Histamine Metabolism

Once formed, histamine is either stored or broken down by an enzyme. Histamine in the central nervous system is broken down primarily by histamine N-methyltransferase (HMT), while histamine in the digestive tract is broken down primarily by di- amine oxidase (DAO). Though both enzymes play an important role in histamine break down, the research has found that DAO is the main enzyme responsible for breaking down ingested histamine. So if you’re deficient in DAO, you likely have symp- toms of histamine intolerance. DAO blocking foods include: > Alcohol

> Energy drinks > Black tea > Mate tea > Green tea

Causes of Low DAO

Gluten intolerance Leaky gut SIBO DAO-blocking foods: alcohol, energy drinks, and tea Genetic mutations (common in people of Asian-descent)

Inflammation from Crohn’s, ulcerative colitis, and inflamma- tory bowel disease.

Medications: • Non-steroidal anti-inflammatory drugs (ibuprofen, aspirin) • Antidepressants (Cymbalta, Effexor, Prozac, Zoloft) • Immune modulators (Humira, Enbrel, Plaquenil) • Antiarrhythmics (propanolol, metoprolol, Cardizem, Norvasc) • Antihistamines(H1) blockers (Allegra, Zyrtec, Benadryl) • Histamine (H2) blockers (Tagamet, Pepcid, Zantac)

Testing for Histamine Intolerance

Elimination/Reintroduction Remove the high histamine containing foods for 30 days and reintroduce them one at a time.

Trial of Helpful Supplements If testing is unavailable to you, you could simply try a diet

low in histamine and add: - Vitamin C/Quercetin - Liver Support, Probiotics, and food enzymes/betaine - Methylation Support - DAO supplementation – amongst others

How to Treat Histamine Intolerance? Remove the high histamine foods for 1-3 months. Most

importantly, find the root cause for the histamine intolerance. If you're on a medication that is causing the intolerance, working with your physician to wean off of these medications maybe important. The main causes that we see are related to GI distur- bance, hormone imbalance, inflammation, allergies and prob- lems with methylation. If you're currently suffering from histamine intolerance, you

may not have to avoid these foods forever. Depending on your unique situation, you may find that you can tolerate some foods better than others, so I encourage you to stay optimistic as you learn important and relevant information about your condition and unique situation.

Written by Alexander T. Augoustides, MD of Piedmont Integrative Medicine, PA, 1411 Plaza West Road, Winzston-Salem. For an appointment, call 336-760-0240. See ad on back cover.

Blood Testing Tests that may be helpful in a situation with histamine re- lated symptoms include:

• Functional GI analysis • IgE & IgG testing for environmental, Candida and Food an- tigens

• MTHFR gene testing

• Hormonal Balance – particularly Adrenals • Inflammation Markers

• Histamine/DAO levels - We can test for histamine levels and DAO levels. A high ratio of histamine/DAO signifies that you are ingesting too much histamine and that you don’t have enough DAO to break it down(Dunwoody).

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