Histamine intolerance: A new way of looking at allergies

By Ronald Hoffman, MD

Do you have allergies? Sneezing, wheezing, burning eyes, or flushing, itchy skin with hives? Do certain foods trigger stomach cramps or diarrhea? Or do you suffer from frequent headaches or migraines, bouts of nausea, severe menstrual cramps, or panic attacks characterized by a racing heart?

You’ve dutifully tried allergy shots—sometimes for years!—to no avail. Antihistamines work for you, but only partially. Food allergy tests keep coming up negative. There seem to be no clear dietary precipitants—your food reactions seem to be all over the map. But your doctor insists your allergy blood tests and skin tests don’t come up positive for foods. Still, you try popular gluten-free, dairy-free or candida diets, but they only make minor dents in your symptoms.

The answer may lie in a new understanding of something called histamine intolerance. Histamine, of course, is what antihistamines are supposed to suppress. Histamine is part of our bodies’ natural response to insults or invaders. It prompts blood vessels to swell and fluid to leak from capillaries, causing swelling. Think of the itching you get at the site of a mosquito bite, in response to the foreign proteins deposited by the insect’s saliva.

Histamine intolerance is actually a “pseudo-allergy,” which is why it’s not picked up by conventional allergy blood tests that measure IgE. It results when histamine levels soar in the body.

To use a bathtub analogy, there are two ways a tub can overflow: 1) If the faucet is turned on too high, or 2) If there’s a stopper in the drain. It’s the same with your body. If either occurs, or both simultaneously, your allergy “tub” can overflow, resulting in symptoms of histamine overload.

The discovery of an enzyme called diamine oxidase (DAO) has helped to unlock the key to histamine intolerance. DAO is normally present in the intestine to control excess histamine. It acts to break down histamine in the gut.

Research indicates that certain individuals are genetically prone to low levels of DAO. It can be measured via a blood test, but requires processing by specialty labs that are not licensed in certain states. More readily available are blood tests that can reveal high levels of histamine, presumably resulting from insufficient DAO activity.

To summarize—and it gets a little complicated here, so bear with me—there are 6 ways that foods can send your histamine past the threshold where you experience allergic symptoms:

  1. The old fashioned way—a direct measurable food allergy, say to casein from dairy (to return to the bathtub analogy, “faucet”).
  2. Foods that are rich in histamines (“faucet”). These include alcohol (especially red wine), aged meats; shellfish or spoiled fish; fermented products like sauerkraut, soy sauce, Worcestershire sauce, yeast extracts and vinegar; and beans and pulses.
  3. Foods that are rich in biogenic amines, which don’t directly trigger allergies, but compete with histamine for degradation by DAO (“stopper”). These include pineapple; bananas; raspberries; peanuts and wheat germ.
  4. Other foods that don’t contain histamine but trigger mast cells to release histamine (“faucet”). These include fruits like kiwi, lime, lemon, pineapple, papaya and plum; additives like MSG, sulfites, benzoate, nitrites and artificial food dyes; and tomatoes.
  5. Foods or beverages that inhibit DAO (“stopper”): Alcohol; black, green and mate tea.
  6. Foods that can cause “leaky gut” (“faucet”). They make the intestines leak, allowing passage of histamine or macromolecules from food into the body, triggering IgE or IgG food allergies. These include alcohol and hot spices like chili peppers.

Finally, certain commonly-used medications inhibit DAO (stopper): These include Elavil, Tagamet, NSAIDs, aspirin, aminophylline, Reglan, verapamil, and Moduretic.

Can you be “allergic” to your own hormones? Many women report a surge in their symptoms of bloating, diarrhea, nasal congestion and wheezing corresponding with their periods—not to mention intense menstrual cramps.

This may not be coincidental. Histamine has been shown to enhance the production of estradiol, making women feel more “hormonal”; conversely, higher levels of estrogen can potentiate the action of histamine, exacerbating allergy symptoms including premenstrual headaches and migraines.

Interestingly, production of DAO by the placenta in pregnancy soars by as much as 500-fold; increased DAO pulls the stopper on excess histamine accumulation. This may explain, in part, why pregnant women often enjoy a temporary respite from allergies.

So what are the practical consequences for you?

If you have symptoms of histamine intolerance (nasal congestion, asthma, hives, headaches, abdominal cramps, diarrhea, etc.);

And your symptoms are partially relieved by antihistamines, or brought on by consumption of any of the above histamine-releasing or DAO blocking foods or medications;

Or, if you’re a premenopausal woman, and your allergic symptoms seem worse at certain times of the month;

Or, your blood tests show high levels of histamine or low levels of DAO;

You should:

  1. Redouble your efforts to avoid histamine-boosting foods
  2. Avoid DAO-blocking drugs
  3. Use natural anti-histamines (C, B6, quercetin)
  4. Take DAO with each meal

Most importantly, seek professional guidance from a health practitioner well-versed in histamine intolerance. Other medical problems can mimic histamine intolerance, and sometimes need to be ruled out before simply following the protocol outlined above. It’s early in our understanding of the complex phenomenon of histamine intolerance, and we’re only just now refining our approach to this challenging disorder. But its discovery finally spells hope for many patients afflicted with a bewildering array of symptoms

Additional Resources:

Maintz L and Novak N, “Histamine and histamine intolerance”, Am J Clin Nutr 2007;85:1185-96http://ajcn.nutrition.org/content/85/5/1185.long 

DAO inhibitor www.histame.com

http://www.histamineintolerance.org.uk

http://www.histamine-intolerance.info

http://thelowhistaminechef.com/histamine-enzyme-testing/

http://www.histaminintoleranz.ch/en/introduction.html

– See more at: http://drhoffman.com/article/histamine-intolerance-a-new-way-of-looking-at-allergies/#sthash.Pl5wUjfO.dpuf
Source: Integrative Heath Network

Is gluten intolerance bullsh*t?

by Ronald Hoffman, MD

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”

Arthur Schopenhauer, German philosopher (1788 – 1860)

To this we might add, in this era of click-bait journalism, a fourth stage: “Then it is ridiculed again.”

Such is the case with gluten intolerance, a real phenomenon that is suddenly taking a shellacking in certain less-enlightened segments of the media.

Articles with lurid titles like these are appearing with greater frequency:

“Does it Even Matter if Gluten Sensitivity is Bogus?” –PLOSblogs

“Gluten Intolerance is Apparently Bullsh*t” –Jezebel

“Your Gluten Allergy is Fake and I Hate You” –Redditt

“Being Gluten-free is Dumb—And Gluten Intolerance May Not Even Exist” –Muscle-for-life

“Calling Bullsh*t on a Fake Gluten Allergy” –LocalBizComedy

“Why a Gluten-Free Diet is Unnecessary and Even Unhealthy” –XoJane

If you haven’t heard of many of these pop culture outlets, don’t worry. The stories aren’t written by health professionals who’ve ever seen a patient. Their snarky, sensationalistic style typifies a new genre of health reporting that’s been unleashed by the democratization of the Internet and social media. The name of the game is to garner the most “clicks” – he who trends most wins.

It’s not surprising that a recent survey showed that only 6% of the population has a “high degree of trust” in the media.

Even Presidential contender Ted Cruz took a swipe at gluten correctness: He pledged not to provide gluten-free MREs to military personnel, signaling his disdain for effete, “PC” liberalism. (Cruz needn’t worry—the military already takes a dim view of gluten intolerance, and provides no special accommodation for soldiers who claim the affliction)

I get that “gluten-free” has become a fashion statement in certain pretentious precincts, and it’s spawned a growth industry for opportunistic food manufacturers who offer a plethora of (often not very nutritious) products. Many people who claim a gluten “allergy” do so with no objective evidence. They’ve never undergone testing, but claim to feel subjectively “better” when they skip wheat and related grains. Undoubtedly, some of the benefits they experience are due to the placebo effect.

So let’s drill down on the scientific study that has all the gluten skeptics exulting. The trial was published in the August 2013 edition of Gastroenterology. It involved 37 subjects with irritable bowel syndrome, all of whom were given a preliminary “FODMAPs” diet for 2 weeks. None of them had tested positive for celiac disease, the uncontroversial “classic” form of gluten intolerance.

The FODMAPs diet is designed to reduce intestinal bloating and gas by eliminating fermentable carbohydrates (fructans, oligosaccharides, disaccharides, monosaccharides, and polyols). That means no grains, no milk products, no sugars, and elimination of certain fruits, nuts and vegetables. While highly restrictive, this diet often yields superb results in sufferers of IBS.

No surprise: The subjects felt much improved. Then they were challenged with either a high-gluten, low-gluten, or no-gluten meal plan and the effects were assessed.

All 3 diets—whether or not they included gluten—produced identical symptoms in the testers: they reported feeling worse.

This was interpreted by the researchers as evidence that gluten intolerance—outside of celiac disease—does not exist. That the subjects felt worse during the challenge period was attributed to the “nocebo” effect—the opposite of a placebo. In other words, gluten intolerance was a figment of their imaginations, since the presence—or non-presence—of gluten made little difference to their subjective responses.

But I see several problems with this study, and its appropriation by gluten-intolerance skeptics:

  • The selfsame researcher—Dr. Peter Gibson at Monash University in Australia—had previously demonstrated the very opposite in a 2011 double-blind placebo-controlled study in which sufferers of non-celiac gluten intolerance showed strong reactions to gluten feeding. Why the discrepancy? Was the first study wrong?
  • Even if gluten-intolerance isn’t really a specific reaction to gluten, but instead is a form of FODMAPs intolerance, isn’t that moot? Patients with fatigue, brain-fog, gas, bloating, diarrhea, constipation and many other baffling symptoms get better with gluten-free diets. I can certainly attest to that based on over 30 years of clinical experience. What difference does it make whether they have candida, wheat allergy, gluten-intolerance, or SIBO (small intestine bacterial overgrowth) when the net result is that they improve when they eliminate gluten? Does that make self-reported gluten intolerance any less “real”?
  • The re-challenge control meals consisted of whey protein—a known precipitant of GI symptoms for a high percentage of IBS sufferers! Isn’t it unfair to conclude that reactions to the gluten were “imagined” because they were indistinguishable from those experienced with whey?
  • In any case, the authors note that “only 8%” of symptoms reported by study participants could be attributable to gluten, which they dismiss as trivial. But, while not statistically significant in this small study, isn’t it worth considering as a trend supporting gluten intolerance?
  • The reintroduction of gluten lasted only 3 days. In my experience, people who benefit from gluten elimination may get away with a little gluten for a short time before symptoms recur. I would’ve liked to see longer term follow up during which time I’m pretty certain that gluten intolerance would have re-emerged in a way that would clearly distinguish itself from the symptoms reported by control subjects who consumed only whey.
  • Finally, if gluten really didn’t make a difference for the folks in this study, you might expect that its reintroduction wouldn’t provoke the adverse reactions the subjects reported. But it did. And maybe it wasn’t just their overactive imaginations at work (Just sayin’!).

BOTTOM LINE: I’m sure even Dr. Peter Gibson would downplay gluten intolerance deniers’ attempts to use his study to call BS on gluten avoiders who aren’t diagnosed with full-blown celiac disease. He’s a FODMAPs guy, having written many papers on the subject, and maybe his message is that some are claiming gluten intolerance when what they’re actually reacting to are fermentable carbohydrates.

I’m not certain it really matters, because many people are obtaining relief from a wide variety of symptoms when they stop eating bread, cookies, and pasta. Of course, it’s dumb to skip gluten just because it’s trendy; on the other hand, don’t let the detractors daunt you if your gluten avoidance has delivered you from bothersome complaints.

– See more at: http://drhoffman.com/article/is-gluten-intolerance-bullsht/#sthash.IT0jm7my.dpuf


Source: Integrative Heath Network

Supplement of the week: DIM

By Ronald Hoffman, MD

Every now and then, I like to highlight a particular supplement that my audience may not be aware of, and go in-depth about its uses, benefits, and potential drawbacks.

This week, I’d like to talk to you about DIM.

Diindolylmethane (DIM) is a versatile nutraceutical for which I find many uses in my practice. It is naturally obtained via dietary consumption of cruciferous vegetables. Brussel Sprouts, Garden Cress, Mustard Greens, 
Turnip, and Kale are rich sources of glucobrassicans, the mother compounds of beneficial glucosinolates like indole-3-carbinol, which is metabolized into DIM. However, heat treatment, particularly boiling and microwaving, degrades
myrosinase, the plant compound responsible for bio-transformation of glucobrassicans into useful molecules like DIM and sulforaphane.

An advantage of supplementation with DIM over consumption of large amounts of raw cruciferous vegetables is avoidance of goitrogenic isothiocyanates. These compounds compete with iodine for binding in the thyroid, potentially contributing to hypothyroidism. DIM is thought not to have goitrogenic properties. To obtain the benefits of DIM contained in just two capsules per day, it is estimated that the average person would have to consume two pounds of raw cabbage family vegetables per day, an intake that might court the danger of thyroid suppression.

DIM possesses hormone-modulating effects. It may do so in several ways. Studies suggest it protects the body from xenoestrogens, compounds that mimic and intensify the effects of estrogen. DIM has also been shown to favorably alter the ratios of “good” to “bad” estrogen. In the prostate, DIM has been found to antagonize the effects of dihydrotestosterone (DHT), an excess of which is associated with risk of enlarged prostate and prostate cancer.

Thus, DIM’s application to hormone-dependent cancers (breast and uterine in women, prostate in men), as well as to the condition of “estrogen dominance”, wherein high estrogen levels promote symptoms like breast pain, fibrocystic breasts, uterine fibroids, endometriosis, PMS, bloating, anxiety, fat accumulation, and heavy menstruation.

Because DIM combats excess estrogen in females, it might help as a diet aid for women who struggle with a pear-shaped fat distribution.

Another theoretical benefit of DIM may be to offset the potential risks of hormone-dependent cancers in patients taking hormone replacement therapy with estrogen or testosterone.

In addition to its hormone-modulating effects, DIM has been found to exert direct anti-cancer effects via a variety of mechanisms: It may promote DNA repair; accelerate the death of cancer cells by restoring apoptosis (programmed cell death); it stimulates the activity of natural killer (NK) cells, the immune system’s surveillance against cancer; and some studies suggests it has anti-angiogenesis effects, depriving growing cancers of their blood supply.

Is DIM compatible with conventional therapy for cancer? Some studies suggest that, not only does it not interfere, but instead may protect normal tissue from the harmful effects of radiation while reinforcing cancer cell destruction. Other research suggests DIM may prevent drug resistance, a major cause of chemotherapy failure.

As a corollary to DIM’s anti-androgen effects, some have proposed its application to conditions of hormone dysregulation like acne, androgenic alopecia, and polycystic ovarian syndrome (PCOS).

Less certain is DIM’s effect on Human Papilloma Virus (HPV). I have long used it successfully as part of a nutritional protocol for women with abnormal Pap smears desirous of preventing progression to invasive cervical cancer. Belief in DIM’s antiviral properties is based on research demonstrating its efficacy against a rare vocal cord disease, recurrent respiratory papillomatosis (RRP), caused by HPV. Preliminary studies and anecdotal reports once suggested that DIM was able to retard the progression of CIN2 and 3 PAP smears, but the latest, most definitive study yielded disappointing findings.

While specific clinical proof is lacking, I have long used DIM as part of my protocol for Barrett’s esophagus, another pre-cancer, along with other targeted supplements, with good results.

A controversy rages in the supplement industry over the relative merits of indole-3-carbinol (I3C) versus DIM. While it is true that I3C has documented intrinsic activities apart from its role as a precursor to DIM, after much research, I sided with the DIM camp. For one, much higher amounts of I3C are required to achieve therapeutic benefits; additionally, concerns have been raised over the safety of I3C; and I3C is said to be less stable than DIM.

Some of DIM’s detoxifying effects may be attributable to its ability to up-regulate cytochrome P450 activity. For this reason, it is advisable to exercise caution whenever using certain medications whose effects might be weakened by co-administration with DIM. And, because of its hormonal effects, it is advisable to refrain from using DIM during pregnancy or lactation, or in infants or small children.

The optimal dosage of DIM for various indications is unclear. I generally administer one or two 75 milligram capsules of Dimpro twice daily. The efficacy of doses greater than 300 milligrams per day has not been established, and some reports of nausea or headache have been reported above that threshold.

What form of DIM is preferable? Researchers prefer standardized BioResponse DIM; to date, most clinical trials have used this formulation. To overcome obstacles to bio-availability, BioResponse DIM is micro-encapsulated in a patented delivery system that is said to guarantee predictable absorption and clinically effective blood levels.

– See more at: http://drhoffman.com/article/supplement-of-the-week-dim/#sthash.wcpGIKiW.dpuf
Source: Integrative Heath Network