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February 07, 2020 HPN 14: Are Your Symptoms Histamine Intolerance? Plus: Hair Loss in Women (Reasons and Fixes), and Cutting Food Costs While Keeping Quality High

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Welcome to episode 14 of Holistic Performance Nutrition (HPN) featuring Tawnee Gibson, MS, CSCS, CISSN, and Julie McCloskey, a certified holistic nutrition coach who you can find over at wildandwell.fit.

On this episode:

Intro and resource links:

Episodes mentioned in this show:

Dr. Michael Breus: Discover Your Chronotype to Optimize Workout Timing, Improve Sleep, Unlock Potential, and More

Brie Wieselman: Foundations of Functional Medicine and Application to Reach Optimization

Julie is training for an ultra! She is training for The Rut 50K in Big Sky, Montana

The Endurance Planet podcast is now under the Health & Fitness category in iTunes.

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Do you have any questions that you would like to ask Endurance Planet? Please email them to [email protected]

Lisa asks:

Histamine intolerance- how to diagnose, what foods to avoid, and is there a fix?

Hi, Thanks for the show! We are told all the time to eat fermented foods, bone broth, eggs, and also many of us who are busy athletes are doing food prep on weekends thus eating leftovers throughout the week. But I think I am having histamine intolerance, and I read those foods are high in histamine. Should I avoid those foods? Are there other foods to avoid? And also how can I verify that I am in fact having a histamine reaction? And if so can I fix it? Some background: I am training for marathons, have been for several years. Female, 36 years old, and worried that maybe I’m having some gut issues and signs of being a bit run down.

What the Coaches say:

Histamine:

Chemical naturally found in some foods; also produced by the body

Forms when the amino acid histidine is transformed into histamine

Any food containing protein can form histamine under the right conditions

Function – to fight off pathogens in our gut. It stimulates our immune system to release killer chemicals that attack the dangerous invaders and keeps our body safe

Motility – keeps things moving, excretes the waste and toxins

Acid – helps our stomach secrete the acids it needs to digest protein

We want histamine, but not too much. An excess can falsely trigger our immune system to release killer chemicals and create inflammation, but since it’s a false alarm and there’s no actual enemy to kill, our immune system is overstimulated for nothing and it ends up hurting us

What’s happening during a histamine reaction?

When our histamine bucket overflows it generally looks like an allergic reaction with flushing, watery eyes, nasal drip, and a bunch of other stuff listed below

1% of the population has histamine intolerance and most are middle-aged women

Histamine is released from immune cells when they detect a threat

When released, it triggers smooth muscle contraction in the intestines (often causing cramps and diarrhea), expansion of blood vessels (often causing low blood pressure), mucus secretion in the nasal passages and GI tract, and many other physiologic effects that are intended to fight off invaders

More common histamine reaction; e.g. a foreign protein triggers histamine release such as pollen, bee sting, pet hair, etc.

Most Common Signs/Symptoms of Histamine Intolerance:

Itching, redness, hives and/or swelling of the lips, tongue, or skin

Red eyes

Swollen eyelids

Atopic eczema

Sneezing and nasal congestion

Menstrual irregularity

Chronic fatigue

Anxiety

Depression

Where is it coming from? What is the root cause?

Mast cell activation syndrome. Estradiol can elicit activation of mast cells > histamine release

Overactive/hypersensitive immune issue

The body has produced too much histamine because of an overactive mast cells/immune response

Intestinal bacteria will directly release histamine

Hormones

High estrogen levels / estrogen dominance

Mast cell activation syndrome – Estradiol can elicit activation of mast cells > histamine release.

Estrogen can also down-regulate the enzymes DAO and monoamine oxidase (MAO) which break down histamine.

“That time of the month” – symptoms common at the start of the menstrual period (or anywhere between ovulation and just before the period starts; i.e., higher estrogen luteal phase)

Also, higher likelihood at menopause, when estrogen levels are on the rise and progesterone is decreasing

Estrogen supplements may trigger histamine intolerance.

The histamine can then trigger more estrogen production- a vicious cycle!

What we want in this equation is more PROGESTERONE!

Can inhibit the release of histamine from mast cells

Increasing Prog to upregulate DAO

The degradation of histamine is impaired

DAO is an enzyme that degrades histamine

Could be a genetic polymorphism that causes a DAO deficiency and thus high histamine

DAO is secreted from the microvilli in the intestine (also produced in the placenta during pregnancy), so any gut imbalance will increase chances of histamine intolerance

SIBO

Dysbiosis

Autoimmune (e.g., celiac, Crohns, non-celiac gluten insensitivity)

Viral/Bacterial Infection

Stress

Leaky gut

IBD

Exercise & athlete tie-in with histamine:

Not quite the same as the general histamine reaction; more localized to muscle tissue

During exercise, histamine is released locally within the exercised muscle tissue; it comes from mast cells, and binds to receptors in muscle

Mast cells triggered during exercise due to localized inflammation, release histamine

Post-exercise role: histamine is a mediator of post-exercise hypotension and vasodilation

Helps increase blood flow- Likely that “histamine contributes to exercise hyperemia during prolonged physical activity (25), but this has not been tested.”

Skeletal muscle glucose and glycogen, “activation of histamine receptors following exercise modifies the delivery of glucose to recovering muscle groups.”

Overall, “relatively little is known about this molecule in the context of exercise physiology, but it appears to be a fundamental component of exercise responses in humans.”

Source: The Intriguing Role of Histamine in Exercise Response

Not a good idea to use antihistamines! We actually want this localized histamine response during and after exercise. Eg. relaxation of blood vessels, an increase in blood flow up to 2hr post, role in DOMS.

“Blocking histamine’s actions during muscle-damaging exercise, via common over-the-counter antihistamines, resulted in increased serum creatine kinase, an indirect marker of muscle damage. Paradoxically, blocking histamine’s actions attenuated muscle strength loss and reduced perceptions of muscle pain for 72 h following muscle-damaging exercise. These results indicate that exercise-induced histamine release may have a broad impact on protecting muscle from exercise-induced damage.”

Study: A single dose of histamine-receptor antagonists before downhill running alters markers of muscle damage and delayed-onset muscle soreness

Instead, if having problems let’s look back to diet and lifestyle management outside of exercise!!

Might need to avoid eating immediately pre-exercise, eat 2+ hr prior. Low histamine foods, etc.

How to test?

Low-histamine diet for 4 weeks and then reintroduce

Serum DAO levels

What to do?

Start with the basics

Run-down:

Cortisol may be dysregulated and immune system compromised (HPA AXIS)

Work on rebalancing cortisol levels through stress management techniques

Why is your body in such a fearful state that it is sounding the alarm of histamine so readily? Fight or flight mode

Start with the elimination of inflammatory foods

Standard elimination diet 3-4 weeks

Paleo’ish; eliminate gluten, dairy, processed foods

Gut soothing and repair nutrients, antimicrobials

Then consider a Low FODMAP for 2-3 weeks to evaluate if it’s working

Then, thirdly, a low-histamine diet – very restrictive, low compliance

Supplement:

Vitamin C – helps degrade histamine

Vitamin B6 – helps DAO do its job

Quercetin – a natural antihistamine

High-Histamine Foods:

The longer the maturation of the food, the higher in histamine. Generally, anything aged and fermented will be high in histamine

Aged Cheese – swiss, parmesan, cheddar, gouda, camembert

Alcohol – red wine has 3x more histamine

Bone Broth

Canned Fish – mackerel, sardines, tuna, herring

Fermented Foods – sauerkraut, kimchi, kefir, kombucha, miso, natto, tamari, coconut aminos

Fermented/Aged Meats – sausage, salami, pepperoni, hot dogs, etc.

Vegetables – spinach, tomatoes, eggplant

Fruits – avocado, dried fruit

Vinegars (pickles, mayo, olives) and yeast products

Leftovers

Soured Foods – sour cream, buttermilk, soured breads

Nuts – walnuts, cashews

Beans – chickpeas, soybeans

Histamine-Releasing Foods:

Alcohol, bananas, chocolate, cow’s milk/cow’s dairy, nuts, papaya, pineapple, shellfish, strawberries, tomatoes, wheat germ, artificial preservatives, and dyes

DAO Blocking Foods (makes it hard for you to break down histamine):

Alcohol, energy drinks, green & black tea

Low-Histamine Foods:

FRESH meat and seafood

All fruit and veg except eggplant, tomatoes, avocados, spinach, pineapple, papayas, dried fruits

Cooked eggs

Dairy Substitutes

Gluten-Free Grains – rice, amaranth, quinoa, teff, millet

Olive oil and coconut oil

Leafy herbs, herbal teas, coffee

Summary of Advice: start by reducing stress so that your immune system isn’t so reactive. Lower training, add in meditation, increase supportive foods, get outside, get good sleep, hang with loved ones. Then work on reducing inflammatory foods that help heal the gut; starting with gluten, dairy, sugar and work your way down the line. Start a food journal if you’re pretty sure you’re reacting to a food but just can’t identify it.

Calesse asks:

Hair Loss- Why?

I’ve got another one for you, a really long standing issue that perhaps you might be able to offer some insight on? (If you pick my question to answer, unless you see fit, no need to read the entire question aloud as I’m going to give you some in depth background here). I am a female who has struggled with thinning hair and hair loss since my mid teens (now late 20s). At certain times it has been worse than others, but it seems to be a somewhat persistent problem for me. When I initially noted the onset of issue and it was at its worst, I was under a great deal of stress with my family frequently moving, I was running track and cross-country and swimming competitively during various school seasons, and I was restricting food intake and was underweight. Through high school I sought therapy and got a better handle on my nutrition and got back to a health weight for my height and build. I’ve been involved in endurance sports since childhood, competed at the D1 level in college, and now compete in local 5ks, 10ks, up to the marathon at an age group competitive level. Over the past 5 years, my weekly mileage as ranged from 40-65 miles per week with a few sessions of light core/ lifting as well.

Despite nutritional supplements such as a multi-vitamin, biotin, and iron and eating what I believe to be a diet adequate to support my lifestyle and training, I still struggle with hair loss. I’ve been tested for thyroid issues and iron/ ferratin and they have all come back “within range.” I also have been taking birth control since the age of 17. My pediatrician initially put me on this to regulate my cycle after getting 1 period at the age of 17 and then not again (for the past two years it’s also actually be serving as contraception now that I am married). Thus, I don’t know what my natural hormone levels are as I’ve read that if female hormones are out of wack or cortisol even, this can affect hair growth.

Even though I feel good at this training level, is it possible my training could be impacting this element of my health? Is there something I’m missing here? Any thoughts would be appreciated. P.S. I wash my hair with a mild shampoo and then conditioner and few times per week, air dry it, and am very gentle in everything I do with it.

What the coaches say:

Possible reasons women lose hair:

Iron deficiency

Ferritin <50 indicative of an iron issue

Estrogen dominance/low progesterone

Any sex hormone imbalance

Check blood sugar regulation which can drive hormonal imbalance

Estrogen makes hair soft and silky while testosterone makes it thicker and coarser. Too much estrogen can make hair too thin and soft, and an oversupply of testosterone (unbalanced by enough female hormones) can make hair fall out

Thyroid problems (even subclinical)

Possibly thyroid issue if: TSH > ~2.5, Free T3 <3.0 or >3.5, Free T4 <1 or >1.5, Reverse T3 <8 or >25

TPO Abs >34