Have you found that fermented foods, bone broth and wine make you feel sick? Do you sometimes feel edgy, anxious or are unable to sleep? Does your nose stay stuffy year-round to boot? You might be dealing with a histamine intolerance.
In today’s episode, integrative nutritionist Heidi Turner explains how histamine works to support various systems in the body, and the inflammatory effect on those systems when we have too much of it. Heidi specializes in complex health issues including SIBO, autoimmune conditions, histamine intolerance, mast cell activation and food chemical sensitivities, and has counseled thousands of patients on ways to reduce inflammation through dietary change and manipulation of the microbiome.
This chat took me by surprise: I learned so much about the connection between seasonal allergies, sleep, stress and SIBO. And we discuss a tangible path to reversing histamine dis-regulation in just a week. If you’ve been suffering from food sensitivities, even on a low FODMAP diet, this episode is a must listen.
A Quick Taste of What We’ll Cover:
- What is histamine and how does it work in the body?
- How over the counter medications work to relieve some histamine symptoms
- Why certain types of excess histamine presents as a runny nose and others affect your gut
- How SIBO can spark the development of histamine intolerance
- Examples of histamine producing foods versus histamine liberating foods
- Testing for histamine intolerance and how to tell if you have it
- The biggest rules of thumb for limiting histamine and how to cook around them
- Long-term approaches to histamine issues and how sleep can be affected
- Supplements you can use for when you have a histamine flare up
- Stress management strategies to help with histamine issues
Resources, mentions and notes:
- Heidi Turner’s website
- SIBO SOS Doctor Directory
- My Rolodex for Holistic Doctors in NYC
- Bi-Phasic low Histamine diet
- Episode 9 on the Bi-Phasic Diet with Dr. Jacobi
- Histamine friendly Instapot bone broth
- Zeolyte for binding histamines
- Meditation Apps: Headspace, Insight Timer, 10 Percent Happier
- Join the SIBO Made Simple Facebook Community Page
- Subscribe to receive a free download of the episode transcript
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WHAT IS A HISTAMINE ALLERGY OR HISTAMINE INTOLERANCE?
PHOEBE: Heidi Turner, thank you so much for joining us today to talk about all things histamine.
HEIDI: Sure, thanks for having me.
PHOEBE: Great. Why don’t we jump right in, because I think there’s a lot of misconception around histamine. I mean, we usually hear the term just on television, in terms of various prescription drugs that help with allergies and such. Can you tell us what it actually is?
HEIDI: Yeah, sure. Yeah, I agree. I mean, our primary connection to histamine is from that perspective. It is, right? Histamine basically is produced as a result of an allergen entering our body and triggering a mass cell that then triggers a histamine release, and then histamine calls on the immune system to get in there and do something about the offender coming through. That’s one of the ways that our body and one of the reasons our body, produces histamine, and it’s probably the one we’re the most familiar with. Then we take that magic anti-histamine – Claritin or Zyrtec or whatever – and it kind of helps to block that response, and then we feel better, and we feel less congested and sneezy and itchy and things like that. That is one of the reasons our body might produce histamine. It’s involved in an inflammatory immune response. It’s there to protect, okay?
We’re always producing histamine. It’s not just that immune response. I mean, histamine is involved in about ten different systems. It regulates about ten different systems in our bodies, so we use it as a neurotransmitter and it’s part of our central nervous system. We use it to help us build stomach acid and help us digest food, in terms of our digestive system. We use it to help build estrogen, to help regulate our hormonal system. We use it to increase mucous within our respiratory track. We use it for a lot of different reasons, and so it’s this really majorly important chemical within our body.
Our body has this wonderful ability to produce histamine to do what it needs to do, and then we have this great enzymatic system that helps to break down the histamine, so that we don’t build up too much histamine in the body. There’s this really great regulatory process – we build a histamine, we break it down, we build it, we break it down – so there’s always this sort of give and take, give and take kind of thing going on, and in a perfect body, in a perfect world, that’s how it works. Histamine is a really critical part of our total health. It is not always the enemy. We kind of think of histamines as these bad things that we’re always trying to block, but actually they’re very beneficial as far as our total health picture.
PHOEBE: Got it. Yeah, no, that’s so interesting, all the various functions that it’s involved in. Before we get into histamine intolerance and obviously its connection to SIBO, I’m just curious, what do these over-the-counter drugs actually do? Do they work?
DO OVER THE COUNTER ALLERGY MEDICATIONS HELP A HISTAMINE INTOLERANCE?
HEIDI: Yeah, sure, depending upon how much histamine you’re building. We have like four different histamine receptors within our body. There’s an H1 receptor, an H2 receptor, an H3 receptor, and an H4 receptor, and the over-the-counter histamines basically cover the H1 receptors or the H2 receptors. The H1 receptors are going to be more involved in that common allergy stuff that’s going to impact our runny eyes and snotty noses, and congestion, and all of that kind of stuff. Basically what those medications do is they block that receptor so that when we produce the histamine, it can’t connect to that receptor. In order for histamine to do what it needs to do, it has to connect to the receptor in order for that whole biochemical response to happen. What the H1 and the H2 blockers do is they kind of get in the way of that histamine being able to do its job, so we don’t get the response that we would normally get.
PHOEBE: But it’s still floating around the body.
HEIDI: Still there, yeah, exactly. We’re still producing it, and the more that we produce, the more we’re locking in, we’re going to have more of those symptoms associated with it. In the H1 realm, we’re going to get more of the snotty/sneezy kind of stuff, and in the H2 realm, we’re going to get more of that gastrointestinal stomach acidy kind of stuff going on. When we take those, they block that and all it’s really doing is just helping to manage symptoms. It’s not necessarily stopping the reaction necessarily from happening, it’s just making us more comfortable.
PHOEBE: So you could still be having a lot of downwind effects or symptoms from ingesting something that’s an allergen and having that reaction to it, but you just might now know it because you’re popping Benadryl.
HEIDI: Sure. Yeah. Basically. The reaction doesn’t really stop. It’s just that we’re stopping our sensation of it, basically.
PHOEBE: Is there any risk with these medications, other than the fact that as we just described, they’re kind of a band-aid?
HEIDI: I think there’s some pros and cons to it. I think the benefits are that you can function. Some people just can’t function who have severe allergies, right, who just cannot – I mean, if you’ve ever had a severe allergic response, it’s pretty significant, can really get in the way of your quality of life. For those people, yes, it’s a band-aid, but if we can’t really get to the source of what’s going on and why we have all these allergies, then sometimes that’s what we have to do.
Certainly, we can use other things – Quercetin or Vitamin Cs or things like that – but for some, we really do need that. For others, it is blocking all of these receptors. Remember, histamines are a really important part of our physiological makeup, so if we’re always blocking those receptors on a pretty consistent basis, potentially we’re going to start to impact other systems in the body, and we’re going to see a certain level of deficiency in terms of our ability to regulate circulation and regulate estrogen, and regulate digestion, and regulate those things. There’s definitely pros and cons to taking those medications, absolutely.
PHOEBE: Yeah, it’s really interesting. I mean, personally, my dad and I both have terrible insomnia, and he used to always give me Benadryl in [06:32] and he used to take Benadryl, like we weaned himself off of the hard stuff, and then uses Benadryl again, like kind of in a pinch. I was just curious, like what’s happening?
HISTAMINE INTOLERANCE SYMPTOMS AND SLEEP
HEIDI: Histamine’s a major part of our sleep cycle, and so for those who have allergies or do produce an excessive amount of histamine, it’s very neuroexcitatory, and so it just sort of like can keep us more anxious or we might notice in the middle of the night those histamine levels rising, like between two and four in the morning. We might, as part of our own circadian rhythm, start to see that start to elevate. Benadryl’s just like a really strong anti-histamine that just takes everything down. The Benadryl works, but at the same time it is a band-aid. At the same time, we have to function in our world, and for some people that’s what they need to do.
PHOEBE: Is it making you sleepy because it’s taking the histamine functionality down too far?
HEIDI: Yeah, it’s just really blocking it down, basically.
HEIDI: Yeah, it’s a pretty intense drug, and a lot of people use it for sleep. It’s incredibly effective for sleep.
PHOEBE: Okay, so kind of the chicken or the egg question I feel like comes with a lot of these immune reactions. Tell us a little bit about what histamine intolerance is. Is it having too much histamine at one time? What are the downstream effects of that? Is it insomnia? What happens?
HEIDI: Okay, so there’s – I don’t know, I kind of look at histamine intolerance a little bit different than histamine dysregulation. When I first started doing this 15 years ago, histamine intolerance was basically noted as you could not tolerate the histamines coming through the diet, like they were triggering more of that histamine response – and I’ll get a little bit more into that – whenever we’ve taken too many foods that were exceptionally high in histamine, and we just didn’t have the enzymes available to break all of those histamines that came in through our food now, and it would kind of trigger a larger histamine response within the body.
PHOEBE: Why is it happening mostly through – well we’ll talk about symptoms a little bit later on, but is it happening mostly through gastro symptoms versus the H1 type symptoms you described before with the eyes and the nose?
HEIDI: Not necessarily. This is where we get into – remember I talked about that perfect situation, where we build histamine, we break down histamine, we build histamine, we break down histamine, and that’s where that lovely regulation – the body is not becoming too full of histamine, basically, right? Because we have those wonderful – there’s two enzymes. One is called diamine oxidase, also known as DAO; the other one is called HNMT, histamine N-methyltransferase. These are the two enzymes that our body builds in order to help us break those histamines down, and that’s in all of these systems that we’re working with.
When the body is producing too much of this histamine, when that whole regulation starts to break down, the body is building more histamine, and the enzymes that we have to break it down can’t keep up. That means we’re now going to have higher levels of circulating histamine. What we might see in that situation is all of those systems that that histamine is impacting could – potentially, we could start to see those ramp up. Let’s say the histamine that regulates neurotransmitters, we can’t break those histamines down fast enough, we’re going to build more of that neurotransmitter, and that is a very neuroexcitatory neurotransmitter – it gives us a little bit more anxiety, kind of turns things on a little bit, might not be able to sleep very well – all of the areas where that histamine is actually creating all of a sudden starts to become more so, and we’re just going to see this increase of the symptom and intensification of the system, basically. Does that make sense?
PHOEBE: Yeah, totally. It’s just funny because I feel like when you hear about people with anxiety and sleep problems – I say this from personal experience – it’s never come up for me, like any question about histamines. I feel like people obviously look to the gut – and we can talk about root causes in a second – and some sort of dysbiosis, but I don’t know, it’s just interesting that histamines don’t come up in casual conversation as much.
HEIDI: They don’t, and I think we’re really just kind of figuring it out. I think there’s much more research. I mean, 15 years ago when I started this, the research was super limited and histamine intolerance was not considered much of a thing outside of Australia and Britain. We didn’t hear about it at all. If you look at the literature now, you see much more in relation to histamine intolerance, you know, histamine, production of bacteria and mass cell issues. We’re really starting to get a greater sense of how potent this particular chemical is within the body. I think it’s a relatively – even within the research world, it’s there but it’s still limited. Certainly, the understanding within the medical world, I think, is fairly limited, and I think that bit by bit we’re starting to see practitioners sign on to it or understand it or consider it a little bit more.
Really, it’s more online. Going to the webiverse, you’re going to find much more there, I would say, but you have to be aware of it and you have to be looking for it. It’s not necessarily a common thing in conversation, so it doesn’t surprise me that it hasn’t been brought up more. When I look at whoa, you’re not sleeping very well, it’s the first thing I think of now. I’m like, okay, let’s look at all the other symptoms you might be having, right? Let’s think about not just the sleep. Are we also seeing you more congested? Do you have any hives? Is your skin itching? Are you getting more reactivity during menstruation? Do you have asthma? Do you have heartburn? Do you have diarrhea? Then I’m going to start looking at all these other systems where histamine is involved, where histamine is regulating, that would indicate – it’s like oh, yeah, I’m also all of a sudden really congested all the time, I have terrible allergies, and oh, yeah, everything is much worse right before my period, and oh, yeah – like then you kind of start to put together – oh, and my gut is just – this heartburn is terrible. Then you kind of start to put together – you have to look at the whole thing, not just the sleep. You have to look at all the pieces and create a narrative around it.
PHOEBE: Obviously it’s not common to discuss it, but how common is it actually in terms of who’s being affected?
HISTAMINE INTOLERANCE TEST & HOW TO KNOW IF YOU HAVE A HISTAMINE PROBLEM
HEIDI: I don’t know. I wish I knew that. In my world, every day! Let me step back from that. That’s a great question because I don’t know. I don’t have a research study to say this is how many people are being affected by this, but I feel like in the 15 years that I have been doing this, I have noticed a substantial increase in terms of – and maybe that’s just because I’m specializing in this more and more people are coming to me for that, and I worked in an autoimmune clinic, so I’m much more exposed to it. It’s definitely – I get this sense of an increase that is occurring. When I think about when I’m assessing for histamine dysregulation – and then we’ll start talking about histamine intolerance. When I’m assessing for histamine dysregulation in the patient that comes to me, what I’m applying are – I’m assessing different triggers. What are the systems that could potentially trigger histamine dysregulation that could apply to this particular person?
The first thing that I look at is the amount of stress that the person has been under, and I would say it is always the common element when working with any kind of histamine dysregulation. We know that stress impacts histamine production significantly. That can be emotional stress, physiological stress – surgeries or motor vehicle accidents, or any kind of traumatic stress to the body. Honestly, I see our exposure to the screens and such stressing the nervous system out as well. I kind of look at all the different stressors within someone’s life, and we’re all stressed to an extent. We live in a fairly stressful world, and I believe that that is really increasing as well and our exposure to information is pretty significant, so I look at it like nervous system activity. I believe that’s increased substantially in the last five to ten years. I can kind of look at that piece, and we’re all a certain level of stress. When we start to really address the stress piece, we will see that histamine dysregulation start to improve in every case. That’s a pretty major piece.
I look at the hormonal piece. Do we have any sort of issues related to hormones? I look at environmental piece. I think our environment has changed pretty significantly as well over the last 10 to 15 years, as far as what we’re exposed to, but significant levels of environmental exposure. Also, I see much more allergy coming through the door. Then I look at the dysbiosis, which is SIBO and overgrowth and imbalance of bacteria within the gut, which we can get more into, and then I also look at their diets. Are we working with foods that are triggering histamine response? Are we looking at a histamine intolerance, which is where the body just can’t tolerate the histamines that are coming through the foods? What’s going on from that perspective?
I look at all of these and apply that when I’m trying to determine whether the patient has histamine dysregulation. In most cases, we can see. I’m always looking for the sources. What can we do? Not just give them the H1, H2 blockers, but what can we do to identify all the places where histamine is getting created in the body. Why are you producing so much histamine? Why is this dysregulation occurring? How can we start to address each of those pieces so that we can reduce the amount of histamine that the body is producing and get you out of this fog that you’re in, or reduce the symptoms, or help with the SIBO, or help with all of these other pieces?
PHOEBE: Gosh, it’s all so complicated and all so connected. It’s interesting. I mean, the whole list that you just laid out is very similar to the list of causes of any sort of autoimmune condition. First of all, let’s get to the histamine intolerance versus disruption. What happens?
HIGH HISTAMINE FOODS & HISTAMINE INTOLERANCE DIET
HEIDI: In histamine intolerance, let’s look at the diet. There are foods that contain histamine. The foods that contain the most amount of histamines are fermented foods. These are foods that are aged, have a certain level of age on them or fermentation on them. They build histamine through bacterial fermentation – a bacteria takes in amino acids and it converts it into histamine. If we have an aged cheese or an aged meat, or we have wine, or we have sauerkraut, or kombucha, or anything that gives us that wonderful depth of flavor, that food is going to be – anything that has a level of age on it from that fermentation is going to be loaded with histamines. Then we have certain foods that contain a natural amount of histamines, like tomatoes, avocados, egg plant and spinach. Those are ones that actually contain a certain [18:24] amount of histamine. Then we have something called histamine liberating foods. These are foods that can trigger a histamine response within the body. They don’t necessarily contain histamine, but they can trigger a histamine response. We have all of these histamines in foods.
When we typically will ingest those things, we have a ton of diamine oxidase – that’s that DAO. That’s one of those enzymes that helps us to break down all the histamines within our system. We have a ton of this DAO that the intestinal cells build, so when we take in dietary histamine, that DAO gets released and it helps to break down the histamines that are in our food so that they don’t adversely impact us. We’re not taking in liquid histamine that’s triggering this immune response. We have all of this DAO that helps us to break it down. That’s in a well-functioning, regulated gut. When we move into that dysregulation, where we’re not producing as much DAO, when we take in those dietary histamines, it’s like drinking liquid histamine. It can trigger this immune response because we don’t have the ability to take that histamine down into something that is less reactive and less inflammatory to our gut, and then we start to see more of this histamine mediated symptoms. We can start to see stomach pain or abdominal pain. We can start to see severe stomach acid, reflux. We might start to see diarrhea.
Those are the three most common situations when we’re working with that level of histamine intolerance. Then the longer that goes on for, then we’re increasing the level of inflammation in the gut, and then we’re creating more leaky gut, intestinal permeability. That histamine is able to then absorb into our system, and then we start to see more of a flood of histamine into circulation. Then we start to see, oh, now I’m more anxious. Now I’m having more itching and welts and hives and things like that. It’s that dysregulation between the DAO in our gut not being able to breakdown the histamine, etc. in our food and then it adding to the load.
HISTAMINE INTOLERANCE AND SIBO
PHOEBE: Does the DAO malfunction, I guess? Does that happen because of SIBO, or does SIBO happen because of all these other downstream effects?
HEIDI: I mean, I do feel like there is this feedback loop happening. The more that I work with, I feel like it just keeps feeding itself. The thought has been always is that SIBO – let’s just put SIBO there first for a second. Okay, SIBO’s there. We got food poisoning, dysmotility. You have the bacterial overgrowth. SIBO creates a level of inflammation in the gut. Not only is histamine going to be a part of that whole process, which then is going to trigger – DAO is going to be like, oh, take that histamine down, but it’s also going to create more inflammation in the gut. Inflammation is going to reduce and create an inability for our mucosal cells within our gut to produce that DAO as effectively. It can not only – it can create that deficiency as well.
The other thought process there is depending upon the type of bacteria that you have because not everybody who has SIBO has the exact same type of bacteria in there. It’s just an overgrowth of your own. If you are someone that is more inclined to build more histamine producing bacteria because some of – not all but some of our bacteria do have more propensity towards increasing and producing more histamine. Then that could also be problematic as part of that whole soup that’s going on in there. Not everybody who has SIBO has histamine intolerance or has histamine issues, so there is a differentiation between the two.
PHOEBE: Not everyone who has histamine issues has SIBO.
HEIDI: That’s exactly right.
PHOEBE: I mean, I’m interested – we can talk more a little bit later on about the specific foods. In terms of the fermented foods, I mean, even without having histamines as part of the conversation, people talk about those being a no-no for SIBO, so I’m curious. Is it because of, I don’t know, I guess their bacterial component, or is it because of the histamine?
HEIDI: Yeah, I think there is so much – everyone can disagree on the use of probiotic food in relation to SIBO. There’s two schools to that thought, I would say. Some recommend just don’t put any bacteria. We have a bacterial overgrowth. Don’t put anymore bacteria into this situation. We need to actually reduce the concentration coming through, so let’s not bring more into the situation. I think that is one school of thought. To add to that, if there is a histamine intolerance, then putting in those fermented foods could potentially increase that level of reactivity within the gut as well.
In other cases, I have seen – in a SIBO situation, I have seen – for those who don’t have histamine intolerance, I have seen fermented foods really help with symptoms. The fermented food piece from my perspective is really a case-by-case situation. It’s like does it help you or does it not? Some people are like that’s how I digest my food. If I can’t get that kombucha in with every meal, I cannot digest my food. It really is dependent upon the person.
PHOEBE: To that effect, I assume there is no test for histamine intolerance or is there?
HEIDI: Yesh, I mean, you can look at the – there’s urine tests that test for histamines. You could look in the urine. There is a test from one of the labs out there that tests both your histamine load in the blood as well as the amount of DAO that’s circulating. We do know from research that those with histamine intolerance typically have lower levels of circulating DAO. We know that, yeah, I mean, there’s test that you can do, but it’s probably just as easy to just take the histamines out of the diet for a period of a couple of weeks and see if you notice a difference, from my perspective, if it’s a relatively easy thing to diagnosis and based on the symptoms that are being experienced and it’s a relatively easy diet to follow for a short period of time just to get a sense of whether that’s something you need to be focused on. These are expensive tests. I just don’t do a lot of testing. Yeah, you could.
The other piece is that the amount of histamine that we produce at any given time is highly variable. You could look at your morning histamine levels, and they might be significantly lower than they are later in the afternoon. Depending upon when you take that test, you may look at them at one point and go, hey, it’s fine. There’s not an excessive amount of histamine. Then if you happen to do it later in the day, then you might see that it’s more elevated and think, oh, wow, I have major histamine issues. I think those tests are very variable, and I think it’s just as easy to do some elimination work.
PHOEBE: If you were someone at home thinking do I have a histamine intolerance, you described, obviously, some of the main symptoms, but in terms of diet, besides fermented foods, are there a kind of big red flag foods that if you notice when you’re eating them and you don’t feel well after that you should think to yourself huh?
HEIDI: Yeah, wine’s usually the first one to go, especially as we enter the perimenopausal stage as a woman. Wine is one, but wine’s loaded with stuff. It’s got sulfites and alcohol. If you’re noticing, wow, I can’t do wine, or beer, or cider but I can do tequila or vodka no problem, that’s a good indicator. All of that fermented alcohol is going to be more problematic than something that’s been distilled. I always like to ask. I ask a lot around alcohol. If someone’s like, oh, my God, I – I get horrible headaches. I cannot sleep at all after I drink wine, or beer, or cider. It’s terrible, and then I get hivey the next morning or whatever, and yet, I can drink a shot of tequila no problem. Then it’s like okay.
PHOEBE: That’s funny. I thought that was everyone. Who does feel great after wine the next day versus tequila? I see what you mean.
HEIDI: Yeah, that’s one indicator, right? Just to start thinking about, oh, that’s interesting, fermented stuff, more problematic than the distilled stuff. Then I look at the diet, and I look to see how much fermented food are you eating? Are you someone that has smoked salmon and avocadoes in the morning and aged cheese and sardines for lunch and then a big huge aged steak with sauerkraut? I look at the concentration of histamine coming through. If you’re someone that tends to veer more towards those really highly flavorful, really spicy foods or using a lot of fish sauces, does a lot of Asian cooking and does fish sauce and a lot of that fermented sauces or soy sauces and things like that, I do look at how much concentration is coming through. That’s the next thing. Then I would say the thing is just other food. That would be more like the fermented stuff. Certainly like the kombuchas and the sauerkraut just because those are exceptionally loaded with histamine.
PHOEBE: How about bone broth or now everyone’s using the collagen powder to add to their everyday latte? If someone reacts badly to one of those things, is that an indication of histamine intolerance?
HEIDI: Yeah, potentially. I mean, it can also just be that there’s something about that particular thing that is not working for you. It’s a tough one with histamine intolerance because it’s not usually just one food. It’s usually a buildup. It is like a boiling pot of water. The more that you consume, the more you’re going to reach our own personal threshold. You still are building DAO. You’re still able to – we have histamine in almost everything coming through, so it’s not like you can’t deal with any of it. It really is a threshold situation, so that’s why I look at the amount coming through as opposed to that particular food coming through.
PHOEBE: Yeah, I mean, I guess it’s similar to FODMAPs in a way. It’s not the ingredient itself that’s the issue. It’s the accumulation and the quantity.
HEIDI: That’s exactly right.
LOW HISTAMINE DIET & FOOD LISTS
PHOEBE: What are you biggest rules of thumb for limiting histamines? When I look at the list of all the histamine liberating foods and the high-histamine foods, it’s like, oh, my God.
HEIDI: If you have SIBO, which we haven’t even gotten to yet, it’s a total disaster because those diets completely contradict each other.
PHOEBE: What are more overarching ways to limit histamines, like number one, taking out the fermented foods; number two…
HEIDI: Yeah, taking out the alcohol. Yeah, don’t have the wine, tomato sauce. If you do a lot of tomato sauce, that would be another one that I would really keep an eye on. Keep your meats fresh. Just keep them fresh. You don’t have to be someone that has to freeze their stuff immediately, unless you do. I mean, if we’re just talking about what are some things that we could just try to shift down the amount of histamine coming through, then I’d say alcohol first and especially try distilled. If that’s something that that speaks to you and you feel like you’d like to have a drink, you’re better to not go with the fermented stuff. You’re better to let the kombuchas go and the fermented stuff go for now. Then keep your meats just in the fresher realm as opposed to the canned, or the tinned, or the smoked, or things like that, so just try to keep things fresh.
PHOEBE: Is it a no can food situation? I know tomatoes are – is it a high histamine, or is it a liberator? I can’t remember.
HEIDI: It’s a high histamine.
PHOEBE: Okay, so I assume that then it’s just a double whammy because you’ve got a precooked sauce in a jar that’s been sitting there for a while.
HEIDI: It’s just concentrated. Yeah, it’s just a concentrated situation. A fresh tomato may go better. Cherry tomatoes typically have less histamine, so most people do better. If you’re putting in tomato sauce, that’s a lot of tomatoes. We like to eat our tomato sauce in abundance, so it’s just shifting down. Yeah, I mean, you may not need to go down that whole take all the histamines out of the diet’s path. You could just start with taking the big guns out and see if that’s enough, and that’s a little less crazy making when it comes to dietary change, especially if we are working with someone who has SIBO and we are working with a low fermentable diet which is, again, naturally high in histamine. Perhaps we just focus on the big guns instead of taking all those liberating foods out and just see if we can get just as far with that. That’s going to be a much more sustainable situation.
PHEOBE: Obviously, eating as fresh as possible, big rule of thumb, but should we avoid leftovers? What constitutes fresh these days?
HEIDI: Yeah, right? I know. For those, we’re working on a spectrum too. There are those who just – all they need to do is take the wine out, and they’re better. That’s like, okay, you’re just – you’re not making that much GAO. It’s down a little bit, but you’re making it. You can manage the rest of it. It really depends upon the person and how much they can tolerate. How much we actually remove from the diets is dependent upon your own personal tolerance, so I think that that’s a really important thing to remember as you move forward with this.
In relation to the leftover piece, there are some who have really severe histamine intolerance, and they really need to make sure that, as soon as they cook their food, it’s going into the fridge. It’s going into the freezer and so that we stop bacterial background. We keep the temperatures either at a high level or at a very low level. We’re trying to get it out of that zone where bacteria is most active. Remember, it’s the bacteria that’s creating the histamine. For some, they really need to make sure that if you’re going to make a big pot of stew for the week, or soup for the week, or whatever it’s going to be, as soon as you finish it, you put it in individual containers, stick it in the freezer, and then just stop that – really try to reduce that bacterial breakdown. For others, I’d say they’re good for the next day. They can make the pot of soup and be able – be fine with having it the next day and have no issue whatsoever. You have to play with that as far as that’s concerned. Just remember that bacterial fermentation is going to occur at a much higher rate when we are either working outside of freezing temperatures or outside of boiling temperatures.
PHOEBE: For something like bone broth, I thought the issue is that it was being cooked for a longer period of time, so you’re extracting more of the collagen and all that jazz. Is it actually that you’re just cooking something over a period of time at a low heat?
HEIDI: Period of time.
PHOEBE: Bacteria could form even if it’s hot.
HEIDI: Yeah, we’re not really boiling it for one thing, so it’s an extended period of time in which we can build that level of histamine. The collagen itself can also have a certain appreciable amount of histamine as well. It’s the extended cooking time that we’re really working with that’s going to be much more problematic.
PHOEBE: For making a low histamine bone broth – obviously, this is the stuff I nerd out about. What do you think is the max amount of time you would want to cook it for?
HEIDI: There’s a question amount. We don’t have a lot of data on this, just so you know. I would just say, clinically, what I can observe is that those who use an instant pot kind of thing and do their bone broth that way, I typically see a little less reactivity to it, just so you know. I usually will say, look, if you’re just going to make a broth on the stove, I’d really keep it to no more than two hours. It’s probably not going to be bone. It’s just going to be a broth. We’re just getting some flavor off of that.
PHOEBE: A slow cooker is not your friend if you have histamine intolerance.
HEIDI: A slow cooker is not your friend. Slow cooker, not friend, no.
PHOEBE: Very interesting, so let’s go back to the SIBO connection. You just brought up again that it’s actually the bacteria that is creating the histamine. What is the relationship with SIBO?
HEIDI: Yeah, so that again comes back to the SIBO itself creating inflammation, reducing DAO through that inflammation either by damaging of the mucosal lining or just using up more DAO because of the histamine from the inflammation itself and/or from the bacteria that you create that are building more histamine in the gut. For those with histamine intolerance, we know that they typically will build more bacteria that produce more histamine. We’re up against a concentration not just from the overgrowth but from the type of bacteria that they’re experiencing. What we’re going to end up with then is just more inflammation in the gut, and sometimes when we apply our low-fermentable diet so like a low-FODMAP diet, or the Bi-Phasic Diet, or a SIBO-specific diet where we really take out a lot of those fermentable foods. Not necessarily high histamine foods but just fermentable foods, that alone – there’s a piece of research that showed that just a low-FODMAP diet can reduce serum histamines eightfold, so just by reducing the fuel for the bacteria, then we see less inflammation in general. We can see then less histamine production in the body, so sometimes just by applying a low-fermentable diet we can see improvements in inflammation in the gut, see improvements in some of these histamine symptoms that you might experience.
Still others, if you apply a low-FODMAP or low-fermentable diet, like I said earlier, it’s diametrically opposite. Tomatoes are low FODMAP, and eggplant is low FODMAP. Spinach, green leaves, have as much as you want. It’s like all those things are low FODMAP, and so I watch this as a practitioner. Just as a patient too, you want to just be aware. If you’re doing the low-FODMAP, or SIBO-specific, or Bi-Phasic diet and you’re doing that and you actually feel worse – and let’s say you’re having more pain, or more diarrhea, or just like, oh, my gosh, you’re having headaches now. Everything just seems to be moving in a not so good direction. That can be an indication that we are also working with a histamine intolerance, and it wasn’t enough to just reduce the histamine through the reduction of fueling those bacteria.
Things have progressed in such a way that you just do not have adequate amounts of DAO to break down what you’re asking it to. That’s when we get into a situation where we need to potentially take down both the fermentable foods as well as the fermented foods and really take that diet down for as short a period of time as we possibly can just to get some relief while we’re getting in there and treating for the bacterial overgrowth. Definitely, we’re moving along the spectrum of just intensification of atrophy within that digestive track, and what do we need to do to reverse that and calm that down as much as we possibly can?
HISTAMINE INTOLERANCE TREATMENT PLAN
PHOEBE: I know you created a bi-phasic, low-histamine diet with Dr. Jacobi who has been on the podcast, Episode 9. We talked a little bit about this in her episode as well, but it’s interesting hearing you talk about this now. Really, the combo of those two things is a Phase 2 for you after the low-FODMAP diet has not improved things.
HEIDI: Yeah, is it a Phase 2 for me? Not so much as a practitioner just because I’ve been doing this for so long that sometimes it’s Phase 1. If I’m really seeing – depending upon the history and what the symptoms are and what they’re experiencing, that might be the first place that I start. If things are fairly severe, then I’m going to move. I’d say, from a general perspective, yeah, to work you way down this line. I mean, how much do we want to restrict the diet? It’s a tough diet, the low-histamine bi-phasic. It is asking a lot from the person as is a low-FODMAP diet, just doing that. Try to take out even garlic, folks, it’s impossible and to still live in this world.
That’s why it’s like, okay, what’s the least amount you need to do? Even if you suspect, okay, I have all this other histamine stuff going on, what’s the least amount that you need to do for your own symptom management? It’s entirely possible that just by doing a bi-phasic approach or just by doing Nirala’s other diet, just the one where we’re just taking out the fermentables, or SIBO specific, or fast track, or low FODMAP, sometimes it’s enough just to do that. Those are difficult unto themselves, but that might get you the symptom relief that you’re really looking for. Those are good places to start. I would say that for a practitioner, and I would also say that for the general public who’s just working with this.
Then if you are really not getting anywhere, you react to all the supplements that you’re taking. If you’re taking oregano and Berberine and neem, or allicin, or whatever, you’re taking these things in, and the gut just will not have it. You’re reacting to everything, or you’re not responding to that diet well, or it just feels like things are not moving in a beneficial direction. Then we might want to start thinking about, okay, how do we tighten this up a little bit more just so we can acknowledge that this gut is really struggling? We really need to give it as much breathing space as possible and allow it to get a little bit of healing done before we start really asking it to kill all the bacteria and manage all this histamine coming through. I would say, from a general perspective, that would be your Phase 2 approach is to implement that low-histamine, bi-phasic diet.
I use it all the time. I’m so glad. I’m so grateful to Nirala for creating her initial one, and I’m so grateful that she asked me to come on and help her with that particular diet. It is an indispensable tool I find as a practitioner. It’s just one of those things that, in most cases, we can get everything calmed down by an application of that.
PHOEBE: How long does it take with something that severe for the histamine to go down and for symptoms to improve?
HEIDI: Symptoms to improve, pretty quickly, within the first week so it’s a fast turnaround. Once you take the histamine down, once you take the – and the fermentables are gone, there’s not a lot of circulating histamine in the gut. Once we really shift that down, we’re not feeding the bacteria, and we’re not asking the gut to digest histamine, which it can’t. All of a sudden, we’re going to really see a major shift down in the gut. It’s fairly quickly, and I try to not keep people on that for any longer than we have to. Is it enough to just do it for a couple of weeks, (sometimes)?
Then also acknowledge that sometimes when we move you to those larger diets, a little more restrictions, sometimes it was just because we took out one particular food from the diet. Not necessarily all those foods. I see eggs being an issue all the time, and they’re on most diets. When we take those – and so people are like eggs, eggs, eggs, eggs, eggs. Eggs in the morning, what else are you going to eat? All of a sudden, things are kicking up. On that low-histamine, bi-phasic, we take the eggs out because it is a histamine liberator, and then people are feeling better. My question as I move them forward is, well, is it just because we took the eggs out? Now, actually, you are going to be able to – that was just the major player in that, and now we can actually expand the diet out a little bit more, or was it all of it, and we’re having a hard time just digesting any kind of histamine? As a practitioner, I’m always questioning that.
It is my goal as the nutrition counselor here or the dietician to expand the diet out as much as we possibly can in the shortest period of time as possible. I don’t want you to stay on this massively restricted diet any longer than you need to and neither do you. It’s like whatever we can do just to make sure that we’re not holding you in a space for any longer than we need to. Psychologically, physiologically, all of it, it’s a really important thing to expand out, and I cannot stress that enough to both patients and practitioners that it’s really important for us to keep moving this along. People get to that point where they’re just feeling horrible. They finally feel better, and then it’s just like, okay, I feel better. I’m going to stay here.
It’s like no. We got to help move you along. It could’ve just been one food that we took out. Can you do this? Can you do that? Can you do that? Then move them into that Phase 2 of the biphasic diet as quickly as we can.
HISTAMINE INTOLERANCE AND THE ELEMENTAL DIET
PHOEBE: Speaking of hyper-restrictive because you’re saying this kind of very restrictive diet for two weeks, can the elemental diet help the histamine piece in addition to the SIBO?
HEIDI: Oh, absolutely, I mean, anytime you’re giving the gut a rest, (A), you’re giving the gut a rest; (B), you’re not giving it really any histamine to deal with because it’s all amino acids that are going to get absorbed. Everything’s getting absorbed so quickly. You’re not really asking much from the enterocytes, and you’re not asking anything from the bacteria. The bacteria are slowly dying off. Sure, yeah, histamine intolerance is one of those things. If we’re really just working – if the SIBO is the major player in your histamine intolerance – remember, I went through that whole thing of stress and hormones and environments and dysbiosis and diet, but if the SIBO is the major stone in that boiling pot of water and you manage that, your histamine intolerance can go away quickly, super quickly. We’ve really reduced the thing that keeps that inability to build that DAO. We’ve really lifted that out of there, and the body is actually able to start healing at that point. Now histamines become much less of a problem. An elemental diet just in its ability to give the gut a rest, not ask it to produce DAO, and kill off the bacteria just unto itself can be treatment for your histamine intolerance.
PHOEBE: I know Nirala mentioned that if it’s not SIBO, it’s very likely SIFO or a fungal or yeast overgrowth that’s causing the histamine intolerance. Since that’s not actually bacteria, how does that work?
HEIDI: Same thing. It’s just whatever is causing inflammation in the gut. In that case then, an elemental diet, you might actually get worsening of your symptoms in that situation because of the high dextrose nature of that. Whenever I see elemental diets, I’m always very cautious about because of that SIFO, potential SIFO component. If I give someone an elemental formula and they really do not tolerate it well and it makes everything that much worse, I really do start to think from a SIFO perspective. I’ve done multiple elemental diets that just go south. I love them. I love the whole idea of them, but at the same time, it’s like W-A-A-H! You start to get a little gun shy after a while because of the reactivity that I see during them, but from my perspective, it can just give us a little bit more information. It’s like, oh, okay, not only working with SIBO, likely working with SIFO, and we need to be thinking from that perspective. Now I know we’ve got a lot going on which is – potentially, if the person is histamine intolerant, we’ve got more that’s creating inflammation in the gut and more that we got to deal with.
PHOEBE: In terms of histamine intolerance as a condition in the long term, does simply making those dietary changes actually move the needle going forward, or is it similar to SIBO, all about getting to the bottom of your root causes and eliminating them?
HEIDI: Yeah, histamine intolerance is absolutely reversible. These aren’t allergies. It’s not like you’re allergic to these foods. This is just a dysregulation, and as long as we get to the source of what is involved in that dysregulation, treating the SIBO, or the SIFO, or any other form of dysbiosis, you’re massively stressed. You got a lot going on, and you’re not sleeping. Yet, the SIBO’s now gone, but you’re still having symptoms.
It’s like, oh, you got to deal with that. Oh, you’re getting three hours of sleep a night. Okay, what do we need to do there? There’s massive amount of stress going on in life. What do we need to do from that perspective? Oh, you’re living in a moldy house, or you’re living in an environment where you’re massively reactive. What can we do from that perspective? You get the idea?
It’s like we have to be thinking about all of these pieces where the body could be building more histamine and leading to that dysregulation. If we just focus on the SIBO or the dysbiosis, we’re potentially missing – we’re just potentially missing the boat there. Most of the time, treating a SIBO is enough to get the person to be like I can eat what I want. I’m eating tomatoes again. I can drink a glass of wine, whatever, without it being an issue, but if treating the SIBO is not the thing and we’re still having these systemic issues or even some gut issues even while it’s gone, now we have to step back and look at all of the other pieces. Where else can we change in your life that can shift that histamine reaction down? Then we can start to see a reversal of more of that histamine dysregulation.
HISTAMINE INTOLERANCE SUPPLEMENTS
PHOEBE: There was something you said that was a very good segue. I asked on Instagram for some listener questions, and I got a bunch, actually. I got a few from a particular friend of mine who now I’m putting all the pieces of her puzzle together. She had a mold issue and is now dealing with histamine intolerance, so that makes sense to me now. She asked, beyond HistDAO, the supplement, are there any other remedies for when you have a flare up after eating or drinking something bad?
HEIDI: Oh, my gosh, there’s so many things. Let me think. I have been recommending zeolites for that recently. Zeolite is like a binder, much in the way of activated charcoal or bentonite clay, which you could also use in that situation, but I do find that zeolite is a little bit more effective at binding histamines specifically. You can buy that online. There’s lots of different ones. If this person is really sensitive and we’re really trying to figure out what’s going on, then I typically use a liquid one that’s a lower dose. Otherwise, you can find it in a powder form and take it. Most people actually do find just the binding of the food and the binding – it also does bind histamine in the gut, so I do find that to be beneficial.
PHOEBE: Do you ever put someone on that for an extended period, or is that only a back pocket thing?
HEIDI: That’s a back pocket thing for a majority of people. For my other patients who are a little bit more leaning towards mass cell activation where they can’t really tolerate any food, then we might use a little bit more frequently. I still try to keep those binders limited because we want to make sure that they can absorb. We want to make sure that everything’s – we’re not reliant upon them. I would say that would be more of a back pocket thing as needed. Then you can certainly – if you want to pop an H2 with Zantac or ranitidine, I still – it’s like, look, if that’s going to work in that moment, there’s nothing wrong with doing that in that moment, as long as you tolerate it, and it doesn’t trigger something in you.
If it actually does help, great, but ultimately, we don’t want to rely on those things. We want to try and keep the triggers as low as possible. If it works for you, if it’s needed, then ranitidine could be your – famotidine could be of some benefit to you as well. I will say that in some cases quercetin can also have that same more immediate antihistamine effect. That one I like to just keep in on a regular basis as more of the general antihistamine that could potentially prevent the reaction that you’re having. It is a little less strong. The reaction’s a little less strong.
PHOEBE: Got it. All right, before you go, one more random listener question. They asked, is histamine intolerance related to oral allergy syndrome, itchy mouth when eating apples or plums or swollen lip when eating beef?
HEIDI: No, not necessarily. Not everyone who has an oral allergy syndrome has histamine intolerance, so it’s a little bit different. That’s more around the – OAS is more around the cross reactivity between different plants. If you have, say, an issue with birch, then you probably don’t do well with apples and carrots and different things because there’s a structurally similar protein that each has that your body is going to be a little bit more reactive to. They all work within that same family. OAS is a little bit different from that perspective. It runs a little bit more along the line of true allergy versus histamine intolerance, which is more – everything we’ve just talked about. It’s more related to that dysregulation.
PHOEBE: Awesome, well, to wrap things up, I’m maybe going to ask you if you have any great stress management tips since you said that was a big root cause. It’s a root cause of everything. Let’s be real.
HEIDI: Yeah, right?
PHOEBE: You said that, by just implementing some of them, sometimes you don’t even have to do any dietary interventions, so tell us what you tell your patients.
HEIDI: Okay, so a couple of things and it depends upon the severity of what they’re experiencing. I think the first line would be, obviously, some form of meditation strategy. If you’re not implementing some level of mediation on a very daily and regular basis, I strongly recommend that. We do know that deep breathing stimulates the part of the nervous system that is the antagonist to the nervous system that gets triggered by histamine. We really want to – whatever we can do to keep you aware of your own stress levels. I feel like that’s what meditation does. It draws an awareness. It draws awareness to your breath. It draws awareness to when you are off in your head, and it keeps bringing that focus back to the breath. That’s all really meditation is.
Different apps I recommend: Headspace and 10% Percent Happier and Insight Timer, just whatever we can do to start implementing that. Certainly, if you’re not exercising, then that helps to build more GABA, which is the antithesis to the histamine as well. The more that we can get your body moving as you tolerate, then that can be beneficial. If you are not sleeping, then we really need to figure that piece out. That is, I would say, the most critical piece as far as reducing your total stress load in the body. Sometimes we can’t sleep because we’re insomnia or because there’s so much histamine circulating. We also need to think about just make sure that the sleep hygiene is as on as possible, turning off the screens two hours prior to going to bedtime, making sure that you’re going to bed at a good hour, not staying up too late, trying to time it so that you’re getting seven to eight per night, just really making sure that you’re following good sleep hygiene. If you need to work with L-theanine, phosphatidylserine, and there’s different things that you can – melatonin. There’s different things that you can work with that could help to support that aren’t just Benadryl reliant. You could help to support those sleep patterns, but sleep becomes a really important thing.
Then I feel like there’s different programs out there, biofeedback, limbic system retraining. There’s lots of different things that I have recommended as well depending upon the severity of the stress level. I would say the one thing that I’m really working with my clients right now is reducing their screen time as much as they possibly can, and I cannot stress this enough. Really getting a sense of how much screen time you get in any given day, especially the phone and the tablet seem to be the most reactive to most of my patients versus the television or even the computer screen but really trying to reduce that as much as you possibly can so that the nervous system is not in a constant assessment. The whole idea around reducing stress is reducing that nervous system activation. We are constantly activating our nervous system by being on our devices. We are also constantly processing that information coming through. To finish that would be whatever you can do to separate from the device, whatever you can do to separate from the information coming in, particularly political information, anything that – news, any of that stuff coming at you that is going to keep triggering reaction, triggering response. What we’re trying to do is ask the body to react less. I cannot stress that enough.
PHOEBE: Oh, it’s such good advice. It’s funny. All of these themes, these basic elements of wellness always come up in the podcast over and over again, and they’re the things I tackled in my book, The Wellness Project. It’s funny. Dealing with SIBO is just like a lesson all over again that just everything is so connected, and you got to get the building blocks down pat before you can deal with the nitty-gritty.
HEIDI: That’s right. I would say the more that you do this work, the more that I do this work – especially with SIBO, we get in there, and we try and kill the bacteria, kill the bacteria, kill the bacteria. We get very myopic of just focusing in that one area, and none of this is possible without other systems involved. The more that I work in this area, the further out I start to look. You just start stepping back more and more and more. It becomes less about the treatment even and more around looking at how we live our lives and looking at our own – how much joy do we have in our life? How much do we express that? How much stress is with us on a fairly regular basis, and what can we do to balance that out?
I’m glad it keeps coming back to that, that every conversation’s come back to that. I really do feel like that is our greatest epidemic is how much stress we take on and our inability to break free of it and really experience a level of joy. That I believe is our greatest epidemic, and it is what is leading to these imbalances and dysregulatory systems so the more that we can really embrace that. Certainly there are other issues. There’s all those pieces that we know to be. It’s not the only thing, but it really becomes a critical part of our healing process.
PHOEBE: Such great wisdom to end on. Thank you so much, Heidi Turner. I will link to a lot of the resources that you mentioned and, certainly, your collaboration with Dr. Jacobi and that bi-phasic, low-histamine diet. Yeah, keep doing all the good work you’re doing.
HEIDI: Thank you so much, Phoebe. This was great.
Disclaimer: The information in this podcast does not provide medical advice, professional diagnosis, opinion, or treatment. The information discussed is for educational purposes only and is not a substitute for medical or professional care.