The Connection Between Food Sensitivities, Histamine Intolerance and SIBO with Heidi Turner, RDN

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is Lindsey Parsons, your host, and today I'm talking all about SIBO, that's small intestine bacterial overgrowth, and histamine intolerance with Heidi Turner, MSRDN, who is an integrative registered dietitian nutritionist at her telehealth-based private practice, Food Logic, located in Tacoma, Washington. She specializes in complex health issues including SIBO, autoimmune conditions, histamine intolerance, mast cell activation syndrome, and food and chemical sensitivities. She spent 12 years at the Seattle Arthritis Clinic at Northwest Hospital, University of Washington, where she counseled thousands of rheumatology patients on ways to reduce inflammation through dietary change and manipulation of the microbiome. She's the co-creator of the low histamine biphasic diet with Dr. Nirala Jacobi and sits on the medical advisory board for the Ruscio Institute. Heidi earned her master's degree from Bastyr University in Kenmore, Washington, and completed her dietetic internship at Virginia Mason Medical Center. But before I get started, if you haven't yet followed or subscribed to the show, be sure to do so. And if you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my free ebook, Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. And if you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the show notes and take that. Now on to the show.

Welcome to the podcast, Heidi.

Thanks so much for having me.

Yeah, it's a pleasure. So my listeners should be pretty familiar with SIBO, which is one of our topics today, but when we last focused on it in particular was probably the episode with Nirala Jacobi in November 2019 in episode 17. I also had episode 36 on IBS and episode 41 with Norm Robillard. But anyway, maybe you could just give us a brief overview of what SIBO is and some of its common root causes.

Oh, sure. So small intestinal bacterial overgrowth, SIBO, SIBO, or SIBO, however you choose to say it, is basically a situation where there is an overgrowth of bacteria located in the small intestine. We basically should have very few bacteria in our small intestine, and the majority of the bacteria that we house should primarily be in the large intestine. So when we have too much bacteria located in the small intestine, it can start to create a level of inflammation, and that inflammation can start to express itself in a number of different ways. We might get different symptoms that we might deem to be very like IBS, um, things like gas and bloat, diarrhea or constipation, sometimes heartburn, sometimes abdominal pain. Really just kind of depends upon the person and what their specific situation is. There are many potential underlying reasons why SIBO might be present. Uh, it is usually considered an issue of dysmotility. So the— we, we kind of rely upon these peristaltic waves to kind of move the contents of our food as well as the bacteria through our digestive tract. And so when that system becomes more stagnant, things aren't moving as effectively, we can start to collect more bacteria in that space. And that can be due to a number of different causes. That can be from a history of food poisoning that can actually impact the something called the migrating motor complex that actually helps us to move our nerves and move those peristaltic waves. It can be relation to certain medications. Antibiotics can cause this. It can be from high levels of stress. I see this quite often, like very high chronic stress that can impact motility. Thyroid issues, uh, long-term proton pump inhibitor use, and then other environmental factors such as living in moldy conditions. There's lots of different reasons that can kind of feed into this dysregulation of the digestive tract and start to accumulate more bacteria.

Thanks. So there are, there are a couple that just come to mind too that are more physical causes, like adhesions after surgery.

Yep.

Or Ehlers-Danlos Syndrome.

Absolutely.

And what was the other one I was thinking about? Oh, traumatic brain injuries.

Sure. Absolutely. Yeah. Anything that gets in the way of those neurons in the gut from really fully expressing and fully moving and communicating with each other can really get in the way. I'd also say like traumatic, you know, you'd mentioned adhesions, so that can be from say endometriosis.

Right.

That can be from any kind of abdominal injuries that you've experienced. So there's lots of different things that can lead to those adhesions as well that kind of block that bacteria in the area and make it so it's difficult to move through.

Yeah. No, I didn't know what an adhesion was and I'm not sure everybody does, but I went through endometriosis. So can you just explain that briefly?

Yeah. It's just basically like scar tissue that's in our digestive tract. Well, it's not even necessarily in the digestive tract, so it could be on the outside and impacting other organs. And so if we have a considerable amount of scar tissue, it can actually adhere to the, you know, our digestive tract is quite large in our abdominal cavity. And so we can see those adhesions basically wrap themselves around our small intestine, especially. And so we can see that and it just kind of creates this narrowing, not necessarily a blockage, 'cause that would create something different, like an actual blockage where things couldn't get through. But there's certainly a narrowing where it's more challenging for things to kind of move through these very small spaces.

Okay, great. So second topic for today is histamine intolerance. So let me ask, what is histamine intolerance and when should people suspect that they have it? Aha.

Okay. So, uh, these kind of run parallel sometimes. So I'll run over to histamine intolerance. And so first, before we talk about what it is, let's just talk about what histamine is first. So we're all on the same page of what that is. So histamine is basically a chemical that our body just naturally produces. We might think of it in relation to allergy. So if we, if we've been exposed to say pollen and we get all snotty and sneezy and allergic-y type of thing, we take an antihistamine. And so histamines are involved in that allergic reaction. So that's one area where histamines kind of show themselves, but histamine is really, it's, it's involved in a lot of other biochemical processes. It regulates our digestion. It helps us to build stomach acid. It is actually a neurotransmitter that regulates other neurotransmitters like serotonin. It's involved in our sleep cycle. It helps us to wake up. It's involved in our menstrual cycle, our circulatory system. So, uh, it's really a, an incredibly important chemical that our body produces. It regulates inflammation as well. So it doesn't just create inflammation, it also regulates inflammation. So histamine's this really, really critical compound that's really vital and important to who we are.

It makes me stop and say, wait a second, if I'm taking an antihistamine, am I messing with all of those bodily systems? Because I do that on a daily basis.

Okay, all right, but we're not there yet. So like in a normal average kind of situation, we are building histamine, we're using histamine, and then we're breaking histamine down. And so that's the key piece in all of this. So if we are building histamine, utilizing our histamine, and then we actually can't break it down— and we'll get into why that might be— and usually it's because we're overwhelming our enzymatic pathways. So if we build histamine, in order for us to break it down, we need enzymes to help us do that. So if we're deficient in of the two major enzymes that our body uses to break histamine down. One is called diamine oxidase, or otherwise known as DAO, or histamine N-methyltransferase, or HNMT. So if we are deficient— and usually DAO is the one that we're thinking about more when we're working with SIBO, just so you know— so if we're deficient in any one of those enzymes, what can happen is we build the histamine, we can't break the histamine down, and so we end up with a lot of, lot of circulating histamine, and we have more histamine than our body can manage, that's where we start to see problems. That's where we start to see symptoms where there's just an excess of histamine, and that's where we might feel more allergic, or we might feel more anxious and awake. Our sleep cycles might get impacted. We might get a lot of digestive issues like heartburn or bloat or diarrhea. So anywhere where histamine regulates different areas, we might see an uptick of those symptoms. And so that's where things become more problematic. And that is a situation of histamine dysregulation. Building too much histamine, don't have enough enzyme to break it down. I got too much circulating histamine. It's binding to all these receptors in my body where histamine typically works, and it's agitating and aggravating and making those symptoms much more. That's histamine dysregulation.

Okay. So I'm hearing symptoms that range from allergies to digestive issues to anxiety.

Absolutely.

Yeah.

Are there any of those that you could say are very, like, you're not gonna see histamine intolerance without seeing them, like a, a typical allergy reaction, like a runny nose or itchy eyes or things like that?

I mean, we can have those symptoms without having histamine dysregulation, and let's kind of talk about what histamine intolerance specifically is, cuz that's a different, they're, they're, they're similar, but it's sort of a different answer to your question there. So a histamine intolerance. Is a situation— so this is going to kind of bring in that SIBO here for a second— is where when we are— so let's step back. When we— our gut produces a lot of that diamine oxidase, that DAO, and we use up a lot of that to help to break down the histamine that comes in from our food supply. So we have all of these foods that contain histamine, and typically these are foods that are usually aged, or fermented like sauerkraut or wine or aged meats, or foods that have been spoiled or hanging around for long periods of time, or just other foods that sort of contain natural amounts of histamine or biogenic amines like avocado or spinach or tomatoes. When we eat those foods, our gut produces all of that diaminoxidase to help us break down those histamines that are in our foods. And if we don't have adequate amounts of diaminoxidase, then what's gonna happen is the histamine that's in the food is going to be absorbed into our bloodstream and create more systemic histamine. And it can also exert just more inflammatory effect in the gut. So if we don't have adequate amounts of that DAO, it's going to cause a histamine intolerance. And that's where we just don't tolerate the histamines that are in our foods. So there's the histamine intolerance, and then there's the histamine dysregulation. I've got too much histamine. I'm building too much histamine. My enzymatic system can't keep up with it. And I'm eating too much histamine and my enzymatic system can't keep up with that. That's the difference. Histamine intolerance versus histamine dysregulation.

Okay. And so is it essentially a spectrum and one is more extreme?

Uh, not necessarily. Yeah. I mean, you know, if you have histamine issues and back to your question, it's like if, if you're super allergic and snotty sneezy, you could have other issues going on that's kind of feeding into that. It doesn't necessarily mean you're histamine intolerant. However, So if you do have a histamine dysregulation going on and your body just isn't making adequate amounts of enzymes to help you break it down, then kind of looking at other things that could be feeding into that, like gut bacteria, histamines in the foods, that's where we wanna start focusing in on other areas. Cuz it's possible we could help to reduce some of those symptoms that we experience from allergies by looking elsewhere at other places where the body produces too much histamine.

Got it. Okay.

Does that make sense?

Yeah. So how, how can SIBO lead to histamine intolerance?

Yeah, exactly. Exactly. So bacterial overgrowth is a situation— there's actually a couple of reasons. So, you know, the bacteria, if we have too many bacteria in our digestive tract, it's, it is inherently creating a lot of inflammation. So they produce something called lipopolysaccharides. Those lipopolysaccharides can induce more mast cell release in the digestive tract, and those mast cells contain a lot of histamine, and that triggers more reactivity. So if we have a lot of inflammation from bacterial overgrowth, then we're using up a lot of that diamine oxidase that our gut is producing. So we're using a lot of that up. So if we're using up all that DAO and we take in a lot of dietary histamine, you might not have enough DAO available for that dietary histamine. So that's the first way. Second way is that we know that in the more recent research is that the type of bacteria that are often implicated in SIBO are histamine-producing bacteria. So things like E. coli or Klebsiella, both of those are implicated as kind of star actors in SIBO, and both of those produce a lot of histamine. So if we have an overgrowth of bacteria in our gut that produce a lot of histamine, that too is going to use up all that diamine oxidase, and it's going to get in the way of our histamine tolerance.

Oh, okay. That's interesting.

I know most of my listeners are struggling with gut health issues, or else you wouldn't be listening to a podcast that is this inside baseball on gut health. So I just wanted to let you know that in addition to being a podcaster, I work one-on-one with clients around gut health issues like IBS, IBD, SIBO, SIFO, or invasive candidiasis, constipation, diarrhea, soft stool, food sensitivities, and other health issues like autoimmune diseases, skin issues, chronic fatigue, and fibromyalgia. I help clients locate the least expensive lab tests that they can order themselves online to determine the root cause of their issues, then educate them on protocols used by practitioners to address those issues. The first step in seeing if health coaching might be right for you is setting up a free 30-minute breakthrough session with me, and you can tell me what you've been going through, and I'll let you know if it sounds like something I think I can help with based on what you've already tried. So you can find a link to set up a free session in the show notes.

So how can you address histamine intolerance through your diet?

Right. So there's a lot of different ways you can do that. And I think we should probably bring the SIBO into this, into this as well.

Obviously, I want to get rid of the SIBO.

You want to get rid of the SIBO, right? Because I just want to make sure that we all understand that, like, whenever you have any kind of dietary intolerance, it's usually secondary to something else, right? Some other dysregulation going on. So we want to make sure that it's not just about Well, take all of these hundreds of foods out of your diet and then you'll be fine.

Right.

Because you might take those foods out of the diet and you might actually feel a lot better, but that's not really the answer because staying on a highly restricted diet for a long period of time is very uncomfortable and socially isolating and all of those things that can come with dietary restrictions. So let's just make sure that that's said before we jump into what do you do with a diet. So, okay, before we get there. So, so there's a number of different things that you can do with a diet, but let's bring the SIBO back onto the table because ideally if we can treat the SIBO effectively, then we can reduce a lot of that intestinal inflammation, which then buys back a lot of your diamine oxidase, in which case we don't necessarily have to eliminate too many foods from the diet. So ideally in a perfect world, we're gonna be able to manage that SIBO, reduce the intestinal inflammation, and we don't have an issue from a histamine perspective. So that alone, so we just wanna make sure that that is covered. Now, let's say you need to do a little bit more with the diet though, because oftentimes when we are working with SIBO, what's generally indicated in a SIBO diet is more of a low FODMAP type of diet. So oftentimes we will do antimicrobial, and then once we're finished with the antimicrobials or the antibiotics, we will usually follow that up with a low fermentable diet. And so these foods aren't necessarily high in histamine, but we do know that a low FODMAP diet can actually reduce intestinal inflammation. And And again, you reduce intestinal inflammation, you can build a little bit more diamine oxidase back. And so that can actually help you with your digestion of higher histamine foods. So sometimes just by reducing things, you know, if you're gonna work with SIBO, sometimes by reducing the bacterial concentration and then actually incorporating a low FODMAP diet, we can actually see a better regulation of histamines in the diet. And we don't really have to do too much more than that. So that's one of the first things we can do with our food and just see how it goes for us. That's number one. Now let's say that doesn't work for you because it doesn't work for everybody. Let's say, man, I cannot kick this SIBO and I'm doing this low FODMAP diet and it does absolutely nothing for me, or it's actually making things worse. So a low FODMAP diet, which is, you know, low in like Brussels sprouts and cauliflower and onions and garlics and things like that, is inherently high in histamine. Foods. So in some cases, if we've got a really significant histamine dysregulation in the gut, and even though we're doing all the things we know to do to combat our SIBO, if we're eating a lot of high histamine foods because we're doing all of these practices, what can happen is we don't have any diamine oxidase. And so we eat a high histamine diet, and so we're going to end up with more intestinal inflammation because of it. So then what we can actually do is go on a low histamine diet. And that's where we really pull out a lot of these aged foods, avocados and spinach and tomatoes and all sorts of different fermented foods that we might be eating because we're trying to feed our microbiome and, you know, bone broths, all these different things that are aged or fermented or old can actually be impacting us adversely. And so sometimes we need to take those histamines out to give the gut a chance to to heal and not just reduce symptoms that we're experiencing like abdominal pain or bloat or things like that, but to also just give the gut a chance to heal.

Yeah.

So yeah, so these are all just different things. I'll just say like there's a lot of different dietary strategies that you can make that can impact or actually reduce your histamine intolerance that don't necessarily just limit you to like taking all the histamines outta your diet. So even like a, a paleo type of diet, like a, a low starch diet or a low sugar diet can actually improve your diamine oxidase and reduce your histamine intolerance as well. So there's lots of different ways that you can approach the diet. Reducing histamines is one of them.

And they serve to do that because they reduce inflammation?

Yeah, absolutely.

Okay.

Anytime you're reducing inflammation, you're allowing the body to support more diamine oxidase production.

Right.

That's the key thing. That's your key guy.

Yeah.

Yeah.

In your—

is diamine oxidase.

So what I'm hearing is that you're typically dealing with the SIBO first, and then you're putting people onto the low FODMAP diet, for example.

Yeah, absolutely. I really try to spare the diet. I'm a dietitian.

You try not to use diet.

I'm a dietitian, and I try not to take foods out of people's diets because it's a challenge, especially things, you know, things like FODMAPs, things like histamines. It's not just one food. It's not just gluten or dairy or Yeah, even starch. It's like there's 100 different histamine foods that were when we're working with the lists, and there's 100 different FODMAP foods when we're working with the lists. And so it can get really challenging really fast. And so I really try to listen to my clients in terms of what's possible. Ideally, we're going to be doing, making some dietary modifications in the short term. And I think that that's the most important thing for us to highlight. If you're going to be making any dietary modification, it is for a very short period of time to manage symptoms and to support healing. It's not to stay on for the rest of your life because if you have to, if you have to take FODMAPs out or you have to take histamines out and you can't get them back in, there's something we haven't fixed. Yeah, there's something else that needs to be done. So from my perspective, back to your question, Is that, you know, do you work with the SIBO first? Sure, absolutely. It's like, what can we do to manage that? Because if that's all we need to get at in order to reduce the intestinal inflammation, then how much more do we need to do from a dietary perspective from there?

So how long would a— and do you tend to use herbal protocols for SIBO or Bifaximin or—

I've, I've used it all. Yeah. So Yeah, so, you know, I'm a dietitian, so I don't prescribe medication, but I usually do work with other practitioners who do. So I have worked with antimicrobials. I've worked with Rifaximin and Neomycin or Metronidazole. I've worked with elemental diets and then also every other possible dietary strategy you could possibly imagine. We've used fasting. You know, there's lots of different strategies to manage the SIBOs. So It's just a question of, a lot, there's a lot. Where do you start? It's a question of tolerance. Maybe the person might not tolerate herbal antimicrobials well. It's a question of expense. Rifaximin is a, can be a $1,000 investment.

Right. Yeah. It's one of, one of those things that's gotta be covered by insurance. So there's no logical reason to take that over the herbals.

That's exactly right. And so if cost is an issue, then your herbals are gonna be a better option for you. Elemental diets are also quite expensive. So you always have to just kind of navigate. Someone's personal bent, their personal belief structure. Some are just like, I don't want to do herbals, I'm not going to fast for 2 weeks, so I'm going to go and get my Rifaximin and I'll spend my $700 or $1,000 and that's what I'm going to do. Versus the next person who might be, nope, I'm not taking antibiotics for nothing and I'm going to go the antimicrobial route. Right. So really, I do a lot of counseling around it when we're really trying to figure out what's going to be the best strategy in working with their SIBO. And then also what's going to be this best strategy in working with their diet. Because having done this for a long period of time, there is never one road for one person. Everybody is different. And I think that's the challenge in us practitioners that work with SIBO or work with dietary restrictions. And is that not only is it challenging for everyone, but everyone's so different, right? Everyone's so different. So you just have to have a lot of tools at your disposal, rather, and then haul help your client make the right choice and then point them in the right direction.

Right. So assuming a typical client is doing an antimicrobial regime of some sort, be it Rifaximin or be it herbals, I'm wondering how long that typically lasts and then how long you would typically put them on to say a low FODMAPs diet, or are you using the biphasic diet? And maybe you can just explain that a little bit.

Oh wow, that's a big question. Sorry. That's okay. It so depends upon the person, depends upon their, their test test results as well, their breath test results, and how strong the SIBO is it. Like, you know, what, what kind of gases are we working with? If we're kind of borderline SIBO, then we might place them on a protocol for a shorter period of time before checking back in. These gases are quite high, then, or it's methanogenic overgrowth, then it might take a little while longer and really depends upon the person and how they're doing and how they're tolerating everything as well. So it's gonna take it could take anywhere from a month at best to several months to, at the, at the very worst, the very longest, it could take several years. It really just depends upon the person and how they're responding. So that's be the, you know, as far as treatment goes, it just depends. Unfortunately, I can't, but I can't give you like a, because everybody's so different.

Right.

Right. Give you like one, that's going to take this long. So it can be a challenging thing. The diet I tried to make for a short period of time is possible with FODMAPs. I'll usually give them, keep a little bit of FODMAP in during the actual treatments, allow the bacteria to feed. They love to feed on those FODMAPs. And then once they're finished with their antibiotics or antimicrobials, we'll then remove those FODMAPs for a period of anywhere from 2 to 4 weeks, sometimes 6 weeks, depending upon how long this is taking. I might just use a standard FODMAP diet. There's lots of different diets out there. There. There's Nirala Jacobi. She has the biphasic diet, which I think is terrific. Allison Siebecker has more of a specific carbohydrate, uh, low FODMAP diet where you take out both FODMAPs and starches as well. I think you've had Norm Robillard on, on, you know, there's lots of different types of diets. The Cedars-Sinai has a different type of diet as well. And then still, Dr. Jacobi and I also developed a low histamine, low FODMAP diet. And so for those who are doing a little bit better on low FODMAP, but we really do feel like there's a histamine intolerance that's pretty severe, then we might place them on that one as well, which is quite restrictive. And even though I helped co-create that, I'm not a big fan of it because it's so restrictive, but it can be quite effective if we're really, really, really inflamed and we just can't get that fire out. In which case, again, back to your question, it might be anywhere generally from 2 to 6 weeks. And again, if I have to go longer than that, I'm— something else is going on. So I gotta keep looking. What's driving the SIBO? What's driving the intestinal inflammation? What's driving the histamine production? You always have to kind of keep digging more and more if you must rely on dietary elimination to be asymptomatic.

Right. And is there with— I know with low FODMAPs there's a reintroduction that's supposed to be category by category, but with histamines, is there categorical reintroductions, or how does one sort of go back into reintroducing them?

Yeah, usually I start with— and so I guess my short answer to your question is no, there isn't really any kind of formal introduction because it is a kind of a threshold issue. Can be with FODMAPs as well, but you can also have certain tolerances to different categories of FODMAPs and not to others. Whereas histamines, it's kind of like a threshold, like how much histamine do I tolerate in a given day or even a given week, in which case the question is how much diamine oxidase do I have available. So what I usually like to start with is keep out the foods that are really high histamine, like your, like wine or beer or high fermented foods. I'll usually keep those guys out for a while because they're going to use up a lot of, a lot of space. They're going to use up a lot of DAO. So I like to maybe start with more of the vegetables. Vegetables that, or the fruits that they might be missing, or nuts or things like that that they might be missing. And we'll just start first with like, what do you miss the most? And you miss your avocado? Do you miss a little tomato? Do you miss a little? And they come up with the answer pretty quickly. So if there's something that they've really dialed down on, then I might introduce those in first. I'm always a little bit judicious with tomatoes to start because they they're not only high in histamine, they're high in a lot like acids and things like that that can be just kind of irritating to the system. So I usually don't start there, but I'll usually start with other— maybe a little spinach, maybe a little avocado, and just kind of get a sense of what their bodies can tolerate. And then we just kind of slowly build from there. And if they reach a threshold at a certain point where they start to get a little bit more reactive, we'll keep those histamines in because we know that we've got some level of tolerance and then we'll just kind of stay below a threshold while we continue to heal the gut.

Okay, so I know that there are foods that have histamine versus histamine-liberating foods. Can you talk a little bit about that?

Yeah, sure. So yes, there's foods that contain histamine, and those are usually the ones that have been fermented by bacteria, like our sauerkrauts or kimchi or wine or things like that. So those are the ones that are particularly high in histamine specifically, but we also have histamine is under an umbrella of a category of chemicals called biogenic amines, and there are a number of them— things like tyramine, putrescine, cadaverine, spermine, spermidine. There's lots of different types, and histamine is one of them. And so most of these actually will use up diamine oxidase. They require diamine oxidase days in order to get broken down. So these foods, things like, oh, let's say banana, isn't necessarily high in histamine, but it is high in other biogenic amines. So if we're eating the banana, sure, we're not putting in more histamine, but we are putting in more of the— I believe it's cadaverine in the banana. I could be wrong, perhaps future saying, but we're putting more of that biogenic amine in and it's using up our DAO. And so anything that's using up our DAO is a problem because when we do bring in those other high histamine foods, it's looking for the DAO as well. And so in order to break down, so there's lots of foods. So when you— that, that have this ability to use up diamine oxidase, those are your histamine liberators, also known as biogenic amines.

Got it. That's interesting. So if you were really careful about just the foods that actually have histamine, then you probably could be okay with eating the other Yep, you got it.

Absolutely. And sometimes we'll just do that. So if I see that taking all of these histamine foods out and/or histamine liberators, because most of the lists that you find online and there's like 30 different lists and they all say different things. Yeah, I know. It's like maddening. But what they can all agree upon is are the foods that are high in histamine. Like no one's going to say that sauerkraut is low in histamine. No one's going to say that wine is low in histamine. It's all of those things. Those fermented aged foods are all high in histamine. Where it gets a little murky is in the biogenic amines, but the majority of these lists contain all of them. So if I'm working with someone and I suspect they've got a histamine issue and I see that they're drinking bone broth and they're taking in sauerkraut and they're drinking wine and they're eating charcuterie every night and smoked salmon every night and canned tuna all the time, then I'm going to start to think, hmm, you know, do we need to take out all of these foods or is it enough just to dial it down? Like, let's make sure your meats are as fresh as possible. Let's lay off the sauerkraut. And sometimes just making those shifts is enough to reduce their symptoms, to reduce that histamine intolerance. And then we didn't have to take out all of the biogenic amines.

Mm-hmm. Okay. So the diet that you developed, that's not the same as the Bi-Phasic Diet?

No, this one is the— so the Bi-Phasic Diet was developed by Dr. Nirala Jacobi in Australia. And so that's more like straight up SIBO.

Okay.

Right. You incorporate that, you treat the SIBO, and then you— so it's very low FODMAP, low fermentable. Basically, it's a low fermentation diet, low fermentable diet rather. When we came together, what we did is recognize that when you're doing a low fermentable diet, you're just naturally increasing the level of histamine that's in there. So like tomato is low fermentable. Fermentable, but it's incredibly high histamine. So what we did— spinach, spinach is low fermentable, but it's incredibly high, you know, biogenic amines. So what we looked to do was to acknowledge that for those who have both things going on, there is so much intestinal inflammation going on that they're not tolerating fermentables or fermented foods. Let's come together and really give them something where the gut can completely calm for a period of time and then start going through an introduction process. So that is a biphasic diet. It's just, it's the low histamine, low fermentable biphasic diet.

Okay.

And so it takes— Phase 1, Phase 2. Exactly.

Okay. You got it. And they can find that on your website or?

On my website and on Nirala and Dr. Drakoski's website. Both of us have it there.

Okay. So say somebody begins treatment with antimicrobials and they have an immediate bad reaction. What might it look like if it's related to histamines as opposed to, say, be a Herxheimer reaction?

Well, if it's a Herxheimer reaction, because they look really similar, Herxheimer reaction, you know, it can, it can be pain, it can be fatigue, it can be— and Herxheimer is when you're kind of going through a level of die-off. You're killing off a lot of stuff. It's all going through your liver. Your liver's having a hard time catching up. Your body's having just a really, you know, it's going through detoxification basically. That's what a Herxheimer reaction is. I typically will see Herxheimer reactions not last that long. So usually if it's a Herxheimer reaction, you're going to see symptoms start to increase usually within like maybe 2 to 4 days. They'll intensify. And then typically after like a week or more, we'll start to see things kind of calm down a little bit. So that would be more of your typical kind of arch of a Herxheimer reaction. Um, they can go longer, certainly depending upon how much bacteria you have to kill off. Might put in something to help support the liver, help to reduce inflammation. If it is a Herxheimer reaction, I might put in a little N-acetylcysteine. I might put in a little vitamin C. I might try to put some things in there, even glutamine, if, you know, we just need to calm some inflammation. So I might put some things in there and see if that works. And then if it does, then we're likely working with a Herxheimer issue. If it's a histamine reaction, which can also be a part of that whole, in that soup, but if it's just a reaction to the actual antimicrobial microbial, I don't see it abating. I see it happening quickly, usually within the first day, because the body is going into an immediate reaction. And then I just don't see it abating. So I will often pull back and maybe start a lot more slowly and see if we can kind of gather a little tolerance with time. But that's usually a difference. If there's just no tolerance at all, and my clients will let me know, It's very common with things like oregano or berberine, which are pretty intense antimicrobials, but we use them all the time for SIBO. And if there's just— they just know, they're like, I cannot do this, there's absolutely no way I'm going to be able to do this, then there's lots of other antimicrobials we can use. And I'll just shift over to different things and see if there's better tolerance. And if there is, then I know that that was probably a histamine reaction, inflammatory reaction that they were having to the antimicrobial itself versus Herxheimer.

And so are you saying that oregano and berberine in particular have histamine in them?

No, they don't. It's just that they're fairly, when we're working, remember we're, we're always working with a level of intestinal inflammation. So if you're someone that, you know, when you put in an antimicrobial like berberine or oregano, they're pretty caustic on that gut lining. And if your gut's just like, I can't even do that, I can't even do that. I can't do blood maps, I can't do histamines, I got all this bacteria in here, it's just too much on my system, that it's more that. No, they are not necessarily high in histamine.

Okay, so the histamine reaction that's coming with them then is inflammatory. Okay, got it. Okay, so once people heal their SIBO, are you seeing this histamine intolerance tend to go away?

Yeah, often. In most cases, I would say if it's just related to the If their histamine intolerance is just related to the SIBO and you're able to manage the SIBO and then get in there with some supportive healing strategies after you've cleared out the bacteria and we kind of, you know, help to kind of regain that microbiome a little bit more, then yeah, absolutely. Because the histamine intolerance should not be a forever thing. It is really just dependent upon the immune system dysregulation in the gut. So if it doesn't go away, and I see this sometimes where we have SIBO, we have histamine intolerance, we treat the SIBO, the SIBO's gone, but histamine intolerance is still there, then it's a question of like, what else is going on?

Yeah, what else might be going on? What are the other possibilities?

Well, I mean, you can just have general dysbiosis, so you can have an— you could have, uh, fungal bacterial overgrowth or yeast overgrowth that wasn't managed, particularly if you did just antibiotics.

Right.

You can have other types of problem, H. pylori. You could have other problem actors in the colon. Like you could have other things going on in the gut that are problematic. You could be massively stressed out. And, and I know that that's going around. So if we have considerable amounts of stress going on and we're really kind consistently off, that really sends a signal to the gut that all is not well. And we know that there's a strong correlation between really high chronic stress levels and not just dysbiosis, but SIBO, as well as mast cell activation of the gut. So, you know, we always have to be thinking about— or hormone— hormones. Some women who are estrogen dominant, or even men who are estrogen dominant, that can trigger more histamine production in the body. Your environment. If you are eating a pretty highly processed diet or eating or exposed to a lot of different chemicals or exposed to mold, all of these things can impact, uh, how much histamine your body produces. So we always have to be thinking about other players that could feed into why your body is making a lot of histamine and using up all of those enzymes that are necessary to break it down.

Yeah.

So start with the SIBO. Hopefully that's it. But if it's not, okay, what else is up?

Right, right. Now you mentioned mast cell activation syndrome. How does this differ from histamine intolerance?

Well, histamine intolerance is just, I have diamine oxidase deficiency and I can't tolerate the histamines in my food. Okay. And so that's histamine intolerance and it's on the same spectrum as mast cell activation, but mast cell activation is a little different. It's, you know, the mast cells are these vesicles that carry histamine. We store most of the histamine that we produce in mast cells. We store it in different parts of the body as well, different cells in the body, but we really do store the majority of our histamine in mast cells. And mast cells are the ones that regulate that immune system reactivity. So we have mast cells in our gut. We have mast cells basically in nearly every area of the body because they're there to us. They're the ones that basically get stimulated if we do have an allergic reaction. If we have an allergy to peanuts or to pollen or something, something like that, we're going to get a mast cell activation, and that's going to secrete histamine as well as other inflammatory mediators throughout the body. We also have those mast cells that do line the gut, and so oftentimes when we do have inflammation going on from dysbiosis, we can see a mass mass cell activation. So the mast cells are kind of in this constant state of release, degranulation, release, degranulation, and they're secreting histamine into the body. And those mast cells can respond to stress levels, they can respond to environmental, they can respond to allergies, they can respond to any number of different activators, sometimes real like a peanut allergy and sometimes benign like smells or tastes in the mouth, we can see those mast cells become more susceptible to benign stimulation. And all of a sudden we've got the mast cells exploding all the time and releasing histamine all the time. That's mast cell activation. That's very different. On the same spectrum because we're working with histamine, but on a, a much more serious note, I would say.

So in terms of knowing that someone has this, is there any kind of testing they can do?

For histamine intolerance or for mast cell activation? Ah, so histamine intolerance, I mean, yeah, you could. If you didn't want to take all the histamines out of the diet, you could certainly— there are a few labs that will just measure your diamine oxidase production versus the amount of histamine that is in your blood. So if you're building a lot of histamine, you don't have a lot of DAO, then you can extrapolate from that. I know I never use those. I usually just do the elimination and, because I find it to be the, the easiest thing. If I take the histamines out, how do I feel? If I add them back in, how do I feel? And so that I think is good enough without having to spend a lot of money on testing. Mast cell activation is very different. You're really looking for all of the different mediators that are released by those mast cells. And so one is histamine, but really they're looking at other mediators as well, things like tryptase, prostaglandins, PGD2, PGF2, chromogranin A. We're sort of looking at all the different kind of heparin. You might just look to see if there's an elevation of those many mediators that, that mast cell releases into the blood. That would indicate that there's some kind of activation going on.

And is dealing with mast cell activation similar to, to dealing with histamine intolerance?

Yes, it is. Not everybody who has mast cell activation has histamine intolerance. So some people who have mast cell issues, they can tolerate— like, their gut is making plenty of diamine oxidase, which means they can eat as many histamines as they want. It's not going to feed into the systemic histamine that they're producing. I'd say that that can happen. A lot of people with mast cell activation do have histamine intolerance. Oftentimes it's a good place to start.

Start.

Just take the histamines out, see if it helps, and you can kind of take it from there. Mast cell activation and dealing with that, you're not— it is a, it's a different protocol because first of all, if your mast cells are leaky and they are exploding all the time, then you got to get that under control. And so you really need to— so stabilization becomes the first thing that you do. And stabilization can come from dietary elimination, it can come from different medications like over-the-counter histamine blockers like Allegra or Zyrtec, H1 blockers, or H2 blockers like famotidine. So we can bring those in to see if we can stabilize. And then mast cell stabilizing medications like ketotifen or cromolyn sodium. There's lots of different, uh, or even Singulair, uh, there's lots of different medications that we can use just to stabilize those mast cells from just telling them to just just chill out so that we can get a sense of what, what's going on, what's our underlying cause, what's driving this mast cell activation. Because it isn't just unto itself. There's always going to be something that's driving that mast cell activation. But stabilization is important to get the person through the day because it is a miserable condition. And so the more that we can just help to calm the system, calm the nervous system, calm, calm people down, it's really very beneficial. We can also use supplementation as well for that. We can use quercetin, we can use vitamin B6, we can use vitamin C, we can use zinc, we can use lots of different things that help to build diaminoxidase or help to stabilize mast cells. So we can do a lot to calm that mast cell activation. And once we've stabilized as best as we possibly can through medication, diet, and supplementation, then we start to look at, all right, what's driving the situation? Does this person have SIBO? Does this person have fungal overgrowth? Has this person been exposed to mold? Is this an environmental issue? Like, is this a trauma that they've experienced? You know, what are all the pieces? Is this high levels of antibiotic use and has led to severe dysbiosis? Often it is a combination of all of those things, and it's a question of how do we address and treat.

Got it. Okay, so obviously there's some complexity here, so I'm not gonna—

Super complex.

—go too deep into the mast cell stuff. Lindsey Parsons. Since our topic is SIBO and histamine intolerance. Yeah.

As you see, like SIBO and histamine intolerance are actually a little bit, a little bit more, I wouldn't, simple is the wrong word. They're just a little bit more clear. Yeah. Yeah. In terms of how to manage. Mast cell activation is its own beast that we have to take on.

Yeah. That might be a topic for a whole nother podcast. Right. Okay. So anything I haven't asked about that, that one should know about this?

Let me think. Well, yeah, I'd say that for, for the at-home person who's dealing with their histamine intolerance, these are just some things that you can work with. There's— okay, so let's say you have a bacterial overgrowth. You want to work with a practitioner who really understands SIBO. I think that's the first, most important thing, that someone who can— who's dealt with hundreds or thousands of SIBO cases can really help you to navigate. Really, really important. So that's the first thing. If you do have a histamine intolerance issue, and be looking for— let's just talk about the symptoms that, that you might experience, because SIBO can be gas and bloat and constipation and diarrhea and things like that, and so can histamine intolerance. But if you're experiencing a lot of GI stuff and you have SIBO, but you're also experiencing other symptoms, and those symptoms can be more those allergy type of symptoms like itchy skin or eyes or sneezy or sore throat or congestion, or you're just really anxious. It causes a lot of anxiety, headaches, sometimes dizziness, temperature regulation issues, insomnia, tachycardia, kind of that fast heartbeat, or blood pressure issues or temperature issues. And you could have one of these things, you could have all of those things. It just kind of depends upon the person. If you are having gut stuff, but you're also having these other things, start thinking about histamines. And I'd also put it for the long COVID person who's still experiencing a lot of symptoms after their COVID diagnosis. And, you know, after they've recovered, if they're having a lot of those issues, we're seeing a lot of mast cell activation, but also histamine issues with that population. So if you're experiencing all of that, to consider doing a low histamine diet and just see how it feels. And then, you know, think, do think about these are some supplementation that you, you can do for yourself, help to support your diamine oxidase production. I always start with vitamin B6, first place I always start. Vitamin C as well, zinc and copper. Those are all things that are really helpful in terms of helping you to build more diamine oxidase and then help to reduce histamine in the body. Things like quercetin or other bioflavonoids. Flavonoids like luteolin or rutin, stinging nettles. These can all be really beneficial to you. Just, and again, it's just symptom management, but they can just help to abate some of the symptoms that you experience.

I'm guessing there's probably some products that put together all these things in one.

That's right. Yeah, you bet. Absolutely.

What are some of those?

One of mine, one that I like, and it depends, sometimes I'll just start with one thing and then see how you do. If you're super sensitive, I'll just go with single ingredients. But if you're not, you can tolerate all those things, there's one called Allerall from Protocol for Life Balance, and it has all those things in it, which I so appreciate. So that one I use quite a bit. And then the last thing I'll say is, you know, your microbiome, that there are bacteria that produce histamine in our gut, there are bacteria that break down histamine in our gut. And so if you're going to be working with, say, probiotics, you really want to work with those that contain bacteria that help you to break histamine down. That can be really beneficial, and it can also improve your tolerance to probiotics if you don't typically tolerate. And if we can use names, things like Vitamica has a great one called Florasymmetry, and another one from Seeking Health is called Histamine X, Probiota Histamine X. And another one from Custom Biotic called D-Lac Free. So these are some of the ones that I might use just to kind of help to regulate that histamine in the gut a little bit more. Just be aware that if you don't tolerate probiotics well, be aware that there are certain strains that do produce histamine that are found in a lot of these formulations. And if you're super sensitive, you might just react to those. So do start with some of the ones that are more specific to to histamine reduction, and then you can always expand out from there as your gut heals and starts to tolerate more. Got it.

Where can people find you, and are you practicing virtually or in person?

Yes, I'm not practicing in person. I am practicing virtually. You can find me at foodlogic.org, and right now I'm a little limited in terms of my availability, but you never know. You never know. I am in the process too of creating classes that help to educate people on all of this. So check back frequently. I'm in production now. And so that can just give you some good useful tips on how to move forward with these conditions. Okay, great.

I can link to that in the show notes. Great. Okay. Well, thank you so much for coming on. This is a lot of really useful information.

I appreciate it. All right. Thanks so much, Lindsey Parsons.

I hope that super in-depth treatment of histamine intolerance was useful to you. I know it was to me. If you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my Gut Healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com. And while I'm not terribly active in other forms of social media, you can also find me on Twitter, Instagram, and Pinterest, and links for all of that are in the show notes. Thanks for joining me today, and here's wishing you all the perfect stool.