Oestrogen & Histamine Intolerance – The Vicious Cycle

The vicious cycle that drives pre-menstrual anxiety, indigestion, headaches & more…

I am meeting more & more women at my private practice in Sydney who have un-diagnosed histamine intolerance. The key to understanding what drives histamine intolerance is to examine its relationship with the hormone oestrogen, and how the two feed each-other in a vicious cycle

The women I meet in my practice have typically done the rounds of conventional testing & treatments with their GP, but haven’t uncovered any significant reason to explain their intense symptoms such as anxiety, congestion, headaches, PMS, pain & indigestion that seem to be much worse right around ovulation and premenstrually

Supplements, herbs & pain medications may be helping to treat their symptoms, but they still don’t feel 100% and have become completely reliant on them to get through their cycle each month

If this sounds like you, histamine intolerance may be the missing link to uncovering the cause of your symptoms

What Is Histamine Intolerance?

Histamine Intolerance occurs when there is a build-up of histamine in the body due to an impaired ability of our body to handle, break-down and metabolise the histamine that we make in the body, and also the histamine that is in particular foods.  When levels of histamine in the body build because we aren’t breaking it down well enough, you may start to experience symptoms of histamine intolerance

A useful analogy for understanding this is the bucket – under optimal conditions our bodies should be able metabolise & break down the histamine we consume in foods and which we make, but if the bucket overflows because we’re not emptying it properly, we can start to experience symptoms of histamine intolerance

It is one of the many food chemical intolerances that many people experience, where their symptoms are all over the place and it seems impossible to figure out which foods they’re reacting to – this is because histamine is in so many foods, so it becomes almost impossible to avoid it completely

The classic symptoms of Histamine Intolerance:

• GIT – Altered bowel function, abdominal pain, nausea, abdominal cramping, reflux
• Headaches , Migraines
• Heavy and/or painful periods
• Joint pain
• Tissue swelling
• Hives, flushing, skin rashes
• Brain Fog, Anxiety, Depression
• Respiratory – congestion, runny nose, sneezing, difficulty breathing

What Does Oestrogen Have To Do With It?

The majority of people who develop histamine intolerance are women, and it appears this has to do with the hormone oestrogen

A big clue that you may have histamine intolerance is if you experience symptoms such as headache/migraine, anxiety, GIT issues that are worse right before ovulation & pre-menstrually

This is because oestrogen rises dramatically leading up to ovulation, and oestrogen is higher premenstrually relative to progesterone, which naturally declines (demonstrated in the graph below)

As women reach these parts of their menstrual cycle where oestrogen rises, this naturally drives up histamine levels because the two feed each other.

It is also common for women to suddenly start experiencing these symptoms during peri-menopause & menopause because although oestrogen levels eventually decline, it is the hormone progesterone that begins to decline initially. So relative to progesterone, higher oestrogen levels can drive histamine intolerance

Interestingly, histamine intolerance symptoms are relieved during pregnancy, due to the placenta increasing production of Diamine Oxidase (DAO) enzyme 500-fold. DAO is the enzyme responsible for breaking down histamine

Numerous studies have demonstrated that oestrogen, particularly the form ‘oestradiol’ (the not so great form), can elicit the activation of mast cells – the cells most known for their role in releasing histamine into the bloodstream when activated by the immune system

So it becomes a vicious cycle where oestrogen & histamine reinforce eachother

> Increase in oestrogen levels triggers histamine release

> histamine causes increases oestrogen production

> chronic symptoms continue in a vicious cycle …

As you can see in the picture, below, once histamine is released it has the potential to cause a large number of symptoms due to its effect on vasodilation, neurotransmitter release, mucous secretion, oestrogen production, smooth muscle contraction & gastric acid secretion

The Key To Overcoming Histamine Intolerance – Treating The Gut

The most commonly mentioned ’cause’ of histamine intolerance is a deficiency in diamine-oxidase (DAO), the enzyme responsible for breaking down histamine. Many people seek out DAO supplements as a way to treat histamine intolerance, but this is unfortunately an expensive band-aid approach that doesn’t address the true underlying cause

DAO is produced by the lining of your intestine, which is an obvious sign that damage to the lining of the gut wall is an underlying cause of histamine intolerance. This is an indirect consequence of underlying gut dysbiosis (microbial imbalance)

Gut dysbiosis is also responsible for directly increasing histamine levels due to imbalances of gut bacteria being responsible for over-activation of the immune system

To to treat over-activation of the immune system, you must address gut dysbiosis. Another clear link here is that altered histamine receptor expression is seen in people with Irritable Bowel Syndrome (IBS), where dysbiosis is a key underlying driver

A downstream of effect chronic dysbiosis I see in many clients is Small Intestinal Bacterial Overgrowth (SIBO), which is very common in people with histamine intolerance. Depending on your symptoms, you may need to rule out & address SIBO if necessary

What To Do If You Think You May Have Histamine Intolerance

• Track your menstrual cycle – Because histamine rises & falls with oestrogen, track your cycle to see if there is a pattern of symptoms intensifying pre-ovulation & premenstrually
  
• Trial a lower histamine diet (see the list below) – Histamine is in most foods to some degree, so it’s more a matter of reducing your total load of histamine containing foods. If you are histamine intolerant, you should notice a level of improvement in your symptoms within 2-3 weeks
  
• Rule out underlying conditions – Ensure you rule out other underlying causes of your symptoms such as Coeliacs disease, Inflammatory Bowel Disease (IBD), Lactose Intolerance, Small Intestinal Bacterial Overgrowth (SIBO). Histamine intolerance is ultimately an underlying symptom of a deeper issue, related to the gut
  
• Check your medications – antidepressant, antipsychotics, blood pressure medications, antibiotics, diuretics, muscle relaxants & malaria drugs are examples of medications that interfere with adequate DAO enzyme production. Do not stop your medications – discuss with your medical doctor and health-care team

Low-Histamine Diet Guide

A great place to start is to experiment with a low-histamine diet. If you have true histamine intolerance, the relief you experience will be rapid and obvious, even if is just slight

There are a large amount of foods that naturally contain histamine, and there are other foods that directly block the DAO enzyme

High-Histamine Foods To Avoid Include

• Fruits – citrus, bananas, papaya, pineapple, strawberries, dried fruits (apricots, prunes, dates, figs, raisins)
• Vegetables – avocados, eggplant, spinach, tomatoes, sauerkraut & other fermented vegetables
• Nuts – all nuts & peanuts
• Dairy – all dairy products including fermented dairy such as yoghurt & kefir
• Dairy Alternatives – coconut yoghurt & other fermented products
• Protein – cured meats such as bacon, salamin, pepperoni, luncheon meats & hot dogs, shellfish, mackerel, tuna, smoked fish, anchovies, sardines
• Starches – Soured breads, wheat germ
• Seasonings & Other Ingredients – Pickles, olives, vinegars, miso, soy sauce & tamari, mayonnaise, artificial preservatives & dyes
• Drinks & Alcohol – Wine, champagne, beer (alcohol in general), kombucha, energy drinks, black & green tea, yerba mate
• Chocolate – sorry!

Histamine “Safe” Foods to Stick To On A Short-Term Low-Histamine Diet

• Fruits – All Fresh fruits except citrus, banana, papaya, pineapple, strawberries
  Vegetables – All fresh vegetables except avocados, eggplant, spinach, tomatoes
• Dairy Alternatives – coconut milk, rice milk, hemp milk, almond mild
• Protein – Freshly*** cooked meat, poultry (frozen or fresh), freshly caught fish, eggs
• Fats – Coconut oil, olive oil
• Seasonings & Other Ingredients – leafy herbs
• Drinks & Alcohol – Herbal teas, no green or black tea; no alcohol

*** Freshness is very important in the foods you eat – notice that many of the foods to avoid are aged or fermented

Avoid eating leftover meats & fish, and strictly avoid any canned fish, as they will be higher in histamine. Frozen fish is fine

Take Action Now

Start tracking your menstrual cycle, trial a low-histamine diet & seek the appropriate help to heal underlying gut dysbiosis & intestinal permeability so that histamine intolerance no longer leaves you struggling with unmanageable & constant symptoms