The Gut Histamine Connection | Podcast #384

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Dr. Justin and Evan Brand discuss the gut-histamine connection in this video. They point out that many patients with digestive issues, skin problems, mood issues, and fatigue often have sensitivities to histamine-rich foods. They suggest focusing on root causes, such as overgrown bacteria in the gut, gut inflammation, and processed food consumption, as the key to improving histamine issues instead of relying on antihistamines or other medications.

Additionally, Dr. Justin and Evan mention other contributing factors to histamine issues, including tick-borne infections, mold mycotoxins, chemical exposures, and heavy metals. To address these issues, they suggest a holistic approach using herbal medicine and aligning puzzle pieces to help patients get better without worsening.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

00:20 – Common Digestive Issues
06:40 – Can H. Pylori cause Histamine Intolerance
10:05 – Ginger as Stimulant
14:02 – Over the Counter and Natural Remedies
19:47How Do You Know if You Have a Histamine Problem?
21:32 – What is Histamine?
24:33 – Takeaways

Dr. Justin Marchegiani: And we are live! Dr. J. here in the house! Evan Brand here as well, we are excited to talk to you guys about the Gut-Histamine connection. This is a common question that we get a lot while in the trenches daily with our patients. Really excited to dive in, Evan what's going on man? It's been a hot minute, how you’ve been?

Evan Brand: Yeah, I've been really well, and this issue, I think, I don't know if it's because you and I are recognizing it more or if it's just because it's more common. Maybe it's a combination of both. But you know, I see so many issues where people start out with a digestive problem. Like they'll complain about stomach pain or cramping, or diarrhea, or constipation, maybe some skin issues, maybe some mood issues, anxiety, depression, fatigue and then all of a sudden histamine comes into the equation.

And people start realizing, “Wow! I'm actually allergic or I'm having these sensitivities to histamine-rich foods!” Like, maybe avocado, that was a big one for me. I would eat avocado I'd get a headache from it then I learned about histamines, and sure enough when I went low histamine, a lot of my symptoms resolved. So I think this is an important piece of the puzzle especially, depending on when people are listening, things are starting to bud and bloom.

And so people may be reacting to outdoor allergens, pollutants, pollen, et cetera things, blooming. I think it's because their bucket is already so full because of gut, in the histamine-producing bacteria, that now they're reacting to the outdoor environment. So people go to the ENT, they jump on the allergy med but that's not necessarily the root cause solution.

Dr. Justin Marchegiani: 100%! I see it all the time where you know, you've got patients that go to you know, the conventional doctor like, “Oh I have mast cells!” And then they're just basically managing that patient with a lot of fancy antihistamines, different things like that to kind of decrease the ability to either make histamine or, help your body kind of degranulate it or break it down. And they're like, “Well this is what I have.” and they're so focused on the actual diagnosis like the diagnosis is its own entity, where the diagnosis, I always tell patients is just a manifestation of a lot of upstream issues working their way down.

And so it's kind of like, you have all these systems that are out of whack whether it's gut, gut bacteria, and we know, for instance, that there's different bacteria when overgrown can drive histamine, you were mentioning that. Morganella, Klebsiella, Pseudomonas, Citrobacter, Proteus. These are all bacteria that are common, like in SIBO and just in general dysbiosis, and these bugs can actually produce a lot of the histamine.

And then, of course, if your gut’s inflamed, you're eating lots of processed flours, acellular carbohydrates, that's what’ll feed a lot of these things and then, God forbade, you come in there and you have some antibiotics, over the course of your lifetime, maybe more than you should. Now you have this perfect storm of like processed foods, you have antibiotics maybe you come in there and you have a lot of glyphosate and roundup exposure, and now that whacks out your brush border, that creates rebound overgrowth as well.

Maybe you have some mold exposure, now you're overly stressed, you have low stomach acid, low enzymes, low bile salt, so you can see how this storm isn't just like this, “Oh! I just have a Zyrtec, or an Allegra, or a Pepcid-AC deficiency.” It's like no no no, that may help you palliatively control some of the histamine symptoms right? Brain fog, dizziness, vertigo, obviously like you to carry a hive skin stuff, it may control some of that fatigue but it's not going to fix it and so you always want to go upstream to the root.

Evan Brand: Yeah and this is not a sexy idea because it's not one silver magic bullet that you and I can offer. We have to tease it apart and go, okay, well over here we have on your stool test for example. We see five, six different bacteria, all producing histamine. We see here you have an older home, you don't have any air purification in the home, so there may be indoor pollutants kind of creating a mast cell reaction.

Then you may have tick-borne infections that I always factor that in, just with my own personal suffering. Lime, Bartonella, Babesia, these things also drive histamine and mast cell activation. Mold, Mycotoxins, those drive it. You mentioned Glyphosate, other chemical exposures, I would assume heavy metals are probably aggravating the mast cells and creating a histamine response as well.

So, when you tell someone, “Hey get rid of the Zyrtec. Let's do this, that, that, that, and that.” It's a little bit harder of a cell but I wouldn't encourage you guys to just take things one at a time, and if you're working with someone like Dr J or myself, we're going to help you to align the puzzle pieces in a way that's going to slowly get you better without getting you worse.

Because the problem is, we'll see people that'll go do Rifaximin and this is their naturopath, or some supposedly Integrative Medical Doctor that went functional, and they'll go put them on Rifaximin or something else for the SIBO, and they flare up worse or maybe they get relief for a month or two, and then they call us. “Hey, I've already been to five, six people. Can you help?” And usually we can we like the high pressure environments

Dr. Justin Marchegiani: Yep 100%! And so, I always try to be the most conservative as possible. Try to use more herbals and get to the root first. Obviously, like the first thing is if you're coming in, and you're super inflamed, you're overly sensitive to histamine, and you're already on some medications, and those medications are typically are they helping you? Whether it's like an H1 receptor antagonist, or an H2 antagonist, or an H1 blocker right? There's typically the H1 and H2 kind of antihistamine type of families right? Whether it's, I think Allegra is one I think Zyrtec one, Pepcid-AC is one, I think Zyrtec is an H2 blocker right?

So there's different families of drugs that fit into those categories. There's obviously some more experimental drugs that are coming out down the pipeline but these are just common ways that your conventional doctor may be managing it. I tell patients, “Hey, if you do that medication, how do you feel? Do you have an improvement?” If you do, that tells me something right? Because if your histamine bucket is full and those medications help, well the root cause now is to pull out the antigens or the foreign material that's filling up that bucket.

Now in some people, I'm like “Hey! What's your environment like? Do you have a bunch of seasonal allergies coming in and impacting your sinuses? Do you have mold in your home?” Because the easiest thing out of the gate is get your air quality in the home clean and flush out your sinuses because a lot of times you're outside, and during the daytime, you're bringing all those weeds and pollens into your sinuses. You're bringing them in even though you're inside in a good environment. You got to get those things flushed out so we'll do saline, we'll do Xylitol, or some biofilm busters and we'll flush that stuff out once or twice a day, and we'll make sure the air in the home is super clean and will rule out any mold issues or environmental issues in the home too.

Evan Brand: Yep they had a question come in about H.Pylori. Can H.Pylori cause histamine intolerance? My gut feeling was yeah. I would throw it in the category of any of the gut bacterial overgrowth. Well, here's the paper on it right here, from an Immunology Journal 2004. Effects of helicobacter pylori on gastric inflammation and local cytokine production. And long story short, it says here results suggest H.Pylori induces lower TNF Alpha and interleukin-6 secretion in the mice. So this is a mice study, they're saying here that H.Pylori produces considerable cytokine production in the infected groups.

Now they did something here, this is kind of interesting. I don't know how they do this. I guess they mess with the enzymes, the histidine decarboxylase, in these mice, so that's interesting. Because they're kind of comparing like a regular mice versus this altered mice, and then they gave the mice H.Pylori, and yeah, I mean, it's a piece of the puzzle right? So I can't say if you just had H.Pylori would that create a histamine intolerance? But it's rare to see that by itself wouldn't you say? Most commonly we're going to see candida or maybe some other bacterial overgrowth with the H.Pylori.

Dr. Justin Marchegiani: Well, also too. If you have H.Pylori right? We don't have to go too far to kind of make it make sense just with the deductive reasoning right? So we know H.Pylori can decrease stomach acid and we know low stomach acid impairs digestion. We also know stomach acid also has a mild antimicrobial effect, right? This is the reason why people make you know, homemade topical cleaners out of like white wine or apple cider vinegar because the acidity actually kills stuff.

And so we know if we have good acidity levels in our gut it's going to make it easier to keep the bug level down in our gut. We also know women that do birth control pills increase the vaginal pH, makes it more alkaline, that makes it easier for yeast to grow, right? We know these! So, we can kind of use deductive reasoning and say, “Hey! If we impact the pH and raise it above where it should be, that can make it easier for bugs to grow. It's very possible.”

Evan Brand: Yeah and you know, the person commented that they have H.Pylori and histamine intolerance they don't want to go to conventional doctors. What can you do to feel better? Well, number one would be get a full workup done. You know, we'd like to look at stool and urine to figure out what all is happening and then we come in with herbal antibiotics and you can knock this thing out within a couple of months unless you have a spouse that's reinfecting you, then we may want to get them on board, but you know, between Dr. J and I, mean we've probably fixed thousands of cases of H.Pylori.

So the cool thing is, with herbs we don't appear to have the same antibiotic resistance that we see with the conventional drugs because now they're moving on to quadruple therapy, which is four different antibiotics at the same time to treat this. So, it's a real mess, and as you know, we've talked about before, as soon as you wipe out one thing then other things are likely to move back in, so maybe you do clear H.Pylori with triple or quadruple therapy. I have seen it be successful but then we see all the other crap move in. the Klebsiella, the Citrobacter, C. diff, other types of Clostridia, those move in, and then those create other problems.

So, it's kind of like you played whack-a-mole, right? Like you knocked the one pathogen out and now you've got these other histamine-producing bacteria that move in so you're still in the trenches here.

Dr. Justin Marchegiani: 100%! And so, I look at it like this: Stomach acid is a really good and first important step. We need that. We know most people stomach acid and bile acids drop and bile acids they're they're slightly acidic but they can also prevent a lot of bugs from growing, right? So, this is really important. People that have sibo tend to have lower bile acids as well. And so, one of the first things that we'll use to kind of stimulate motility and stimulate acid production, we'll use a bitter call Ginger, and Ginger is also a mild H2 blocker.

So, it can also help modulate histamine a little bit which is really cool while also stimulating digestion. which is really interesting. And then we'll use like, people will use like you know, an H2 blocker like Pepcid-AC, but the problem is that drug actually will block hydrochloric acid levels, where some of the natural H2 blockers like ginger won't actually block it, it will actually stimulate it which can be much better. This is why drugs have side effects, they tend to disrupt and block inhibit enzyme pathways so you tend to have more side effects. Where herbs just tend to enhance and support.

Evan Brand: Yeah, well said and I was just going to throw in Ginger too is always helpful when you have nausea because a lot of these gut bugs can produce nausea, I told you years ago when I had H.Pylori. Not only did I have anxiety, but man, my nausea was out of control especially on an empty stomach, it was awful. So, I would just do these Ginger chewables and that would really help tamp it down.

Dr. Justin Marchegiani: Yeah! yeah exactly. Now I tell patients like, obviously, lifestyle is a foundation, like the food you eat, diet, sleep. But if you're eating like really good high-quality grass-fed steak or salmon but you're not able to break it down well that's a problem. So that's why like foundational digestive support is going to be the foundation it's almost equal that up with food because if you can't break the food down, the food even though it's healthy, can also be a stressor on your body.

So, I really want to get the HCL, get the enzymes dialed in. Now some people when their guts really raw and they have a lot of histamine issues, they may not be able to handle much hydrochloric acid and that's where working with a clinician, like some patients, they kind of jump to conclusions they like try HCL, they have a negative reaction like no it's not for me and they kind of just jump ship. It's like, “Wait a minute!” Like utilize the thousands of patients that we have data points from and figure out what does that mean? What's plan C? What's Plan D? What's plan E?

Because there's ways that we can either lower the dose, increase enzymes and bile acids, use bitters, there's other little tweaks that we can make to make that work and then also what does it tell you about your body? It tells you you probably have atrophic gastritis. You probably have a really thinned out gut lining, and we really have to work on building up those enterocytes, building up you know those goblet cells, building back up those parietal cells, really that mucosal lining really building it back up.

Evan Brand: Yeah and question came in about gastritis. Well figure out what's causing it, you know. Gastritis is just the, it's like the upper GI IBS. What I mean by that is like you go to the conventional doctor if you get referred to the gastro, with diarrhea, constipation, they'll throw the IBS label on you like they did to me years ago. If you have any kind of issues up north, you know say stomach or higher, then you may get this gastritis diagnosis.

And often what's going to happen is, they may throw in that acid blocker, reducing stomach acid further, now your food's not digesting well, now you're getting a buildup of these histamine producing bacteria, now you develop histamine intolerance all because the doctor was trying to fix the gastritis and put you on the acid blocker. So he screwed up this whole, there's a negative domino effect that happens once the pharmaceutical is put in for gastritis.

So, our remedy would be to come in and say number one, do a stool test. We would likely run the GI map, that's our favorite at the time of this recording. And with that stool test, we would look at cow protectant, which is your gut inflammation, we would look at pancreatic enzymes, look for H.Pylori, look for all the bacteria, and then we would do it in the proper order. So maybe there are some soothing herbs like you mentioned in the beginning and then ultimately knocking the infection down that's causing gastritis.

So, you can't just glutamine your way out of this. You can't just chamomile tea your way out of this. Ultimately there's something driving it. So I'm cool with the the natural, soothing remedies. You could drink a gallon of aloe juice a day if you want but it won't clear the bugs. So really got to figure out what's driving it.

Dr. Justin Marchegiani: Yep exactly! And so one of the big things I'll use, I'll use Manuka Honey because I find it can have a natural antihistamine benefit. It can release, it can reduce the body's production of histamine plus it's very soothing. They use it in burn victim units in hospitals. It's also antibacterial. So if you have a you know, higher level bacterial load in your gut let's say H.Pylori, it could probably start knocking it down a little bit. I would say I would never rely on Manuka Honey to addressH.Pylori by itself but it's a gentle way to start.

Again, I don't like to come in there and throw heavy herbs out of the gate because I just find if someone's gut is raw and we throw a whole bunch of clove or mastic, or whatever oregano, or berberine, that can sometimes irritate an already sensitive gut lining. So we want to really work on getting everything dialed in the first month or two and you know, how that food is cooked and prepared makes a big difference as well. So I like ginger, I like Manuka Honey.

Again, glutamine or glycine or collagen, so a good building block, but like Evan said, if I throw a whole bunch of building block, let's say, wood into a burning building, does that really fix anything? It's like “No! We got to get the fire down!”, right? So yeah, here's this building block, but we got to get the fire down, and it's not bad to throw it in there, maybe with some aloe, or some DGL, or some ginger, or some Manuka Honey, or something that's really anti-inflammatory and gentle. I have no problem with it, but you got to look at it talk about it with your functional medicine doctor. Have the big picture plan. Don’t just go and throw stuff at it at like willy-nilly.

Evan Brand: Yeah and the truth is, when you're desperate and you're miserable, you're gonna run somewhere and do something. So, I would encourage people, if you are in the current state of suffering, you have histamine issues, you have gut issues, you're having this gut histamine problem happening. Just either reach out ASAP to us so we can help tamp it down, or do something gentle and slow. Don't just go jump on three, four, five drugs.

I've seen it they get on Chromolin and you named several other pharmaceuticals, they jump on those and then now you have to clean up the issues with that. Now there's potential Osteopenia or Osteoporosis because they've been on acid blockers for 20 years screwing up their mineral absorption. So, now you have a bone density problem, or now there's a mobility problem because their hips are weak, right? So, it's like there's other collateral damage that happens when you are incorrectly tamping down the acute situation of stomach burning, GI pain, gut issues of any kind, histamine problems.

I would encourage people pace yourselves but you know, don't. I don't want to talk people out of getting care, I'm not saying that like if you need a colonoscopy because you're bleeding out of your butt, yeah you got to figure it out. If you're vomiting blood, yeah you got to figure it out ASAP. But if it's this subpathological issue, meaning there's no formal diagnosis you've been given, they just kind of brush you off and send you home with a couple over-the-counter remedies, then you really got to start digging.

So get your stool looked, at get your urine looked at, and check out your partner too. Your partner could be a vector. So that's why I always ask the question, “Hey, you know you have these gut issues what about your spouse or your partner? Do they have the same issues? Yep they sure do! What about your kids? Oh yeah, my kids guts are messed up too.” Okay then we find out this infection is whole family-wide, so if we can, sometimes we're working on the whole family.

Dr. Justin Marchegiani: Yeah 100%! And again, you know, most diagnoses, you know, really aren't that helpful like let's say, you have some inflammation in your stomach, you're like, “I need to go to my doctor and get a diagnosis.” So, let's say they just look at symptoms and they say, “Okay, well, you know, we're gonna just try to give you an acid blocker because, we, you have irritation, right? That sounds like a gastritis, which just means gut tissues inflamed. Itis means inflammation. Gastro means gut, stomach. And then, maybe we're going to give you Gaviscon, kind of coat that stomach, maybe we'll recommend Tums or an acid blocker. Maybe we’ll give you a steroid.”

Maybe the next thing is, that doesn't work then they're going to recommend a scope. Let's say they see an ulcer there, they may test for H.Pylori, they may be getting closer. But now they're throwing a whole bunch of antibiotics at it that only works seventy percent of the time, and can create bacterial overgrowth in other areas. And so, they may not get to the root underlying issue and they may just try to symptom spot and so I always tell patients how does the diagnosis get to the root cause?

Now if you're bleeding, you have a serious ulcer, you may need something to reduce in the inflammation acutely. But in the end what happens next because you still didn't get the root cause addressed? Why did you have that to begin with? What foods were you eating? What kind of imbalances do you have in your gut? What kind of lifestyle problems do you have? So you have to look deeper.

If I go to the doctor and I have knee pain, right? All the doctor is going to say is “Oh my gosh! You have arthritis in your knee!” He literally said the same thing back to you, just in Latin, right? She said you have arthritis which means joint, arthro-itis means inflammation of the joint. He literally just said the same thing back to you! You said, “Hey Doc! My knee hurts!” and he just said, “Of course! You have inflammation of the joint.” Which you're like, “Of course! Like, no crap right?” Now, question is why? They may say, “Well, your cartilage is wearing thin, we need to put a total knee in there.” But how did that happen, right? Should I add in collagen? Is my exercise wrong? What caused that? “Hey! Should I look at Prolotherapy or stem cells?”, right? 

There's so many other means of looking at things that may have helped you in between, and now again if it's so far gone, and you're not willing to make a change in your diet or lose weight, that may be your only option, right? But I always tell patients, “You want to know all your options!” You want to understand kind of the diagnostic language. A lot of times, they're just telling you the same thing back and they're just spot treating symptoms. Sometimes that may be necessary but most times you're just ignoring the root cause.

Evan Brand: Yeah and we jumped into the nitty-gritty quick. So if people got lost in the weeds of “How do you know you have a histamine problem”, a lot of people don't. So this could be allergies, where you're reacting strongly to the outdoor environment. Like when pollen starts blooming and the flowers are coming on the trees, all of a sudden you're reacting, you're getting stuffy, you're getting brain fog, you mentioned dizziness, vertigo, you mentioned the rash on the skin, it could be flushing, you could have a stronger reaction to leftovers, so the longer protein is going to sit, you're going to have more histamine.

So, if you eat yesterday's burger for lunch and you feel weird after that, that could be a sign. Spices and herbs could aggravate that too.

Dr. Justin Marchegiani: Fermented foods! Do you have a reaction without it? Do you get a lot of brain fog when you have kombucha or sauerkraut?

Evan Brand:  Yeah, spicy foods like chips. Like even if you're doing these avocado oil barbecue chips and all those spices if you kind of feel weird woozy after that. Alcohol intolerance, if you take a sip and you're already toasted, you know, that's a potential histamine issue. what else?

Dr. Justin Marchegiani: Well you see it, you see it with a lot of Asians too, right? Asians typically get that like red glow and and what do they take? They take Pepcid-AC, which is an H2 receptor blocker. So a lot of Asians are very sensitive to alcohol. So they intuitively know that's why you see Pepcid-AC being consumed typically by Asians because of the alcohol sensitivity, right? And so, it's important to know that. Now, anything else you want to add there Evan?

Evan Brand: Native Americans too. They're pretty sensitive to alcohol. I've seen that.

Dr. Justin Marchegiani: Oh yeah, oh yeah. I mean you can go back to the, you know, hundreds of years ago. That was clear with, you know, different hard alcohol cause major problems for sure.

Evan Brand: Insomnia because you know, histamine is a neurotransmitter too so it can really make you alert, it can make you anxious too. Fatigue even. I've seen histamine issues driving fatigue but the anxiety, heart palpitations. I've seen in more extreme cases, chemical sensitivity, reacting to fragrances, that's a lot of it.

Dr. Justin Marchegiani: Good, now like what is histamine guys? Right, histamine is actually made from the amino acid histidine. So histidine's a nutrient, it's an amino acid your body will make it. Now, the more you are inflamed, the more the gut bacteria is off, the more you're low in certain nutrients, because certain nutrients that actually help you make the DAO enzyme, Diamine Oxidase, which actually helps you break down histamine, right?

Or also, the N-Methyl Transferase, HNMT is another enzyme but these enzymes are commonly found in kidney, kidney tissue but that will help break it down. Now, SIBO can impact it, copper, vitamin C, B6, these are all nutrients that are needed to help break down histamine, by making those enzymes. Now histamine, right? It can actually make acid in your stomach so it could actually potentially cause a little bit of reflux. It can cause issues with sleep, memory, cognitive issue, brain fog.

Histamine is a vasodilator. Think like if someone punched you in the eye, and it gets swollen, there's actually a histamine response. So, histamine acutely is it's good, right? You bump your elbow, it's opening up the vessel so you can get blood cells there to attack and get the damage down and then also bring the inflammation out. So, histamine acutely is totally fine, it gets a bad rap. It's when you're in a chronic state that's where it's problem because now it's causing everything to kind of dilate and swell and you have this chronic kind of bloat and inflammation issue, right?

Obviously, chronically inflammation is typically going to cause blood vessels to narrow because that's typically what chronic inflammation does but histamine the goal is to dilate. So you want to look at a big picture. Now you have the H1 receptors, these are going to be your smooth muscle cells. H2 are going to cause abdominal and nausea issues, right? So when you take a lot of the H2 blockers like Pepcid-AC, that may help with nausea. Your H3 are going to impact sleep and appetite and your central nervous system and then H4 are going to impact your spleen, your white blood cells, your colon.

So again, histamine by itself it's normal, it's when it's in that chronic inflammatory state that it's a problem.

Evan Brand: Well you know, what's interesting too, this is all involved in blood flow, kind of a tangent here, but I just think it's interesting, you know. Erectile dysfunction and loss of libido happens often during the H2 receptor agonist. This is like a 75% occurrence. So these people are having sexual issues now, where maybe they're getting put on testosterone or something else to try to help the erection issue but really, they're just on a histamine antagonist that's screwing up that pathway. So, once again it's like a side effect if something leads to another issue so.

Dr. Justin Marchegiani: Yeah, but we talked about like Pepcid-AC is an H2 blocker, right? But also ginger can block, pin block H2 as well, but it also can have a stimulatory effect on the hydrochloric acid. Kind of a little bit contradictory from what Pepcid is so it's interesting.

Evan Brand: Yeah, well, we ought to wrap this thing up, but I do want people to have resources. Well, we've covered the test, the urine, the stool, get your gut looked at with the gut bugs. If you're on drugs, let's try to find a better solution than being stuck on those. Let's heal up your gut. If your gut is leaky or you've got some gastritis going on, low histamine diet we covered that. Actually, we have a low histamine diet guide that I put together, like a PDF, it's free, there's no catch or anything, so I'll put a link on my podcast when we upload this. There'll be a link in the show notes for that.

Dr. Justin Marchegiani: Yep! I would say gluten sensitivity of course, anything processed, gluten, any of those, things can increase it. Again, there's certain medications that can also increase it so if you're chronically ill, you have a lot of health issues, and now you start getting into this poly-pharmacy cycle, guess what? That could also cause histamine problems. So NSAIDs, if you're taking ibuprofen, or aspirin every day, could be a problem. If you're on antidepressants, Prozac's, Olaf, right? Think about it. I think it was, I saw an article like, is it 20% of boys in fifth grade or on antidepressants. That's crazy!

Immune modulators right? The big drug by Abbott I think is Humira right? Because the patents running up this year, they use that for a lot of I think, a lot of chronic gut issues right? A lot of chronic inflammation, Humira is a big one. Enbrel, Plaquenil, you have other anti, things that help blood pressure, (inaudiblke) Metoprolol right? Then you have your Allegra, your Zyrtec, and then you have your your Tagamet, your Pepcid your Zantac, all your H2 blockers.

Evan Brand: Yeah, this is a crazy list. I was just looking at medications and histamine and how it affects DAO, yeah you covered almost all of them. Those immune modulators are huge too because you know, let's say you have some gut issue like, we know, there's certain bacteria in the gut that can drive things like rheumatoid arthritis, so Proteus, Citrobacter, some of these autoimmune triggering bacteria. So, let's say you have that bacterial overgrowth from antibiotics, now that drives some sort of autoimmune joint issue like RA, and then you get put on an immune modulator like Humira, now you develop histamine intolerance if you didn't already have it, then you get put on a mast cell stabilizer like Chromalin or a histamine blocker there. I mean man it turns into a mess quick doesn't it?

Dr. Justin Marchegiani: Oh my gosh! Yeah! Like you mentioned with the Humera right? You could have RA, or some kind of a chronic gut issue, Psoriasis, and now you're on this drug and then that creates more histamine issues, and then you never fix the underlying issue to begin with. Now, in functional medicine world right? We're going to get to the root cause there may be some things that we use that are palliative to work on supporting what's happening right?

That could be Coresatin, could be vitamin C, it could be stingy nettle, it could be NAC, it could be ginger, right? We may use some natural, just getting inflammation down will actually reduce histamine. So, we may do some of these things, if necessary, we may work on the environment stuff. We may say, “Hey, we're going to get you an Austin Air or an Air Doctor, high-quality HEPA filter for your home because you're getting too much antigens from the foreign environment that are stimulating histamine.”, right?

And so, you've got to look at the root. Now, we want to just make sure we round everything up. There could be some tests that you do from your conventional medical doctor. You can do the N-methyl transferase, 24-hour urine. You could do a histamine plasma, right? These are some tests, but it's not going to tell you what to do. It may give you a baseline, “Hey, my histamine's in the top 10% of the reference range.” “We're going to do some of these things. Come back in a month.” “Oh, look! It dropped!” So it could just kind of give you an indication that it's, you're moving in the right direction. It's not going to tell you what to do because your conventional doctor will just say, “Hey, here's some, right, antihistamine medication, fill in the blank to reduce it, that's not going to fix it. We may do other things, but that at least gives you a baseline or a starting point.

Evan Brand: One other question this really opens up the ability for us to do part two, part three on this, the hormonal connection to histamine. Question came in, Adam asked, “Can women cycles cause issues monthly with histamine?” And then, you wrote about mast cell, and the answer is yeah. That estrogen will actually stimulate the mast cells. I've looked at a few papers on this before. So, estrogen will cause mast cells to release more histamine, and it will actually down-regulate DAO.

So, you see, so many women having issues now, I mean there's so many xenoestrogens and things from the environment, combine that with plastics and other things affecting estrogen. A lot of these women are estrogen dominant, so then when they have the spike in estrogen throughout the menstrual cycle, for sure, you're going to have a histamine flush.

Dr. Justin Marchegiani: Yeah, so in general what happens with histamine just to kind of echo. Histamine can stimulate the ovaries to actually make more estrogen. That creates more estrogen dominance so think of any of your PMS symptoms, breast tenderness, cramping, mood issues, sleep issues, irritability, back pain, that's going to cause more of those symptoms.

Progesterone at the same time does stabilize your mast cells. It does upregulate DAO. So it helps you deal with it better. So you're going to create more estrogen dominance,e and that's not going to be good. Anytime you create more inflammation also too, your progesterone tends to have a very anti-inflammatory effect, and so the more you stimulate your progesterone to be used for your anti-inflammatory cortisol, you tend to increase this estrogen-dominant situation.

Evan Brand: Yep, all right, well let's wrap this up. I know I got to run it, you gotta run here. I think we did great but let's do a hormonal histamine one. I think we could unpack that. I think we could do half an hour just on that topic if not longer.

Dr. Justin Marchegiani: Yeah I'll come back here after guys to answer some more Q7A stuff. But Evan, great chatting with you all. You guys want to reach out to Evan – Sees patients worldwide, get to the root cause. Dr. J.,, feel free myself. Reach out to patients worldwide. We're here to support y'all! Take action! Action! Action! Action! Think of one thing you can execute on today guys.

Evan Brand: Heck yeah! All right, man, it's a pleasure!

Dr. Justin Marchegiani: Hey! Pleasure is mine! Take care all right,! 

Evan Brand: See you soon! Peace! Bye!


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