Do You Suffer from Digestive Problems after Enjoying Red Wine or Cheese? Part 1
Symptoms and Diagnostics
Over the last few years, I observed more and more patients with an array of symptoms that didn’t fit in one of the boxes I knew.
Their main complaint was a never-ending story about stomach pains, cramps, diarrhea, gallbladder problems, and so on. But, what was common among these patients was a clear connection between their symptoms and the food they ate.
All of them felt sick after ingesting red wine, aged cheese, some meats, bacon, cake, and bread. At first, I assumed they had an allergic reaction to those foods, however, their lab reports come back normal.
So I decided to dig deeper and did a med line ( an online library for medical literature) search. Unsurprisingly, there weren’t many studies on their reactions to the foods to be found. I believe this is because of the nature of the dis-ease.
The symptoms affected almost every organ: They range from arrhythmia, high or low blood pressure, skin irritations, fatigue, asthma, runny nose, stomach and bowel problems, diarrhea and nausea to migraines, other headaches, a disrupted sleep rhythm, gallbladder problems, and dysmenorrhea in women.
What I discovered surprised me. It turned out the culprit to their list of symptoms was histamine intolerance.
Histamine is a so-called biogenic amine that is synthesized from histidine, an amino acid. We all have histamine in our leukocytes, platelets, certain stomach and bowel cells, kidneys, liver, lung and skin cells. And we all need histamine to a certain extent. It modulates immune reactions, helps with the production of gastric acid, supports our cardio-vascular system and acts as a neurotransmitter in our brain to regulate wake and sleep cycles.
It appears the problem for histamine-intolerant patients is an extremely slow degradation process.
On the other hand, studies have shown that individuals with chronic inflammatory bowel disease seem to have more histamine producing cells in the inflamed area, which also leads to cramps, mucosal swelling and a disruption of the mucosal barrier. In other words, food particles cross the barrier between intestine and the surrounding blood vessels. This is normal; however, in an inflamed area of the intestine, bigger particles or ones not fit for further use by the bowel get into the blood stream. The body responds to this crossover as an allergic reaction.
The degradation of histamine happens in our guts. The enzyme that triggers it is called diamine oxidase. The production and release of this enzyme is sometimes blocked by medication or alcohol. Or there is too much histamine present because of certain foods that liberate histamine from the cells, or there is an inflammation of the gut.
As you can see, these wide-spread actions of histamine can cause harm in a susceptible body.
Very often patients with suspected histamine intolerance go through every diagnostic test under the sun without a result that points to an explanation.Their cardiac work up comes back normal, and endoscopy of their stomachs and bowels is normal.
Patients who suffer from lactose or fructose intolerance—even when they take precautions—still feel bad. Since the symptoms appear to be food related, most patients are tested for different allergies. But, ultimately, nothing shows up in the results to explain their continued symptoms.
With histamine intolerance, you often get “pseudo allergies,” which means the symptoms look like an allergy, but the blood work doesn’t show the expected results.
What I observed with my patients is they often have long-term bowel problems. And while their symptoms weren’t severe enough to involved a doctor, they were not normal and disruptive.
Inevitably, at some point, the symptoms get worse. This process is so slow that patients don’t realize they are in a downward spiral. By the time they show up at my door, they have had the whole diagnostic work up without a clear result. They feel sick yet, they have “nothing“ from a laboratory perspective that warrants it.
The tricky part is to diagnose this sneaky disease. Since there are so many organs involved and the symptoms frequently change, it usually takes several years to recognize histamine intolerance.
Here are tests you can encourage your doctor to run:
You can measure the diamine oxidase activity, which should be above 10 U/ml to rule out histamine intolerance. Results between 3 and 10U/ml are considered normal; unfortunately you can still have symptoms even with results in normal range. In that case clinical symptoms lead the way. A diamine oxidase activity below 3U/ml is considered too low and you will probably have problems that support the diagnosis.
Another test is to measure the N-methyl histamine levels in your urine, which should be lower than normal. You can also have your copper, vitamin B6 and C levels measured with lower than normal levels. Copper, vitamin B6 and C are part of the histamine degradation process.
The gold standard remains a diet almost free of histamine for 4 weeks. After that time, your doctor should do a provocation test, which will require you to eat histamine-rich food. I always shy away from this for my patients. For me, it doesn’t make sense to actually make them worse again just to prove my theory. I find it cruel. If the diet didn’t work, they probably had something different anyway.
Before you leap to the diagnosis of histamine intolerance, you must first rule out the following: Crohn’s disease, food allergies, ulcerative colitis, colorectal neoplasms, asthma, chronic renal failure, liver cirrhosis, neurodermitis, and eczema.
If you have one of the above-mentioned diseases, you most likely have a problem with too much histamine. However, you also have a known and treatable cause for it. You’ll benefit from the treatment of histamine intolerance, but don’t forget to take care of the original disease.
As mentioned above, the cause for the disease is either a block of the degrading enzyme diamine oxidase or an increased liberation of histamine due to inflammation or drugs or food.
Next week I will discuss the symptoms from a chinese medicine point of view.
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