Episode 48: Allergies and Food Intolerances? Look To The Gut
Can't step outside in the spring without sneezing up a storm? Do leftovers make you feel queasy? What about “health-supportive” foods like bone broth, sauerkraut and kimchi?
All of these symptoms point to signs of histamine intolerance, which today’s guest, Heidi Turner, knows all about. Heidi is an Integrative Registered Dietitian Nutritionist and specializes in complex health issues including SIBO, autoimmune conditions, histamine intolerance, Mast Cell Activation Syndrome and food chemical sensitivities.
On this episode, she talks to Andrea about why people have allergies in the first place and how typical ways of dealing with them, such as antihistamines, aren't getting to the root of the problem.
They start out with a crash course on histamines and mast cells, then dive into how we should be thinking about these issues in the context of gut health versus tamping down our symptoms with bandaid drugs.
Resources mentioned on the show:
On this show, you’ll learn:
- What are histamines? (1:53)
- Histamine and sleep regulation (4:53)
- What are mast cells? (5:42)
- How does this all connect to the gut? (7:21)
- Why do people have allergies? (9:30)
- Solving complex cases (14:03)
- Probiotic supplementation and how are they different (16:08)
- What histamine blockers do in the body (20:41)
- Helpful supplementation (23:56)
- How diet plays a big part in reducing histamine load (28:01)
- How long someone can expect to be on a low-histamine diet (32:48)
- What strains of probiotic are histamine producing or degrading? (42:27)
- Enzymes to help break down histamine (48:22)
Andrea Wien: Welcome to The Microbiome Report powered by BIOHM Health. A leader in gut health and the first line of probiotics to address both bacteria and fungi in the gut. I'm your host, Andrea Wien, and today we're talking about something that nearly everyone has at least some experience with, allergies. Whether you sneeze up a storm during spring pollen season or can't even look at a peanut without breaking out in hives, there's usually something that causes your allergies to flare up. My guest, Heidi Turner, spends her time uncovering the common root causes of allergies and helping her patients overcome their symptoms for good. Heidi is an integrated registered dietician with her own private practice for the last 14 years. She sees a broad range of very complex immune and chronic issues every day. Her specialties include autoimmune conditions, small intestinal bacterial overgrowth, also called SIBO, digestive issues and mast cell and histamine disorders. On this episode I talk to Heidi about allergies, histamine intolerance, common allergy medications and natural long lasting remedies that target the reasons why we react to our environments in the first place. This show is packed with actionable advice and excellent tips about how to tackle your allergies and keep them in check for good. Enjoy the show.
Heidi, thank you so much for joining us.
Heidi Turner: Yeah. Thanks for having me.
Andrea Wien: I would love to just set the groundwork for our discussion and define a few terms and processes if you will just to make sure we're all on the same page for this discussion. So can you walk us through what histamines are, mast cells, how they function with what we call allergies? How does that all work together?
Heidi Turner: Let's talk about what a histamine is and then we kind of move our way through there. Basically, we kind of think of histamines from a allergy perspective. So many of us understand the word histamine as when we're thinking of antihistamines. So we might take a medication such as a Claritin or a Zyrtec or something like that to calm a histamine response that's maybe related to an allergy that we might have. So histamines are basically just chemicals that our body produces for a number of different purposes throughout the body. One of the things that it does do is it does mediate our allergy response. So let's say we inhaled a pollen, we have a mast cell reaction that produces histamine. I'll get to mast cells here in a second. That produces histamine. Histamine basically opens up all of our blood vessels so that our immune system can get in there to do something about it. And if we take an antihistamine and that helps to kind of calm all of that down so we don't have that kind of snotty, sneezy kind of stuff, runny eyes that we might typically see when we're working with an allergy.
So that's one way that histamine kind of works in the body that we're probably more familiar with. But histamines actually…Our body is kind of rife with histamine receptors. We use histamine for a lot of different biochemical purposes. We use it as a neurotransmitter. It has sort of a neuroexcitatory ability. It helps with our sleep and our wake cycle. It helps us to metabolize and produce estrogen as part of our menstrual cycle. It helps us with our heart rate and our blood pressure and our cardiovascular system. And it also actually helps us to produce stomach acid and helps to support digestion as well. So histamine is like…We have these histamine receptors placed all throughout our body. So histamine is a really important part just as far as us doing everything we need to get done. So when we produce the histamine, typically we will produce it, our body produces enzymes that break it down. And once we break it down we're done with it and we move on. So we have this lovely regulatory system where we kind of build histamines, break them down and then move on until we build more and then break them down and move on. And then we have a nice little regulated homeostasis within the system.
So that's kind of how histamines…Where they might exert themselves, what they are, how they work. In a nice good kind of balanced situations everything is good. Does that make sense?
Andrea Wien: Yes, absolutely. And I was blown away when I heard you talking in a different podcast that they regulate sleep. My friend Phoebe, you were on her show and she was talking about how her and her dad take Benadryl sometimes to go to sleep. We know that Benadryl makes you sleepy. You give it to kids sometimes. It blew my mind that it was because it's down regulating this histamine response. It's so interesting.
Heidi Turner: That's right. You got it. So oftentimes…And we can get to this. But oftentimes if you kind of get that wakefulness between say like two and four in the morning, often histamine is involved in that whole process. And so that can be what I'm assessing to see if someone might have some histamine issues going on. It's one of the things I'm looking for that oh my gosh, I wake up at 2:00 and I can't get back to sleep and my brain's on my body's on and I just can't calm it down. Histamine can kind of be a piece of all of that.
Andrea Wien: And I'm sure we'll get into red wine also because that…Or wine in general. We'll definitely talk about it. But I think I hear…A lot of clients come to me and say, "If I have a glass or two of wine I'm waking up at that 2:00, 4:00 window and I can't fall back to sleep." So we'll get into that. But okay, mast cells.
Heidi Turner: We'll get into that. You're jumping ahead here but yes. Exactly. Yeah. And the mast cells, because you had mentioned mast cells. Allergies, mast cells go…So we kind of move from kind of the histamine. All right. So it has a lot of different things. And so the mast cells, that's when we are kind of working more with our allergy situation. The mast cells are these little cells that kind of roam the body looking for problems, looking for the allergens or the pathogens coming through that they perceive to be threats. And so let's say you have a peanut allergy. The peanut comes through, the peanut protein comes in, then that mast cell is going to be there to be like oh, there we go. It's specific to the peanut. Get the peanut. It's going to grab the peanut and once it connects we're basically…Well, actually we're going to have an IgE antibody first connect to the peanut and then that mast cell's going to connect to the IgE antibody and then everything's going to explode. And then that mast cell space is going to explode histamine and heparin and all sorts of cytokines and things. Immune system mediators that warn the immune system to get in there and do something about it.
And so that's where we have these mast cells there to protect us. And from anything that it perceives to be problematic such as an allergy. We'll bring up mast cells a little bit further in as well, but just to kind of lay the ground as far as what is what and who the players are, mast cells contain histamine but we also produce histamine for different purposes throughout the body.
Andrea Wien: Now, how does this all connect to the gut? Are those enzymes that are breaking down the histamine made in the gut? Are we making histamine in the gut? What's the tie there?
Heidi Turner: Exactly. Yes and yes. So we are…Let's see. Well, obviously we have our bacteria in our gut and we have lots of different types of bacteria in there. And so we have bacteria that have been shown to produce histamine, and we have bacteria that have been shown to degrade histamine. And histamine, like I said, it's a really important chemical in our body. Histamine is not only there to help us with digestion but it's also there to help protect our immune system. So we do have lots of bacteria in there that are kind of also down there saying like okay, hey we got something coming through that might be a little problematic. Build a little histamine. We deal with it. That builds an immune response. And then we have other bacteria that are there to say, it's okay, now we're done with that, let's break it all down. So again, another nice little regulatory process going on in there. So we have bacteria that are in there. We also have cells of our digestive track, of our small intestines. Specifically an enzyme called diamine oxidase that we produce. DAO that we produce. And so when we eat foods…This what we'll get to next. When we eat foods that contain histamine…And we have a lot of foods that we eat that contain histamine. Almost all of our foods contain a certainly amount of biogenic amine.
So when we take that in what these little intestinal cells do is they create this enzyme called diamine oxidase and it's just one of the things that helps to break down the histamine that comes in our food. And it helps to break it all down. And once we break it all down then we are less inclined to absorb the histamine that contained in that food into our bloodstream. Because too much histamine in our bloodstream for some people is going to trigger more inflammation and trigger more allergy type of symptoms. That's where the wine comes in.
Andrea Wien: Right, right, right. So we've kind of been talking about in an ideal body, in an ideal situation this is the process that's happening. Why are we dysregulated? Why are people having seasonal allergies or allergy to their dog or something that they've eaten? What's going on? Where's that dysregulation happening?
Heidi Turner: Yeah. And it can be for a lot of reasons. A lot of people have had this from the very beginning since they were young, and have had lots of seasonal allergies or allergies to their dog or such or foods or such. And so there is that dysregulation in the gut that's going to impact that. Either we are born with a lot of bacteria that produce a lot of histamine. And naturally we have seen studies that show that. Those who have histamine issues have a lot of allergies or histamine intolerance. This is where we're going. Typically, have lower amounts of bifido strains. And the bifido strains are the ones that typically degrade that histamine in the gut. And so some might just be more predisposed to that, where they are carrying more bacteria that create more histamine. So that's one possibility. And then the other possibility where we get more into gastrointestinal dysbiosis. And that's where we're working more with issues say related to SIBO or inflammatory bowel disease such as Crohn's or colitis or yeast overgrowth, where we're working with an imbalanced microbiome that are producing all of their byproducts like lipopolysaccharides, mycotoxin, all of their kind of byproducts that kind of create an inflammatory state in the digestive tract.
Once we create that inflammatory state, we're irritating the body's ability to produce more of that DAO. So that when we take in more histamines in our foods, we're less inclined to be able to break them down and we're adding more histamine into an already inflamed situation. Absorbing more histamine in, creating more systemic inflammation as well. So back to your question, the issue often is related to that dysbiosis creating inflammation and impairing your body's ability to manage the histamine that's coming through the diet by reduction of that DAO.
Andrea Wien: So is it too strong to say that all allergies are tied to gut?
Heidi Turner: I don't know if it's too strong to say that. I'd say like 90 to 95% of the time. It's rare. And I'll give this example which is where I thought that maybe this or the other 5% lied. But in most cases I will say of my patients that have allergies, I do see coexisting gut issues. Or if they don't have a lot of gut issues by simply kind of bringing more of these histamine degrading bacteria into the mix, we'll see benefits to them. I have had a few situations where we have severe histamine issues going that look to be histamine mediated. So this is where we kind of get into kind of a histamine intolerance, histamine dysregulation I like to call it more, where we might start to see all of these places that histamine shows itself. Like as a neurotransmitter, we'll see more anxiousness going on, or we might see more scratching, hiving or snotty, sneezy kind of stuff. Or we might see more people waking up in the middle of the night with insomnia. We might see more of these kind of situations where there's an overstimulation of these histamine receptors where I have seen that without any gut issues at all.
Earlier in my career I kind of bypassed the gut. I went well okay, there's no gut issues so we'll just think about other things that are feeding in. And eventually I said just in case we're missing something with the gut, let's make sure we're looking. So we did a stool test and we did a breath test and this person had the highest hydrogen levels I've ever seen on any person on a SIBO breath test, on a lactulose breath test. And she exhibited no gut issues whatsoever. No gas, no bloat, no constipation, no diarrhea, nothing. And so all of her symptoms were more external and systemic. And so once we treated the SIBO all of her histamine issues came down and we never once saw the gut be an issue.
Andrea Wien: It's so interesting too. Like I have celiac disease and I don't ever get gut issues. We often think of celiac as something…Someone's in the bathroom or bloated or in pain. For me, it's always, always, always more like psychological, brain fog, those types of issues. So I can imagine, when we're looking at any of these complex cases it's like you can't just rely on one marker of health.
Heidi Turner: Absolutely. Yeah. And don't get too distracted by what's going on. Say oh, it was headaches so it's there. Right?
Andrea Wien: Right.
Heidi Turner: Oh it's just skin…So it's there. Always come back even if it's not the things that's screaming at you. Come back to it. Rule it in. Rule it out. I have had a few cases where we were seeing lots of these histamine-y kind of issues. And I was looking at the gut and it was clean. We did every possible test. And the gut was clean and I wag giving them probiotics and it wasn't making any difference. And for them it was an environmental issue within their home. So they were being more reactive to things that were going on in their environment. And that was mainly impacting. And then the other piece in all of this is looking at stress levels. Because that too can really adversely impact our histamine load. And so yes that can also impact our microbiome. So again, the microbiome can be downstream and the microbiome can be affected downstream in relation to environment as well. It's important to be looking at the microbiome absolutely, but we also need to be thinking about all these other players that might feed into what's going on as well.
Andrea Wien: Now, you mentioned there were two different paths. Someone could be allergenic from the start. They have different bacteria that they're predisposed or born with and that's one type where someone's had allergies their entire life. That's my sister. So my younger sister has constantly had allergies. She's been allergic to everything. She walks outside and her whole life explodes basically. And then you're talking there's more people…I think this would be more like my husband where he had seasonal allergies. He did a lot of gut healing, cleaned up his diet and they went away. Now he's still allergic to dogs. So when we're looking at these two different types of people, on my sister's side, are you just supplementing that person that might be predisposed to have that gut bacteria with probiotics that are better for degrading the histamines? How are we thinking about these two different or do you think about them differently?
Heidi Turner: I don't think I do think about them differently. I still am kind of looking at the history there first. Okay, this has been something that's been with them their whole lives. Well, I still want to know, what else has been with them their whole lives? A lot of them I find do have methane dominance. That a lot of them have been constipated. And so there is a level of methane dominance going on. So perhaps there's something else playing into that. So I'm still interested in that other person. I don't just way well, it's been their whole life. I still want to make sure that I'm treating them in the same way that I am the person who just all of the sudden started to get more reactive. I still want to make sure that if they haven't gone through the procedures of getting tests, doing stool tests, getting breath tests, getting urine tested to make sure that we're good from an environmental or a yeast perspective, is there something that has been with them their entire life that we've been unaware of that's driving that? So we still have to kind of be thinking from that perspective.
So I don't necessarily think I'd treat them differently. I just kind of think of it from, if it has been within their whole life, are we missing anything? And then if we're not…Let's say we look and everything's clean, then I do find that it's helpful to not just provide them with the probiotic piece. But we also do need to kind of take a look, are there other things that we can do with the diet? Are there things that we can do potentially with some antimicrobials that we might be able to at least shift around that level of histamine in the body? So oftentimes we will shift down histamines in the diet. Do we have to kind of keep a certain threshold of dietary histamines coming through? Do we have to maybe put in maybe some low dose antimicrobials to reduce some of those more high histamine producing strains while we kind of supplant them with more histamine degrading strains and give them prebiotics and give them lot of good fibers to help support that?
So we're still going to be doing all of those things in that particular population. In your husband's situation…And he's kind of already done all the work. And he's been able to shift everything down but we still have the issue with the dog.
Andrea Wien: My son's very upset.
Heidi Turner: Yeah, I was going to say. Then there's different things that we can potentially apply there. Providing he's kind of already done everything and tried the probiotics and tried all these different things and maybe shifted down a little bit of the histamine that might give him a shot at tolerating the dog. If that's not the case then certainly you can look at more alternative treatments. Low dose immunotherapy for the dog specifically. You can look at NAET which is a form of just kind of kinesiology in that sense that I've actually seen people be able to clear their allergies fairly well. Sometimes limbic system retraining can be beneficial to asking the system to be less reactive to something coming at it. So there's lots of different…As you're hearing, there's a lot of different approaches here. You kind of have to always, regardless of how long this has been going on, everybody needs to be kind of looked at in the same way and then treated individually depending upon what they've got going on.
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All right, I want to come back to the diet piece in a minute because I know that it can be very different than a lot of what we talk about on here. And I'll just say fermented foods, that's something that we talk all the time it is beneficial for microbiome and maybe not for histamine. But before we do that, I want to chat about histamine blocking drugs because I think that that, to bring it back to the beginning of our conversation, is something that most people are pretty aware of. If you have an allergic reaction or…My husband for example does take a Zyrtec when he knows he's going to be around dogs. And so when we're taking that histamine blocking drug, what's it actually doing in the system?
Heidi Turner: It's basically making it so that the histamines that our body is producing…So it's blocking. Let's step back. We have a variety of histamine blocking drugs. We have H1 blockers, H2 blockers. Those are the ones that we're going to be grabbing over the counter. The H1 blockers are like the Zyrtecs the Claritins, the Allegras, the Xyzals. Then you have the H2 and those are typically used for the sinuses, the watery eyes, the itchy skin. That's where more of our H1 receptors reside. And so when we take that classification it's going to block the little receptors, our histamine or H1 receptors, so that when we do produce the histamine it does not exert the same effect and we don't get all of those symptoms that we experienced. When we buy H2 blockers…Well, we're not taking ranitidine right now. So we're not taking…Nobody should be taking-
Andrea Wien: Zantac.
Heidi Turner: Zantac.
Andrea Wien: Yep. For more reasons than just what's out there.
Heidi Turner: More reasons than just what's out there but there was some link to cancer there. So if you are still taking that, please stop. Most people have shifted over to a Pepcid, famotidine. That's an H2 blocker. We typically have high amounts of H2 receptors in our digestive tract. And so oftentimes we'll take those when we're dealing more with digestive issues, heartburn, that type of thing. And that just kind of again, blocks those receptors and keeps the histamine that we are producing from exerting itself in a stronger way. So when we take those things it just kind of calms everything down so that ... It's not necessarily stopping us from producing the histamine necessarily. It's just that it's kind of reducing its effect in the body. So it's just symptom management.
Andrea Wien: Right. So it's not actually getting rid of the histamine, it's just masking the symptoms enough that you don't feel terrible.
Heidi Turner: As with most medications. Yes.
Andrea Wien: Yes. Now, there's some histamine blockers that work for some people and not for others. Just to go back to my husband, the Zyrtec works for him for the dogs but Claritin does not. So is there a microbiome component there? Is something happening in the gut that is I guess making it so one works and one thing doesn't?
Heidi Turner: I'm not entirely sure. That's a great question. I don't know if there's any literature on that that I'm aware of. And I'm not entirely sure. Because I do see that quite a bit where they'll take the Zyrtec and they can't function. They're exhausted or it really makes them sleepy. It does absolutely nothing for them. And then they take the Claritin or the Allegra and everything clears up. So I'm not clear on that.
Andrea Wien: I think it's an interesting area. We're starting now I think to really understand even with something like a non steroid anti-inflammatory, a Tylenol or something like that, that the gut bacteria really have such a role to play in how effective those medications are. So I wouldn't be surprised if we do learn something about that.
Heidi Turner: Yeah. That's interesting though. Yeah.
Andrea Wien: Now, there are some alternatives. Like I know my sister takes quercetin, vitamin C. There's some of these more supplement herb type things that we can take. Is that having the same impact on the histamines? Is it just blocking the symptomatology or is there actually support for the body?
Heidi Turner: A little bit more support for the body there. So I do prefer these if you tolerate them. And so I particularly like vitamin C because it actually helps with the degradation of the histamine. So we're going to help break it down a little bit more effectively. So that's good. So I like that. Plus you're getting lots of other benefits from vitamin C. I always like it where we can take something and also get benefits in other areas. The quercetin actually is kind of stabilizing the mast cell. That has a little bit more…So when we are kind of working with the mast cells…Remember we come back to the mast cell exploding and then kind of releasing all that histamine and releasing all of that cytokine that helps bring the immune system in and we get all that reaction happening. And quercetin can actually help to stabilize the mast cell so it isn't quite as persnickety. It doesn't have the tendency to explode quite as effectively. And that's where you're going to get some benefit there. I do work with a really sensitive population. And so that sensitive population often doesn't tolerate the herbal or even the supplemental kind of things. They typically do much better with medication.
And I would say, that's a really general statement. Because I also have patients that don't tolerate any of these things that come through. But I would say that if the herbal stuff…And when I think of other herbs I think of they've shown butterbur to have really…If you have chronic migraines related to histamine, butterbur can be beneficial. Holy basil can be beneficial. And that also has an ability to kind of calm the nervous system down or help from an adrenal perspective. Nettles, stinging nettles have been beneficial. Black seed oil is also lovely and also has an anti microbial effect as well. So there's lots of things that we can take depending upon what our body needs. And so you might take the vitamin C and all it gives you is diarrhea. And it has absolutely no effect on your histamine.
So you kind of have to work your way through because it's a question of what system needs to be supported the most to help calm down that histamine response. So if you're working more from that perspective you might need to just kind of…I always try one thing at a time just to make sure that I'm targeting things well. Again, I work with a really sensitive population that doesn't like a lot of things all at once. Their bodies don't. So I typically go with things one at time and see what's working and see where we need to stay and where we need to increase or decrease. So I might go there. But if they just don't tolerate it, if their body is just so sensitive to those herbs or to the vitamins then we might need to go over to the OTCs and try those. And again, none of these things are resolving the issue. They're not treating the underlying cause of the issue. And I want to make sure that that's understood as well.
That even if all of these things work and you take the Zyrtecs and that's terrific and it's keeping you functional and you take the quercetins and that's great and that's keeping you functional. I think that's really important to stay functional in your life. Like I think about your husband. He can't avoid dogs. And to take a Zyrtec and to go into somebody's home that has a dog, that's a fine place to stay. It's okay. But if we're using all of these things to stabilize something, that's fine to keep yourself functional in your life but I just also encourage you to keep digging and keep looking underneath what else is driving this histamine load and what needs to be either reduced or attended to.
Andrea Wien: Okay, so let's get into that because fixing it from the root cause level, diet plays a big role in this. And I know we're going to break some hearts talking about wine. But can you give us just a picture of what you do when you're working with clients to reduce the histamine load in food?
Heidi Turner: Mm-hmm (affirmative). Sure. First I'm just going to take a…Let's step back a second and talk about the histamines in food and then I'll tell you what I do. We touched on the fact that histamines in foods. So there are naturally occurring histamines in foods and the ones that are the highest are tomatoes, eggplants, spinach and avocado. So those are four ones that have the most ability…The avocado is the toughest one I think and the tomatoes. Nobody cares about the eggplant. [inaudible] avocado and maybe the spinach are the toughest ones I'd say because typically people are eating a lot of those because they're allowed on a lot of these diets. If they're doing keto or if they're doing paleo or something like that we typically eat a lot of those foods. But those are particularly high histamine. Also foods that are fermented or aged. This is where the wine comes in. When we ferment or age we do so with bacteria and these particular type of bacteria that we usually ferment with contain an enzyme called histidine decarboxylase. And they use that to kind of take the histidine that's found in many of these foods that we are fermenting and they produce histamine out of it. It's what makes it taste good.
When you have a really nice aged cheese, that's because you built a lot of that histamine in there. A really nice aged wine is because you built a lot that histamine and lactic acids and things like that in there. Sauerkraut, ferments, misos, all of those things build a lot of flavor through that fermentation process. But unfortunately part of that fermentation process builds a lot of histamine in there as well. So we also have…And I won't belabor this one too much. But we also have something called histamine liberators. And these are just foods that contain other types…They don't necessarily contain histamine but they do contain something called biogenic amine. And this is just a family of amines. A histamine is one of them but there's spermidine and spermine and futracine and cadaverine. There's lots of other…Tyramine.
Lots of other biogenic amines that are found in the majority of the food that we eat. Particularly our plant products. And they do…Some of them do kind of tap into that DAO. So they use some of our DAO in our gut. So for some, if we're deficient in that DAO and we're taking in a lot of these high histamine foods and a lot of these histamine liberating foods and we take all of these in and our gut is just like, "I don't have it. I don't have the DAO to break this down guy.", then what's going to happen is the histamine is going to not only circulate in the gut, trigger more of an inflammatory response, but we're going to absorb that histamine into the system and that's where we're going to overdo the amount of histamine that we have circulating and that's where we're going to start to get more of that kind of systemic reaction. And that's where you might be waking up in the middle of the night after drinking a couple of glasses of wine. That and alcohol. Alcohol does that to our sleep as well. So when you combine alcohol and histamine together it's kind of this really bad recipe that just kind of stimulates the body in such a way that sleep is not going to be a good thing that night.
Andrea Wien: Now, what I thought was so interesting, when my sister really started doing a lot of this work and looking into all these things and trying to heal herself from allergies, she was like, "I can't have leftovers really and I can't have anything that's in a slow cooker. That is my enemy." And I thought that was so interesting. Can you talk a bit about why that is?
Heidi Turner: Yeah. It's just their natural breakdown. So think about fermentation. That comes from a natural breakdown of the food and bacteria is a part of that. So the longer the food is hanging around then the more…Within what, four or five days, our food is generally going to spoil in the refrigerator. And so pretty quickly we're going to start to see that breakdown occur. And for those who are severely…You have a severe histamine dysregulation, even adding more of that histamine in via that breakdown is going to be more problematic. So they may eat the chicken that they cooked or the beef that they cooked, be perfectly fine with it on day one and sometimes day two, but as you move further into it you're going to get more of that fermentation, more of the breakdown and more of the histamine building up. And all of a sudden it's a completely different meal.
Andrea Wien: So when you're working with someone and you're putting them ... I'm assuming you're putting most people on a low histamine diet to start. How long are they staying on that? Are they just avoiding these foods or are there foods that they're adding in also that can be helpful?
Heidi Turner: Yeah. So first of all I've got to take a look at what they're currently doing. It's interesting, some people just kind of naturally and intuitively eat a low histamine diet that have allergy issues. Just because they've just kind of determined over the course of time what feels best and what doesn't feel good. So I always kind of look for that just to kind of see where the intuition has brought them. But initially what I'll do…In most cases people are still eating high histamine foods. It's particularly difficult when I'm working with an Asian population because they use a lot of those fermented sauces and if they work with a lot of Asian cooking, fish sauces, soy sauces, things like that. And what we'll often have to do is really kind of dumb down the diet. Particularly with that population it's tough because they really rely on those sauces to flavor their foods. Also see this when we're working with people who do a lot of salsas or avocados or things that really like to…Hot sauces. Things like that. We'll often have to shift all of that down. And when I say dumbing it down, I just mean it just takes away the flavor of everything when you go onto more of a low histamine diet.
Andrea Wien: It certainly sounds like umami. It's like all these foods, tomatoes, mushrooms, soy sauce, fish…These are all the things that give us that umami flavor.
Heidi Turner: Gosh. I know. When you're accustomed to that and that's what makes food taste like anything, it's a really hard…It's a very bland diet and I warn them about that. And that's the place where we start. I'll just say look, let's just start here. Just so you know and most of your listeners know, you're going to find about eight different low histamine diets out there and they're all going to differ on what's high histamine and what's low histamine. It's best to just choose one. Because generally I find that if you at least reduce down the histamine by even 80% you're going to notice some kind of shift. And everybody can agree on all of these lists that the ferments are an issue. The tomatoes and the avocados and eggplant and the spinach are issues. No one contests that. It's when we get into the histamine liberating foods that I think it draws a lot of confusion. And that's where we start to see these different varying lists. But I'll just kind of stay to that. If you're going to do a low histamine diet, choose one. There's a great one from the Swiss, it's called SIGHI. And that's a good one to start with I would say.
So I have my own that I've developed over the course of time. I'll place the client on it for a couple of weeks. Two weeks is generally enough. Histamine typically…It's a fairly fast…Once you take it down, people typically notice improvements within the week. So it's not like this long six month thing you have to kind of do until you notice any changes. So most people will notice a difference fairly quickly if it's working for them. But I like to give a full two weeks just to make sure we're…Checking to see how somebody does on it. If they're noticing a really huge difference off of it, then my question as the practitioner is, "Okay, is this a histamine intolerance or did we just remove something that your body didn't like? Maybe it's just avocados your body doesn't like but it's okay with the rest of it." So I'll often go through a reintroduction process. Oftentimes we'll just reintroduce all of the histamine foods back in. See how the person does. Just load them up. And I do that for about a three to four day period and just see how the body responds.
And what's interesting is that let's say they're doing better. We load them up with the histamines and oftentimes in day one they're like eating histamines. This meal, second meal, third meal eating it and they're doing perfectly fine. They're not really noticing any changes. And then as they move into day two…Okay, keep loading, keep loading, keep loading. Then as we're kind of moving into day two, day three, that's when they're starting to hit a threshold. And so with histamines…And that's when they're going to start to get more reactive. And I think it's really important to know that each person has their own threshold of how much histamine intolerance they have. So if you do notice a benefit from this, you'll want to kind of go through that loading process to get a sense of at what point do you react? Was it day one? Day two? Day three? Because the earlier you react the lower your threshold. We're going to really have to limit the amount of histamines that you're taking in for the time until we figure out what's going on.
If you're getting into day three before you react, I know you can probably eat a fair amount of histamine without getting too much reactivity. We're still going to start looking for the underlying stuff but we know that you have a little bit more to work with and you can tolerate a little bit more.
Andrea Wien: So by doing the diet alone is there actual healing happening or is it just kind of a short term fix to allow you to get in there and do some gut healing and those types of things?
Heidi Turner: I'd say both. I'll use it first of all…Symptom management, which is huge for a lot of people. Particularly when they're just not sleeping or they can't eat anything or they're constantly sneezing or they've got a migraine 24/7. Just shifting it down just to kind of see the forest from the trees is really helpful just from a stress perspective, a psychological perspective. It's really beneficial and that's always helpful when we're trying to reduce inflammation in the body. Also just to reduce inflammation. Just to reduce that down I have found that as we look to find what the underlying cause is, I find that…Let's say it's a SIBO situation. I often find that if we reduce some of that inflammation, it does help with the treatment tolerance. So if we're going to give you some oregano and berberine or something like that to treat the SIBO, sometimes if we have a lot of histamine coming through and there's a lot of inflammation going on in the gut, sometimes when we start adding more of this stuff into actually treat the underlying cause, you're not going to tolerate it. Because there's just so much inflammation happening. And then the actual treatment is not going to be that effective.
So what I like to do is kind of calm stuff down. Get the gut as calm as we possibly can. Get the person as calm as we possibly can. The nervous system, all of that. That's going to give us a better leg up as far as getting the treatment through and I find the efficacy is much better. So is it a treatment? Like if you just did that would you treat it? No. You're just doing symptom management. You still got to get to the underlying cause. But it might help with the success of whatever treatment you do throw at it.
Andrea Wien: Well and for listeners who might be thinking, maybe this is something that's going on for me, it's easy enough to do the diet on your own for two weeks and then if it does help your symptoms, to find a practitioner then who can dig a little deeper and uncover some these root causes. At least you have a thread to start pulling at.
Heidi Turner: Absolutely. Oh, absolutely. Because a lot of practitioners aren't as tuned into to the histamine intolerance piece. So for you to bring that to them I think is…It's getting you…You're coming in ahead of the game I think. Yeah, I think it can be a beneficial tool for you to try. Now, if it doesn't work, you're having all of these histamine symptoms and it doesn't work ... Because I see this a lot and I want to make sure that people understand. If you're having hives and sinus issues and things that are clearly histamine mediated, and you do a low histamine diet…Like oh, I got a histamine issue, I got to do a little histamine diet. If you do a histamine diet and it doesn't work for you or it makes things worse, please don't do that diet. That may kind of sound funny or crazy, but at the same time I see particularly practitioners when they identify, oh this is a histamine issue, they'll tell their patients to go on a low histamine diet.
And then the patient comes to me because they're already working like a SIBO diet which is the exact opposite of a low histamine diet by the way. And they don't know what to eat. My first question is, "Well wait a minute, when you took the histamines out did it make any difference to your symptoms?" And a lot of the times they'll say no. And I'm like, "Well why are you restricting histamines in the diet?" And they're like, "I don't know. Because my doctor told me to." I'm like, "Back up. Let's get them back in." This just happened the other day and we got them back in and she was just like, "Oh, thank god." And I said, "Did it make things worse when you added them back in?" She said, "No. There's no difference whatsoever." I'm like, "Great. Eat them please." Because psychologically, it's rough when we do these diets.
Andrea Wien: Definitely. Yeah. At the end of the day, you know your body better than anyone. So if you're doing something that's not making you feel better or good in your body then that's a sign. That's something that you should pay attention to.
Heidi Turner: Absolutely.
Andrea Wien: So I just want to end on…We've mentioned that the gut bacteria plays such a huge roll. And I think a lot of times when people are doing gut healing protocols they are adding in enzymes and probiotics. But there are certain strains as we've talked about that are not beneficial if you have histamine issues so just taking whatever probiotic might come your way is maybe not helpful. Can you talk about the strains that we know are histamine producing and histamine degrading and what people should be looking for in those products?
Heidi Turner: Yeah sure. I'll just kind of…When we're working with SIBO…Because this is very common to see SIBO and histamine intolerance go hand in hand. So I'll just say that from the outset. So when we're working with SIBO the two bacteria that kind of star in SIBO or that have been shown to have greater prevalence when working with SIBO, that's ecoli and klebsiella. Those two specifically are histamine producing bacteria. So just know that i we're working with an overgrowth, when we have kind of an overgrowth of those histamine producing bacteria, that alone can be kind of kicking things off. So again, as you move through your treatment, as we see a reduction in the overgrowth, we might see a reduction in histamine intolerance without having to specifically kind of work in any kind of probiotic or give any thought to any kind of probiotic. Because you actually might tolerate a more wider broader strain of probiotic once you deal with the SIBO. So I want to just kind of step back and say that first.
But if you are working more with probiotics and you're working with this histamine intolerance and we're trying to bring in more histamine degrading strains, most of the full spectrum probiotics you're going to find on the market will have some histamine producing bacteria. Paracasei, bulgaricus, lactobacillus brevis, acidophilus in some has been more problematic. The lactobacillus strains I would say in general, though there are some strains which I'll get to here, can be a little bit more problematic to those with histamine intolerance. Where I typically will focus them in on…And this is where there are some actual products out there that have considered all of this and are kind of packaging them up. I really do try to bring more bifido strains in. And it's particularly the infantis strain I work a lot with. That would be found in your Align probiotic. But if you don't want all that added junk in there there's a great baby formula from Jarrow. So they have infant drops and that's a great way to kind of titrate up. I will often start with a single bifido strain. I like that one because it reduces visceral hypersensitivity but also helps to degrade histamine.
And then I might build them into a larger bifido. Like just more strains. There's a great one from Seeking Health that's just a bifido strain. It's the ProBiota Bifido I believe it is. And then there are a few lactobacillus strains that I particularly like. And that's plantarum, rhamnosus, gasseri, salivarius. Those ones will be found in a really great product from Custom Probiotics and those are the D lactate free ones. And they've put in a bunch of bifido strains with those beneficial lacto strains. And for some people, when we bring those in, it can really help to shift down some of their symptoms. But I am always very cautious so I start with one strain, see how it goes and then kind of build out from there. But I will say, that depending upon how you're doing you may not tolerate any probiotic at this point. So if you're severely histamine intolerant, particularly if you have a pretty significant SIBO situation going on, sometimes just any probiotic is going to trigger an immune response in the gut. And so oftentimes I'll just have to kind of step back and I don't even consider probiotics until we're further down the road.
So I'm very cautious. And again, go to the individual. So if you tolerate those things, great and you feel that they provide you benefit, terrific. If they don't then you just need to step back. Either give it a rest, wait until you get further into say SIBO treatment or into anything else that you're doing, and then consider layering in. Go with single strain, move into the bifidos, then move into the bifido with a lacto and then maybe you can graduate into more of a full spectrum sprain without having to worry about it from a histamine perspective.
Andrea Wien: Yeah, that's really helpful. And it does make me think. You were talking about SIBO and when we look at the H2 blockers that are really dampening down stomach acid production, we can start to see this stuff's all connected. So maybe we're having an overgrowth of the bacteria in a SIBO case because we're not making enough stomach acid to kill those bad guys that are in there. So we can really start to put these pieces together. So it's not a one size fits all as you're saying.
Heidi Turner: Absolutely. And remember what impacts your stomach, acid as well, stress. We can't forget that because all…The gut feeds into everything. So that's the other piece. When we're working with histamine, that's my next step. And I'm not just looking at the gut, I'm also looking at the nervous system. And so histamine's a pretty potent neurotransmitter and so when we have more stress, we are producing more histamine. And we're also telling our gut bacteria to produce more histamine as well. So we also need to be thinking and we're in stressful times right now so just making sure that we're paying attention to that as well. And I think that's almost most important place to be focusing on. Because the gut listens. The enteric nervous system of the gut is listening to the central nervous system and vice versa. But if we've got a lot going on, we're basically sending signals to the gut that not all is well. And they will respond in kind. Our bacteria responds in kind, our nervous system of the gut responds in kind. And that is going to start create more issues related to low stomach acid, dysmotility, all of the things that are related to SIBO as well as this histamine intolerance. So don't forget that piece as well. Really important. Because sometimes we can get really focused so much on the gut that we forget what's feeding into that. So really important piece.
Andrea Wien: That's so helpful. One last question. I can already hear people saying, "Okay, well if the enzyme is the things that's breaking down all this histamine and I don't have enough of the enzyme, can I just take the enzyme?"
Heidi Turner: You can. I'll just say so. Yes. That's a great questions. There are DAO enzymes. Diamine oxidase enzymes. Honestly, I see them work in about 20% of my clients and they're exceptionally expensive. And so it's one of those things that I haven't fallen in love with. And I know that it's sort of the first thing of like, just take the DAO stuff and when I see somebody is taking DAO I always ask them, "Do you find it helps?" And I'm going to guess like eight out of 10 say no. They're like, "I don't know." And I said, "Well what would happen if took it out? Do you notice any difference?" And they take it out and they don't notice any difference. So yes you can take them and yes they can beneficial, but please make sure because they're about a buck 50 a pill, that's a lot to be spending on something that may or may not be beneficial. I'm more inclined to again, try and help to reduce the inflammation. Certainly vitamin B6, copper, those things can be of some benefit as far as helping you to build more DAO. Taking in foods like sprouts, like broccoli sprouts or pea sprouts, those type of things have naturally occurring DAO. Bringing more of those things in.
Like there's lots of things that we can help to support it without spending so much money or taking something that we're not entirely clear on. So I'm always very just kind of…Take it as it comes on the DAO. Individual on the DAO. If it helps, great. If it doesn't, do not waste your money.
Andrea Wien: Yeah. And I think our listeners, they've been inundated now with going to root cause and really working on diet and healing so I can't imagine that anyone would be just throwing away their money. If people want to hear more about you, you work with clients so can you talk a little bit about the work that you do and how people can work with you or find you online?
Heidi Turner: Yeah, sure. I have a telehealth based practice. I'm here in Tacoma, Washington but I do see people strictly on telehealth or on telephone if you're sick of looking at the screen. A lot of people are these days. You can find me at foodlogic.org.
Andrea Wien: Great. Well Heidi, thank you so much for joining us. This was really helpful. I think it gives people a lot to think about and if people are suffering with allergies and think it's part of everyday life and part of the seasons changing that they could find relief and they can really get to the root cause of what's going on. So thank you so much for joining us.
Heidi Turner: You bet. Thanks so much.
Andrea Wien: Thanks as always for listening. To connect with Heidi head to foodlogic.org and to connect with BIOHM Health, our podcast sponsor, go to biohmhealth.com. Remember it's B-I-O-H-M. You can also check out our podcast page by heading to biohmhealth.com and clicking on the podcast tab. BIOHM is a total microbiome company with products designed to address the critical roles of bacteria and fungi in gut health. Until next time, be safe and I'm Andrea Wien.
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