944: Histamine Masterclass and Incorporating MCAS With Dr. Meg Mill

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Katie: Hello and welcome to the Wellness Mama Podcast. I’m Katie from wellnessmama.com. Aand I am here today with Dr. Meg Mill to learn all things histamine, histamine imbalance, intolerance, and what’s going on in the body when that happens. As well as anything related to MCAS, which is Mast Cell Activation Syndrome.

And as I learned in this episode, this is a much more broadly applicable and nuanced topic than I originally understood, and it relates to a lot of areas of health. So it might be something that is actually a missing piece for a lot of people that we don’t realize. And Dr. Meg is a brilliant voice on this.

She’s a leading women’s health expert of PharmD, a certified functional medicine practitioner, as well as a bestselling author and host of her own A Little Bit Healthier podcast. And her specialty is helping women overcome fatigue, hormone imbalance, and unexplained symptoms so they can feel comfortable, happy, and confident in their bodies again.

And you will see why today. She’s so well spoken, shares so many actionable tips. I learned a lot in this episode. Let’s jump in.

Dr. Meg, welcome. Thank you so much for being here.

Meg: Thank you so much for having me.

Katie: I am excited to learn from you today, and we’re going to get to do a couple of episodes together. In this first one, I know you have tremendous expertise on the topic of histamine and all that comes under that umbrella. And I feel like there are a lot of people who know that they maybe are struggling with something related to histamine, as well as perhaps a lot of people who might be and not even know it.

So I would love to deep dive into this topic today and get to share your wisdom and knowledge. So to start off, can you introduce us to the topic of histamine? What it is and like how it affects us biologically,

Meg: Yes, I think it’s something that we’re just seeing affect people more and more and it’s one of those things that is often out of balance and it leading to a lot of symptoms in people that they’re not even realizing. So histamine actually is a biogenic amine. So when your immune system detects like an allergen or an invader, histamine is released primarily from your mast cells and your basophils.

So these are part of your immune response. We have two different immune systems. We have an innate immune system, which is right there, ready to go. Anything that comes in, you know, we’re ready to respond. And then we have an adaptive immune system, which is more specifically tagging things. So the mast cells are part of your innate immune system.

So it actually is saying, okay, we have an invader, we have to do something. So it acts as immune defense. So it helps protect against like pathogens, we said. It regulates stomach acid secretion actually, so it increases the breakdown of your foods and aids in digestion. It affects neurotransmitters, serotonin, neuroepinephrine.

So it can actually be involved in your wakefulness and your resting. So sometimes people, when they’re having histamine issues, which we’ll get into, sometimes the anxiety or insomnia are their only symptoms, which can make it really confusing because a lot of people think of it as an allergic response.

So it is also a part of an allergic response. It can cause bronchial constrictions because it’s protecting the airways and it actually purposely causes inflammation. So it actually recruits immune cells to the site of infection or injury and increases vascular permeability to actually increase blood flow because again, we’re trying to get out an invader.

So it’s actually causing inflammation, which for a short period of time is fine. But the problem happens when this occurs long term.

Katie: That makes sense. And that’s fascinating. I didn’t know that even just anxiety and insomnia are tied to that, but it makes sense. I was just thinking, as you said that, how only a couple of times in my life have I taken Benadryl, but it made me so tired, is that when someone might take Benadryl and feel really tired. Is it that same response happening?

Meg: Yeah. So we have actually four different types of histamine receptors in your body. So when we think of the allergic response, that’s our H one receptor, but they’re also, yes, there is a drowsy effect from them. That’s the H one receptor is actually working. That’s where the Benadryl is working, on your H one.

But then there’s an also the H two receptor and that has the one that has more to do with the gastric acid secretion. So that’s where people are going to take things like pepsid is an H two blocker. So that’s where that mechanism comes in. And then there’s H three, which are more likely the ones that are affecting your neurotransmitters. And then there’s H four that also do other things. So it’s interesting because we’re saying histamine, generally people are just like, oh, that’s allergies, but we see people have symptoms like, again, we do see the nasal congestion, the sneezing, but we see headaches and migraines. I see it huge with my headache, migraine ladies, fatigue, heart palpitations, dizziness, anxiety, PMS symptoms, irregular periods, flushing, joint pain, like we said, sleep disturbances, vertigo, rashes.

So it’s this whole body issue because of all these different type of receptors rather than just one thing. And I think that’s where it can also be confusing because you could have a lot of different symptoms that are going on at the same time and they cross over with other things too.

Katie: Yeah. And I would love to, I know you’ve already mentioned some, but to dive deeper on what some of those symptoms are to look out for, especially.  I’m a big believer that symptoms are messengers. So rather than thinking of them in a negative light, I always think we can learn from them, even if they’re uncomfortable in the moment.

So I’d love to get kind of a full list of symptoms, at least like an overview, what to look out for that might be related to histamine. Cause based on what you already said, it seems like there are a lot of things people wouldn’t, to your point, connect to histamine or allergies that might be really related.

And then building on that with these four different types, are they all handled the same way or are those kind of like different categories if someone’s going to address it?

Meg: Yes. So, so let’s go, we’ll go through the symptoms and then I’ll kind of look at how we start to approach this. So, you know, yeah, we’re looking at it from top to bottom. So we’re saying the nasal congestion, the sneezing, the allergies, the asthma, difficulty breathing, those are more of your… rashes, skin issues.

Those are more of your typical, like we said, more where you think of allergies. I really often see it in headaches and migraines, there’s a huge histamine connection. So if you’re someone who is having headaches and migraines, and that’s where we’ll get a little bit more into, but some of these things can vary with hormones too, because sometimes you may be more reactive to some of these symptoms versus other times in the month.

And we can further dive a little bit more into that. We also see fatigue. So if you’re having fatigue, heart palpitations, dizziness, anxiety, brain fog or difficulty concentrating, more drastic PMS symptoms, we can see irregular periods of flushing, joint pain, sleep disturbances, high or low blood pressure. And often we also could see vertigo. Another thing that you might notice if you have histamine issues is that you’re more sensitive. So generally you could be that person that maybe you’re more sensitive to different types of foods, or maybe you’re more sensitive to like chemical smells or different things.

We often see this increased heightened sensitivity. So when we’re looking at this, what we need to do is we need to put it back into balance because as we talked about, we need histamine in our body. It’s not something that’s like we’re trying to get rid of altogether, but we need to have this balance.

So when I talk about this, I like to think of it as a bathtub analogy. So we have a bathtub and as long as the plug is open, and you’re pouring water into that bathtub at a regular pace, you’re never going to overflow. You’re going to create this balance, this homeostasis in the water. But the problem that starts to happen is either that we plug the bathtub and you can’t break the histamine down, and/or you turn up the water. So things are coming in too fast, so we’re not able to break down at the rate that things are coming in. So in order to break down our histamine in our body, we have two pathways. We have a diamine oxidase pathway and histamine and methyltransferase pathway. So for the diamine oxidase pathway, that’s actually in your digestive tract.

So we need to be able to break down histamine that we have in our foods. And so we need to make sure that we have a healthy gut lining, that we have good enzymatic capability. So addressing gut health and we’ll talk about how to do that sort of in a histamine related way, so that can be really important.

And some people have genetic variants here too, that make them not be able to break down histamine in their food as well. The other place is in your cells. So in your cells, you break down histamine by methylating. And that’s where the histamine and methyl transferase comes in. Now, a lot of people have MTHFR variants.

So you’ve probably heard of the MTHFR. People are talking about it a lot. And what that generally means is that you don’t break down folate well,. You don’t utilize the folate in order to methylate in the methylation process. So one of the things that we look at is, okay, are we giving you methylated folate?

Are you having, are you able to utilize, put your foot on the gas and be able to utilize what you actually need to start methylation. But the trick here is that some of the pathway metabolites in between are actually stronger than the histamine itself. So we can start to see N-methylhistamine in there.

And if you’re not looking at that whole pathway, if you’re not clearing it from the bottom, you can also start to see like, okay, maybe you are taking a methylated B vitamin and it makes you feel worse. So it’s kind of looking at it this like a whole pathway. Can you actually break down the histamine? So then we have to look at it the opposite way and say, okay, well, we can, you know, we’re looking at breaking down the histamine, but what’s turning it up?

So we have different things, like we can have, we know there are Histamine producing and mast cell activating microbes that are in the in the gut there. We’re learning more and more about that all the time. So certain microbes could actually be causing this. You could have underlying infections. So you could have a parasite, yeast, you could have these opportunistic bacteria that are saying, okay, alert immune system. We need to react because we have these things that people aren’t even realizing. You could have, mold exposure, you could have Lyme disease, the underlying that you don’t know, even high levels of stress. And this response that were the fight or flight stress response. We could have viruses.

We’re seeing a lot more after COVID, EBV, things like that. So what we’re saying is…and environmental exposures are another thing. So what we’re saying is your immune system is seeing all these things, it’s overreacting, which is causing your mast cells to release more histamine. And that’s really, it’s like this is a complicated thing. So I feel like I went on and on, but I wanted to just kind of get through the different processes because we’re looking at these pathways and processes of what your body’s reacting.

Katie: Wow, there’s so much valuable stuff in what you just said. And it definitely seems to be, like you said, a very multifaceted thing and not like a single cause and solution approach. However, it also seems like because this is so connected to everything, that understanding this and working on getting it in balance to your point, not getting rid of it, but getting it in balance could be drastically helpful across the board in a lot of aspects of health.

And I’d love to understand more about the hormone connection you mentioned, because as you were saying that, I wondered if this is a big missing link for a lot of women, especially. When they kind of have these symptoms they don’t really know how to dial in or how to handle and it doesn’t seem to be only related to whatever the hormone thing going on is.

It makes sense to me that if there’s also a histamine component that’s not being looked at, like that could make the symptoms, hormonal symptoms, really frustrating and kind of elusive to figure out.

Meg: Yes. And it’s also something, another thing that goes into this that’s elusive is because there’s this hormone link, your symptoms can be different at different times of the month. And I think that’s another thing that adds to the confusion because, like I’m just going to use a glass of wine, for example, because that’s a high histamine food.

That’s a huge one that triggers a lot of headaches for people. So people could say that, okay, I can, I’m going to have a glass of wine at this point, and I’ll get a migraine and I’ll feel terrible. Maybe I’ll have all these symptoms, but then I can have it another time of the month and I’m not feeling anything, it’s fine, so it’s just not the wine. And that’s not necessarily the case because you have different hormone levels at different times of the month. So we’re looking at, we’re going to get into what starts to happen. So estrogen, there’s actually estrogen receptors on your mast cells.

So estrogen is going to stimulate the mast cells to release histamine. So we start to see when we have high levels of estrogen, we start to see more histamine release. Estrogen also inhibits breaking down the histamine, and it can impair diamine oxidase. So we also see, okay, when we have high levels of estrogen, we’re seeing more histamine release, we’re seeing more in pair of the breakdown. While progesterone helps actually support diamine oxidase. So when progesterone is at a higher level, we’re actually getting more breakdown of histamine. And so when start to see some of these imbalances, when we start to see an estrogen dominant type situation, we’re starting to see more histamine symptoms typically because we’re seeing higher levels of estrogen.

So we’re seeing more release of histamine without the actual balance of progesterone to be able to help support that breakdown and support that diamine oxidase. So typical times of the month where you would be more likely to see histamine reactions, if you’re still menstruating, are ovulation and right before your period. So during the ovulation, because we’re going to see that spike in estrogen, it’s going to be higher. And then right before your period, particularly if you have higher levels of estrogen than progesterone, we see some of these symptoms become more prominent when women start to enter perimenopause, because in perimenopause, we’re often seeing estrogen production is still staying high, but we’re starting to see the decrease in the progesterone.

Katie: That makes sense and that’s so fascinating. I really wonder if that is a missing piece for a lot of people. And I can only guess based on what you’ve already said that the solution to this is also varied and multifaceted.  I’d love to talk a little bit more about the gut aspect, especially because you mentioned that histamine issues can seemingly cause low stomach acid and gut related problems.

And I would guess also that working on the gut can help histamine probably and vice versa. But how does the gut specifically come into play when we’re understanding about histamine?

Meg: Yes. And this is very interesting because when we’re talking about gut healing, we often are hearing a lot about probiotics, about bone broth, and about fermented foods. And all three of those things can make histamine issues worse. And so we have to look, when we’re talking about gut health, we have to look at it in a little bit of a different angle here because, so if you’re someone who you’ve tried the probiotics and for some reason you just do not feel well on the probiotics or fermented foods. You’ve tried all these things and they don’t seem to be working.

You likely could have histamine issues because so we know now, like we’re saying that there are histamine producing and mast cell activating bacteria. So one of the things that we need to look at when we’re looking at it through this perspective is these particular bacteria. So these are things like Citrobacter, Clubsiella, Morganella, there’s different bacteria that we know are histamine producers.

So is it your bacteria or is it you sometimes, you know, when we’re asking. So we one, need to be able to reduce that bacteria. We also need to make sure that we’re supporting the healthy bacteria. We really need to focus, in this case, on your mucosal layer too. So remember the diamine oxidase is in that mucosal layer.

And you know, there’s a lot of enzymatic functions that happen in the mucosal layer. So we have to make sure that you have a good mucosal layer. So we’re thinking of things like making sure that there’s a good levels of akkermansia. So akkermansia is a good commensal bacteria that we want to make sure we have high levels of that, that we’re supporting that.

We also want to look at, often we’ll look at something called secretory IgA. When we’re starting to see this picture, we often see low secretory IgA levels, and those are also supportive of our immune function. So we want to make sure we have a really good immune function in the gut too. So it’s really saying, okay, I do stool testing because I think that that gives you the picture of  when we’re looking at this kind of a situation, the regular five hour approach isn’t necessarily making people feel better.

Because we’re doing some of those things where we’re giving them things that could be bothering them. So, you know, I really like to do a stool test and see, okay, what does your microbiome look like? Are we having histamine producing bacteria? Do we have candida? Do we have a parasite? Do we have something that’s activating your immune system?

And we work on bringing those down. Then we also work on supporting the mucosal layer and then optimizing digestion and absorption. Because even if you’re eating a perfect diet, if you’re not digesting and absorbing well, you’re not getting the nutrients you need to support some of these things. So we need to make sure that we are absorbing the nutrients. We need to support a lot of the other digestive functions and just functions in your overall health and balance.

Katie: That makes sense. And these, the different gut testing you’re talking about, is that something someone can do to find out if they have histamine related things going on? Or like, what is the diagnostic criteria for knowing if you’ve got histamine stuff?

Meg: Yeah, that’s a great question. And it’s hard. So the stool tests will tell you what’s going on. So that’s going to give us the picture of what’s going on. So I think that is really helpful just to see, okay, what is going on in your microbiome and what do we need to do to bring all of this back into balance? And generally when we’re looking at this, when we do gut healing and we do it in the right way, we do bring things back into balance and the symptoms get better. So it is a very good picture. Now, we also can do blood histamine levels, but I find that to be a very weak diagnostic measure because we’re seeing a lot of people with low blood histamine levels that have symptoms.

And so my advice is, if you feel like you have symptoms, there’s things that you can do to feel better and you don’t need to have that diagnostic criteria. If  we take this a step further even, there’s actually diagnostic criteria for what we call mast cell activation syndrome.

Now you can have histamine intolerance without having mast cell activation syndrome and mast cell activation syndrome starts to happen when your mast cells really become angry. They just start firing to everything. It’s this, okay, I have all these layers of things that have built up, like all those things we were talking about turning the water up and then your mast cells basically say, okay, we’re reacting to everything.

We’re going to start reacting to food. We’re going to react to supplements. We’re going to react to water, maybe. We start to see this overreaction of our mast cells. Even then you have diagnostic criteria for that because it’s actually a medical diagnosis and we see high tryptase levels.

You have to go to someone who’s knowledgeable in diagnosing that. But even then I see a lot of people who have the symptoms and aren’t getting the diagnostic criteria. So I think that that is something that people are looking at, Okay, what, what do I have? What is my label? And you know, that can give you a great place to start.

But when we’re talking about something like this, because we’re seeing it as a whole body issue and we’re not necessarily seeing good diagnostic criteria, I would recommend going on symptoms.

Katie: That makes sense, and addressing the person not just the lab results. I feel like that’s a recurring theme in functional and holistic medicine. I’d love to touch on, you mentioned a few in relation to gut health, but what are some of the high histamine foods that someone, maybe if they notice, especially a reaction to those, it might be a good sort of first sign that something’s going on with their histamine levels?

Meg: Yes, and that is the first thing, if you’re looking for something that you can do right now, just to start to see like, okay, is histamine an issue for me?  You can start to actually try to do a low histamine diet. Now, I do want to say with a low histamine diet, that isn’t something we necessarily want to use as a crutch and live on long term.

There are a lot of healthy foods in this category. And so we want to say, okay, we’re using this as an evaluation. We’re not going to use it as our long term solution, but it can give you a great starting point to see how you’re reacting to some of these foods. And everyone can react a little bit different. So one of the things, we have high histamine foods first. So those are going to be foods like aged cheeses, fermented foods, cured meats, we mentioned alcohol. Then we have histamine liberating food. So these are going to be foods that trigger the liberation of histamine from the mast cells. And those are things like strawberries, bananas, tomatoes.

So we see avocados in there as high histamine foods. So these again, we’re mentioning are healthy foods. And then we have also foods that limit diamine oxidase. So they don’t let you break down the histamine well. So tea is actually one of those that can be a big factor there. The other thing when we’re looking at this is really paying attention to freshness, because if you’re a meal prepper and you prepare all of your meals, let’s say Sunday, and that’s like a great way for you to work with your family and get everything ready. It might backfire on you with histamine intolerance. So you want to look at freshness. Leftovers over 24 hours can grow histamine in them. So we want to make sure that if we are going to meal prep, we flash freeze. So I would say prepare your food and then freeze it because that will slow down that growth.

So you don’t have to not do that. I know that’s hard for people’s schedules. And sometimes people can get in these great schedules of like, this is the way I can eat healthy. This is the way I can get things done, but we just have to go within the parameters. So I would say make sure that if you’re going to meal prep, that we actually freeze it.

And I actually will share, I have a guide that’s an essential guide to histamine intolerance. And we have lists of foods and we have guides of how to eat. So we have it broken down. It’s, I think about 25 pages and there’s a lot of information in there. So I can also share that with you too.

Katie: That would be awesome. And that’s fascinating to know, like the different ways certain categories of foods maybe aren’t directly related to histamine, but still can trigger histamine. I feel like the nuance of that’s really helpful to understand. I’ll definitely link to your website and your guide, because I know you have so many more resources than we can cover in a podcast episode.

I would guess maybe people listening are hearing parts that maybe resonate with them or that they are noticing in their own lives. So I’d love to also address some of the solutions a little bit too. You’ve already touched on those some, but what are some of maybe the first baby steps people can take? And are they different if it’s like a hormonal related histamine thing or skin issues or digestive? Or is there like a good general baby step starting place?

Meg: Yeah, so I would say the first thing that I would recommend to do is become a health detective. So when we’re looking at some of these things, we want to look at you individually and we want to look at your patterns. So you can start by looking at the high histamine foods and saying, okay, how do I react?

I have people that have dialed in so well that they know that they can have a handful of nuts, but if they eat a whole bag of nuts, they’re gonna have a migraine let’s say. Or we can say, okay, I can do olives fine, but bananas really bother me, or I can’t eat bananas, but I can do avocados. And, you know, we’re looking at these nuances within the histamine foods and how do you actually react?

So I think actually just looking at this,I know people don’t want to write down everything they eat and I totally understand that. So what we do is we start to, if you have a reaction, if you have symptoms, what did you eat the last 24 hours? And if you start to see, you know what, there’s patterns here in what I’m seeing. Some people can really start to see these clear patterns.

Okay, then there are foods and bring those foods down and see, does that make a difference? We also can add things like a quercetin or a vitamin C that are supportive. We can also add diamine oxidase enzymes. So those are things that we can add in to help you break down the histamine. So we also want to look at stress.

So one of the things, that I actually work on alongside of all of the functional medicine when we’re doing the testing, when we’re rebalancing the hormones, when we’re working on rebalancing the gut, is actually also nervous system work. Because again, fight or flight is telling your body, okay, I’m running from a lion.

I’m not digesting well.  I’m on high alert and sometimes that’s when we see this overreaction too. So we also want to work on stress. What can you do to regulate your nervous system no matter what’s going on? I know that we all have a lot of stress in our life at different times. So can you self regulate yourself no matter what’s going on in your surroundings and bring yourself back into that parasympathetic nervous system? So those are things that you can start to look at. But another thing is pulling down the amount of environmental toxins and stressors that you have on your body.

So things like getting an air filter for your bedroom, getting a water filter, looking, are you living in a moldy environment? Mold’s going to be another thing that’s really going to put your immune system on high alert. So again, we’re saying, okay, we’re exposed here all the time, what kind of environment are you living in?

So starting to look at, okay, what’s going on in your environment can be another thing that can be a place to start.

Katie: Got it. That’s super helpful. And I love that you said also the important caveat that while this low histamine diet can be really helpful short term, that it’s not the longterm goal. I feel like this is an important point to highlight with any kind of temporary dietary restrictions. I had a similar experience with AIP for instance, and that was a very helpful tool for me longterm, but I realized my goal was not to thrive in this very like limited narrow window of things I could tolerate, but actually over time to heal my body and expand the things that I could consume without having any reaction. And I would guess this is similar for histamine as well. So I would love to hear a little bit about the sort of long term, like what does long term resolution look like?

Is it possible for most people? Llike are most people able eventually to move out of this more structured approach in the beginning into more resilience and ability to integrate these foods longterm?

Meg: Absolutely. That’s always our goal. So I agree with you. My goal is always to expand. So I know that’s one question a lot of people have, you know, am I going to feel restricted? And our goal is actually always to have you expand. We use it more as a tool for understanding what’s going on in your body and we want you to be able to expand because we want you to be able to have all of these nutrients.

So we really need to bring your body back into balance. So when we go back to that bathtub that we were talking about at the beginning, what are all the things for you as a unique person that are one, triggering your mast cells to release more histamine and two, that are inhibiting your body from breaking it down.

So we’re looking at like a seesaw approach really here where we’re saying, okay, we need to work on being able to break down any histamine that’s in our system. And everyone’s going to have a little bit of a genetic variation of that. But, one of the things I want to mention when we’re saying this is that you generally don’t have these symptoms as a child.

So, when you’re looking at this array of symptoms that we’re talking about, you’re not necessarily even genetically if you’re set up to not be able to break down histamine as well. I am, I have the genetic variants that limit that. But the symptoms don’t start generally until we have all of these other things that pile up.

So that’s where we have to say, okay, how can we work on breaking it down versus how are we managing all the other things that are causing more histamine levels? So we also then need to focus on, okay, are your hormones balanced? Are you detoxifying well? You know, do we have your gut healed? Do we have your immune system calmed down? Is your nervous system in balance? All of these things, and put those back into balance.

Katie: Got it. And if anything, that to me speaks to just how much the whole body is interconnected and how it’s almost never a single approach to fix something. However, the good news there is just like these things seemingly can get into a negative spiral, if we have a lot of things out of whack, we can also seemingly create like a positive upward, kind of flywheel when we get a lot of these factors dialed in. And seemingly, at least in my case, it was once I started getting those pieces figured out, improvement happened actually very quickly once I was like giving my body enough positive inputs for those changes to happen. So I love that you have these practical steps for people to work on that can lead to like really positive shifts, not even just in histamine, but in so many areas of their health.

And I know there’s much more in this topic that we haven’t even gotten to get into yet. So if someone is wondering if they have this going on or they know they have histamine issues, where can they find you and where do you recommend that they start?

Meg: Yeah. So my website is meg mill.com. So I have a lot of free resources. I have a lot of like free guides, information. I have a podcast called a little bit healthier. So join us over there. You’re a podcast listener. We talk about all the things that you can do in your life to be a little bit healthier. So that comes out every week.

And I address a lot of this in that podcast too, where we’re talking about all of these tips, but I would… and then I’m over on Instagram @ drmegmill. It’s just D R M E G M I L L. So yeah, I’m always trying to put information out there. A lot of times we’ll just jump on a free master class just to come in and talk about it and get to ask me questions because I know there’s a lot of confusion around so many health topics these days. So, ask me, I love answering questions. I love connecting with people and I’d be happy to help any way I can.

Katie: Amazing. Well, those links will be in the show notes for any of you listening on the go. And Dr. Meg, this has been a fascinating episode. I didn’t know too much about histamine going in, and it’s amazing to hear how much this is probably related to a lot of things that might be going on for someone. And that there are solutions that can help someone move to a much greater state of health.

Thank you so much for the work that you do around this and for your time today.

Meg: Thank you so much for having me.

Katie: And thank you for listening. And I hope you will join me again on the next episode of the Wellness Mama podcast.