What is Histamine Intolerance? Surprising Symptoms You Need to Know with Dr. Elizabeth Boham

Mark Hyman, MD

Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Mark Hyman
Coming up on this episode of The Doctor's Pharmacy.

Dr. Elizabeth Boham
One thing I always say to people is, you know, this is not a lifelong condition. Right? This is not like, you're not, like, histamine intolerant forever and ever. Yeah. Right?

It's not like, oh, you've got this condition. It's never gonna go away. We've gotta ask that question why. Right? What is triggering this for this person?

Dr. Mark Hyman
Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out function health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplement store, for a summary of my favorite and tested products.

Hi. I'm doctor Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field.

So let's just jump right in. Welcome, Liz. Great to have you back on the podcast today.

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

Dr. Mark Hyman
So as you heard from the introduction, Liz has been a long time colleague of mine for, I don't even know how many decades now. It's a little scary. At least two and a half, I think. Oh, no.

Dr. Elizabeth Boham
It's all good.

Dr. Mark Hyman
And, you know, Liz Liz, doesn't age a bit. I don't know what you're doing, but, we we have been working together deep in the world of functional medicine, to try to really help people who are struggling with conditions that are often not getting good solutions to nutritional medicine and dealing with people with chronic symptoms that are often mysterious or strange, things that get often dismissed by doctors or ignored or they don't know how to address or treat. And so at the Ultra Wellness Center, we really dive deep into unpacking a person's story, the whole timeline of how they got sick, and what the root causes are. So really kinda dive into the root causes, around illness. And and today, we wanna talk about a really common problem that you and I both seen a lot, which is people having a lot of histamine reactions.

And we're gonna explain what that is, But there's a whole spectrum of of let's call it allergy or activation immune system that results in hives and a whole host of other symptoms, and they can be very extreme from mild intolerance of histamine in the diet to full blown, what they call mast cell activation syndrome, which is a much more advanced, case of problems people get with, their immune system kind of going a little haywire. We're not gonna go too deep into, mast cell activation syndrome today. We might come back to that later. But, let's why don't we start by by talking about a patient that you had who was suffering from histamine intolerance, what the symptoms she had were, what she presented with, and what what you kind of found. And then we're gonna go through at the end, so stick with us.

We're gonna go through the end how actually we can treat this condition and what you did for this particular woman and her outcome. It was pretty impressive. And again, it's it's stuff that just you're not gonna get from your regular diet.

Dr. Elizabeth Boham
Yeah. So, I mean, I've been interested in histamine intolerance for a long time. And as you said, one of the reasons is because we get patients who have all of these reactions, and we're trying to help them and get to the underlying root cause. And this this patient really sort of was, brought it home for me. Right?

Because she came to see me she came to see me when she was 39, but she had been having migraines, like, 5 to 15 days of migraines per month for the last 15 years. Right. So she'd been struggling with migraines for a long time and tried everything. Right? All different sorts of different medications and nothing was helping.

And when we got her really good history. Right? We get a really good history and look at her timeline. You know, she noted or we noted that this all started 15 years ago after she had a lot of stress at work. So she was her job became really stressful 15 years ago.

And then she started to have all of these problems and started to get migraines, and then they just got out of hand, which we which we so often see. Right? We'll see it just it just escalates for people. And so when with again, taking her detailed history, we found out that when these migraines would happen, she'd also get a lot of congestion in her nose, and she'd get a rash. And so her her story, her history really clued me into thinking about histamine as an issue.

Because we know that histamines, high histamines or histamine intolerance can cause migraine headaches in some people, and it can cause rashes in other people, their hives, and, of course, nasal congestion and runny nose and other people. And so I started to think, well, maybe for this woman, we have to think about histamine intolerance. And so we put her on a low histamine diet. And we did some other things as well that as I said, or as you mentioned, we'll get to at the end. But, it was amazing because after a few a few weeks, her migraines just started to dissipate significantly.

And, the last time I spoke to her, she hadn't had migraines in in a few years. And, you know, so they slowly just started to go away, and then she just stopped having migraines. And all because of a low histamine diet, which is really impressive. And so, you know, I think it's such an important topic for us to delve into because there's there's so much around it that we need to talk about. And, so it can be pretty impressive and and effective.

Dr. Mark Hyman
Yeah. I mean, I think that's I've seen many patients who, you know, have hives all over who struggle with all sorts of immune dysregulation, and that it's often mysterious. You know, this chronic they call it chronic urticaria. It's one of the things we learned in medical school. And it's essentially a kind of an overactive, immune system, particularly a part of your system that's involved with allergy that includes mast cells.

And and so I I'd like to kind of get into the science a little bit behind this because I think people need to understand what is histamine, what are mast cells, how does this all work, you know, why why do we have this? And then let's get into sort of some of the more details about, like, why some people are histamine intolerant, why they can't break it down effectively, and and how you test for it and all that. So so let's kinda get into that. What is histamine and and and, you know, what what is going on here with the body that that we are seeing this kind of outrageous, overreaction for so many people?

Dr. Elizabeth Boham
Absolutely. So histamine is an immune chemical and it's produced in the body, during a reaction, during an allergic reaction or an inflammatory reaction. It's also found naturally in foods. So so some foods are higher in histamine than others, but histamine is also produced in the body as a reaction. So histamine comes from our mast cells.

Mast cells are part of our immune system, and they line, the the the, barriers of the body. So their mast cells are are lining the digestive system. They they line the, nasal passageways. They, can line the skin, and they're really an important part of the immune system that helps defend against pathogens like bacteria and viruses from getting into the body and also allergens from getting into the body. So it's a really important part of the immune system that, can create things like, when mass cells will produce, like, histamine and cytokines, which can produce mucus and inflammation, which can support or prevent these things from coming into the body when we don't want them to.

Though sometimes those symptoms are, you know, troublesome for people, it's it is an important part of the immune system. And, and and so what happens when somebody has histamine intolerance, there's this imbalance. The body is producing too much histamine or you the body can't break down enough histamine, or you're eating foods that have too much histamine in it and you don't have the ability to break them down quickly enough. And when there's that imbalance going on, that's what we call histamine intolerance.

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

Dr. Elizabeth Boham
It's such a good question that we wanna ask and we always ask, right, in functional medicine that question, why and and what could be the triggers. And I think that's really important to think about. So we do know there's genetic predispositions. Absolutely. Some people, you know, don't break down histamine as easily as others genetically.

But it does trigger us to think about, okay, what's going on? Has there been a shift in the gut? Is there increased intestinal permeability? Has there been a shift in the microbiome? Is there some dysbiosis that's that's causing this?

Because one thing I always say to people is, you know, this is not a lifelong condition. Right? This is not like, you're not, like, histamine intolerant forever and ever.

Dr. Mark Hyman
Yeah. Right?

Dr. Elizabeth Boham
It's not like, oh, you've got this condition. It's never gonna go away. We've gotta ask that question why. Right? What is triggering this for this person?

You know, you need to get that good detailed history and look at their timeline and try to think about these triggers because then we can figure out how to treat this person. So, you know, is it stress? We know that stress is a is a major trigger for people. We know when cortisol levels are high, then we don't break down our histamine as well. We know that, you know, was there was there a shift in the microbiome?

Right? Was there some was there some antibiotics somebody took? Or did they get some stomach bug that caused inflammation in the gut that that's then started this histamine intolerance? Or, you know, was it some shift in medication? You know, we we know that some medications can can decrease the breakdown of histamine.

So things like Ibuprofen, taking too much Ibuprofen, or other pain medications, or certain antidepressants, or of course antibiotics may also cause a shift in how we process our histamine. And then the other thing we look at too is is mold. Because for some people, mold exposure can can result in more histamine release from the mast cells and then more histamine intolerance in some people. So, you know, that's really important, that underlying question of why.

Dr. Mark Hyman
So basically what you're saying is is, you know and I always say this, functional medicine is the medicine of why not what not, oh, why you have histamine intolerance, but why do you have it and what are the reasons. And there are so many things that can disrupt our immune system from, like you said, disturbances in our gut microbiome, which create a leaky gut and toxic bacteria or bacterial overgrowth. It could be environmental toxins that make us susceptible and script our immune system. It could be mold exposure. It can be some genetic factors that affect our ability to break down histamine.

We'll talk about how to deal with those things and how to test for that. And we also see, you know, like you said, stress and other factors can really trigger this whole histamine intolerance phenomena, which is really just just often disabling for people because they get so triggered by their environment and by their diet, and they're kind of always itchy and miserable. And it's something that actually can be like you said, doesn't have to be a lifelong syndrome, but actually can be properly treated in a way that that actually gets rid of it. And so I think, what what is the, you know, the sort of, thinking around the, the the mast cells? How are they kind of triggered so that that releases histamine?

Because mast cells are part of your white blood cell system that's everywhere, particularly in your gut, that that triggers, when they get triggered, they release histamine, and that creates this overactive immune system.

Dr. Elizabeth Boham
Right. So there's so many things that can trigger it. You know, they've looked at things as we were talking earlier about, like, mycotoxins and how mold toxins, toxins from molds or mycotoxins can cause, more histamine released from the mast cells and that can cause more inflammation in people's body and create this sort of vicious cascade of events that can happen for people. And and, you know, we even though, like, infections can do it, there's been a lot of research looking at COVID and how that can, you know, how that triggers the mast cells to be producing a lot of cytokines in in this inflammation and results in this in these these processes. And and as you were mentioning earlier, right, we know that shifts in the microbiome are huge and that can result in changes in the bugs in the gut and that can result in changes in the amount of histamine produced.

And ultimately, also that can result in inflammation in the digestive tract. And if there's inflammation in the digestive tract what happens we get that increased intestinal permeability, right? What we call leaky gut and then that results in us becoming more intolerant to foods and more intolerant to the histamine in foods. In addition, when there's inflammation in the digestive system, this enzyme that breaks down histamine called d a o, diamine oxidase. Right?

So this is an enzyme that we have in the digestive system and it lines the intestinal barrier. And if there's inflammation in the digestive system, we don't produce as much d a o enzyme. And so then what happens is we don't break down our histamine as much. We become more intolerant to histamine, and then there's also in that in that place of inflammation, there's increased intestinal permeability and then we absorb too much of that histamine and then we become just more and more reactive. And so so we do know genetics impact how much DAO enzyme somebody makes, but ultimately, we have to go back to the gut because if there is a lot of inflammation there, that also decreases the amount of DAO enzyme somebody makes, and it also results in more increased intestinal permeability, which just causes this whole thing to cascade.

So we've gotta go back to the gut and and ask that question, what's going on there?

Dr. Mark Hyman
Yeah. I mean, it's really, you know, often really the gut and leaky gut and gusty spiosis is is probably one of the the biggest drivers. And and yet, you know, as you mentioned a few other things like DAO, I just wanna dive into that a little bit because there's an enzyme that our bodies make that is designed to break down histamine, called diamine oxidase or DAO. And sometimes people have a variation in that enzyme which inhibits their ability to fully, like, let's call it metabolize or break down, histamine, which then leads to a humiliation of histamine and more histamine intolerance. So there are ways actually to treat that with with giving people the enzyme.

You can give them, you know, DAO enzymes as a supplement that will help to actually break down the histamine and help with some of this. Certain medications also can really affect histamine intolerance and trigger it, like the NSAIDs or anti inflammatory drugs like Advil or or Aleve. Antibiotics, antidepressants, all can inhibit DAO, which leads to sort of slower histamine breakdown. So some of that is medications and, some of the people just also have hormonal stuff. And I know this particular case of this woman, she had significant hormonal issues because estrogen can increase histamine release and reduce the DO activity.

And that's why, like, women have more histamine related symptoms during certain phases of their menstrual cycle. I think there's also nutritional deficiencies, right, like b 6 and copper, magnesium, vitamin c can also lead to it. And anything that triggers sort of inflammation in general can just make you more reactive. Right? So whether you have allergies or infections or autoimmune disease and alcohol, there's another big factor that can inhibit a DAO and also increase histamine release, which makes it all worse.

And obviously, you mentioned mold and environmental toxins also overwhelm the body's ability to tend to deal with this. So you've got so many different causes. And so as part of a functional medicine approach, what we do at Ultra Wellness Center is really dive into how do we think about all these factors because they might have the same end result symptom. Right? Histamine intolerance.

But the causes may be different and the treatments may be different, which is what's so fundamental of functional medicine. I always say just because you know the name of the disease doesn't mean you know what's wrong with you. Right? And this is a perfect example where you can have many, many different factors. And I mean, it's not just one.

It's many things that are that are affecting a mis leaky gut or, you know, maybe an enzyme deficiency or, you know, maybe mold, more nutritional deficiencies, or drink too much alcohol or whatever. All that really can lead to kind of worsening problems and and symptoms like we we see. One one of the things I wanted to do you have any other thoughts to add about the the causes or thinking about that?

Dr. Elizabeth Boham
You know, I mean, I think that's so true. I think so often we wanna find the cause. Right? So we go, oh, well, what's the cause of this for me? And so often we realize it's multiple things coming together, and that then something pushes your body over the edge.

So and it's important to work on all those different causes for that person because that then helps your treatment to be much more successful. So so you don't wanna just suppress the symptoms though sometimes you do need to do that. You need to think about all of those different things that may be influencing somebody's risk for for getting this. And so, absolutely. And and you'll see when we talk about this case later, we did work on multiple different things.

I mean, of course, the the low histamine diet helped her for a while. But what's really important is the low histamine diets are not forever diets either. We don't wanna be restricting foods for too long, hell especially healthy foods. Right? And so we've gotta figure out how do we help the body heal and and stop reacting so much so that, we can we can reintroduce foods for people.

So, yeah, multiple multiple areas multiple ways we're looking at things.

Dr. Mark Hyman
Yeah. For sure. And and in terms of, just to kinda touch on it for a second, how is how is histamine intolerance different from this mast cell activation syndrome?

Dr. Elizabeth Boham
Right. So, you know, histamine intolerance, like, some symptoms of histamine intolerance will will include things like headaches or migraines, congestion, congestion after you eat especially. Digestive issues are really high on the list. Abdominal pain and bloating, diarrhea, constipation. We talked about the rashes that can happen, urticaria, hives, rashes that can happen.

And, but we also know that histamine intolerance or high levels of histamine can cause a lot more systemic things as well. So, or other systemic symptoms. So things like low blood pressure, heart palpitations, dizziness, vertigo feelings, anxiety. So sometimes people will feel more anxious when their histamine levels are high. Chronic fatigue.

And so, you know, histamine intolerance

Dr. Mark Hyman
nasal congestion. Right? And sometimes even asthma symptoms and

Dr. Elizabeth Boham
Absolutely. Right? Absolutely.

Dr. Mark Hyman
People move away and fog and Mhmm. It's like everything. Right? Mhmm. So it got me dismissed as, you know, the people don't put the dots together and the doctors don't often put the dots together.

And and these symptoms are often seen as disparate or not not connected, but they're all really connected. Right?

Dr. Elizabeth Boham
They are. Right. They are. And it it is it, you know, to be honest, I've often not put the dots together. Right?

So it is, it is not always easy. We're always like, oh, this person has headaches. Why are they getting headaches? Or they're having digestive issues. And and then all of a sudden you go, oh, this is all related, and I've gotta be thinking about histamine.

And, and so, you know, it's we've learned a lot over the years too, and to be able to help people as well. So I think of mast cell activation syndrome, it's more systemic. There can be a lot more things going on. And, and and, you know, when we say the word histamine intolerance, we're really thinking a lot about that, you know, that reaction that happens from eating a food, and, and and that histamine reaction, or that histamine imbalance that occurs after a meal, where there's just too much histamine around and the body's not able to break it down. And, but you know what?

It's often a clinical diagnosis. Right? So it's it's often based on looking at that person's story and understanding, you know, really understanding their timeline and what their symptoms are and looking for those interconnections that can really help us to determine if this is what's going on for them. Because the testing is isn't is imperfect.

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

Dr. Elizabeth Boham
Right. So, you know, you can measure histamine levels. Right? So, whether you can measure histamine levels in the blood. So you can measure something called histamine and tryptase in the blood.

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

Dr. Mark Hyman
Right. It's not it's not super reliable.

Dr. Elizabeth Boham
Right? No. It's not. And so a lot of times, these tests come back negative, meaning they look normal, but that doesn't mean the person doesn't have issues with histamine. So just because these tests are negative, it doesn't mean, oh, you can check that box and say histamine's not an issue.

So, in addition to those tests, you know, we're always looking a little deeper. So we can measure things like we can now measure things like DAO levels. So you can actually measure that enzyme level, which is many times helpful. We can look at things like, is there increased intestinal permeability? You know, by doing some tests that look at antibodies against zonulin and lipopolysaccharides because that can give us an an indication that this may be an issue.

And we also

Dr. Mark Hyman
So zonulin is like the gluten marker for excess gluten and and lipopolysaccharides are toxins that bacteria make that create inflammation. So those are bad things that happen in your gut and that can trigger this.

Dr. Elizabeth Boham
Right. And then when there when the body makes antibodies against them, that means that there is increased intestinal permeability. So it's a test that we do to give us a sense of is there increased intestinal permeability, and is that where we need to work to help improve this person's health? And we also look at genetics. We look at genetic markers all the time, you know, that can influence how well you make that DAO enzyme, as well as how well you break down histamine through methylation.

So there's a bunch of different genetic snips we will evaluate for that will also give us some information about, like, how much is this person at risk for having issues with histamine.

Dr. Mark Hyman
Yeah. It's interesting. And, you know, I think, you know, a lot of people have even weird symptoms like dermatographism where you kind of scrape your skin with a fingernail and it'll just like welt up and look at. So, you can write stuff on your skin and it's like graffiti.

Dr. Elizabeth Boham
Right.

Dr. Mark Hyman
But these are really a whole host of really disparate symptoms. And again, this is a spectrum, right? Systemine intolerance, mast cell activation syndrome. They're all part of a continuum of dysfunction of your immune system, overreaction of the allergic response in the body, and triggers all this cascade of downstream symptoms. The problem is traditional medicine doesn't do a very good job of this and throws a lot of medication at it.

Anti histamines, things like Allegra, Claritin, Zyrtec or what we call H2 blockers, another histamine receptor like Pepcid or Tagamet. And then these, you know, mast cell stabilizer, which actually I think are can be helpful, like chromolyn sodium, which we which we use. You can take it orally, as a as a liquid before you eat to kind of decrease any reactions to food. And I find that extremely helpful, during safe medication. But there's more serious ones like Singulair for liquidryant inhibitors, which are which are, you know, strong medications, steroids.

So that's really kind of the the toolkit. And it's a very limited toolkit and often doesn't really solve the problem. It just masks the symptoms. So the beauty of functional medicine is that it helps us really start to think about the symptoms. And as you mentioned, we do a deeper dive.

We look for things like leaky gut, for food intolerances. We look at dysbiosis, what's happening in the gut. We also look at mold and environmental toxins and hormone levels and all the things that we know really are are relevant when it comes to sort of trying to understand the root causes of of overactive histamine response. So I I think it's it's an area I think we have a lot of success with and a lot of different approaches than traditional, you know, health care. I think the, you know, the the the interesting thing about, you know, histamine is that, you know, it also is in food.

Right? So, people have to eat. You know, you make histamine in your body, but you also get histamine from various foods. And and I'm and maybe you could sort of share, you know, what what initial approach would be, from a functional medicine perspective. You know, we we stew with the deep diagnostics, as you mentioned, you know, look for leaky gut, look for dysbiosis, look for hormone imbalances, toxins, look for food sensitivities, look for mole issues.

We we do, you know, genetic testing to look at histamine related enzymes like DAO and maybe even urine or histamine level. So we do a whole range of tests. But then, you know, once we find out someone has this, what what's kind of the general approach that you would take, to to dealing with the root causes?

Dr. Elizabeth Boham
So right. We wanna calm down the body and and calm down this reaction, this overreaction

Dr. Mark Hyman
that's happening in the body.

Dr. Elizabeth Boham
And so so we will often, happening in the body. And so so we will often do a trial of a low histamine diet, and it can be very effective as I mentioned with this patient with migraines and how effective it was. But what's important, I think really important to just start off with is this is not a lifelong diet because there's a lot of really healthy foods that have histamine in it. Right? That or even can cause histamine to be released in somebody's body.

So what we ultimately wanna do is decrease the body's reaction, to these foods and heal leaky gut. But let's start talking about this low histamine diet because it is it is a really great tool that we are using often. And just it's for for a bunch of reasons. One, to see how much is this is histamine related to this person's symptoms. And then, how can we help start to calm down the body's immune reaction, and then over time we work to relax the diet.

So what what we always do is we do phases, so we're not overly restricting foods. And it's, you know, because it's important to recognize that the amount of histamine in a food varies significantly depending on how long that food has been sitting there, how long that food is is, you know, how long it's since it's been picked or or caught and, or prepared. We know that foods that have been the longer they've been, sitting there, they will histamine levels will go up. And so it's important to to to think about a lot of different things when we're doing a low histamine diet. So in terms of the phases, what we start with first is removing alcohol, especially beer, and wine, and champagne.

Those as as you mentioned earlier are are foods or drinks that are high in histamine, and they also block the body's ability to break down histamine. So we pull those away first. And, we also work with people to make sure that they are not keeping a lot of leftovers around. They're eating foods that are fresh, very newly prepared. If they if they do have leftovers, they wanna freeze those foods right away because the longer the food is is sitting there, the more histamine it will produce.

For example, we also know, like, with fish, For example, you wanna try to eat fish 30 minutes after it's been caught. Well, you know, because that will have those

Dr. Mark Hyman
lowest I love them now.

Dr. Elizabeth Boham
Exactly. That's so hard to do. So a lot of times people will have frozen fish, which is good because those fish are often frozen very quickly after being processed.

Dr. Mark Hyman
That's interesting. Yes. That's interesting.

Dr. Elizabeth Boham
And they're gonna be lower in histamine. But the key is when you defrost your fish, you wanna you wanna prepare it right away and consume it right away. Because the longer it's being defrosted or the longer that, you know, if you eat that food 2 day 2 days after you prepared it, there's gonna be higher levels of histamine in it. So all of that can be really complicated. So I will always recommend, and, you know, we do this at the Ultra Wellness Center.

You know, we have what, 7 nutritionists now. You know, I always recommend people

Dr. Mark Hyman
to work with a nutritionist.

Dr. Elizabeth Boham
I work with a nutritionist because because it it can be such a complex process to figure out and to remove, and you wanna do it in a healthy way where you're not overly restricting. But, you know, it can be really helpful. So you wanna have fresh foods, minimally processed foods, and, you wanna have foods without those additives in it that like sulfates and MSG. Things that can trigger more of a histamine response in the body. No.

Dr. Mark Hyman
It's just like, you know, the aged cheeses, fermented foods, alcohol. Right. Those are all really full of histamines. To be really careful with those then.

Dr. Elizabeth Boham
Absolutely. We put a lot of those in phase 2. So if phase 1 isn't isn't isn't enough to calm down the body, then we'll move and and pull away the canned and smoked fish, anchovies, which unfortunately, that's one of my favorites. But again, this is not a lifelong lifelong meal, food restriction. Processed and fermented meats, we pull away.

Aged, cheeses, pickled and fermented foods, which like sauerkraut, kimchi, yogurts, kefir, mustard, ketchups, vinegar, soy sauce. You know, a lot of these as as we talked about earlier are really healthy foods. So, we wanna be able to add them in in the future. But sometimes, again, we pull them out for a period of time to see how much that helps somebody's symptoms improve. And they typically will see improvements in 2 to 4 weeks.

So it's like a 2 to 4 week removal to get a sense of how much things calm down in the body. There's there is even a phase 3, where we have to restrict even more and pull away some, plant foods like avocado, spinach, tomatoes, pineapple, citrus foods that can also trigger some histamine reactions in some people's body. And so, so so again, we do it in phases. And we can, you know, we can attach this handout, I think. Right, Mark?

To the for for people?

Dr. Mark Hyman
In the show notes, we'll put a handout on on the different phases so people can listen in and actually figure out, you know, what to do by looking at this handout that we have provided the Ultra Wellness Center. We'll put a link to it. And I think I think, it's it's kind of a good guide on how to get started on your own. But but, you know, one of the challenges is that even if you do all that stuff, you know, I I always, you know, I I always say, you know, we need to figure out not, you know, what you're sensitive to, but why you're so sensitive. Right?

And and that's sort of the next phase. You can get people immediate relief by removing histamine and by giving them, you know, DL enzyme and maybe some other things that sort of are mitigating symptoms, you know, whether it's antihistamines or chromaline or whatever you're gonna give them. But at the end of the day, to really resolve this, you have to dig deep into the root causes and to try to deal with those things that that that we really are good at in, like, functional medicine but are not so great at in traditional medicine. And, you and that involves everything from optimizing and fixing the gut, whether it's bacterial overgrowth, fungal overgrowth, leaky gut, inflammation, healing and repairing the gut, which, you know, we have a whole program, 45 R program in functional medicine. I've done many podcasts on the gut.

Optimizing nutritional status, it affects their immune system, whether it's vitamin c, b b 6, magnesium that support histamine metabolism. And and and also the stress reduction part, which is really key because that activates everything, getting regular sleep, exercise, but then also diving. See, would you have mold? Do you have environmental toxins? Do we have heavy metals causing this?

Do we have something else going on that we need to treat directly? And how do we up regulate your detoxification system? So we we we really treat both the histamine syndrome itself, but also then dive into root cause treatment so that people don't have to suffer with this their whole life. And that's really the difference. Right?

Dr. Elizabeth Boham
Absolutely. So, you know, there are foods that we, you know, we really wanna focus on. Right? So both the the foods that are lower in histamine, but also we wanna focus on foods that are naturally rich in quercetin and luteolin. And these are these, phytonutrients that have natural antihistamine qualities in them.

So things like onions and apples, things like olive oil and, greens, cauliflower, blueberries. These are natural anti inflammatory foods that can help with calming down the immune system. And there are times, you're right, that we will also add in supplements of of quercetin and luteolin and, even nettles. We work on on, you know, getting more Yeah. Turmeric in the diet because it's naturally anti inflammatory.

And and, you know, as you but but like as you mentioned, we ultimately wanna work on healing that increased intestinal permeability. And it's, you know, if if that's what we suspect is the cause for that person. Right? So we we need to really evaluate the microbiome. We've got some new cool tests that are looking at, the the all the different bugs in the gut, the whole microbiome.

And there's some there's some bugs in the gut that are more likely to produce more histamine, and some bugs in the gut that are are more likely to not produce more histamine. So we can we can now evaluate that, which is fascinating. And, you know, there are certain probiotics that are less likely to produce histamine, such as like the Bifidobacterium infantis. We know that, lactobacillus rhamnosus, those are those are probiotics that are are less likely to produce a lot of histamine and and can be really effective when you're working on on healing the gut as well.

Dr. Mark Hyman
Right. So that's how specific it gets. I mean, I don't know if you all picked up what what Liz just said, but, you know, probiotics are not just one uniform category of product. They're they're different probiotics that have different effects and can be used for different conditions, whether it's they're now psychobiotics used for mental health issues. There's ones that are used for weight and metabolism.

The lactobacillus thrombosis and the bifidobacterium infantis seem to be particularly effective with histamine and mast cell release. So I think that's that's really important to understand. This is really personalized, and and and no one gets treated the same with the same condition. It really is is personalized based on the diet, based on the causes, based on the right supplements for them, based on probiotics you're giving. You know, one of the things I wanted to talk to you about, which we didn't chat about before, but I think it's worth, you know, bringing up, which is, you know, why why has our immune systems become so dysregulated?

When, you know, I just came back from the South America in the Amazon jungle, and these don't have autoimmune disease. They don't have allergy there. And, I mean, they were, I mean, I was still there. One of the delicacies they had there was these giant grubs, which are like this big, basically, big fat larvae or something. I don't know what they are or something.

And, now they were eating that, but they eat all kinds of weird stuff. And they, you know, they typically have more worms, in in these indigenous cultures. And when when you look at the data on this, there's this whole philosophy around the hygiene hypothesis. Why are we seeing more allergy, autoimmunity, in in in in the western world? And and part of the hypothesis is we're sort of over sanitized and that we don't have the same exposure to the microbes that we did, you know, 1000 of years ago, and that's led to real dysregulation.

And, you know, the part of our immune system, the IgE part, which is often involved in this histamine response is is is an ancient part of our immune system that's been historically something that dealt with worms and parasites and things. And one of the treatments has been explored, and I'm I've actually used it successfully in a number of patients who have, you know, high rates of allergy and food sensitivity, leaky gut, histamine, mast cell activation system syndrome is worms. And, we learned about this through through one of my, mentors and our mentors, Sidi Baker. And he uses a a class of worms called HDCs or hymen hymenalaptistaminida, sister systrochoids and, or HDCs. He calls them little dudes.

And the question, you know, have have you, used this, and how have you found it to be effective? And, you know, what's your perspective on this? Because I think it's it's one of those things that kinda shocked me when I use it. I had a patient with IgE levels over a 1000, should be under a 100, and we gave him this. And his IgE levels dropped to normal, and his allergy symptoms all went away.

His hives and histamine response went away. It was quite it was quite striking. So I'm curious if you have any thoughts in it or experience with it.

Dr. Elizabeth Boham
Yeah. So no. I have used it as well and have had some really interesting responses in terms of calming down autoimmunity and and overreactivity as well. And I think it's, you know, it's it's really asking that question of how do we rebalance the gut microbiome, which is I think such a important question to ask and, also really complex. So, you know, a bunch of years ago, we were just like, well, let's give probiotics because we're like, this is gonna rebalance the microbiome.

And though I think probiotics are incredibly effective, they're not the whole thing. And, you know, so I think I think that that how do you rebalance somebody's microbiome? Well, first, we have to talk about prevention and stopping this ultra processed food intake that is we're we're consuming. Right? And where where every and then the like, the ultra clean and then all the antibiotics that are are in our food supply.

Unfortunately, that has caused this crazy shift in our microbiome, and and all the antibiotics we give people too. Right? So there's just been, unfortunately, this shift in our microbiome that I think is resulting in this this all this immune dysregulation. And then how do we how do we fix it? How do we heal it?

Everything from, you know, from probiotics, but then we have to think about the prebiotics that feed the probiotics. Right? So, you know, pomegranate powder and, you know, fiber. And and then we have to think about the postbiotics because postbiotics are these compounds that come from probiotics that, that help with healing the gut and can really have a good impact also in terms of shifting the gut immune I'm sorry, the body's immune system. So I've been using a bunch of postbiotics as well.

You know, things that includes things like butyrate, but there are also some some postbiotics that are derived from fecal transplant that can that can help with rebalancing the immune system. Right? In in addition to those little dudes, it's really trying to figure out how can we, you know, rebalance somebody's immune system and shift the microbiome, after the damage, unfortunately, we've we've caused for some people.

Dr. Mark Hyman
Yeah. And then finally, you know, sort of the final common pathway often is is through, you know, the gut, but there are a lot of causes of dysfunctional gut. Right? Toxins, molds, stress. Right?

Hormonal dysfunction. I I wonder if we can kinda, you know and by the way, just so people understand about these worms, they they they're not human worms. They don't take up residence in your gut. They pass through. You take them every 2 weeks.

You do stepwise increasing doses over the course of a number of months to get to a dose that relieves your symptoms. And then after a while, you you stop it, which then then allows you to, kinda get back to a more normal baseline. And, it's, it's, it's actually people are doing it on their own. There you can buy it online. It's, you know, sometimes go through a doctor, but it's, it's kind of, I kind of one of these areas in medicine that's, it's starting to get attention and there's even, you know, treatments for with different worms that are being used for inflammatory bowel disease and other things.

So it's definitely an area of interest, and I think the the sort of hyper sterilization of our modern society and the introduction of all these novel food compounds and toxins and, like you said, all these antibiotics, like, gut busting drugs. It's sort of led to this sort of almost increasing rates of of people having food sensitivities and and histamine intolerance. And food sensitivity is sort of like you know, is more of a mild version of this, but it's a spectrum. Right? It's all just like you're on or off.

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

Dr. Elizabeth Boham
Right. So this woman came to see me when she was 39. And and as I've mentioned before, she was having, like, 5 to 15 headaches every month. And they started and they were migraines. Sorry.

So they were they were, you know, there were migraines with an aura that are very debilitating. It's you know, she was she was very debilitated from this. And as I mentioned, she also noted that when these migraines would come on, she would get this nasal congestion and the rash. And that really helped me, you know, she helped me go, oh, I gotta think about histamine here. And and the other thing we gathered from her history, as you mentioned, is these symptoms were worse around her period.

And a lot of women notice this. You know, they notice that migraines will get worse right before their period. And, and and that can be because of this estrogen dominant situation. And for some women, it gets worse, when they're going through perimenopause because when you're, getting closer to menopause, when you're in those years before you go into menopause called perimenopause, you may have these anovulatory cycles, which means that not you might still get your period every month, but every month you might not release an egg from your ovary. And as a result, you don't get that increase in progesterone that was happening back when you were in your premenopausal years.

Right? When you were in your fertile years, you might call it. And and as a result, you there's even more of an imbalance between estrogen and progesterone. So estrogen's almost higher because progesterone's lower. So that imbalance then can cause more symptoms of what falls into this category of estrogen dominance, which for some women is includes migraine headaches, right, or worsening PMS or trouble with sleep.

Right? So she, you know, was coming to see me in her perimenopausal years because she was 39. So she was, you know, having, she she definitely on testing showed that she was, perimenopausal. She, you know, I could tell based on her estrogen and progesterone levels that she was in those perimenopausal years. And so we did work on lots of things.

So as I've mentioned earlier, we started with the low histamine diet. And, and within within a short amount of time, she started to see improvement. And she found it really helpful. And and so that was great because it helped to help her just feel better. And then it could help us get off this cycle of taking too many pain medications, which can make the histamine intolerance worse.

Right? So we it helped us break that cycle a little bit just to get her on that low histamine diet. And we we also added in the DAO enzyme with each meal so that she didn't react as much to the food she was eating. And I gave her some, vitamin c and b 6, 2 times a day. So that would help her body break down histamine.

And that was all really helpful. I gave her things to help her her migraines as well, like magnesium and riboflavin and coq10, because they can be really effective for people with migraine headaches, and and that may have been helpful too. But but then we looked deeply from the estrogen perspective. So we did some testing that looked at how she breaks down her estrogen. Right?

So we looked at estrogen metabolism, and we we realized that she wasn't breaking it down as well. So we added in things to help her body break down that estrogen more. And one of my favorite things to do in this situation is sulfurathane, which comes from your cruciferous

Dr. Mark Hyman
vegetables. Interesting.

Dr. Elizabeth Boham
Yeah. Because it helps the body break down estrogen. And we also saw on her stool test that she had a high level of this beta glucuronidase. And that is an enzyme in the gut that occurs when there is this imbalance in the gut microbiome called dysbiosis. She had a high level of this enzyme beta glucuronidase, which allowed the estrogen to get reabsorbed into her body.

Mhmm. So we also use something called calcium d glucarate to bind the estrogen. So both the Sulforaphane and the calcium d glucarate helped with lowering, essentially lowering her estrogen levels or helping get that estrogen out of her body.

Dr. Mark Hyman
Yeah. This sort of shows how we work in motion medicine. Like rather say, oh, you have high estrogen, low progesterone. Let's give you, you know, a drug or the pill to shut things down. Well, like we go, well, how's your estrogen being metabolized?

What's the gut hormone connection? How do we deal with that? And then like you said, this particular patient had an overgrowth of bugs in her gut. They were producing the enzyme, this beta glucuronidase, that was basically unpackaging the estrogen when it's packaged up by your liver, allowing it to get reabsorbed into her body, creating more estrogen and then creating a vicious cycle and leading to, you know, this whole hormonal dysregulation, histamine excess, and, you know, the whole the whole mess that she was having. And and it's it sort of speaks to this sort of the personalization.

Right? Because somebody else might not have had that who has systemic intolerance, and you treat them differently. And and, and it really is so critical because you can't just kinda do a one size fits all treatment. Right? And for this particular person, you know, you also needed to think about, you know, other therapies that can help with estrogen metabolism.

So it's not just getting rid of the bugs in her gut. You can even use an antibiotic like Flagyl, for example, to get rid of it. Or you can use a probiotic like Saccharomyces to help reduce the beta glucuronidase and kinda cut down on those clostridial producing those clostridial bacteria that are producing this XX enzyme that messes up your estrogen metabolism. Right? And so, you give her specific histamine.

You give her Coricetan. You give her the sulflurophane from the broccoli to help metabolize estrogen, the calcium, but you create which helps break down the estrogen. So you get a lot of things that are, you know, certainly not not that you and I learned in medical school.

Dr. Elizabeth Boham
That's true.

Dr. Mark Hyman
That are extremely, extremely effective when you put it all together. It's not like one thing or two things. You have to sort of deal with everything, and it's unfortunate. It would be nice to find that, you know, magic pill. Just take this pill and you'll be fine.

Well, yeah, if you gave someone, you know, steroids, yeah, their histamine intolerance would go away. But they would also dissolve their bones, get diabetes, high blood pressure, dementia, and a lot of other things. You know? Right. You don't wanna do that.

Dr. Elizabeth Boham
And what we know about the antihistamines, right, also, like, they can help with the immediate reaction in the body, But but the body is trying to make histamines. So if somebody takes antihistamines for a while and then stops them, they just get more of a histamine reaction come back. So you have to

Dr. Mark Hyman
Mhmm.

Dr. Elizabeth Boham
You have to get to that underlying root cause and wean them off to the off of the antihistamines. So that they just don't make more histamines again. Right. Or too many histamines.

Dr. Mark Hyman
Yeah, exactly. And so tell us more about how how this patient responded and what happened and you know, was this person permanently on a histamine free diet? Or like what what what how did she do?

Dr. Elizabeth Boham
Right. So I mean, I think, you know, one of the things I started when I told you about this person is we talked about that one of the triggers for her. And that you know 15 years when this whole this these migraines started, she had a shift in her work. And so she had a lot of stress from work. So she also had to do a lot of work regarding finding other modalities to calm down her body.

You know how to interact with work and not be so reacted from it you know reactive from it and have some breath work techniques and, meditation, and yoga, and journaling. All those things we know that helps, you know, manage your cortisol levels better, and and handle stress better. And that was really helpful for her as well. And we saw immediate response with the low histamine diet, but we had to do all of these things so that over time, we could relax that low histamine diet. Because, you know, we don't wanna be, as we talked about earlier, on this restrictive diet forever.

And we want to, we want people to be able to tolerate the histamine in foods, more over time. So for her, she was able over time after, like, 3 or 6 months, she was able to slowly cut, you know, calm down on the restrictions in her diet, adding in more higher histamine foods slowly over time. And now, she will just take the DAO enzyme occasionally. So if she goes out to eat, has some some alcohol, some champagne, if she has, you know, certain meals that are that she knows are more likely to cause a histamine response for her, she might take the histia the the DAO enzyme, but she doesn't take it all the time, and she doesn't need to. And her migraines have subsided, and she's feeling good, and so, which is which is really nice.

Dr. Mark Hyman
And do they need to take, like, is she gonna take these supplements forever? Like the histio enzyme that's gonna help her metabolize it or she take other supplements that she needs or do people just kind of get back to new equilibrium when they don't have to do so much?

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

Dr. Mark Hyman
It's so great. And and what's so beautiful about this is that is that, you know, using the the functional medicine framework, which is it's not a it's not a test or a supplement or even a specialty. It's just a way of thinking about disease in a very different way based on root causes and based on the body and how it's connected as a system. And then it's really focused on personalization. It's focused on optimizing function in different systems like the gut immune system or hormonal system.

And maybe illustrate through this case how we can start to optimize the gut, how we start to optimize hormonal balance, how we start to optimize diet and reduce inflammatory diet. And and that that's so important. And I think we we do this across the board, whatever conditions people are suffering from. And that's really why why we, you know, really are are in business at the Ultra Wellness Center, to help people figure out these complex chronic problems. We're you know, we we used to both work at Canyon Ranch, which is a health resort, and I I often, you know, call myself a resort doctor because we work there.

But the joke is we're the doctors of last resort. And, you know, we we really are so excited because we we've done this for so long, and we can help so many people. And we encourage people to really check it out. And, you can go to ultra wellness center.com to learn more about how we how we treat all sorts of different issues and what we do there. Also, in the show notes, we're gonna put, the list of of the the dietary recommendations, what histamine free diets are.

We're gonna put scientific references that document what we're saying. And, also, we're gonna put in, you know, what are the supplements we talked about and so people understand how to how to actually apply this. So I think, you know, it's been great to have you back on the podcast, Liz. You know, so many people, benefit from these. I can't tell you how many people approach me and say, you know, I I heard your podcast.

I came to the Ultra Wellness Center. I had this fix or that fix. I'm just so grateful. Grateful. And I think it's really why we're we're, we're doing what we do because we really love it, and we also love to see people get better from things that often are not well done by the traditional medicine.

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

Dr. Mark Hyman
Yeah. All right. Well, we'll see you back again. I know for sure on The Doctor's Pharmacy podcast, Liz, and we're listening. I hope you have a fun day and, we'll see you next time on The Doctor's Pharmacy.

Dr. Elizabeth Boham
Thank you.

Dr. Mark Hyman
Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at doctor Mark Hyman, and we'll see you next time on The Doctor's Pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more.

And now you can have access to all of this information by signing up for my free Mark's Picks newsletter at doctorhyman.comforward/markspicks. I promise I'll only email you once a week on Fridays, and I'll never share your email address or send you anything else besides my recommendations. These are the things that helped me on my health journey, and I hope they'll help you too. Again, that's doctorhyman.comforward/marxpicks. Thank you again, and we'll see you next time on The Doctor's Pharmacy.

This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and function health where I'm the chief medical officer. This podcast represents guests opinions and neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services.

Now, if you're looking for your help in your journey, seek out a qualified medical practitioner. You can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultra wellness center.com. If you're looking for a functional medicine practitioner near you, you can visit ifm.org and search find a practitioner database. It's important that you have someone in your corner who is trained, who's a licensed health care practitioner, and can help you make changes, especially when it comes to your health.

Keeping this podcast free is part of my mission to bring practical