Histamine Intolerance and the Menopause

Histamine Intolerance and the menopause- Is there a link?

The menopause can be a really tough time for many women. Often women can think that HRT may be their saviour, but what if it actually makes things worse? And why?

Whilst there can be other reasons for this, in clinic we see many women who have found that HRT makes their symptoms worse due to the impact these hormones have on the histamine levels in their body. (1)

“What?” you may cry. You can’t even get through the menopause without potentially reacting to chocolate, wine or pizza? What is the point? So lets take a look at what histamine intolerance is and how this can be effected by the menopause.

What is histamine intolerance?

Histamine is a chemical that we naturally produce in our bodies and is often found in the food and drink that we consume (back to the chocolate and wine again!). It acts as a chemical messenger and has many important roles including in gastric acid secretion, our inflammatory response to infections and muscle contractions. (2)

Usually, the levels of histamine circulating around the body are tightly regulated, so it’s presence doesn’t cause any significant symptoms. Histamine intolerance occurs when we are unable to regulate the amount of histamine in our bodies and levels rise.

Common triggers that increase our histamine levels include food and drink, environmental responses to things like pollen, infection, common allergies and stress.

What causes histamine intolerance? 

1.        An over production of internal histamine due to conditions like Mast Cell Activation Syndrome (MCAS), mastocytosis, allergies and disruption to the gut microbiome (all the bugs that live in our gut, which are really important to our health!) (2)

 2.        Reduction of histamine breakdown as a result of some medications, genetics, hormones and gastrointestinal disease like inflammatory bowel disease. (3)

Symptoms of histamine intolerance

Some of the symptoms of histamine intolerance are really similar to common menopausal symptoms, which is why it often doesn’t get diagnosed. These include:

·        Migraines

·        Dizziness

·        Anxiety

·        Insomnia

·        Fatigue

·        Hives

·        Irregular heart beat and palpitations

·        Shortness of breath

·        Digestive symptoms

And many more! It really can affect your whole body. (4)

The link between histamine intolerance and the menopause

We don’t have any research on how many women struggle with histamine intolerance and the menopause at the moment but we often see many women in clinic who have been struggling with this on their own for years. Please don’t suffer in silence! We need to keep doing better by women who are going through the menopause…. It is 2024 after all.

It is likely that women have been experiencing this for years but most of the research we have on the condition has come out in the last 10 years so the concept is relatively new and many Health Professionals either have not heard about it yet, or are still learning about the condition.

Many women are presenting during the perimenopause or the menopause with either worsening symptoms of histamine intolerance or new onset symptoms.

There appears to be several reasons for an increased risk of histamine intolerance during the menopause including:

·        A change in hormones. (2)

·        An increase in stress levels. (5)

·        The impact of both of the above on gut health

Hormones and histamine intolerance during the menopause

When your oestrogen increases, your body releases more histamine. Histamine then stimulates your body to release more Oestrogen. This results in a really vicious cycle! (1)

But doesn’t oestrogen decrease during the menopause? Yes, but during the perimenopause levels of oestrogen can be all over the place and peaks of Oestrogen can actually be higher than in a normal menstrual cycle.

If you have always been sensitive to hormonal impact on histamine levels, you may have noticed that symptoms of histamine intolerance have always been worse in the second half of your menstrual cycle when you experience several peaks in Oestrogen levels. (2, 6) This is certainly something that I have started to experience in the last 12 months or so after an infection with a big dose of stress.

The link between hormones and histamine is complex. It is really important to see a Doctor with expertise in managing the menopause and histamine intolerance if you are struggling.

How to identify if your symptoms are due to the menopause or histamine intolerance

It’s really important to see a professional experienced in this area to help you look for clues. As Health Professionals we are looking for clues such as:

·        Did you feel amazing during pregnancy? Although Oestrogen levels in pregnancy are high, our body also produces LOTS of one of the enzymes involved in histamine breakdown. (7, 8)

·        Has HRT containing oestrogen made your symptoms worse? For most women, HRT can help menopausal symptoms, however for those with histamine intolerance it can sometimes have the opposite effect and make things so much worse.

·        Do you feel worse when you have food and drinks high in histamine such as processed or aged meats, tomatoes, alcohol?

·        Do symptoms get worse on exposure to environmental allergens? If you have hay fever, an increase in symptoms may indicate that your symptoms may be more histamine lead than menopause related.

·        Do you find that antihistamines help? This may indicate a link between your symptoms and histamine.

The link between stress and histamine intolerance

Stress can increase the amount of histamine in our body through the release of cortisol, our stress hormone, so the more stressed we become the more histamine we release. In addition to this, stress can have a direct impact on our gut bacteria, which also have the ability to produce histamine. (9) Once again, it becomes another vicious cycle. The more unwell we feel, the more stressed we become. The more stressed we become the more histamines we produce.

We can, however, break this cycle!!

Ways to calm the nervous system and break that histamine stress cycle include:

·        Getting out in nature

·        Meditation

·        Yoga nidra

·        Yoga

·        Breathing techniques

·        Doing anything you enjoy!

And don’t feel that you need to do this for hours to get the benefit! I’ve been known to use a 5 minute meditation app on my lunch break, or parked up in the car waiting to collect my son from school.

The diagnosis and treatment of histamine intolerance

Currently there is no test which can diagnose histamine intolerance, and being diagnosed can often be a long and difficult journey for people. (4)

The gold standard diagnostic tool of histamine Intolerance is eliminating high histamine foods for 2-4 weeks and then re-introducing them one by one to identify any particular food sensitivities and your individual histamine threshold. The diet is not easy, which is not helped by the HUNDREDS of different lists available which all disagree with each other.

Can a Dietitian help with histamine intolerance during the menopause?

Yes absolutely! In fact I would suggest it is  essential if deciding to embark on a low histamine diet!

A dietitian can help guide you through the low histamine diet and give you accurate information on what foods are high in histamine. This will help you avoid unnecessary dietary restrictions which could compromise your health and make histamine intolerance worse. They can, also, help you to enjoy a happy and healthy social life with this condition!

Most people need multiple tools in their toolkit, such as stress management and medications, to manage histamine intolerance during the menopause; not just diet. A Dietitian can help support you to build your ‘toolkit’ and signpost on to medical help or working with your existing team if needed.

There are some supplements such as Diamine Oxidase enzyme (DAO) that may be helpful, and a Dietitian can talk to you about which ones may help and which ones are just a waste of money and time! (4)

Conclusion

There is definitely a link between histamine intolerance and the menopause and you are not imagining it or going mad (both things I’ve heard from my patients!). Management often involves multiple tools including diet, stress management, medications and supplements.

Key Takeways:

·        Oestrogen can increase histamine levels and histamine can increase Oestrogen.

·        Women are presenting with histamine intolerance during the perimenopause or menopause.

·        Symptoms of histamine intolerance can improve. Don’t suffer alone!

If you are interested in learning more about histamine intolerance and the menopause, I have partnered with Your Menopause by Harley St at Home, an expert-led platform dedicated to empowering women through every stage of menopause.

I have worked with them to produce a 30 minute course split into 3 bite sized chunks that looks at histamine intolerance and the menopause https://your-menopause-by-harley-street-at-home.circle.so/checkout/histamine-intolerance-course?affiliate_code=f97db2

Please note that I am an affiliate for this course, which means that I earn commission on any sales of this course at no extra cost to you.

Chloe Hall is a Dietitian who specialises in histamine intolerance, Mast Cell Activation Syndrome  (MCAS), long covid and gut health. Chloe is passionate about supporting people with these conditions due to her families personal experience with these conditions. She volunteers for Mast Cell Action, the national MCAS charity, on their Dietetic panel and as an advisor for ‘The IBS network’, the national IBS charity.

 References

1.           Kalogeromitros D, Katsarou A, Armenaka M, Rigopoulos D, Zapanti M, Stratigos I. Influence of the menstrual cycle on skin-prick test reactions to histamine, morphine and allergen. Clin Exp Allergy. 1995;25(5):461-6.

2.           Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007;85(5):1185-96.

3.           Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT, Latorre-Moratalla M, Vidal-Carou MDC. Histamine Intolerance: The Current State of the Art. Biomolecules. 2020;10(8).

4.           Hrubisko M, Danis R, Huorka M, Wawruch M. Histamine Intolerance-The More We Know the Less We Know. A Review. Nutrients. 2021;13(7).

5.           Ito C. The role of brain histamine in acute and chronic stresses. Biomed Pharmacother. 2000;54(5):263-7.

6.           Draper CF, Duisters K, Weger B, Chakrabarti A, Harms AC, Brennan L, et al. Menstrual cycle rhythmicity: metabolic patterns in healthy women. Sci Rep. 2018;8(1):14568.

7.           Hamada Y, Shinohara Y, Yano M, Yamamoto M, Yoshio M, Satake K, et al. Effect of the menstrual cycle on serum diamine oxidase levels in healthy women. Clin Biochem. 2013;46(1-2):99-102.

8.           Boehm T, Pils S, Gludovacz E, Szoelloesi H, Petroczi K, Majdic O, et al. Quantification of human diamine oxidase. Clin Biochem. 2017;50(7-8):444-51.

9.           Ferstl R, Frei R, Schiavi E, Konieczna P, Barcik W, Ziegler M, et al. Histamine receptor 2 is a key influence in immune responses to intestinal histamine-secreting microbes. J Allergy Clin Immunol. 2014;134(3):744-6.e3.