Graphic from Healthy Pixels: The Many Faces of Histamine Intolerance (well worth reading)
Almost a month ago I blogged about Histamine Intolerance, a widespread and under diagnosed condition. I have been preoccupied with this topic, and have since heard from many readers who recognize themselves in the widely inconsistent and variable symptom picture that can be associated with it.
Please read my first post on the subject, as well as Freshness Counts, on the blog Diagnosis Diet, by my esteemed colleague, another Boston psychiatrist with a curiosity about the relationship between food and health, Georgia Ede, MD. This will provide a good background.
Histamine Intolerance can be used as a frame work to understand the connection between many different symptoms, and to provide an understanding of the way that they are linked by a common underlying pathophysiology. For instance in my own case, “What is the relationship between depression and anxiety, insomnia, hypotension, constipation, tinnitus, easy bruising, and dry eyes?” Answer: They could all be manifestations of excess histamine in the body. Histamine intolerance flies beneath the radar of most doctors, and can easily result in a misguided treatment approach.
Syphilis used to be called the Great Pretender because it could present with such variable and diverse symptoms, that doctors often missed the diagnosis. Histamine Intolerance is a modern day Great Pretender.
Take my housekeeper Sandra. She had been suffering from a mysterious syndrome that had been getting worse. It began with migratory arthritis; first her elbow became massively swollen. After that resolved her knee was affected, then her wrist. Next it switched to migratory myositis, with bizarre painful swelling of her triceps, and then her forearm. Then she began to be afflicted with hives, and other odd skin lesions. The final symptom was an agonizing muscle spasm of the side of her back that would come in waves like contractions of the uterus during birth. She could not sleep and was completely debilitated.
The doctors gave her pain medication, steroids, muscle relaxants, anti-convulsants, nothing helped. She had been following a GAPS-like diet, which was my two cents, but with no relief. I continued to research on the internet, and came upon a site called The Reluctant Raw Foodist , which was written by a woman with severe Histamine Intolerance who had similar symptoms to Sandra. Sandra began to follow a modified version of her protocol, and the terrible spasms which had been continuous for three weeks resolved in two days. No other symptoms have returned. This was 2 months ago.
Prominent psychiatric symptoms can be the presenting complaint of a patient suffering from Histamine Intolerance, with anxiety, panic and insomnia. Unfortunately food sensitivities are still not part of the vocabulary of most psychiatrists. It is still the very unusual psychiatrist who asks a patient about diet, when trying to make sense of the current symptoms and history. The most common treatment modality offered by psychiatrists to the anxious patient who is not sleeping is medications.
It is interesting to note that some anti-depressants and anti-psychotics have prominent anti-histaminic side effects, such as blurring of vision, dry mouth, sedation, headache, dizziness, increased appetite and weight gain, to name a few. When a patient tries to discontinue the drug, symptoms of histamine intolerance can manifest, such as profound insomnia and anxiety, and it can be difficult to come off the medications. Monica in her blog Beyond Meds writes in detail about her experience of the terrible aftermath of psychiatric polypharmacy in a valuable post entitled Multiple Drug Sensitivities.
I would like my readers to understand that I also prescribe psychiatric medications to some of my patients, and believe that they can be very useful in certain situations. But if a patient has gut dysbiosis which has resulted in food intolerances and sensitivities that are expressed as anxiety, depression or insomnia, it may be that if they would modify their diet and supplement with probiotics, that there would be no need for prescription medication.
This is equally true for people who are carbohydrate intolerant. The average American eats between 300-600 grams of carbs a day. A healthful amount would be around 60 grams for many people. Excess carbohydrate consumption can often result in decreased energy, depression and anxiety. When a patient is motivated to take on the hard work of dietary change, then that is clearly what is indicated, and not prescription medications. The general lack of awareness that psychiatrists have of the relationship between psychiatric symptoms and diet results in very poor care of patients and a great deal of harm.
The cook book author and blogger at the Low Histamine Chef, Yasmina Ykelenstam , believes that healing Histamine Intolerance depends not only upon eliminating high histamine foods, but upon including foods which are naturally anti-histaminic and anti-inflammatory. She is coming out with several new cookbooks, one with a Paleo perspective, which reflect this philosophy. Herbs such a thyme, holy basil and greens such as amaranth are just a few of the foods she highlights on her blog.