The Dr. Hyman Show - Is Histamine Intolerance The Cause Of Your Mysterious Symptoms? with Dr. Todd LePine

Episode Date: February 1, 2021

Is Histamine Intolerance The Cause Of Your Mysterious Symptoms? | This episode is sponsored by Athletic Greens and Dr. Hyman's Sleep Master Class. Most people are familiar with certain histamine conditions, such as the development of a welt from a bee sting or hives from a peanut allergy. However, symptoms ranging from brain fog to digestive problems, menstrual cycle problems, nausea, vomiting, edema, palpitations, and anxiety can all also result from issues of histamine intolerance. Unfortunately, this issue commonly goes undiagnosed, often resulting in years of ongoing frustration and suffering among individuals struggling to find the cause of their mysterious symptoms. In this episode, Dr. Hyman sits down with Dr. Todd LePine to talk about how they work with patients to get to the root cause of histamine intolerance. They discuss the rising prevalence of mast cell activation syndrome (MCAS), how gut health influences histamine, and much more. Dr. LePine graduated from Dartmouth Medical School and is Board Certified in Internal Medicine, specializing in Integrative Functional Medicine. He is an Institute for Functional Medicine Certified Practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. LePine’s focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring the natural balance to both the mind and the body. His areas of interest include optimal aging, bio-detoxification, functional gastrointestinal health, systemic inflammation, autoimmune disorders and the neurobiology of mood and cognitive disorders. Dr. LePine teaches around the world, and has given lectures to doctors and patients at American College for Advancement in Medicine (ACAM), Age Management Medicine Group (AMMG), the University of Miami Integrative Medicine Conference, The Kripalu Center in Lenox, MA, and is on the faculty for American Academy of Anti-Aging Medicine (A4M). Dr. LePine is the head of the Scientific Advisory Board for Designs for Health and a consultant for Diagnostic Solutions Laboratory. He enjoys skiing, kayaking, hiking, camping and golfing in the beautiful Berkshires, and is a fitness enthusiast. This episode is sponsored by Athletic Greens and Dr. Hyman’s Sleep Master Class. Athletic Greens is offering Doctor’s Farmacy listeners a full year supply of their Vitamin D3/K2 Liquid Formula free with your first purchase, plus 5 free travel packs. Just go to athleticgreens.com/hyman to take advantage of this great offer. In this modern world we place too much value on staying busy and deprioritizing sleep, which is why Dr. Hyman created his first ever Master Class. It guides you through the most important steps to getting better sleep, starting today. Get free access to Dr. Hyman’s Sleep Master Class at drhyman.com/sleep.  In this episode, Dr. Hyman and Dr. LePine discuss: Symptoms of histamine intolerance The rising prevalence of Mast Cell Activation Syndrome (MCAS), and the effect of EMFs on mast cells Histamine producing foods, and the connection between histamine intolerance and leaky gut  Testing and diagnosis of histamine intolerance Pharmaceutical drugs that drive histamine intolerance Nutrients that support histamine balance Patient cases Additional Resources: The Functional Medicine Approach To Ending Migraines  https://drhyman.com/blog/2020/12/11/podcast-hc34/ What Is Leaky Gut And How Can You Treat It? https://drhyman.com/blog/2020/03/20/podcast-hc2/ A Simple Diet Experiment That May Solve Most Of Your Health Issues https://drhyman.com/blog/2020/08/22/podcast-hc24/ How To Recover From Chronic Lyme And Tick Disease https://drhyman.com/blog/2020/05/21/podcast-hc11/

Coming up on this episode of The Doctor's Pharmacy. It's a spectrum illness and you can have mild, moderate, and severe forms of it. And there's a whole variety of different things that are involved. And you sort of have to treat each person individually looking at their unique situation, their history, their genetics, their gut microbiome. Hey everyone, it's Dr. Mark. My main goal with diet is to use food as medicine. But even when we eat super well,

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go to drhyman.com forward slash sleep and sign up today free. That's drhyman.com forward slash sleep. Welcome to Drs. Pharmacy. I'm Dr. Mark Hyman. That's Pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you feel like crap, you may be suffering from a rare condition, which may not be so rare, called histamine intolerance, which we'll get into. You were to handy histamines, which is when you have an allergy, but a lot of people make too much histamine, which is what causes all the allergies, and they just feel like crap, and they have swelling, and fluid retention, and they have all kinds of issues. We're going to talk about it in depth with my friend and colleague at the Ultra Wellness Center, Dr. Todd Lepine, graduate of Dartmouth Medical School, internal medicine doc.

He's on the faculty of the Institute for Functional Medicine, teaches all over the world. Well, not now. He's doing it all virtually like most of us. But he's one of the leading thinkers and contributors to the field of functional medicine. We've worked together for over two decades. I started out at Kenya Ranch a long time ago, and he's one of the smartest dudes on the planet in functional medicine. I'm so happy to have you again on this special episode of the Doctor's Pharmacy, our house call episode. Thank you, Mark. Okay, histamine. What the heck is histamine? Why should we care? And tell us why it's so important and why it contributes to so many people's unnecessary

suffering. So histamine is found naturally in the body. The body makes histamine. We also consume histamine. And the interesting thing about histamine is it is also part, it's released by mast cells as part of our first response to offending organisms like viruses. So mast cells are like a white blood cell. Exactly, yes.

Type of white blood cell. Type of white blood cells, yeah. And the also interesting thing is that histamine actually works as a neurotransmitter. And when you think about this, this is really an interesting thing. And as I was preparing for this, I sort of stumbled upon some things which I thought was really quite fascinating, is that when you take antihistamine, what happens to you? You get drowsy. Exactly. So histamine, when it's at high enough levels, it stimulates the brain. Histamine is actually involved in the sleep-wake cycle. Well, I mean, Tylenol PM or Advil PM, it's Tylenol, Advil plus

Benadryl, which is an antihistamine. Right. So it's a balance. Like, you know, too much histamine is bad. Too little histamine is also bad. So when you actually totally block histamine, you actually get sleepy. It'll actually be involved with the sleep-wake cycle. And modafinil, which is the drug that people take, that actually works on histamine. Provigil. Provigil, exactly.

Actually, part of that works on the histamine. So it keeps the histamine levels higher, so it keeps your brain sort of awake, if you will. Incredible. So most people are familiar with certain histamine conditions, right? If you get hives, if you have a peanut allergy, if you have this condition we call dermatographia, which sounds weird, but essentially it's if you scratch your fingernail on your skin, it'll create a red welt. Yes, yes. That's it. You you scratch your fingernail on your skin, it'll create a red welt. Yes, yes.

That's it. You can literally write your name on your back and it'll kind of have raised letters. And that's actually a poor man's way. I oftentimes will use that with patients to determine how much histamine they're having in the connective tissue because the mast cells are the type of white blood cells that are in the connective tissue of the body. And when they have excess amounts of histamine in them or they release histamine too easily, you will get this thing called dermatographism

where you can take your finger and stroke on the skin and you will form a red line and it'll stay there. And sometimes it'll get really welty and raised. And that will tell you that there is a problem with excess amounts of histamine in the body. Yeah, and it's something that, you know, we've all experienced. And when you get a bee sting or something like that, you'll see this raised wealth. But what happens for some people, they don't necessarily get the hives and they don't get these raised wealth on their skin, but they do suffer a whole range of symptoms. So when someone walks in your office,

what are the clues that alert you to the fact that they might have a histamine problem? Because by the way, most traditional doctors don't even know anything about this syndrome. Yeah, if you have allergies, take an histamine, but that's about it. But there's a whole host of problems that people suffer from that are mostly misdiagnosed, poorly treated, and create so much suffering, which is unnecessary. Yeah. And there's a term out now, which when I was in medical school, we didn't even have it. It was called, it's now called MCAS, mass cell activation syndrome. Like it's a real medical diagnosis. It's a real medical diagnosis. I mean, we're seeing a lot of it now.

And the question is, is why are we seeing so much mass cell activation? It's a really, and I've been puzzling on this myself. Yeah, I never took that class in med school. I know, right, exactly. But it's true. It's a big thing now. We're seeing a lot of it. And it's not like there's one cause for mass cell activation.

There are multiple causes. And I actually even, when I deep dived into the literature, one of the things that I stumbled upon was the effects of EMF on mast cells. EMF is electromagnetic frequency. So like your cell phone, cell towers, Wi-Fi. Absolutely. Absolutely. And there's some work by a woman, Johansson out of, I think it's Sweden, who's done some work on the effects of EMFs on mast cell degranulation. And there's some good studies showing that EMFs are one of the things in susceptible individuals that cause their mast cells to release more histamine that drives this allergic inflammatory response.

So that's fascinating. And so what are the sort of symptoms that you see people coming in with? Well, they oftentimes will react to every food. They're sort of the people who they can't, they have a more and more restricted diet because the more foods that they eat, it'll trigger because lots of foods contain histamine or will get broken down.

Histidine is an amino acid. And when you consume foods that are high in histidine, things like meats have a lot of histidine, your body will actually break it down into histamine. And normally the body can process that. But when you have problems with either too much ingestion or too much production of histamine or not enough breakdown of the histamine, then you'll have problems with histamine intolerance. And these are typically a lot of people who have food allergies. And Mark, I think you've done this yourself.

This is really interesting is the old way of treating food allergies was what? Chromalin sodium. Remember using that? And it's actually a pretty good treatment for people who are really, really reactive to foods. And the way that chromalin sodium, because chromal is actually used for patients with asthma. Yeah, you inhale, it's an inhaler. It's an inhaler, exactly. And it's a very effective drug.

For really bad cases, chromal and sodium can be very, very helpful for patients who have severe histamine responses to foods. And it's true. And people can come in with all sorts of weird symptoms that just are misdiagnosed. They have headaches, they can have migraines, nasal congestion, sinus issues, fatigue. Brain fog.

Brain fog, digestive problems, menstrual cycle problems, nausea, vomiting. And if it's really severe, you can get really bad cramping, you can get edema, tons of fluid retention, palpitations, anxiety, your temperature regulation is off, dizziness. So a lot of people come in with all these weird symptoms. I don't know what's wrong. I've taken an antidepressant. But there is a way to diagnose this. And so if you're suffering from any of these issues, there may be a chance that it could be a histamine issue. And when you have someone who comes in with all these symptoms, and by the way, a lot of people have edema and fluid retention. You can just stick your finger in their body and their tissue. You can feel it's puffy and swollen.

You can get edema in the legs. You can see just people carrying a lot of extra weight and fluid. There's often some type of histamine activation there. Well, sure, because the mast cells, which are the cells that contain histamine, they're actually found in the spaces, the interstitial spaces in the connective tissue of the body. So that's why they get puffy, because those are where those cells that are high in histamine reside. And it can really be something that leads to chronic fatigue syndrome, this mast cell activation issue. It's a big deal. And most of the time, it's just completely missed. Yeah. I mean, if you ask the average doctor, say, doc, I think I have mast cell activation syndrome. Can you please get me the

test and diagnose me? They're going to go, I don't know. Yeah. You know, let me check your histamine levels. So, so when you have a patient with this, how do you begin to think about diagnosing this? Because, you know, it can, it can be a big, it can be a big deal for people. And I want to share a case later. You're going to share some cases of some patients who suffered for decades, decades, and finally get better when we treat them. Yeah. Well, again, we talked on the last podcast about the role of leaky gut in the microbiome. Interestingly, when you have dysbiosis, some of the bacteria will actually cause more of

your body to produce excess amounts of histamine. So that's another thing where when the histamine is in excess in the digestive tract, that can be related to food consumption, which are high foods in the histamine, or the bacteria are actually causing the breakdown of histidine as an amino acid to go into histamine. So dysbiosis is one of the things that can trigger excess amounts of histamine. That old nasty gut thing again. We're talking about the gut here on the Doctors Pharmacy podcast and especially on our House Club episodes because it's such a fundamental thing and it's connected to everything.

And the microbiome is so critical in so many aspects of our health. And I remember when we started doing this, Todd, decades ago, and we'd say, oh, people have a leaky gut, or there's problems with their gut flora, they have dysbiosis, they would just laugh at us. Literally, doctors would just laugh at us and think we were completely crazy. And yet, it is now one of the most important areas

of research in medicine is the microbiome and understanding leaky gut. And you see all kinds of papers in scientific literature using the term leaky gut. And you see all kinds of papers in scientific literature using the term leaky gut. I'm like, wow. This is, I literally remember sitting, it was in 1997, and I was at Canyon Ranch, and I was having dinner with some guests,

and there was some doctors in the crowd, and we were having nice dinner, and I was talking about leaky gut, and this woman was an allergist, so her specialty was allergy and things like histamine. And she looked at me and she says, you're just completely nuts. There is no such thing as leaky gut.

You know, this is just a bunch of, you know what? And I just was like, looked at her like, oh boy. You know, and it's now, you know, 25 years later and medicine's really come along. It takes a long time, but people are still struggling. And I think the obvious, you know, the obvious, the worst sort of case scenario of a histamine reaction is obviously anaphylaxis. But it doesn't have to be that. So talk about how we begin to

diagnose it. We look at what tests besides a SIBO test? Well, you can measure histamine in the blood. You can also measure tryptase, which is another marker for mass cell activation. You can also measure, there's another test, which in my preparation for this, I've not measured, I haven't found the lab that does it, but it can be measured as N-methyl histamine, which is a breakdown product of histamine. That is another one that can be done. And then again, I think one of the tests for me

is dermatographism. I find that a very helpful clinical test to determine if a person's mast cells in interstitial spaces are overly reactive and releasing lots of histamine. Yeah. And we also do a test for DAO deficiency. Yes. Yeah. So talk about what that is. DAO is an enzyme, right?

Yes. So DAO is a diamine oxidase. So this is an enzyme that our body has and it helps to break down histamine. So histamine has to be, you know, consumed, it's used, and then it has to be detoxified. And if this enzyme is lacking in a person, for whatever reasons, the enzyme may be turned off, you will have problems with detoxifying histamine, especially in the gut. And there are enzyme products that you can use, DAO enzymes that you can use, that patients respond very, very well to this. Yeah, we do that here at the Cultural Wellness Center. We give people hist-DAO and enzyme support. And it's interesting, there's a lot of things we do every day that block

DAO production. Alcohol, black tea, green tea tea which is a good thing mate energy drinks these all block dao production so it's going to increase your your histamine intolerance yeah exactly yeah and then you know you can you can use um uh his anti-histamines and the other thing we had another podcast earlier on migraines and this is i found this also very interesting is one of the things that is a histamine blocker is Butterbur. And Butterbur is used in migraines. And the reason why Butterbur works in migraines is it actually is working on an antihistamine level.

Because you can get an allergic brain, if you will. We know about that where you get fuzzy in the head and you can get headaches and things like that. So excess amounts of histamine has an impact on the brain. Yeah. We know about that where you get fuzzy in the head and you can get headaches and things like that. So excess amounts of histamine has an impact on the brain. Yeah. And so when you see these patients, you can do some of the genetic testing, look for these DAO deficiency issues. You can look at histamine levels.

You can look at some of these byproducts. You can do tests for DAO deficiency. You can look at some of the other factors that might be causing it, like leaky gut, food sensitivities. All that is really part of what we do here at the Ultra Wellness Center when we check these patients' history and we look at their lab tests. And then when they come in and you have this suspicion, because sometimes it's hard to diagnose, you have a suspicion, it's pretty easy to test of test and try different approaches that allow people to see if it's an issue. So what are the dietary things that we'd start with?

Because a lot of histamine triggers are in the diet. And so we can have a low histamine diet. So what's a low histamine diet? Or what actually are, put it this way, what are the foods that have the highest histamine that we should be avoiding? Yeah, so basically the way to think about it is bacteria produce histamine. So if you have food that's old, if you have food that's sitting in the refrigerator for a couple of days,

guess what happens? The bacteria actually break down histidine, the amino acid into histamine. So no leftovers for these people. Leftovers, exactly. Leftovers, exactly. Oh boy, I live on leftovers.. Maybe just like the next day. And then fermented foods. Fermented foods are fermented by bacteria. So anytime we have food that's old or fermented, things like Parmesan cheese, aged meats, et cetera, cured meats, et cetera, they have high histamine, and that's part of the fermentation

process. And yet we talk about fermented foods being so good for you, like sauerkraut and kimchi and natto and miso and exactly and this is where this is where this is where these these really good foods in someone who has histamine intolerance is like putting gasoline on a fire and they'll they'll say well i'm getting worse it's like well no you should be getting worse these are good foods for you no you have histamine problems what is that saying was good for the gooses and good for the gander, right? I think this is so critical what we're talking about here, Todd, because functional medicine is personalized medicine. Absolutely, yeah. It's precision medicine. And it's not only medicine, it's precision nutrition. Yeah. So it's really important to understand that even though

this way of eating may be great for some people with fermented foods and eating avocados and having delicious shellfish. Bone broth. Bone broth. That's another one. Right. We think, oh, these are great foods, but you might be killing yourself. Of course, alcohol and beer and all that is a problem.

Wine. But we're really here focused on what is right for you. Yeah. And I think dietary dogma really interrupts personalization approach to nutrition. Some people do great on vegan diets, some people do terribly. Some people do great on keto and some people do terribly. So there's no one size fits all approach.

And what really frustrates me Todd, and probably I imagine you too, is that there's all these people out there on the web and internet and promoting this and that approach and this and that diet, and they're not seeing patients. And the thing about seeing patients is it's incredibly humbling. If you've seen tens of thousands of patients, you know, you can't be dogmatic. You can't say, this is the way. You have to be vegan or you have to eat meat or you have to eat fermented foods. It's like like you go, wait a minute, everybody's different. And what works for one may not work for another.

Yeah, one man's food is another man's poison. That's right. And even good, quote, good foods. You know, we're talking about good foods. And so I think this is a really important point, particularly people who have histamine issues, which is a lot of people at some level or another, they should consider trying a histamine-free diet. And also other foods that we think are also great, maybe triggering histamine, like papayas and chocolate. Oh my God, chocolate, which I love, would be terrible to get this

condition. Dried fruit, certain nuts, food dyes, additives, you know, wheat germ. Wheat germ is supposed to be health food, right? Tomatoes, bananas, all these things may really cause increased histamine production. And sadly, in order to get this under control, sometimes you need to be restricting some of these foods for a while to allow your body to heal. It's not forever. That's the thing is, I think you're absolutely right. An elimination diet is not something that you do forever. And a low histamine diet is also something that you don't necessarily have to do forever. And I think that the key thing is really working with a really good well-trained experienced functional

medicine nutritionist who can help you navigate all of the nuances of what to eat what to avoid uh what what to take as in terms of supplements can be very very helpful absolutely you know the things that we want to focus on if you have a histamine intolerance or foods that are low in histamine like fresh really fresh food is the key, right? Not old food. Like you said, fresh meat, freshly caught fish, not fish has been sitting around for a while or canned fish is not as very good. Fruit that's not citrus fruits. Eggs are great. Not gluten grains get away from the gluten, but quinoa and,

and black rice, not dairy, avoid dairy, but you can have coconut milk or almond milk, lots of veggies, but no tomatoes, avocados, spinach, or eggplant, right? So, you've got to be smart about this and it's a little complicated and often you need help with the nutritionist. All the good oils and fats that we like, those are all great. So, you know, it's pretty much how I eat. I mean, I do eat avocados and certain things, but I really pretty much eat protein and vegetables and it works so well for these patients um so so todd when you see a patient like this tell me about a case that you might have had where where it sort of uh kind

of got you thinking about this and allowed you to to really drive down into into really the diagnosis and the treatment well you bring up an interesting thing because you know as i uh have seen more and more patients and i i think we are seeing more patients who have histamine intolerance, call it mast cell activation syndrome to what degree, is there are certain individuals who can be a little bit more predisposed towards this. So people who have Ehlers-Danlos syndrome, the hypermobile people can actually have, for whatever reasons, will have a higher incidence of histamine intolerance. The other thing in the case I recently had

was a patient who came in to me with severe mast cell activation syndrome. It was on a whole bunch of different medicines, including chromium, which we talked about earlier, to decrease food reactions to histamine. And I saw the patient, and he gave a very interesting history, had this skin lesion, which sort of like morphed into this, almost like a scarring type ulcerated lesion

on his back area. He saw multiple dermatologists, had a biopsy, had part of the area removed, and was ultimately diagnosed with some type of form of a scleroderma, sort of like a malignant scleroderma, which is sort of interesting and like, oh, what's that related to? But he was also having all of these histamine type reactions. And then when I asked him a bunch of questions, you know, I started thinking about, well, guess what? Lyme disease is also associated with histamine intolerance because Lyme bacteria resides in the connective tissues in the body. It sort of hides there.

And that in turn can actually activate those mast cells, which mast cells are the first line defense or one of the first lines of defense against infectious agents. And when I asked him, because he had a lot of fatigue and brain fog type symptoms too, but maybe that was related to something else. So I asked him about potential exposure. So lo and behold, he ended up having a low CD57 count, which is oftentimes a marker. It's not diagnostic of Lyme, but it tells you that the immune system is not working so well. And when I did advanced testing on him, he had actually had conventional lab testing. I think we talked about that in another podcast, how regular conventional lab testing for Lyme disease is not that helpful. But I did a specialized T-cell Eli spot test on him,me, uh, Eli spot test lit up like a Christmas tree. Wow. Right. So he had Lyme disease. He had Lyme disease, which was actually

triggering a lot of his, uh, uh, mass cell, uh, activation, uh, type symptoms. Um, so, uh, so I were, I've been working with him for a while and he did very well. Uh, we, I put him on, uh, a, uh, supplement, which is a combination of quercetin, which can help with- It's like a natural antihistamine. Natural antihistamine. Turns out it's really good for COVID too. Yeah, exactly. Very powerful phytochemical.

And he did very well by adding nettles along with quercetin in supplement form. He also worked with nutritionists, got on a low histamine diet, dramatically made a huge, huge improvement. His brain was working better and his energy was better, but he still wasn't 100% better. So that's where I went to the next level. And he's, you know, currently actually being treated for Lyme. And it's in the medical literature. And I sort of stumbled upon this because I had this patient come into me. And she had the same thing. She had severe mast cell activation. She was on Zolaire.

She was on injections for- It was like 20 grand a year. Yeah, yeah, exactly. Yeah, 20 grand a year. 20 grand a year. To control the histamine, which could be controlled by diet and these other things. Exactly. And her condition actually turned out to be the same

thing. It was actually undiagnosed Lyme disease. And this is, I think, one of those things where you have to think about it, not that Lyme disease causes everything, but Lyme disease is such a tricky condition that you've got to be thinking about it. Anybody who comes in- It's a great masquerader. It's like syphilis. Exactly. It's like the great masquerader. And people can come in. I've seen people with Parkinson's symptoms. I've seen people with brain fog. I've seen people with rheumatoid, you know, seronegative rheumatoid arthritis.

Chris Christopherson at Alzheimer's, quote Alzheimer's. Exactly. I had one patient with fibromyalgia who was, you know, quote unquote fibromyalgia, whatever that means. It means you're hurt all over. And so Lyme can actually mimic fibromyalgia, whatever that means. It means you're hurt all over. So Lyme can actually mimic fibromyalgia. So you really gotta think about it. It doesn't present as one neat little boxed diagnosis.

You gotta really think about it. Well, that sort of speaks to one of the foundational concepts of functional medicine, is that one disease can have many causes. Like histamine intolerance can have many causes. And one cause, like Lyme disease, can have many causes. Like histamine intolerance can have many causes. And one cause, like Lyme disease, can create many diseases. Lyme disease can cause neurologic issues and joint issues and skin issues and chronic fatigue and Alzheimer's and mast cell activation syndrome

and POTS and all these weird diagnoses that doctors treat as if they're the thing, but actually it's something else. Right. You know, what's also interesting about histamine is that, you know, there are processes in our body, you mentioned this DAO enzyme that breaks down histamine. And a lot of things interfere with it. You talked about some of the foods that interfere with it, but there are also a lot of drugs that interfere with histamine breakdown through this DAO

enzyme. Antibiotics, antidepressants, antipsychotic medications, diuretics, even things like muscle relaxants, pain meds, GI meds, meds for reflux like the acid blockers, TB meds. And even over-the-counter stuff we use all the time like aspirin and naproxen, like Aleve, Voltaren, anti-inflammatories, all can be really driving this inhibition of this enzyme that breaks down histamine. So you might be taking all these drugs, you might be eating all these foods, you might be nutritionally deficient. All these things can really be driving this histamine intolerance. And what's interesting is that in order to actually

have the ability to break down histamine using the AO, you need certain nutrients, right? There's certain nutrients that really play a role like vitamin B6, vitamin C, copper, magnesium, manganese, zinc, calcium, B1, B12, folic acid. All these are critical nutrients and many of us are deficient. If you look at the nutritional testing we do here at the Alchewanna Center, I don't know about you, Todd, but people say, oh, you don't need vitamins, and oh, people are eating a healthy diet, they're fine. Nonsense. I mean, we don't guess, we test. And we look and see the amount of nutritional deficiency that exists are just massive, even in our population, which is a relatively affluent, well-educated population, imagine how bad it is.

And I've seen what I call virgin patients. People have really never seen a functional medicine doctor who have lower socioeconomic status, underserved patients, and they have massive deficiencies. And I think we really can take out the bad stuff, whether it's foods or drugs, and we can add in the good stuff, which is the right foods and the right nutrients. And that's really what's so powerful about functional medicine. So I just recall a case, I want to share a little bit of this guy who just was the most complicated patient. He, for years and years, had tremendous swelling everywhere. He'd get these lesions all over his body and he would have skin breakdown.

He had fluid retention. No matter what he ate, he couldn't lose weight. And he was always puffy and swollen. And it turned out he had this histamine intolerance syndrome and we diagnosed him and we put him on a low histamine diet. We gave him the chromalin, which chromalin is a mast cell inhibitor. So it basically blocks the release of histamine from these white blood cells. And you can take it before you eat and it's very safe. It's very, it's very, very effective

medication, very effective. It's prescribed for food allergies, but it's incredibly effective for this. I give them, he was also really severe. So we gave him another medication, Zantac, which is a histamine blocker. It's another histamine drug, even though it's for acid severe, so we gave him another medication, Zantac, which is a histamine blocker. It's another histamine drug, even though it's for acid stomach. And we gave him other supplements like quercetin. We gave him the histio. We sort of piled a lot of stuff on in order to help him. For severe cases, you got to do that.

And he was so severe. And it was amazing what happened to him. And after 35 years of misdiagnosis and suffering and struggling, he was seeing the best doctors. He lost 35 pounds without really trying. All the fluid went out of his system. It was all fluid. Fluid, yeah. Interstitial fluid. Fluid, yeah. It was like the Michelin man. And he's got healed. He felt better. And it was just really quite an amazing case. And I think it was one of the more extreme cases of histamine intolerance I've ever seen. And he had to be very extreme, but you know, there's, there's a middle ground depending on

where you're at and what you need to do. So if you are, think you're suffering from any of this stuff, then it's really important to get properly assessed and treated. And, and people go from doctor to doctor to doctor and they don't get an answer. And if you're, if you're really struggling, it could be this phenomena of histamine intolerance. Yeah, absolutely. Yeah. I think it's a spectrum illness and you can have mild, moderate, and severe forms of it. And there's a whole variety of different things that are involved. And you sort of have to treat each person individually, looking at their unique situation, their history, their genetics, their gut microbiome. Absolutely.

I mean, this guy had Babesia as well we had to treat. He had thick infections. Did he actually have Lyme or did he just have Babesia? He had Babesia and he also had bacterial overgrowth in his gut. So people had leaky gut, people have irritable bowel, people have inflammatory bowel disease. They tend to get more of this histamine problem too. So you just got to look for all the clues.

And it's really, really powerful when you see patients like this and they recover simply by understanding how their system is out of whack. And it's really about getting them back in balance. And often over time, by healing the leaky gut, by providing the nutrients they need, by sort of reducing the trigger foods, by adding in the foods that are beneficial, these patients do get better. Yeah. And I'm sure, Mark, that was a very rewarding case because, you know, there's nothing, I think, that drives doctors is helping to relieve suffering. You know, when you see somebody who's suffering mentally, physically for years, and they're not getting answers and they're saying, oh, it's in your head here, take an antidepressant.

That's that's bad medicine. Yeah. Well, you know, I hate to vilify doctors, too, because, you know, we just we just don't learn about this stuff. Yeah. It's like, you know, you expect a doctor to speak Chinese, but they never were taught Chinese. Yeah. Well, you know, I was, but I, you know, I one of my one of my sayings that I Chinese. Yeah. Well, you know, I was, but. I, you know, I, I, one of my, one of my sayings that I say to my patients is, you know, I went from being a medical student to a student of medicine.

I mean, unless you're a physician and you're constantly learning, you know, the stuff that you learned in, you know, the old joke was, you know, whatever you learn in medical, half of it was wrong, but we don't know what half of it is. That's right. The Dean, the Dean of our, our medical school got off the first day of medical school well i have good news and bad news half of what we're going to teach you in five years is going to be wrong and the bad news is we can't tell you which half exactly exactly right exactly yeah so uh but we we're really at this uh i think this is extraordinary beginning of a new era of medicine.

I think we are emerging from the dark ages of medicine today. Oh, yeah. And I say that in all seriousness because traditional healthcare, traditional medicine is focused on a paradigm that's based on diagnosing diseases by symptoms and by geography. Where is it in your body and what is the symptom? And then we group people into categories according to symptoms. You know, you have depression,

you have rheumatoid arthritis, you have dementia, you have diabetes. But there can be many, many causes for each of those diseases, and yet they all get treated uniformly. And doctors don't understand how to navigate the paradigm shift of systems biology, which is explaining how everything is connected.

I remember this patient who said, I have a doctor for every inch of me. Yeah, all the ologists. All the ologists, right? And it's no fault of their own. It's what we learned in medicine. It's what you and I learned in medical school. And it took us having some breakthrough to say, wait a minute, this doesn't make sense anymore.

The body is a system, it's an ecosystem, everything's connected. And I would venture to say, Mark, you actually bring up a really good point because I've seen all those patients who have, they have a cardiologist, they have a gastroenterologist, they have a dermatologist, they have an immunologist, they have a neurologist,

and the more ologists that you have, the more dangerous it is. Well, then you get more piles of pills. Yeah. And there's a pill for every yield. But the thing is that- And they don't talk to each other. If you have a migraine and joint pain, and you have eczema, and you have irritable bowel, and you have a little prediabetes, they all get treated differently by different doctors. I mean, they get treated by separate

doctors, and every doctor really does the same thing. So we talk about second opinions. There really is no second opinions in traditional medicine. There may be nuances on how people do stuff, but it's the same old, same old. And functional medicine really is a true second opinion. It's a true approach that digs down into the biology, the underlying biology, and doesn't get hooked on the diagnosis. And the teacher we both had, Sid Baker, one of the greatest thinkers in medicine, I think in the 20th and 21st century, he said, we do this phenomenon called naming and blaming. We name the disease and then we blame the name for the problem and then we tame it with a drug.

So you come in and you're sad, you're helpless and helpless and you have no interest in life and you can't sleep and you're not eating and you don't want to have sex anymore. The guy says, I know what's wrong with you. You're depressed. That's what's causing your symptoms. It's not the cause of your symptoms. It's the name of your symptoms. They go, I know how to fix it. Take an antidepressant. But depression is not a Prozac deficiency. It could be a million things. It could be the changes in your microbiome or a vitamin D deficiency or omega-3 deficiency or mercury poisoning, or maybe you took too much acid blockers and you have B12 deficiency, or maybe your thyroid's not working. I mean, I could give you a million different reasons. And we have no

roadmap in traditional medicine to get there from here. And that's what functional medicine really does. It helps us navigate this complex territory of disease. And Sid Baker goes, you're giving the wrong map for the territory of illness. And we're giving the map of these labels. So it's like if you're going to New Delhi and you get a map of New York City, it's not going to help you.

So- They get you into trouble. They get you in trouble. So we got to come up with a new map. And that's what functional medicine is, folks. It's really a new map for navigating the territory, the landscape of disease. And it is so gratifying after doing this for so many decades. That's why you and I both work so hard on it because it's really not getting out there to enough people. And a lot of this you can do on your

own. A lot of this really doesn't need a doctor. Yeah. And the fun part of this is too, is I'm old enough to remember when there was no internet. We used to have to, you know, we wanted to look something up. We'd have to go to the medical library to do that. And I can remember as a physician, I was a primary care doctor in Stockbridge, a local town doctor. Oh, my God. And when the internet first came out and I could go on to the National Library, the PubMed, and I could do it through an old program called Lonesome Doc. Yes, I remember that.

I remember that. And I said, oh, my God, this is a game changer. Now it's like I have the library on my laptop. Yeah, you literally say, I want to know about histamine. So you go to the library and say, can you pull all the articles that might be relevant on histamine? Or you look them up in a journal and you write them down. And your level of ability to learn and process information,

and that's really how I've learned so much is just digging into the original research. Yeah, exactly. And the ability to access that information now, like I do so much of my research. Thank God I have a laptop and an internet connection because you can find amazing stuff and you know i just give me a cup a good cup of coffee and uh some time and i can research amazing amounts of stuff and one thing a little hiss to me to wake you a little hiss me to wake me up and and and one thing will lead to the to the other and uh it's like a rabbit hole you go you follow this trail and that trail because it is all connected it is it actually is all connected and sometimes you know uh And sometimes chance favors the prepared mind.

When you're looking for certain things, certain things will start popping up, and you start, oh, yeah, that's a connection there. Oh, I see how that's related to that. I think that's right, Todd. I think what you're describing in your understanding and processing of all this data is a different set of filters

that is much broader than a traditional doctor. So a typical neurologist or cardiologist or gastroenterologist, they'll read deep into their silo. They'll look at all the papers in their framework, but they don't look across disciplines. And what's so fascinating is when you look across all these different diseases, they all have the same common root issues.

And we talk about the matrix in functional medicine, which is this framework for looking at the body that is based on understanding that health or disease is either balanced or imbalanced in these basic functional biological networks in the body. And so across the spectrum of diseases, these same networks are getting out of whack. So if you're a neurologist, you could have leaky gut, you could have mitochondrial issues, you could have inflammation, you could have nutritional deficiencies, you can have hormonal disruptions.

Same thing with diabetes, same thing with rheumatoid arthritis. And so you go, well, these diseases are actually all the same. They're just manifested differently depending on that person's unique genetics and predispositions and where the target goes. And so we get so hooked up on the diagnosis, whether it's histamine or migraines

or depression, the diagnosis is just the first step in the process of unraveling what's going on. Yeah, yeah, exactly. And it was the holy grail when I was a medical, the holy grail is, and you got brownie points for being able to make the diagnosis. Exactly. It's to make the diagnosis. Exactly. It's called the differential diagnosis. So you could look at the symptoms, the physical exam, the lab tests, and the guy who wins the prize is the guy who can name that disease, like Jeopardy.

Exactly. And you name that disease and you win. You got your gold star. You get your gold star. And then afterwards, it's just cookbook. Yeah. It's total cookbook. Paint by numbers.

It's sad to say, I hate to break it to all people, but doctors, there is a bit of an art to it in which you do. But if you have a diagnosis, here's the standard of care. Here's the drugs you use. Here's the surgeries. Here's the steps you take. And it's not that complicated. So it's kind of boring.

It's formulaic. It's very formulaic. I mean, I used to practice emergency room medicine. You did too. And you think it's exciting and thrilling. It's actually boring because the kidney stone gets these three drugs. The heart attack gets these four drugs. The asthma patient gets this protocol. The migraine patient gets this cocktail. And it's like, after you learn it, it's just, it's kind of boring the key is making the diagnosis but in functional medicine the diagnosis is just the first step in understanding the complexity of what's going on then you go okay well why yeah not not what disease do we have but why is this

going on absolutely yeah you also you made you made me think of um a great book and i oftentimes recommend this to my patients uh written by our friend Jeff Bland. A fantastic book. And I highly recommend reading it. It's called The Disease Delusion. Yes. Fantastic. Yeah. We are deluded.

We're deluded by how we think of disease. Yeah. Exactly. And when you look at it from a systems biology and a broad approach, he does a very great job of articulating exactly what you're saying. And this is why it's such an exciting time in medicine, because all these silos are breaking down. We can't deny it anymore.

The microbiome is blowing apart everybody's conception of disease. I said, you know, when your theory doesn't match the facts anymore, you got to change your theory. And I think that's what's happening in medicine now. And it's really, really exciting. It's a very exciting time. I think, you know, the knowledge is exploding. And now that we have computers and bioinformatics and, you know, even artificial intelligence, you know, we're only going to get able to do better analysis of things

and really dial in the personalization of medicine. Absolutely. And we're, we're talking about a real personalization around using, you know, much less invasive toxic interventions. Cause even the system mean thing we're talking about, you know, it's, it's pretty straightforward when you, when you look at it, it's just getting rid of the bad stuff that triggers it, adding in the good foods that help you heal, fixing your leaky gut, taking a few nutrients, maybe taking a few very low toxicity drugs that can help. And just people get so much better. So Todd, thank you so much for being again on The Doctor's Pharmacy. This has been a great conversation about histamine, about how it can masquerade as all sorts of things. I would encourage you if you're suffering from all kinds of weird, big symptoms, check it out. Learn about it. Listen to this podcast. Share

with your friends and family. Come see us at the Ultra Wellness Center. We're here doing virtual consults, ultrawellnesscenter.com. See people from all over the world. You don't even have to come here anymore because of COVID. It's been a great boon to helping people access us without having to schlep on a plane or stay in a hotel or eat crappy restaurant food. So it's actually good. And we do miss seeing people in person, but it is actually a good compromise. And if you love this podcast, please share it with your friends and family on social media. If you liked it, also leave a comment.

We'd love to hear from you. Have you dealt with your histamine issues? Maybe you can share your thoughts about what worked for you and subscribe wherever you get your podcasts. And we'll see you next week on The Doctor's Pharmacy. Hey, everybody. It's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my

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