chronic symptoms that are often mysterious or strange, things that get often dismissed by doctors or ignored or they don't know how to address or treat. And so at the Ultra Wellness Center, we really dive deep into unpacking a person's story, the whole timeline of how they got sick and what the root causes are. So really gonna dive into the root causes. around illness. And, and today we want to talk about a really common problem that you and I both seen a lot, which is people having a lot of histamine reactions. And we're going to explain what that is. But there's a whole spectrum of, of, let's call it allergy or activation of the system that results in hives and a whole host of other symptoms. And it can be very extreme from mild intolerance of histamine in the diet to full-blown what they call Mast cell activation syndrome, which is a much more advanced case of a problem that people get with their immune system kind of going a little haywire. We're not going to go too deep into Mast Cell Activation Syndrome today. We might come back to that later. But, Liz, why don't we start by talking about a patient that you had who was suffering from histamine intolerance, what the symptoms she had were, what she presented with, and what you kind of found. And then we're going to go through at the end. So stick with us. We're going to go through the end, how actually we can treat this condition and what you did for this particular woman and her outcome. It was pretty impressive. And again, it's stuff that just you're not gonna get from your regular doc.

Yeah, so I mean, I've been interested in histamine intolerance for a long time. And as you said, one of the reasons is because we get patients who have all of these reactions and we're trying to help them and get to the underlying root cause. And this patient really sort of was, brought it home for me, right? Because she came to see me, she came to see me when she was 39, but she had been having migraines like 5 to 15 days of migraines per month for the last 15 years. So she'd been struggling with migraines for a long time and tried everything, right? All sorts of different medications and nothing was helping. And when we got her really good history, right? We get a really good history and look at her timeline, you know, she noted, or we noted that this all started 15 years ago after she had a lot of stress at work. So she was, her job became really stressful 15 years ago. And then she started to have all of these problems and started to get migraines. And then they just got out of hand, which we so often see, right? We'll see it just escalates for people. And so when, again, taking her detailed history, we found out that when these migraines would happen, she'd also get a lot of congestion in her nose and she'd get a rash. And so her story, her history, really clued me into thinking about histamine as an issue because we know that histamines, high histamines or histamine intolerance can cause migraine headaches in some people and it can cause rashes in other people, their hives, and of course nasal congestion and runny nose in other people. And so I started to think, well, maybe for this woman we have to think about histamine intolerance. And so we put her on a low histamine diet and we did some other things as well that as I said, as you mentioned, we'll get to at the end. But it was amazing because after a few a few weeks, her migraines just started to dissipate significantly. And the last time I spoke to her, she hadn't had migraines in in a few years. And, you know, so they slowly just started to go away and then she just stopped having migraines and all because of a low histamine diet, which is really impressive. And so, you know, I think it's such an important topic for us to delve into. to because there's so much around it that we need to talk about. And so, it can be pretty impressive and effective.

Yeah, I mean, I think that's, I've seen many patients who, you know, hives all over who struggle with all sorts of immune dysregulation and then it's often mysterious. You know, this chronic, they call it chronic urticaria is one of the things we learned in medical school. And it's essentially a kind of an overactive immune system, particularly a part of your system that's involved with allergy that includes mast cells. And, and so I, I'd like to kind of get into the science a little bit behind this because I think people need to understand what is histamine, what are mast cells? How does this all work? You know, why, why do we have this? And then let's get into sort of some of the more details about, like, why some people are histamine intolerant, why they can't break it down effectively and, and how you test for it and all that. So, so let's kind of get into that. What is histamine and, and, and what is going on here with the body that we are seeing this kind of outrageous overreaction for so many people?

Absolutely. So histamine is an immune chemical and it's produced in the body during a reaction, during an allergic reaction or an inflammatory reaction. It's also found naturally in foods. So some foods are higher in histamine than others, but histamine is also produced in the body as a reaction. So histamine comes from our mast cells. Mast cells are part of our immune system. system and they line the barriers of the body. So their mast cells are lining the digestive system, they line the nasal passageways, they can line the skin, and they're really an important part of the immune system that helps defend against pathogens like bacteria and viruses from getting into the body and also allergens from getting into the body. So it's a really important part of the immune system that can create things like mast cells will produce like histamine and cytokines, which can produce mucus and inflammation, which can support or prevent these things from coming into the body when we don't want them to. Though sometimes those symptoms are, you know, troublesome for people. It is an important part of the immune system. And so what happens when somebody has histamine intolerance, there's this imbalance. the body is producing too much histamine or the body can't break down enough histamine or you're eating foods that have too much histamine in it and you don't have the ability to break them down quickly enough. And when there's that imbalance going on, that's what we call histamine intolerance.

And why do some people get this more than others? Like, I don't really have any hives or I haven't really had any allergies and there's not much allergies in my family. Is it a genetic thing? Why do people have this? What's going wrong?

It's such a good question that we want to ask, and we always ask, right, in functional medicine, that question, why? And what could be the triggers? And I think that's really important to think about. So we do know there's genetic predispositions. Absolutely. Some people, you know, don't break down histamine as easily as others genetically. But it does trigger us to think about, okay, what's going on? Has there been a shift in the gut? Is there increased intestinal permeability? Has there been a shift in the microbiome? there's some dysbiosis that's causing this. Because one thing I always say to people is, this is not a lifelong condition. This is not like you're not histamine intolerant forever and ever. It's not like, oh, you've got this condition, it's never going to go away. We've got to ask that question, why? What is triggering this for this person? You need to get that good, detailed history and look at their timeline and try to think about these triggers because then we can figure out how to treat this person. is it stress? We know that stress is a major trigger for people. We know in cortisol levels are high, then we don't break down our histamine as well. We know that, was there a shift in the microbiome, right? Was there some antibiotic somebody took or did they get some stomach bug that caused inflammation in the gut that then started this histamine intolerance? Or was it some shift in medication? We know that some medications can can decrease the breakdown of histamine. So things like ibuprofen, taking too much ibuprofen or other pain medications or certain antidepressants or of course antibiotics may also cause a shift in how we process our histamine. And then the other thing we look at too is mold because for some people mold exposure can result in more histamine release from the mast cells and then more histamine intolerance. in some people. So, you know, that's really important, that underlying question of why. So basically what you're saying is, you.

Know, and I always say this, functional medicine is the medicine of why, not what, not oh, you have histamine intolerance, but why do you have it? And one of the reasons and there are so many things that can disrupt our immune system from, like you said, disturbances in our gut microbiome, which create a leaky gut and toxic bacteria or bacterial overgrowth. It could be environmental toxins that make us susceptible. we can script our immune system, it could be mold exposure, it can be some genetic factors that affect our ability to break down histamine. We'll talk about how to deal with those things and how to test for that. And we also see, you know, like you said, stress and other factors can really trigger this whole histamine intolerance phenomena, which is really just, just often disabling for people because they get so triggered by their environment and by their diet and they're kind of always itchy and miserable. And it's something that actually can be like you said, doesn't have to be a lifelong syndrome, but actually can be properly treated in a way that actually gets rid of it. And so I think what is the sort of thinking around the mast cells? How are they triggered so that it releases histamine? Because mast cells are part of your white blood cell system. that's everywhere, particularly in your gut, that triggers, when they get triggered, they release histamine and that creates this overactive immune system.

Right, so there's so many things that can trigger it. They've looked at things, as we were talking earlier, about mycotoxins and how mold toxins, toxins from molds or mycotoxins, can cause more histamine released from the mast cells and that can cause more inflammation in people's body and create this this sort of vicious Cascade of events that can happen for people. And, and, you know, we, even know, like, infections can do it. There's been a lot of research looking at covid and how that can, you know, how that triggers the mast cells to be producing a lot of cytokines and in this inflammation and results in this, in these, these processes. And, and as you were mentioning earlier, right, we know that shifts in the microbiome are huge, and that can result in changes in the bugs in the gut, and that can result in changes in of histamine produced. And ultimately, also that can result in inflammation in the digestive tract. And if there's inflammation in the digestive tract, what happens? We get that increased intestinal permeability, right, what we call leaky gut. And then that results in us becoming more intolerant to foods and more intolerant to the histamine in foods. In addition, when there's inflammation in the digestive system, this enzyme that breaks down histamine called DAO, diamine oxidase, right? So this is an enzyme that we have in the digestive system and it lines the intestinal barrier. And if there's inflammation in the digestive system, we don't produce as much DAO enzyme. And so then what happens is we don't break down our histamine as much, we become more intolerant to histamine, and then there's also in in that place of inflammation, there's increased intestinal permeability and then we absorb too much of that histamine and then we become just more and more reactive. And so, so we do know genetics impact how much DAO enzyme somebody makes, but ultimately we have to go back to the gut because if there is a lot of inflammation there, that also decreases the amount of DAO enzyme somebody makes. and it also results in more increased intestinal permeability, which just causes this whole thing to cascade. So, we've got to go back to the gut and ask that question, what's going on there? Yeah, I mean, it's really, you know.

Often really the gut and leaky gut and gut dysbiosis is probably one of the biggest drivers. And yet, you know, as you mentioned, a few other things like DAO, I just want to dive into that a little bit because there's an enzyme that our bodies make that is designed to break down histamine called diamine oxidase or DAO. And sometimes people have a variation in that enzyme which inhibits their ability to fully, let's call it metabolize or break down histamine, which then leads to the accumulation of histamine and more histamine intolerance. So, there are ways actually to treat that with giving people the enzyme. You can give them DAO enzymes as a supplement that will help to actually break down the histamine and help with some of this. Certain medications also can really affect histamine intolerance and trigger it like the NSAIDs or anti-inflammatory drugs like Advil or Aleve, antibiotics, antidepressants all can inhibit DAO which leads to sort of slower histamine breakdown. So sometimes medications and people just also have hormonal stuff. And I know this particular case of this woman, she had significant hormonal issues because estrogen can increase histamine release and reduce the DAO activity. And that's why, like, women have more histamine related symptoms during certain phases of their menstrual cycle. I think there's also nutritional deficiencies, right? Like B6 and copper, magnesium, vitamin C can also lead to it. And anything that triggers sort of inflammation in general can just make you more reactive. Right. So whether you have allergies or infections or autoimmune disease and alcohol, you know, it's another big factor that can inhibit DAO and also increase histamine release, which makes it all worse. And obviously you mentioned mold and environmental toxins also overwhelm the body's ability to tend to deal with it. So you've got so many different causes. And so as part of a functional medicine approach, what we do at the Ultra Wellness Center is really dive into how do we think about all these factors? Because they might have the same end result symptom, right? Histamine intolerance, but the causes may be different and the treatments may be different. which is what's so fundamental of functional medicine. And I always say just because you know the name of the disease doesn't mean you know what's wrong with you, right? And this is a perfect example where you can have many, many different factors. And obviously it's not just one, it's many things that are affecting a leaky gut or maybe an enzyme deficiency or maybe mold, more nutritional deficiencies or drink too much alcohol or whatever. All that really can lead to kind of worsening problems and symptoms like we see. One of the things I wanted to, do you have any other thoughts to add about the causes or thinking about that?

You know, I mean, I think that's so true. I think so often we want to find the cause, right? So we go, oh, well, what's the cause of this for me? And so often we realize it's multiple things coming together and that then something pushes your body over the edge. So, and it's important to work on all those different causes for that person because that then helps your treatment to be much more successful. So you don't want to just suppress the symptoms, though sometimes you do need to do that. You need to think about all of those different things that may be influencing somebody's risk for getting this. And so absolutely. And you'll see when we talk about this case later, we did work on multiple different things. I mean, of course the low histamine diet helped her for a while, but what's really important is the low histamine diets are not forever diets either. We don't want to be restricting foods for too long, especially healthy foods, right? And so we've got to figure out how do we help the body heal and stop reacting so much so that we can reintroduce foods for people. So yeah, multiple areas, multiple ways we're looking at things.

Yeah, for sure. And in terms of just kind of touch on it for a second, how is histamine intolerance different from this mast cell activation syndrome.

Right. So, you know, histamine intolerance, like some symptoms of histamine intolerance will include things like headaches or migraines, congestion, congestion after you eat especially. Digestive issues are really high on the list. Abdominal pain and bloating, diarrhea, constipation. We talked about the rashes that can happen, urticaria, hives, rashes that can happen. But we also know that histamine intolerance or high levels of histamine can cause a lot more systemic things as well, or other systemic symptoms. So things like low blood pressure, heart palpitations, dizziness, vertigo feelings, anxiety. So sometimes people will feel more anxious when their histamine levels are high. chronic fatigue. And so, you know, histamine intolerance- Dr.

I get a lot of nasal congestion, right? And sometimes even asthma symptoms and- Dr.

Absolutely, right? Absolutely.

Brain fog and it's like everything, right? So, it can't be dismissed as, you know, people don't put the dots together and the doctors don't often put the dots together. And these symptoms are often seen as.

Disparate or not connected, but they're all really connected, right? They are, right, they are. And it is, you know, to be honest, I've often not put the dots together, right? So it is not always easy. We're always like, oh, this person has headaches. Why are they getting headaches? Or they're having digestive issues. And then all of a sudden you go, oh, this is all related and I've got to be thinking about histamine. And so, you know, we've learned a lot over the years too to be able to help people as well. So I think of mast cell activation syndrome, it's more systemic. There can be a lot more things going on. And when we say the word histamine intolerance, we're really thinking a lot about that reaction that happens from eating a.

Food.

And that histamine reaction or that histamine imbalance that occurs after a meal where there is just too much histamine around and the body's not able to break it down. But you know what? It's often a clinical diagnosis, right? So it's often based on looking at that person's story and understanding, really understanding their timeline and what their symptoms are and looking for those interconnections that can really help us to determine if this is what's going on for them. Because the testing is imperfect.

Yeah, that's right. I mean, in terms of traditional medicine, what would be the traditional approach to diagnostics, testing, and then treatment? And then let's sort of talk about how we would approach this from a functional medicine perspective.

Right. So, you know, you can measure histamine levels, right? So, whether you can measure histamine levels in the blood, so you can measure something called histamine and tryptase in the blood, and you can measure histamine in the urine. It's called a methylhistamine urine test. that's done. And that test is often done both functionally and conventionally. And it can be helpful if the levels are high. So if the levels are high, you go, oh, this person has an issue with histamine. But what's a problem with this test is that the levels fluctuate a lot during the day and depending on what you just ate and the amount of food you ate and how We'll talk about this later.

It's not super reliable, right?

No, it's not. And so a lot of times these tests come back negative, meaning they look normal, but that doesn't mean the person doesn't have issues with histamine. So just because these tests are negative, it doesn't mean, oh, you can check that box and say histamine's not an issue. So in addition to those tests, you know, we're always looking a little deeper so we can measure things like you can now measure things like DAO levels. So you can actually measure that enzyme level, which is many times helpful. We can look at things like is there increased intestinal permeability, you know, by doing some tests that look at antibodies against zonulin and lipopolysaccharides, because that can give us an indication that this may be an issue.

And we also- and zonulin is like the gluten marker for excess gluten and lipopolysaccharides are toxins that bacteria make that create inflammation. So those are bad things that happen in your gut and that can trigger this. Right.

And then when the body makes antibodies against them, that means that there is increased intestinal permeability. So it's a test that we do to give us a sense of is there increased intestinal permeability and is that where we need to work to help improve this person's health? And we also look at genetics. We look at genetic markers all the time. you know, that can influence how well you make that DAO enzyme as well as how well you break down histamine through methylation. So there's a bunch of different genetic SNPs we will evaluate for that will also give us some information about like how much is this person at risk for having issues with histamine?

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And now let's get back to this week's episode of the Doctor's Pharmacy. Yeah, it's interesting. And, you know, I think, you know, people have even weird symptoms like dramatic graphism where you kind of scrape your skin with a fingernail and it'll just like welt up and look bad. So, or you can write stuff on your skin. It's like graffiti. Right. But these are really a whole host really disparate symptoms. And again, this is a spectrum, right? Histamine intolerance, mast cell activation syndrome, they're all part of a continuum of dysfunction of your immune system, overreaction of the allergic response in the body and triggers all this cascade of downstream symptoms. The problem is traditional medicine doesn't do a very good job of this and throws a lot of medication at it. Antihistamines, things like Allegra, Claritin, Zyrtec, or what we call H2 blockers, another histamine receptor like Pepsid or Tagamet. And then they use, you know, mast cell stabilizers, which actually I think are, can be helpful like Cromolyn sodium, which we, which we use. And you can take it orally as a, as a liquid before you eat to kind of decrease any reactions to food. And I find that extremely helpful. It's very safe medication. But there's more serious ones like Singular for leukotriene inhibitors, which are, which are, you know, strong medications, steroids. So that's really kind of the the toolkit. And it's a very limited toolkit and often doesn't really solve the problem. It just massive symptoms. So the beauty of functional medicine is that it helps us really start to think about the symptoms. And as you mentioned, we do a deeper dive. We look for things like leaky gut, for food intolerance, as we look at dysbiosis, what's happening in the gut. We also look at mold and environmental toxins and hormone levels and all the things that we know really are are relevant when it comes to sort of trying to understand the root causes of overactive histamine response. So, I think it's an area I think we have a lot of success with and a lot of different approaches than traditional healthcare. I think the interesting thing about histamine is that it also is in food, right? So, people have to eat. You know, you make histamine in your body, but you also get histamine from various foods. And, and I, and maybe you could sort of share, you know, what, what initial approach would be from a functional medicine perspective. You know, we, we do with the deep Diagnostics, as we mentioned, you know, look for leaky gut, look for dysbiosis, look for hormone imbalances, toxins, look for food sensitivities, look for mole issues. We, we do, you know, genetic testing to histamine related enzymes like DAO and maybe even urinary histamine levels. So we do a whole range of tests, but then once we find out someone has this, what's kind of the general approach that you would take to dealing with the root causes?

So right, we want to calm down the body and calm down this reaction, this overreaction that's happening in the body. And so we will often do a trial of a low histamine diet, and it can be very effective, as I mentioned, with this patient with migraines and how effective it was. But what's important, I think really important to just start off with is this is not a lifelong diet because there's a lot of really healthy foods that have histamine in it, right? Or even can cause histamine to be released in somebody's body. So what we ultimately want to do is decrease the bodies reaction to these foods and heal leaky gut. But let's start talking about this low histamine diet because it is a really great tool that we are using often. And just for a bunch of reasons, one, to see how much is histamine related to this person's symptoms. And then how can we help start to calm down the body's immune reaction? And then over time we work to relax the diet. So what we always do is we do phases so we're not overly restricting foods. And it's, you know, because it's important to recognize that the amount of histamine in a food varies significantly depending on how long that food has been sitting there, how long that food is, you know, how long it's, since it's been picked or caught and or prepared. We know that foods that have been the longer they've been, sitting there, they will, the histamine levels will go up. And so it's important to think about a lot of different things when we're doing a low histamine diet. So in terms of the phases, what we start with first is removing alcohol, especially beer and wine and champagne. Those, as you mentioned earlier, are foods or drinks that are high in histamine and they also block the body's ability to break down histamine. So we pulled those away first. And we also work with people to make sure that they are not keeping a lot of leftovers around. They're eating foods that are fresh, very newly prepared. If they do have leftovers, they want to freeze those foods right away because the longer the food is sitting there, the more histamine it will produce. For example, we also know, like, fish, for example, you want to try to eat fish 30 minutes after it's been caught. Well, you know, because that will have the lowest level of histamine. Exactly. That's so hard to do. So a lot of times people have frozen fish, which is good because those fish are often frozen very quickly after being caught.

Oh, that's interesting.

Yes. And they're going to be lower in histamine. But the key is when you defrost your fish, you want to prepare it right away and consume it right away. Because the longer it's being defrosted or the longer that, you know, if you eat that food two days after you prepared it, there's going to be higher levels of histamine in it. So, all of that can be really complicated. So, I will always recommend, and, you know, we do this at the Ultra Wellness Center, you know, we have, what, seven nutritionists now? You know, I always recommend people work with a nutritionist. I work with a nutritionist. because it can be such a complex process to figure out and to remove, and you want to do it in a healthy way where you're not overly restricting, but it can be really helpful. So you want to have fresh foods, minimally processed foods, and you want to have foods without those additives in it like sulfates and MSG, things that can trigger more of a histamine response in the body.

No, it's just like, you know, the aged cheeses, fermented foods, alcohol, those are all really full of histamines. You have to be really careful with those.

Absolutely. We put a lot of those in phase two. So if phase one isn't enough to calm down the body, then we'll move and pull away the canned and smoked fish, anchovies, which unfortunately, that's one of my favorites. But again, this is not a lifelong meal. food restriction, processed and fermented meats we pull away, aged cheeses, pickled and fermented foods, which like sauerkraut, kimchi, yogurts, kefir, mustard, ketchups, vinegars, soy sauce, you know, a lot of these, as we talked about earlier, are really healthy foods. So we want to be able to add them in in the future, but sometimes, again, we pull them out for a period of time. to see how much that helps somebody's symptoms improve. And they typically will see improvements in two to four weeks. So it's like a two to four week removal to get a sense of how much things calm down in the body. There is even a phase three where we have to restrict even more and pull away some plant foods like avocado, spinach, tomatoes, pineapple, citrus foods that can also trigger some histamine reactions in some people's body. And so again, we do it in phases. And we can attach this handout, I think, right, Mark, to the... For a few people.

Yeah, in the show notes, we'll put a handout on the different phases so people can listen in and actually figure out what to do by looking at this handout that we have provided at the Ultra Wellness Center. We'll put a link to it. And I think, it's kind of a good guide on how to get started on your own. But, you know, one of the challenges is that even if you do all that stuff, you know, I always say, you know, we need to figure out not what you're sensitive to, but why you're so sensitive. Right. And, and that's sort of the next phase. You can get people immediate relief by removing histamine and by giving them, you know, DAO enzyme and maybe some other things that sort of are mitigating symptoms, you know, whether it's antihistamines or chromaline or whatever you're going to give them. but at the end of the day, to really resolve this, you have to dig deep into the root causes and to try to deal with those things that, that, that we really are good at in functional medicine, but are not so great at in traditional medicine. And, you know, and that involves everything from optimizing and fixing the gut, whether it's spectral overgrowth, fungal overgrowth, leaky gut, inflammation, healing and repairing the gut, which, you know, we have four and five R program in functional medicine. I've done many podcasts on the gut, optimizing nutritional status that affects their immune system, whether it's vitamin C, B6, magnesium that support histamine metabolism and, and, and also the stress reduction part, which is really key because that activates everything, getting regular sleep, exercise, but then also diving, seeing, well, do you have mold? Do you have environmental toxins? Do we have heavy metals causing this? Do we something else going on that we need to treat directly? And how do we regulate your detoxification system? So, we really treat both the histamine syndrome itself, but also then dive into root cause treatment so that people don't have to suffer with this their whole life. And that's really the difference, right?

Absolutely. So, you know, there are foods that we, you know, we really want to focus on, right? So, both the the foods that are lower in histamine, but also we want to focus on foods that are naturally rich in quercetin and luteolin. And these are these phytonutrients that have natural antihistamine qualities in them. So things like onions and apples, things like olive oil and greens, cauliflower, blueberries, these are natural anti-inflammatory foods that can help of calming down the immune system. And there are times, you're right, that we will also add in supplements of quercetin and luteolin and even nettles. We work on getting more turmeric in the diet because it's naturally anti-inflammatory. But like as you mentioned, we ultimately want to work on healing that increased intestinal permeability. if that's what we suspect is the cause for that person, right? So we need to really evaluate the microbiome. We've got some new cool tests that are looking at all the different bugs in the gut, the whole microbiome. And there's some bugs in the gut that are more likely to produce more histamine and some bugs in the gut that are more likely to not produce more histamine. we can now evaluate that, which is fascinating. And, you know, there are certain probiotics that are less likely to produce histamine, such as like the bifidobacterium infantis. We know that lactobacillus rhamnosus, those are probiotics that are less likely to produce a lot of histamine and can be really effective when you're working on healing the gut as well. Right.

So that's how specific it gets. I mean, I don't know if you all picked up what Liz just said, but probiotics are not just one uniform category of product. They're different probiotics that have different effects and can be used for different conditions, whether it's now psychobiotics used for mental health issues, there's ones that are used for weight and metabolism. The lactobacillus rhamnosus and the bifidobacterium infantis seem to be particularly effective with histamine and mast cell release. So I think that's really important to understand this is really personalized and no one gets treated the same with the same condition. It really is personalized based on the diet, based on the causes, based on the right supplements for them, based on probiotics you're giving. One of the things I wanted to talk to you about, which we didn't chat about before, but I think it's worth you know, bringing up, which is, you know, why, why has our immune systems become so dysregulated? When, you know, I just came back from the South America in the Amazon jungle, and they just don't have autoimmune disease. They don't have allergy there. And, I mean, they were, I mean, I was down there, and one of the Delicacies they had there was these giant grubs, which are like this big, basically big fat larvae or something. I don't know what they are or something, and. now they were eating that, but they eat all kinds of weird stuff. And they, you know, they typically have more worms in, in these indigenous cultures. And when, when you look at the data on this, there's this whole philosophy around the hygiene hypothesis, why are we seeing more allergy, autoimmunity and, and, and in the Western world, and, and part of the hypothesis, we're sort of over sanitized and that we don't have the same exposure to the microbes that we did, you thousands of years ago, and that's led to real dysregulation. And, you know, the part of our immune system, the IgE part, which is often involved in this histamine response, is, is, is an ancient part of our immune system that's been historically something that dealt with worms and parasites and things. And one of the treatments has been explored, and I've actually used it successfully in a number of patients who have, you know, high Rates of allergy, food sensitivity, leaky gut, histamine, mast cell activation syndrome, is worms. And we learned about this through one of my mentors and our mentor, Sidney Baker, and he uses a class of worms called HDCs or Hymenolepis diminuta, sister coits, or HDCs. He calls them little dudes. And the question, have you used this? how have you found it to be effective? And, you know, what's your perspective on this? Because I think it's, it's one of those things that kind of shocked me when I used it. I had a patient who had IgE levels over a thousand should be under a hundred. And we gave him this, and his IgG levels dropped to normal, and his allergy symptoms all went away, his hives and histamine response went away. It was quite, it was quite striking.

So I'm curious if you have any thoughts in it or experience with it. Yeah. So, no, I have used it as well and have had some really interesting responses in terms of calming down autoimmunity and overreactivity as well. And I think it's really asking that question of how do we rebalance the gut microbiome, which is, I think, such an important question to ask and also really complex. So a bunch of years ago, we were just like, well, let's give probiotics because we're like, this is gonna rebalance the microbiome. though I think probiotics are incredibly effective, they're not the whole thing. And so I think that how do you rebalance somebody's microbiome? Well, first we have to talk about prevention and stopping this ultra processed food intake that is we're consuming, right? And then the ultra clean and then all the antibiotics that are in our food supply, unfortunately, that is this caused this crazy shift in our microbiome and, and all the antibiotics we give people, too.

Right.

So there's just been, unfortunately, this shift in our microbiome that I think is resulting in this, this, all this immune dysregulation. And then how do we, how do we fix it? How do we heal it? Everything from, you know, from probiotics. But then we have to think about the prebiotics. that feed the probiotics, right? So pomegranate powder and fiber. And then we have to think about the postbiotics because postbiotics are these compounds that come from probiotics that help with healing the gut and can really have a good impact also in terms of shifting the body's immune system. So I've been using a bunch of postbiotics as well. that includes things like butyrate, but there are also some postbiotics that are derived from fecal transplant that can help with rebalancing the immune system. In addition to those little dudes, it's really trying to figure out how can we rebalance somebody's immune system and shift the microbiome after the damage, unfortunately, we've caused for some people.

Yeah. And then finally, sort of the final common pathway often is, is through, you know, the gut. But there are a lot of causes of dysfunctional gut. Right. Toxins, mold, stress. Right. Hormonal dysfunction. I I wonder if we kind of, you know, and by just so people understand with these worms, they, they, they're not human worms. They don't take up residence in your gut. They pass through. You take them every two weeks, you do stepwise increasing doses over the course of a number of months to get to a dose that relieves your symptoms. And then after a while, you stop it, which then allows you to kind of get back to a more normal baseline. And it's actually, people are doing it on their own. You can buy it online. Sometimes go through a doctor, but it's kind of one of these areas in medicine. starting to get attention. And, there's even treatments with different worms that are being used for inflammatory bowel disease and other things. So, it's definitely an area of interest. And, I think the sort of hyper-sterilization of our modern society and the introduction of all these novel food compounds and toxins and like you said, all these antibiotics, all these gut-busting drugs, it's sort of led to this almost increasing rates of people having food sensitivities. and, and histamine intolerance. And a food sensitivity is sort of like, you know, is more of a mild version of this, but it's a spectrum.

Right.

It's not just like you're on or off. And I'd love you to sort of maybe dive now a little bit into this case a little more, because in this case, it wasn't just, you know, that, that she was having intolerance to foods, but she also is having a lot of hormonal issues, which I think people often don't, don't connect to, like, allergy. Right. And so we know that in terms of estrogen, when you have high estrogen and we call estrogen dominance, which is driven, we'll get into why people have that, it does inhibit the breakdown of histamine and it does lead to more likelihood of having histamine intolerance or even MCAS or mast cell activation syndrome. So tell us more about how this patient did and what you found with her. and what some of her issues were.

Right. So this woman came to see me when she was 39 and as I had mentioned before, she was having like 5 to 15 headaches every month. And they started, and they were migraines, sorry. So they were actually, you know, they were migraines with an aura that are very debilitating. It's, you know, she was very debilitated from this. And as I mentioned, She also noted that when these migraines would come on, she would get this nasal congestion and the rash. And that really helped me, you know, she helped me go, oh, I got to think about histamine here. And the other thing we gathered from her history, as you mentioned, is these symptoms were worse around her period. And a lot of women notice this. You know, they notice that migraines will get worse right before their period. and that can be because of this estrogen dominant situation. And for some women, it gets worse when they're going through perimenopause because when you're getting closer to menopause, when you're in those years before you go into menopause called perimenopause, you may have these anovulatory cycles, which means that you might still get your period every month, but every month you might not release an egg from your ovary. And as a result, you don't get that increase in progesterone that was happening back when you were in your premenopausal years, right? When you were in your fertile years, you might call it. And as a result, there's even more of an imbalance between estrogen and progesterone. So estrogen's almost higher because progesterone's lower. So that imbalance then can cause more symptoms of what falls into this category of estrogen dominance, which for some women includes migraine headaches, right, or worsening PMS or trouble with sleep, right? So she, you know, was coming to see me in her perimenopausal years because she was 39. So she was, you know, having she definitely on testing showed that she was perimenopausal. She, you know, I could tell based on her estrogen and progesterone levels. that she was in those perimenopausal years. And so we did work on lots of things. So as I mentioned earlier, we started with the low histamine diet and within a short amount of time she started to see improvement and she found it really helpful. And so that was great because it helped to help her just feel better and then it could help us get off this cycle of taking too many pain medications which can make the histamine intolerance worse, right? So it helped us break that cycle a little bit just to get her on that low histamine diet. And we also added in the DAO enzyme with each meal so that she didn't react as much to the food she was eating. And I gave her some vitamin C and B6 two times a day so that would help her body break down histamine. And that was all really helpful. I gave her things to help her her migraines as well, like magnesium and riboflavin and CoQ10, because they can be really effective for people with migraine headaches and that may have been helpful too. But then we looked deeply from the estrogen perspective. So we did some testing that looked at how she breaks down her estrogen, right? So we looked at estrogen metabolism and we realized that she wasn't breaking it down as well. So we added in things to help her body break down that estrogen more. and one of my favorite things to do in this situation is sulforaphane, which comes from your cruciferous vegetables.

Interesting.

Yeah, because it helps the body break down estrogen. And we also saw on her stool test that she had a high level of this beta-glucuronidase, and that is an enzyme in the gut that occurs when there is this imbalance in the gut microbiome called dysbiosis. She had a high level of this enzyme, beta-glucuronidase, which allowed the estrogen to get reabsorbed into her body. So we also use something called calcium D-glucarate to bind the estrogen. So both the sulforaphane and the calcium D-glucarate helped with lowering, essentially lowering her estrogen levels or helping get that estrogen.

Out of her body. Yeah, and this sort of shows how we work in functional medicine. Like rather than say, oh, you have high estrogen, low progesterone, let's give you, you a drug or the pill to shut things down. Well, like we go, well, how is your estrogen being metabolized? What's the gut hormone connection? How do we deal with that? And then, like you said, this particular patient had an overgrowth of bugs in her gut. They were producing an enzyme, this beta-glucuronidase that was basically unpackaging the estrogen when it's packaged up by your liver, allowing it to get reabsorbed into her body, creating more estrogen and then creating a vicious cycle and leading to, you know, this whole hormonal dysregulation, histamine excess, and and the whole mess that she was having. And it speaks to the sort of the personalization, right? Because somebody else might not have had that who has dysmenorrhea intolerance and you treat them differently. And it really is so critical because you can't just kind of do a one-size-fits-all treatment, right? And for this particular person, you also needed to think about other therapies that can help with estrogen metabolism. So it's not just getting rid of the bugs in our gut. You could even use an antibiotic like Flagyl, for example, to get rid of it. Or, you can use a probiotic like Saccharomyces to help reduce the beta-glucuronidase and kind of cut down on those clostridial producing, those clostridial bacteria that are producing this XX enzyme that messes up your estrogen metabolism, right? And so, you give her specific probiotics or hydastatin, you give her Quercetin, you give her the sulforaphane from the broccoli to help metabolize estrogen, the glutamate, which helps break down the estrogen. So you're doing a lot of things that are, you know, certainly not that you and I learned in medical school. That's true. And that are extremely, extremely effective when you put it all together. It's not like one thing or two things. You have to sort of deal with everything. And it's unfortunate. It would be nice to find that, you know, magic pill. Just take this pill and you'll be fine. Well, yeah, if you gave someone, you know, steroids, yeah, their histamine intolerance would go away. They would also dissolve their bones, get.

Diabetes, have blood pressure.

Dementia and a lot of other things, you know? You don't want to do that.

And what we know about the antihistamines, right? Also, like they can help with the immediate reaction in the body, but the body is trying to make histamine. So, if somebody takes antihistamines for a while and then stops them, they just get more of a histamine reaction come back. So, you have to get to that underlying root cause and wean them off of the antihistamine so that they just don't make more histamines again, right? Or too many histamines.

Yeah, exactly. And so tell us more about how this patient responded and what happened and was this person permanently on a histamine-free diet or how did she do? Right.

So I think one of the things I started when I told you about this person is we talked about one of the triggers for her. that, you know, 15 years when this whole, this, these migraines started, she had a shift in her work. And so she had a lot of stress from work. So she also had to do a lot of work regarding finding other modalities to calm down her body. You know, how to interact with work and not be so reacted from it, you know, reactive from it and have some breath work techniques and meditation and yoga and journaling, all those things we know that helps, you know, manage your cortisol levels better and handle stress better. And that was really helpful for her as well. And we saw immediate response with the low histamine diet, but we had to do all of these things so that over time we could relax that low histamine diet because, you know, we don't want to be, as we talked about earlier, on this restrictive diet Forever. And we want to, we want people to be able to tolerate the histamine in foods more over time. So for her, she was able over time, after like three or six months, she was able to slowly cut, you know, calm down on the restrictions in her diet, adding in more higher histamine foods slowly over time. And now she will just take the DAO enzyme occasionally. So if she goes out to eat, has some alcohol, some champagne, if she has certain meals that she knows are more likely to cause a histamine response for her, she might take the DAO enzyme, but she doesn't take it all the time and she doesn't need to. And her migraines have subsided and she's feeling good. And so which is really nice.

And do they need to take, like, is she going to take these supplements forever, like the histamine that's going to help her metabolize it, or should she take other supplements that she needs? Or do people just kind of get back to a new equilibrium where they don't have to do so much?

You know, I find that when the body calms down, people get back to a new equilibrium and they really don't have to be so restrictive or taking all these supplements forever and ever. That's the usual situation. so, you know, our, that's really our goal is to calm everything down, heal the gut, calm down that stress response in the body, rebalance the microbiome so that the body is not just overreacting like that. So, yeah, absolutely.

It's so great. And, and what's so beautiful about this is that, is that, you know, using the, the functional medicine framework, which is, it's not a, it's not a test or a supplement or even a specialty. It's just a way of thinking about disease in a very different way based on root causes and based on the body and how it's connected as a system. And then it's really focused on personalization. It's focused on optimizing function in different systems like the gut, immune system or hormonal system. And, you know, you've Illustrated through this case how we start to optimize the gut, how we start to optimize hormonal balance, how we start to optimize diet and reduce an inflammatory diet. And that's so important. And I think we do this across the board, whatever conditions people are suffering from. And that's really why we really are in business at the Ulta Wellness Center to help people figure out these complex chronic problems. We used to both work at Canyon Ranch, which is a health resort. And I often call myself a resort doctor because we worked there. But the joke is we're the doctors of last resort. and, you know, we really are so excited because we've done this for so long and we can help so many people and we encourage people to really check it out. And you can go to ultrawellnesscenter.com to learn more about how we treat all sorts of different issues and what we do there. Also in the show notes, we're gonna put the list of the dietary recommendations, what histamine free diets are, we're gonna put scientific references that document what we're saying is also we're gonna put in, you know, what are the supplements we talked about so people understand how to actually apply this. So I think, you know, it's been great to have you back on the podcast, Liz. You know, so many people benefit from these. I can't tell you how many people approach me and say, you know, I heard your podcast. I came to the UltraWellness Center. I had this fix or that fix. I'm just so grateful. And I think it's really why we're doing what we do, because we really love it and we also love to see people get better from things that often are not well done by traditional medicine.

Yes. Thank you, Mark. It's been great to be with you.

Yeah. All right. Well, we'll see you back again. I know for sure on the Doctors Pharmacy podcast, Liz and, and we're listening. I hope you have fun day. And we'll see you next time on the Doctors Pharmacy. Thank you. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe. wherever you get your podcasts and follow me on all social media channels at Dr. Mark Hyman. And we'll see you next time on the Doctor's Pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free Mark's Picks newsletter at drhyman.com/markspicks. I promise I'll only email you once a week on Fridays and I'll never share your email address or send anything else besides my recommendations. These are the things that have helped me on my health journey and I hope they'll help you too. Again, that's drhyman.com/markspicks. Thank you again and we'll see you.

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This podcast is separate from my clinical practice at the UltraWellness Center and my work at Cleveland Clinic and Function Health where I'm the Chief Medical Officer. This podcast represents my opinions and my guest opinions and neither self-nor the podcast endorsed the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for your help in your journey, seek out a qualified medical practitioner. You can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com If you're looking for a functional medicine practitioner near you, you can visit ifm.org and search find a practitioner database. It's important that you have someone in your corner who is trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public. In keeping with that theme, I'd like.

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