Do you have histamine intolerance?
It could be confused with an increased burden of mast cells, one of the main types of cells that release histamine.
Tune in for two lab tests that can help you tell the difference.
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Here is the link to the episode that lists the symptoms of histamine intolerance in more detail, and covers food sources of histamine:
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Read the Transcript
Here’s some testing that can be useful for histamine intolerance.
Hi. I’m Dr. Chris Masterjohn of chrismasterjohnphd.com. And this is Chris Masterjohn Lite, where the name of the game is “Details? Shmeetails. Just tell me what works!”
And today we’re going to talk about some testing for histamine intolerance.
I’ll link to the last episode in the description of this one, where I describe histamine intolerance in a lot more detail. But briefly, it means that you suffer from diarrhea, or headaches, or any symptoms that are reminiscent of allergies in response to the histamine content of the foods that you eat.
And one thing we might want to know in something like this is, is it histamine intolerance, or is it allergies, or is it something else? And in particular, could it be that you have an increased burden of mast cells, which are one of the main types of cells that release histamine.
Now, food allergies that cause these types of symptoms are generally classical food allergies, where the standard testing that an allergist would use would be the right approach to identifying those food allergies.
In terms of histamine intolerance, the two tests that are useful are serum diamine oxidase activity. Diamine oxidase is an enzyme that gets rid of histamine. It’s the main enzyme present in the gut, so it’s the most relevant enzyme when talking about tolerating food histamine, and blood levels of serum diamine oxidase, or DAO, are low in histamine intolerance.
Histamine intolerance could be mimicked by mast cell activation syndrome or an overburden of the cells that produce histamine. You could have a chronic excess of histamine because of the excess mast cell burden, and the food coming in provides more histamine that fills up your histamine bucket and pushes you over, or you could have mast cells accumulating, for example, in the gut where something in the diet is then activating them to release the histamine, but that burden of mast cells is the actual problem more so than your inability to clear histamine in the gut normally.
You can look for the excess burden of mast cells by looking at serum tryptase. Now, serum tryptase is a very easy test to get. LabCorp has it. Quest has it. In general, most doctors would be able to easily order it. Serum diamine oxidase activity is not easily available. As far as I can tell, the major laboratories that I would think to use in the United States do not carry it. There’s a laboratory Medichecks, based in England, that does carry diamine oxidase activity. If you happen to know of other labs that offer diamine oxidase activity commercially, please let me know in the comments.
So it might not be realistic to measure diamine oxidase activity, but measuring serum tryptase activity could be very useful in the sense that if serum tryptase is elevated, it indicates an excess burden of mast cells, and that indicates two things, number one, that when you’re thinking about nutritional approaches, you want to focus on ones that may reduce mast cell burden instead of focusing on ones that may increase diamine oxidase activity, increase your ability to clear histamine. And then number two, that might indicate something very important about why those mast cells are there that your doctor—that you can then work with your doctor to try to address because if you have an inflammatory burden somewhere, that might be an indication of another disease process that needs investigation.
Now, in terms of the nutritional approaches to stabilizing mast cells, or reducing mast cell burden, or to supporting histamine clearance, I’m going to deal with these— I’m going to deal with these successively in a series of episodes that will culminate in an episode that ties it all together and all the different nutritional approaches that you could use.
So stay tuned for future episodes for that. Now, if you look in the literature, many people advocate using more advanced testing that is even more impractical. For example, many will argue that the gold standard should be taking samples of your intestines to look at your intestinal expression of diamine oxidase or even other enzymes that are involved in histamine metabolism, and some would advocate as the gold standard giving you a blinded histamine challenge where you are exposed to histamine doses that have been added to tea, for example, versus a placebo to see whether your symptoms respond specifically to the histamine.
These are deeply impractical in most cases, but I think the serum tryptase measurement, and if you can find it, serum diamine oxidase measurement, although they might not give you the absolutely definitive answer to what’s going on, they can certainly point you in the right direction and be useful.