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

February 7, 2020


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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:

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:


  • 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
  • Asthma
  • Low blood pressure
  • Heart arrhythmia
  • Abdominal pain
  • Bloating
  • Diarrhea
  • Gas
  • Nausea
  • Vomiting
  • Headache
  • Dizziness
  • Sleep disturbances
  • 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.”
  • 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
    • Thyroglobulin >0.9
    • The thyroid panel  that Tawnee mentioned
  • Autoimmune
  • Check ANA, RF, Thyroid ABs
  • Hashimoto’s thyroiditis, lupus, psoriasis, alopecia, and more
  • Inflammation
  • HsCRP & ESR
  • High cortisol levels/HPA axis dysfunction
  • Stress balance, overtraining, etc.
    • High stress depletes us of vitamins and minerals
  • Androgen dominance  (e.g. High testosterone, DHEA)
  • Possible signs of PCOS
  • High 5-alpha-reductase/DHT
    • The enzyme that converts T to DHT- find this out via DUTCH test; DHT is potent androgen and indicated in male pattern baldness
    • If free T high, also check to see if SHBG is low (it binds to excess hormone)
  • Birth Control
    • “The AHLA believes that it is imperative for all women especially for those who have a history of hair loss in their family to be made aware of the potentially devastating effects of birth control pills on normal hair growth.”
    • Contraceptives with a high androgen index (more similar to testosterone than progesterone)
    • Medroxyprogesterone acetate, levonorgestrel, norgestrel, and etonogestrel. They cause hair loss by shrinking (or miniaturizing) hair follicles. It’s a slow process, you could be on the pill for years before your hair starts falling out
    • Contraceptives with a low androgen index
    • Drospirenone, norgestimate, and cyproterone
      • Don’t cause hair loss when you take them, but will when you stop them because of a rebound surge in androgens
    • Not ovulating, not making your own estrogen and progesterone
    • Stress, iron deficiency, excess dieting, autoimmune or gluten allergy that damages the gut, insufficient protein, zinc, and EFA’s. Also, synthetic progestin can have an androgenic effect that can provoke hair loss
  • Types of hair loss and what they mean
    • Overall thinning – stress, thyroid, hormones
    • Patchy- cortisol, B vitamins, heavy metals, autoimmune
    • Male pattern baldness/receding hairline – hormones like T, cortisol, estrogen, progesterone

What do to?

  • Depends on the underlying root cause (see list above). Start by working with a functional medicine practitioner or health coach to dive deeper. Don’t start just throwing supplements at it or special shampoos.
  • That said, here are a few tips:
    • High fatty acids/omega-3s in diet
    • Moderate exercise, not excessive
    • Digestive support to make sure absorbing vitamins and nutrients in food
    • Improve nutrient intake and absorption
    • Protein and Omega 3’s
    • Pay attention to the frequency and quality of protein intake
      • Whether you’re active or not we need a minimum of 1.5 grams per kilogram of body weight for active individuals
    • Zinc, Iron, Iodine, B’s
    • Reduce stress, training, increase digestion, modify diet, prioritize sleep
    • Be Patient
    • It will take at least 2 months. Once hair is pushed into the telogen phase (resting follicle stage) it will continue to fall out for 2-4 months later, you can’t really reverse it back into a growth phase. So you may continue to see hair loss even if applying the best treatment

Mike S. asks:

Food costs for athletes

I’m keeping this short. What advice do you have for minimizing food costs as much as possible while still maintaining high nutritional value?
There are two things I can’t change: I need to eat low carb (not keto) and I need to eat meat. My body and mind just perform a lot better so long as I maintain those two requirements. I also love my vegetables.
I currently spend $500/month on food, which is ridiculous. I have high caloric needs, but I also have a ton of student loans I’d like to pay off.
Thank you as always. You are the best.

What the coaches say:

  • Walden Local – quality meat and fish CSA in the NE that delivers to Concord
  • Misfits Market – organic fruit and veg delivery box, 40% less than what you’d find in stores! Each box has 12 different types of fruit and veg, weighs between 10-13lbs and feeds 2 people for a week for $22 or an 18-22lb box for $35 said to feed 5 people per week
  • Thrive Market for the staples
    • Tawnee’s stats as a 5-year Thrive member: projected annual savings is over $700 (lifetime savings over $3k after 5 years!)
    • Join at EndurancePlanet.com/shop; which also helps support the podcast!
  • Cut out the middleman and buy at farmers market/veg stands/join a CSA. Hunt. Forage. Grow your own veg and herbs
  • In stores: don’t buy at eye level, take your time in the store and look up and down the shelves. Make a list and stick to it. Only buy what is on sale. Buy in bulk. Skip the packaging. Shop in season. Cook lots and freeze meals. Try different grocery stores. Shop the ugly fruit and veg bin. Buy discounted items that are about to go bad.
  • Next month apply some of these things and only allow yourself to spend $450, then $400, and see how low you can get it while still fulfilling your needs
  • Tawnee mentions a few other resources:

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