Tag: histamine

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Individual Nutrition assessment – an example chart note

What is health care? What is included in an individualized health care appointment?

The answer varies with the type of specialist you are seeing – and what they are allowed to do within their facilities’, or the individual’s insurance plans protocols.

My nutrition counseling experience was in prenatal/early childhood, and residential (nursing home) facilities.

Chart notes would be written for high risk clients when working in either role. Occasionally the nutrition assessment and recommendations note would be sent to the physician directly if very high risk.

As a preventive health focused prenatal/early childhood counselor, or for residential facility chart review (nutrition assessments of all nursing home residents considered high risk nutritionally, occasionally would include an in person visit with the resident to visually observe and ask further questions about their health and diet symptoms.

Patients typically do not see a chart note. They might be given the ‘Problem’ and ‘Assessment’ sections as an action list of recommendations on a simpler handout. The medical chart has a Care Plan section where recommendations for a daily change in care might be added – such as adding a high protein snack in the evening.

I would typically spend a half hour to an hour per client and writing a good note might take an additional 15 minutes. Current insurance standards have been set which limit physicians to 15 minutes per patient appointment – and only scheduling/discussing one symptom per appointment. That would make a differential diagnosis fairly impossible.

  • The entirety of a person’s symptoms – and what makes the problems worse, and what seems to improve things – is what provides clues to the underlying issues that may have led to the increased inflammation and/or decreased function.
  • Health is a balance of not too much inflammatory response -> autoimmune or allergies – or too little -> rampant infection and catching every cold.
  • Health is also a balance of enough nutrients and not too many toxins to cope with, whether from air, water, food, or touch, or from internal production of stress chemicals caused by emotional or physical stress.

Autoimmune issues are particularly challenging because many odd symptoms can occur, and more than one type of autoimmune antibody may be involved – not just one ‘autoimmune disease’ – several. Low vitamin D makes autoimmune issues more likely to occur, and low magnesium can make low vitamin D more likely – even with supplements of vitamin D.

Low magnesium also increases inflammation symptoms, pain, and anxiety, depression or anger and irritability.

A physician might look at my example note (below) and think: ‘but this is not my field‘ — exactly — please refer to the specialist – a registered dietitian or clinically trained nutritionist. Caution, there are many ‘nutrition certification’ programs online which are not equivalent to a college education, internship, and the equivalent of a lawyer’s Board Exam.

The client gave permission to share the write-up for educational purposes or maybe to help someone. Patients know that pain hurts, and that health is better. Too often I hear from physicians something like ~ ‘we don’t know what is causing this, … so the patient will probably die‘ – but it is regarding symptoms that likely involve nutrient deficiency.

Even sick patients need to eat or be fed and their nutrient needs are likely increased, or decreased, due to the illness, for a few specific nutrients affecting or being used in excess by the underlying issue. Telling a patient there is no hope is providing a nocebo – a negative expectation. Saying “I don’t know,” – when that is the true situation – would at least not be setting up a roadblock for the patient to seek further information or a second opinion.

If in reading my example chart note*, as a physician, you think, ‘but this is not my field‘ — exactly — you are correct – but it is the patient’s whole health that matters, not just symptoms that may be temporarily controllable by medications.

SOAPE note

The SOAPE chart note* below, is an extended version compared to what would be likely to be written in a patient chart. SOAPE note: Subjective, what the client said; Objective, what the clinician observed; Assessment; what the clinician believes may be underlying issues; Problem/Plan, recommendations being made by the clinician; Evaluation – an opinion statement about the likelihood of positive change, based on the overall attitude or motivation the client is presenting and social factors that may impact the client positively or negatively.

I included extra information that might be in a report to the client, with the education they might need to understand the reasoning for the recommendation, or how to proceed. Complex strategies can take several weeks of a class like setting possibly with cooking and tasting demonstrations. My web pages and posts try to provide self care guidance so a motivated learner could just try things and see if they help.

I added some additional info links for the version in this post, to pages or posts that provide some next step guidance, Gluten Free diet? what is that? The products on the market are not ideal suppliers of nutrients in my personal and professional opinion and learning how to bake gluten free can be healthier and less expensive for the nutrient value. My websites are my file cabinet of patient handouts, some of it.

While working as a public health nutrition counselor I did occasionally write a very thorough note for someone with a complicated case, and send it to the client’s physician on their or their child’s behalf.

Nutrient deficiencies can lead to death (niacin/pellagra example) – and can turn around dramatically very shortly after the nutrients and any cofactors are provided (nutrients are a team – refeed gradually and in balance).

Sometimes nutrition care is a life or death situation. Continue the nutrient deficiencies and deterioration can be rapid, and death can be the result. Niacin deficiency, pellagra, has a nickname for symptoms – the four D’s: “Pellagra defines systemic disease as resulting from a marked cellular deficiency of niacin. It is characterized by 4 “D’s”: diarrhea, dermatitis, dementia, and death.” (1) If there is severe lower leg rash and edema – suspect a B vitamin deficiency.

Nutrition assessment

Subjective:

  1. CoV like symptoms, mild, ~ early outbreak mid 2020, left a new problem, 2. swollen throat, reflux like pain/not quite reflux though, flair up of CoV symptoms again later when family had it 2021, again not too bad. 
  2. Swollen throat symptoms – has had labs showing autoimmune thyroid condition.
  3. Thyroid symptoms had improved a year or so earlier after stopping use of wheat/gluten and dairy. Recently started using ginger tea for the throat problem and it sooths. Hasn’t used long term, recent addition. 
  4. Reading about eosinophilic esophagitis did not sound like the problem. 
  5. Reading about histamine/MCAS symptoms did sound like it might be a problem. Tomato/salsa particularly, chicken causes congestion. Likes to drink orange juice.

Objective:

  1. Pale complection, may suggest magnesium deficiency/low vitamin D, low level anemia of chronic inflammation possibly.
  2. Throat visibly enlarged in pattern of enlarged thyroid gland 

Assessment: 

  1. CoV, even with mild symptoms, may have increased autoimmune antibodies, or created new types. Pale complection may suggest magnesium deficiency/low vitamin D, low level anemia of chronic inflammation possibly.
  2. Enlarged thyroid gland would be likely to cause difficulty swallowing at times, particularly if a food flair of the underlying autoimmune antibody sensitivity. (The thyroid gland presses inwards also and can narrow the throat significantly – *personal experience from also being an autoimmune thyroid patient, swallowing a large supplement can be very painful, and may feel stuck even.)
    1. Eosinophilic esophagitis might also be adding to swallowing symptoms if early stages, wouldn’t be causing as severe reflux symptoms as a more advanced case which is more likely to be what is described in articles about the problem. Food sensitivities are the most frequent cause and include gluten, dairy, eggs, and other common food sensitivity foods.
  3. Autoimmune thyroiditis can be a gluten molecular mimicry problem – the thyroid hormone chemically is similar to the gluten molecule. 
  4. Autoimmune antibodies to other food chemicals might also flair up an underlying autoimmune overactive eosinophile problem, white blood cells. Ginger contains a chemical similar to albumin and an egg sensitivity might be triggered by a sudden increase in use of ginger – or chicken – or eggs, or any animal product containing albumin. *also learned from personal experience – this can be a significant problem – I developed sensitivity to eggs and gradually realized I needed to exclude all sources of albumin or my symptoms would flair up again (non healing rash, not quite eczema – more wounds, lack of skin regrowth).
    1. An apparent ‘wheat/gluten’ sensitivity might be an albumin sensitivity, see one of my early posts with the information about plant albumin in wheat and ginger: Wheat is rich in albumin – so are ginger and egg whites.
  5. Histamine sensitivity seems a problem worth working on by decreasing trigger foods. Orange juice could be an additive problem food. The total load is part of the problem but even small amounts can set off the allergy cells that increase inflammatory cytokines and pain/inflammation signals – swollen, itchy, sore throat, dry eyes, but it can also effect mood when a more severe problem – extreme anxiety and fear, or out of control, hyper-excitable.

Problem:

  1. Elevated iron and symptoms of anemia of chronic inflammation may be a lingering CoV effect or of autoimmune conditions – it can be common to have several types of autoimmune antibodies also, and there has been cases of LongCovid where autoimmune antibodies were found. The spike lodges in a receptor and antibodies are made against the receptor, instead of against spike.. 
    1. Iron chelators may help mitigate chronic inflammation damage, restore energy level if that is a problem. The quercetin is one, continue regularly, opposite the niacin protocol if following that., or eat more of the good plant sources of a few, EGCG, pomegranate peel, green tea, oregano, olive leaf extract, there are many see the Iron chelator section of this Resources & Iron Chelators list. 
    2. Epsom salt soaks for a topical source of magnesium, help immune function, energy level, fluid balance. Continue if already using or start 1-3 times a week.
    3. Sunshine or Full spectrum light 20-30 minutes per day and or a moderate dose vitamin D3 ~ 600-1000 IU. 
    4. Avoid glyphosate residue. Consider supplementing with DMG, dimethylglycine, bulk powder, 1/2 spoonful once or twice a day in water or with a little juice and water. (too much juice is not really good for us).
  2. Thyroid problems in the modern world are likely related to excess fluoride and bromide and too little iodine. Cautiously increasing iodine and 200 mcg selenium may be helpful. Higher dose for one month can help the body to dump fluoride, bromide and chloride. When there is a lack of iodine the body will build molecules with the other halides, but then the thyroid hormone or other chemical won’t work right. Lab tests may show ‘normal’ levels of thyroid hormone but symptoms of hypothyroidism may still be present.
    1. In autoimmune conditions, when possible, it is essential to identify the trigger foods and strictly avoid them. It can take 6 months for antibodies to fade away, at which point symptoms should improve, but memory B cells still exist so even little tastes of the problem foods can set off a new 6 month batch of autoimmune antibodies that will attack the thyroid gland, or esophagus, or wherever else the problem point is located. 
    2. In this case eggs/chicken/ animal products/ ginger/ albumin /*hemp kernels too then/, may be part of the problem foods – 
    3. Elimination type diets that start with the least risky foods and gradually reintroduce things one at a time can be the best way to individualize what is the problem for you the individual. 
  3. Gluten was definitely identified as a part of the thyroid problem by removing, it already had helped to stop that. Dairy has a variety of allergens, and also would have albumin. Removing food triggers strictly, can help a swollen thyroid gland reduce in size – versus get more swollen when trigger foods are eaten.
    1. Gluten free baking recipes and tips for converting recipes: effectivecare.info – G8. Cookies & Bean Soup. -> and it mentions that increasing corn or corn flour instead, is not ideal either. Corn or gluten can increase zonulin which also increases leaky membranes in the gut or blood brain barrier, and more open membranes can increase risk of allergens entering undigested from the diet. See: What is Zonulin? (2)
    2. A quick mix recipe that can be used for pancakes or muffins, a post: Pancakes in a Jiffy – Quick Bread Mix.
  4. Eosinophilic esophagitis may be related to food sensitivities, so as food elimination is attempted it would also be helpful to pay attention to the swallowing symptoms to see if change occurs other than the swollen pressure feeling of the enlarged thyroid gland.
    1. “Research shows a strong connection between food allergies and eosinophilic esophagitis (EOE). These six foods are most commonly associated with this allergic response: dairy, wheat, soy, eggs, nuts, and seafood/shellfish. Unfortunately, there is no accurate test to identify food allergies* connected with EOE.” (3) 
    2. *The food sensitivity is not the same type as tested for people who get hives to peanut butter or eggs or are allergic to bee stings. It is food sensitivity that activates white blood cells though, called eosinophils. 
    3. During normal function eosinophils fight parasites for us. So …. Maybe they are doing something in ‘autoimmune disease’ that involves their normal function too fighting an unidentified parasite – or they are responding to chemicals of the six foods listed above in an allergy-like way. 
    4. Asthma and allergies involve increased eosinophil activity, which can lead to inflammation symptoms and tissue damage: “Eosinophils can consume foreign substances. For example, they fight substances related to parasitic infection that have been flagged for destruction by your immune system. Regulating inflammation. Eosinophils help promote inflammation, which plays a beneficial role in isolating and controlling a disease site.” […] “…eosinophils play a key role in the symptoms of asthma and allergies, such as hay fever. Other immune system disorders also can contribute to ongoing (chronic) inflammation.” (4) 
  5. Eliminating common histamine problem foods may help anxiety and inflammatory symptoms. Orange juice, tomatoes, fermented foods, or older leftovers, cranberries, others, it is a lengthy list but can make a huge difference *personal issue for me also.
    1. More info on page MCAS/Histamine, jenniferdepew.com: MCAS/HIstamine.
    2. Summary of foods to avoid, or a few helpful in an over-reaction: Histamine Food Lists. it is a document (6)

Evaluation:

Client seems motivated and capable of making positive changes for improving health, cheerful and confident amid a complex set of problems, and has support of family.

So does my disclaimer make more sense now?

  • Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

My professional and personal expectations of individualized health care guidance does not include a 15 minute appointment limited to discussing one symptom. In seeking a health care provider I recommend searching for ‘functional health’ or possibly holistic but that is less precisely used than ‘functional’. The orthomolecular approach is also whole body and restoring function oriented.

*am I taking clients? I am working in that direction but I am still in initial stages of having a system set up.

Change is easiest by just practicing the desired habit and the more often it is remembered, practiced, then the more that brain pathway will be strengthened and the old one is gradually deactivated, becomes harder for the nerve cells to fire instead of being an automatic habit like happens without even thinking consciously – to change that ingrained of a habit takes substituting a new pattern rather than trying to ‘attack’ with ‘will power’. Work with nature and it will work with you. Attack and it tends to have an undesired ripple effect.

Pain hurts, health is better.

We all die, the question is quality of life while living – and enjoying that life while living.

Namaste – the soul in me, sees the soul in you.

We are all children, under the care of Mother Nature and Father Sun.

Where there is light there is life, and there is hope.

Reference List

  1. Hegyi J, Schwartz RA, Hegyi V. Pellagra: dermatitis, dementia, and diarrhea. Int J Dermatol. 2004 Jan;43(1):1-5. doi: 10.1111/j.1365-4632.2004.01959.x. PMID: 14693013. https://pubmed.ncbi.nlm.nih.gov/14693013/
  2. What is Zonulin? https://www.creative-diagnostics.com/blog/index.php/what-is-zonulin/
  3. 6 Food Elimination Eosinophilic Esophagitis, oregonclinic.com, https://www.oregonclinic.com/6-Food-Elimination-Eosinophilic-Esophagitis-EOE 
  4. Eosinophilia, symptoms, mayoclinic.com, https://www.mayoclinic.org/symptoms/eosinophilia/basics/causes/sym-20050752

Documents, Posts & Pages

  1. Wheat is rich in albumin – so are ginger and egg whites, post transcendingsquare.com
  2. Resources & Iron Chelators list, document https://docs.google.com/document/d/1XiwJBPoFUnUTQKcRAW_8NMriQMt8b31zjeTY4zV0wJo/edit?usp=sharing
  3. effectivecare.info – G8. Cookies & Bean Soup, webpage
  4. Pancakes in a Jiffy – Quick Bread Mix. post transcendingsquare.com
  5. MCAS/Histamine. webpage, jenniferdepew.com
  6. Histamine Food Lists. document, https://docs.google.com/document/d/17iz9lsJyGqIUUjF0p-totXp4R2GhgRi2Na4gYueisTM/edit?usp=sharing
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Glyphosate increases histamine, both may be a factor in COVID19

Recent posts include a long one on glyphosate, biofuel, and liver disease and how it may be increasing inflammation in severe COVID19; and two other posts (a, b) are about how an immune allergy type reaction increases histamine and a variety of symptoms, and which may be a factor in LongCovid. Foods and the health of our intestinal microbiome, bacteria and other microbes, can also increase histamine directly or indirectly. Some foods contain histamine and others cause more histamine to be produced. Glyphosate residue may also cause an increase in histamine. (1)

Genetics may be a factor in who is more at risk for having excess histamine. There is an enzyme needed to break down the excess histamine from foods, within the intestinal tract, which some people may not be able to make. It can be purchased as a supplement and taken with meals. Other people may have overactive mast cells which are the type of immune cell that produces histamine throughout the body. (1 , 2)

If the mast cells are overactive, MCAS – Mast Cell Activation Syndrome, symptoms may be more severe than a seasonal allergy type of histamine reaction and may include: “rashes, hives, itching, flushing, fainting, headache, abdominal pain, nausea, vomiting, gastroesophageal reflux disease (GERD), fatigue, chronic pain, trouble breathing and many more.” (2) To complicate trying to figure out if this is a problem for oneself or a patient the overactivity of mast cells may also be associated with other complex conditions that have varied symptoms too, including: “allergies, autism, autoimmune disorders, cancer, diabetes, Ehler-Danlos syndrome, postural orthostatic tachycardia syndrome (POTS), fibromyalgia, Lyme disease, mastocytosis, migraines and obesity.” (2) Add the various symptoms together and a person might have a confusing mixture of “twenty to thirty symptoms” and feel “extremely ill.” (2)

Lab tests frequently are not helpful for many of the conditions or MCAS and it may also be unclear whether a person is having histamine symptoms because of intestinal digestion or microbiome problems or due to overactive mast cells throughout the body. Severity of symptoms may be worse if the problem is related to mast cell activation throughout the body. Treatment approach would also be different. Some people might be helped by use of the digestive histamine enzyme while others wouldn’t need it. Both types, digestive histamine excess and mast cell over activity, would be helped by decreasing histamine containing foods or ones that increase release of histamine from mast cells. Eliminating all histamine from the diet would be impractical if not impossible. Reducing the amount might make a significant difference though in reducing the negative symptoms. More details about identifying the type of problem with lab tests or other clinical indicators and an elimination diet description are available here: westonaprice.org. (2)

Glyphosate as a stimulator of histamine release (1) would create a different list of foods to avoid. See the previous post “a long one on glyphosate,” the list of tips are summarized at the top of the post, so the full length can be skipped if desired.

Over active mast cells may involve cannabinoid deficiency. Mast cells have both Cannabinoid Receptor Type 1 and Type 2 on the cell surface and when activated they cause an inhibition of the mast cell.

“Mast cells contain CB1 and CB2 receptors, which when activated inhibit mast cell release (R). Research shows that cannabinoids can suppress mast cell degranulation. … Our results show that CB1 and CB2 mediate diametrically opposed effects on cAMP levels in mast cells. ” (3, 4)

“We have previously shown that exposure of mast cells to cannabinoids that bind to both CB1 and CB2 cause a net suppression in the proinflammatory responses.” […] “At short time points, ligation of either CB1 or CB2 leads to a suppression of cAMP levels. However, over a longer exposure time course, the cAMP responses that follow ligation of the two receptors are diametrically opposed. These results allow us to draw two conclusions. First, the results imply that CB1 and CB2 receptors are not redundant when co-expressed in mast cells. Secondly, the results suggest that the two receptors couple to distinct signalling pathways that diverge downstream of the Gαi/o proteins to which they are both coupled.” (4) – that may suggest that a short time, small amount of THC & CBD may not help suppress the mast cells, by increasing cAMP sufficiently, a longer exposure, larger dose is needed – and that both the CB1 and CB2 receptor types need to be activated for the suppression of mast cell. CBD activates CB2 receptors and THC activates CB1 receptors.

“CBD alone without THC maybe ineffective at treating dysfunctional mast cells because THC has a strong binding affinity for both CB1 and CB2 receptors, cannabidiol (CBD) has no particular binding affinity. Instead, many of the therapeutic benefits of CBD are created through indirect actions.” (3)

Edibles or smoke? “However, when it comes to MCAS patients who are more severe, they tend to not tolerate ingesting the Medical Cannabis oil or edibles but may can inhale the actual Organic Medical Cannabis Flower and find great relief from MCAS symptoms.” (3)

More information about mast cells and what they do is included in Mast Cells: MCAS, genetics and solutions. geneticlifehacks.com (1) Viruses can activate mast cells, which then release histamine and other inflammatory cytokines and chemicals. The immune mast cells are also called granulocytes because when activated they release little packets, granules, full of the inflammatory chemicals. Flu virus has been found to activate mast cells and mast cell inhibitors helped reduce lung damage and mortality in severe cases of influenza. Too much inhibition during an active infection might not be helpful though, because the goal is to kill the virus infected cells or other pathogens that can activate mast cells. (1)

What does histamine do?

“Brain histamine promotes wakefulness and orchestrates disparate behaviors and homeostatic functions.” […] “Dysfunctions of the histaminergic system may also contribute to the pathogenesis of multiple sclerosis and its murine model of experimental autoimmune encephalomyelitis,” […] “Histamine neurons send broad projections within the CNS that are organized in functionally distinct circuits impinging on different brain regions.” (5)

Histamine promotes wakefulness, so an excess may lead to insomnia problems, and it affects a lot of varied behaviors and balance of functions throughout the body, disparate – a wide range of behaviors, which suggests why there can be such a wide range of symptoms, and homeostatic – balance of body functions – no longer as able to stay at an even center, too tired, or too excited, too cold or too flushed, numbness or pain – roughly. Too itchy too often.

“Histamine itch and non-histamine itch are mainly mediated by TrpV1 and TrpA1 respectively. In addition, Trp channels can be coupled to cytokine receptors, toll like receptors or may even be directly activated by pruritogens.” (6)

Inflammatory bowel disease (IBD) can involve overactive mast cells and excess histamine activating Trp channels in the intestines, (1), leading to sudden diarrhea and/or pain. “Pruritigens” refers to other chemicals that directly activate Trp channels such as horseradish or Latex that cause itching, (pruritus). Others may cause the bowel symptoms of IBD including cinnamaldehyde from cinnamon, capsaicin from hot pepper, curcumin in turmeric, and other chemicals in spices or herbs like ginger, cloves, and mint. Previous post 1, post 2/webpage G3.5-3.6.2, G5.

Yes, it is not easy to figure out what you can eat if you have Mast Cell Activation Syndrome, or to safely use as skin care products or medications as some of the ingredients might be Trp channel activators.

Medications that may help reduce mast cell activation in the condition of Irritable Bowel Syndrome, similar to Inflammatory bowel disease but less severe, include mast cell stabilizers and “a medication to reduce prostaglandin E2 synthesis (e.g. a COX2 inhibitor) stopped the hypersensitivity in the animal model of IBS. [ref]” (1) Pomegranate peel extract and other antioxidants may act in part through COX2 inhibition. (previous post) Prep tips for pomegranate & the peel: G13.

Mast cell activation may also be involved in autoimmune diseases including Multiple sclerosis, Type 1 Diabetes, and Rheumatoid arthritis. (1) The excessive release of cytokines and inflammatory chemicals can lead to cell damage in surrounding tissue. Mast cells tend to be located within specific tissue areas of the body or along epithelial layers (skin and membrane linings of blood vessels or other tissue), rather than be free moving like some other types of immune white blood cells. (1) Some people may have overactivity in some areas of the body rather than throughout the entire body.

Regarding COVID19 illness, the cytokine interleukin 6 (IL-6) tends to be present in excess, (8), and it is a mast cell activator. (1) Vitamin C can help inhibit IL-6. (7)

Psychological stress causes mast cells to release their histamine and other chemicals – uh oh, time to think serenely about that. (1)

Tips to worry less – can you do anything about them? If no, try to let them go. Writing worries on notes and putting them in a worry jar is one idea – you did something about it. You can look through your worries later. If yes, plan your time – 1. write down your goals, long term – 5-10 years, mid length, this year, and short term, this day/week/month, and 2. make an action plan, what steps to take today, write a list. 3. Do your plan, cross off your list items. It can feel more organized and good to check off your short term goals, and more peaceful to have a plan. (9)

Regarding the complexity of Mast Cell Activation Syndrome, or histamine from food – writing down your symptoms and daily food, beverages, and other lifestyle issues that standout from your routine can help to start seeing a pattern of which foods or habits might be adding to the problem. Elimination diets are quiet simple to start and need to be followed for a couple weeks to get the body cleared out of the potential problem foods and hopefully start feeling better, whether itchy, headaches, fatigue, brain-fog, or pain, numbness, or other symptoms. Then add only one thing back and see if symptoms return. Symptoms may be fairly immediate, or the next day or two so gradual reintroduction will be easiest to track whether it seems to cause symptoms.

Lab tests and other help and medication may be nice too, if available, but an elimination diet can be done fairly easily and safely. Stick to a variety of foods from the different food groups and read bottles on any supplements or medications to check for ingredients that might also be trigger substances ‘starch’ is usually wheat or corn based unless specifically labeled like tapioca or arrowroot starch. Other post (a) includes links with a food diary and information about elimination diets for histamine issues. Not all people have exactly the same sensitivities and there can be an additive effect, many problem foods on the same day as stress – may become a flare up. Some of the lists vary and some are more restricted than others, but most have similarities in the worst risk foods. Starting with eliminating some of those and seeing if you start feeling better can also be a way to work towards learning what are problem foods for you personally.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Reference List

  1. Mast cells: MCAS, genetics, and solutions, geneticlifehacks.com, https://www.geneticlifehacks.com/mast-cells/
  2. Hidden in Plain Sight: Histamine Problems, westonaprice.org, https://www.westonaprice.org/health-topics/modern-diseases/hidden-in-plain-sight-histamine-problems/
  3. Www.TickedOffMastCell.Org, Medical Cannabis: Mast Cell Activation Syndrome, 10/24/2019, ibcnj.com https://ibcnj.com/medical-cannabis-mast-cell-activation-syndrome/
  4. Small-Howard AL, Shimoda LMN, Adra CN and Turner H, Anti-inflammatory potential of CB1-mediated cAMP elevation in mast cells. Biochem. J. (2005) 388, 465–473 https://anandaenterprises.com.au/wp-content/uploads/2019/12/Anti-inflammatory-Potential-of-CB1-mediated-CAMP-Elevation-in-Mast-Cells.pdf.pdf
  5. Passani MB, Panula P, Lin JS. Histamine in the brain. Front Syst Neurosci. 2014;8:64. Published 2014 Apr 28. doi:10.3389/fnsys.2014.00064 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009418/
  6. Sun S, Dong X. Trp channels and itch. Semin Immunopathol. 2016;38(3):293-307. doi:10.1007/s00281-015-0530-4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4798920/
  7. Härtel C, Puzik A, Göpel W, Temming P, Bucsky P, Schultz C: Immunomodulatory Effect of Vitamin C on Intracytoplasmic Cytokine Production in Neonatal Cord Blood Cells. Neonatology 2007;91:54-60. doi: 10.1159/000096972 https://www.karger.com/Article/Abstract/96972#
  8. Grifoni E, Valoriani A, Cei F, et al. Interleukin-6 as prognosticator in patients with COVID-19. J Infect. 2020;81(3):452-482. doi:10.1016/j.jinf.2020.06.008 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278637/
  9. Gerry McCann, How to Manage Your Time Worry Less and Discover more Happiness, youtube.com, https://youtu.be/RgBb4xNrM-s
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Histamine excess – self help through diet.

Some foods may be particularly beneficial for helping people who tend to have too much histamine. Personal strategies from a non-medical sufferer are available here: Shutting Down Histamine Reactions (Quickly) healinghistamine.com.

Foods or herbs suggested include: Apple, Fennel, Watercress, Parsley, Broccoli, Cauliflower, Ginger, Thyme, Rosemary, Turmeric, and the phytonutrient quercetin. healinghistamine.com. Without looking for further reference links – that list does include many foods and herbs that I have found helpful over the years and currently. Fennel is available as a vegetable, celery like, and also as crunchy seeds.

Having learned of the link between foods and histamine levels while writing the last post, it has helped to avoid the foods that are mentioned, or reduce them. A bad reaction for me, can be very odd behavior and anxiety. Histamine excess symptoms of congestion and seasonal pollen allergies have been a long term problem for me and many of the foods recommended to avoid I had already learned to avoid, but others I wasn’t aware of the connection.

Bad mood changes are later in the day or the next day or two, so making a connection between a food and a symptom can be difficult. It can be simpler to keep a basic meal pattern and only change one thing at a time, so it is easier to recognize a link between symptoms the next day and a new food.

Health is worth some work.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Reference List

  1. Yasmina, Shutting Down Histamine Reactions (Quickly), healinghistamine.com, https://healinghistamine.com/shutting-down-histamine-reactions-quickly/
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Histamine excess may affect long Covid sufferers.

Histamine may be a familiar word for seasonal allergy sufferers. Anti-histamine medications may be used during pollen season for those with a itchiness and a runny nose. Others may have a year long sensitivity as the problem can also be genetic, due to less of the enzyme that is needed to breakdown histamine. The diamine oxidase enzyme, (DOE), is available as a supplement that can be taken with meals. (1)

We make our own histamine in response to allergy type sensitivities. Mast cells are part of the immune system that might become overactive and produce more histamine than we want during pollen season – or possibly after having experienced an infection such as COVID19. People experiencing odd symptoms months after seeming to recover from the worst of the respiratory and other symptoms of COVID19 may be experiencing excess histamine and mast cell overactivity. See this video for more information: Nicola Haseler interviewing Dr. Tina Peers regarding histamine and overactive mast cells after COVID19 recovery (LongCovid). (7)

Dr. Bruce Hoffman discusses Mast Cell Activation Syndrome – overactivity of the immune Mast cells in more detail. Lab tests for histamine, or other chemicals involved in the inflammatory response are not necessarily reliable and may require a refrigerated centrifuge, which may not be standard lab equipment. The problem may involve genetic susceptibility but not necessarily, anyone might develop symptoms given a combination of stressors. Emotional or physical stress, lack of sleep, and the foods we eat may over activate mast cells throughout our body or within the mucosal lining of the Gastrointestinal tract (from the mouth, already the way through). Someone with recent bowel illness, may have a short term reduction in the diamine oxidase enzyme needed to break down histamines in food. The enzyme is produced in the lining of the intestinal tract.

“…we’re inundated, so to speak, with multiple stresses far more than our capacity to withstand them. Our immune system, it just gets triggered because of multiple stressors. And there are many triggers for mast cell activation. Poor sleep. Stress is one of the biggest triggers. Food, I mean, food is incredible in its ability to trigger the mast cells…” […] “So education is first. Second is to try and identify the triggers that trigger their mast cell activation. And this is one of the greatest challenges because there are many triggers from, you know, hot, too much heat, too much cold, stress, poor sleep, as mentioned. And then we get into the more obvious triggers, chemicals, heavy metals, dietary antigens, and then infections or inflammatory triggers like mold.” – Dr. Bruce Hoffman (8)

Family history may also be a factor, trauma for the person may have left them with an identity of illness; or trauma earlier in the family’s history may have left epigenetic changes. Changing diet and lifestyle, and pursuing health can be a lot of work, and which may even be resisted as the patient improves, (psychoneuroimmunology). Misdiagnosis of the physical problem as a somatization disorder (“it is all in your head”) may also be a problem according to Dr. Hoffman. (8)

The itchiness is not in my head – it is all over my body.

How do you even be a healthy person if you have never known health, nor has your family? What do people do all day? Go for a walk, without sneezing – cook delicious food that doesn’t leave you with a mystery headache later on – so many choices, but change can be difficult.

We also get some from foods that contain histamine naturally. Other foods may have increased content as it ages – fresh is best for people with histamine excess. (4) Freezing a larger batch of food in meal size portions might be a sensible way to prepare fresh foods (that don’t have food additives or seasonings that you need to avoid). Fermented foods such as yogurt, saurkraut and kombucha are popular currently, for the goal of improving intestinal health and the microbiome, (the balance of beneficial bacteria and other microbes within the GI tract). However they may make someone with overactive mast cells worse instead of better. Vitamin C may help. (8)

Avoiding foods that contain histamine or may increase our tendency to make more can help allergy sufferers or the people with the genetic difficulty breaking down the excess. Symptoms can include headaches as well as itchiness and runny nose. Fatigue may also be a problem as well as other odd symptoms or chronic pain. Anxiety and schizophrenia symptoms may worsen with excess histamine. (1, 3, 4)

There is plenty of information on the topic available so I will link to it rather than try to replicate it here. Several of the articles make the point that the problem is additive and histamine is not something you can avoid all together. Small amounts or a taste may be okay, but several foods or beverages over the course of the day may lead to an uncomfortable headache that evening. (3)

  • Amy Myers, MD, provides an overview of the food lists of foods to avoid, or consider eliminating and then adding back to check tolerance, a list of lower histamine foods, symptoms that may be linked to excess histamine, and a list of medications that may be increasing histamine, amymyersmd.com. (1)
  • People with histamine food sensitivities may also be sensitive to lectins, oxalates, and pesticides. Foods more likely to be low or high in histamines are also labeled with a code for lectin (L), oxalate (O), or pesticide residue ![food] on a website by Beth O’Hara, a Functional Naturopath, mastcell360.com. This includes the most extensive food list and includes seasonings and food additives to avoid, or which might be less of a concern to use. (2)
  • Brief list of symptoms that may occur, along with foods to avoid, and a sample day’s menu of lower histamine foods. (3)
  • Extensive list of symptoms or physical traits that may be associated with people with a lifelong sensitivity to histamine is included in this article about histamine. Mood problems of increased anxiety are not uncommon for people with histamine intolerance problems. Sleep problems may also be a concern. (4)
  • Tracking your symptoms and daily food is recommended by this site, histamineintolerance.org.uk; Food List: (5), the Food Diary is a downloadable link from this page: (6).
  • Medications, lab tests for diagnosis, and nutrients or phytonutrients that may help if the individual is not overly sensitive to them already are discussed in detail in the interview with Dr. Hoffman, audio or the transcript or available on Dr. Hedberg’s website: (8) . Dr. Hoffman also makes the very important point that an apparent ‘drug’ sensitivity might really be a reaction to other components of the tablet or capsule, or even contaminants, which is also something to look at on labels for other supplements and over-the-counter medications. Psychoneuroimmunology and the effects of trauma on the brain, and possible cognitive therapy approaches are also discussed in more detail.

Writing down your daily foods, beverages, and symptoms can be a good way to watch for patterns in what seems to make you feel better or worse. Food sensitivities can also vary with how much stress you are experiencing and whether you slept well, or drank enough water. Once you are more familiar with your patterns and know which foods and habits are helpful then recording your daily foods and symptoms may no longer be necessary.

Health is worth it. Happy dining, and good sleep to you!

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Reference List

  1. Amy Myers, MD, Histamine Intolerance: What You Need to Know, amymyersmd.com, https://www.amymyersmd.com/article/histamine-intolerance/
  2. Beth O’Hara, Low-histamine diet: How it can benefit you and what to eat, Low and High Histamine Foods Lists mastcell360.com https://mastcell360.com/low-histamine-foods-list/
  3. How to follow a low-histamine diet. Nov 13, 2018, houseofwellness.com.au, https://www.houseofwellness.com.au/health/conditions/follow-low-histamine-diet
  4. Histamine, histamine-sensitivity.com, https://www.histamine-sensitivity.com/histamine.html
  5. The Food List, histamineintolerance.org.uk, https://www.histamineintolerance.org.uk/about/the-food-diary/the-food-list/
  6. The Food Diary, histamineintolerance.org.uk, https://www.histamineintolerance.org.uk/about/the-food-diary/
  7. Long Covid + Histamine / MCAS – Dr Tina Peers in conversation with journalist Nicola Haseler. Oct. 16, 2020,
    nicola haseler, youtube.com https://youtu.be/vr2bb0b4X14
  8. Mast Cell Activation Syndrome with Dr. Bruce Hoffman, interview by Dr. Nikolas Hedberg, https://drhedberg.com/mast-cell-activation-syndrome-dr-bruce-hoffman/