Itching and IBD (part 2): Histamine Intolerance

Hello…Hello…Hello! Is there anybody out there?

I feel a little like Pink Floyd in that it’s been a long time, nearly a year, since I’ve written, and if there is anyone left subscribing to my blog, I applaud your patience. The last time I wrote, I promised a series on itching and IBD. It’s been a difficult topic for me to explore and I’ll briefly tell you why:

  1. I needed a break from blogging. I promised when I started that I wouldn’t succumb to fluff. You know what I’m talking about—that by-the-title looks-really-interesting article which has absolutely no substance at all. It leaves you hungry. Like whipped cream, it tastes great but lacks nutrition. Making every article concise, precise, well researched, and useful takes more work and more energy, and with the onset of increased rashes, brain fog, and sleepless nights, I just didn’t have the energy. I know—excuses, excuses.
  2. There isn’t a great literature out there explaining the origins and treatments for itching and IBD. Given the little that’s written about it, and given that I’ve been suffering from five years of nearly ubiquitous itching, I needed time to experiment and journal before I felt I could write about it in a way that kept with my ‘no fluff’ philosophy.

There you have it, my not-so-great excuses for nearly a year of silence. I hope you’ll pick up with me and we can keep healing together.

Before you start reading: Itching and IBD are two difficult enough topics by themselves. Bring them together, and they are even more enigmatic. This is where you come in: if you have experiences, knowledge, remidies which have worked for you, please share them in the comments. If you see places where I’m just plain wrong, please add a correction in the comments—we will all benefit this way from your knowledge and experience.

Now on to the meat.

itching

In my reading and experience over the past year, I’ve come across lots and lots of people who are suffering from infuriating itching as a concurrent symptom of their IBD. For some it seems cyclical (it comes and goes), for some it’s constant. Whether yours comes and goes, or comes and stays the first message I want you to hear: You’re not alone.

Lots of us deal with itching, rashes, and other histamine symptoms as a result of or as exacerbated by IBD. This may not be of much solace as you’re covered in wet towels on your tenth sleepless night, but it’s what I can give.

Histamine Intolerance

I chose to write about histamine intolerance because it’s the most likely explanation for the largest population of IBDers with itching. Chris Kresser did a nice piece on histamine intolerance on his blog. There is also a good post on MindBodyGreen. These are good primers to what I am about to discuss, but aren’t specific to IBD and both left more to be said, in my opinion. I recommend you read them.

What is Histamine Intolerance?

According to Maintz and Novak1, histamine intolerance results from a disequilibrium of accumulated histamine and the capacity for histamine degradation. In other words, when the amount of histamine in your body exceeds your capacity to get rid of it, you get the symptoms of histamine intolerance. Really the term “histamine intolerance” is a misnomer; I see nothing in the literature that tells me that people actually become intolerant of the essential neurotransmitter, histamine; rather the body just gets overburdened with it for one reason or another. It should be called “Histamine Overload”, or something more accurate. I’ll use the common term for this post, but now you know: I don’t like it.

How do I know if I have Histamine Intolerance?

If you have chronic itching, rashes, swollen or runny sinuses, allergy symptoms that just won’t go away, you may have histamine intolerance. Here’s a quick way to test: If you react to red wine, fermented food, or cured meat, you’ve increased your confidence that histamine intolerance may be an issue for you. You can also try a low histamine diet for 2-3 weeks to confirm; if your symptoms get better, then you’ve done something right (!).

Here are a few of the symptoms of histamine intolerance as outlined by Chris Kresser:

  • Pruritus (itching especially of the skin, eyes, ears, and nose)
  • Urticaria (hives) (sometimes diagnosed as “idiopathic urticaria”)
  • Tissue swelling (angioedema) especially of facial and oral tissues and sometimes the throat, the latter causing the feeling of “throat tightening”
  • Hypotension (drop in blood pressure)
  • Tachycardia (increased pulse rate, “heart racing”)
  • Symptoms resembling an anxiety or panic attack
  • Chest pain
  • Nasal congestion and runny nose
  • Conjunctivitis (irritated, watery, reddened eyes)
  • Some types of headaches that differ from those of migraine
  • Fatigue, confusion, irritability
  • Very occasionally loss of consciousness usually lasting for only one or two seconds
  • Digestive tract upset, especially heartburn, “indigestion”, and reflux

I know for me, I’ve always experienced allergy-like symptoms—all of my life, even before colitis. Even in my earliest memories, I had runny nose, swollen sinuses, and a touch of asthma (which I grew out of). My father has the same tendency; so does my brother.

Why do I have Histamine Intolerance? (What are the mechanisms at play?)

There are four mechanisms at play here. One or a combination of these may be relevant to you.

  • Genetic Downregulation of the Histamine Breakdown Enzymes: There are two main enzymes which degrade histamine in your body, histamine N-methyl transferase (HNMT, or HMT) which works to break down histamine in the central nervous system, and diamine oxidase (DAO) which works to break down histamine in the gut and ingested histamine. A mutation in the pathway of either can cause too little of one or both of these enzymes to be produced in the body, which would lead, over time, to an accumulation of histamine. So if you’re deficient in DAO, you likely have symptoms of histamine intolerance.
  • Environmental Downregulation of the Histamine Breakdown Enzymes: A nutritional shortage of the precursors (vitamin B6, copper, and vitamin C) to these enzymes can be a cause of too little DAO or HNMT being produced. Also, certain drugs block the action of DAO (ask your doctor, if you think this may be going on).
    • Causes of Low DAO
      • Gluten intolerance
      • Leaky gut
      • Small intestinal bacterial overgrowth (SIBO)
      • DAO-blocking foods: alcohol, energy drinks, and tea
      • Genetic mutations (common in people of Asian-descent)
      • Inflammation from Crohn’s, ulcerative colitis, and inflammatory bowel disease.
      • Medications:
        • Non-steroidal anti-inflammatory drugs (ibuprofen, aspirin)
        • Antidepressants (Cymbalta, Effexor, Prozac, Zoloft)
        • Immune modulators (Humira, Enbrel, Plaquenil)
        • Antiarrhythmics (propanolol, metaprolol, Cardizem, Norvasc)
        • Antihistamines (Allegra, Zyrtec, Benadryl)
        • Histamine (H2) blockers (Tagamet, Pepcid, Zantac)

Although histamine blockers, a class of acid-reducing drugs, seem like they would help prevent histamine intolerance, these medications can actually deplete DAO levels in your body

  • Inflammation of the gutàleaky gut: Leaky gut from chronic inflammation, through mechanisms you can read in the cited paper below, releases histamine forming compounds that would otherwise stay in the gut mucosa, leading to an increase in total body burden of histamine.
  • Therapeutic Probiotics: Oh boy.
    • This is also why those of us with histamine intolerance cannot tolerate fermented foods. Indeed, I can’t even smell yogurt or sauerkraut without getting hives. The same thing happens with your therapeutic probiotics—they form histidine, and increase your total body burden of histamine. This would be okay, if our bodies could properly process, or otherwise had a lower burden of histamine.
    • Chris Kresser suggests that bacterial histamine (really histidine, a precursor to histamine) release may be due to SIBO. This is fine, but it doesn’t have to be SIBO. We know that probiotic bacteria (e.g., lactobacillius) form generous amounts of the histamine precursor, histidine, during the fermentation process. Those of us who take therapeutic doses of lacto-fermenting bacteria for Crohn’s or colits can have the same elevation in histamine without having SIBO.

A fifth I might add here is heavy metal toxicity. There isn’t a lot of scientific literature out there to explain why people with, for example, mercury toxicity often experience itching. There is, however, a ton of clinical observations if you visit the mercury chelation/mercury toxicity healing forums. More about mercury in the future.

Hey, why didn’t you mention food?

Food is definitely a factor in controlling and alleviating the symptoms of histamine intolerance, but it is not a mechanism, in that certain foods can increase your body burden of histamine because they form or carry histamine forming compounds. Probiotics are kind of in this category, but I added them above because they are a ubiquitous natural treatment for IBD; thus, most of us cannot avoid them in some form.

One of the therapeutic options we have for treating histamine intolerance is a low histamine diet. Decreasing your intake of histamine rich or histamine releasing foods is a good way to begin to get an idea if histamine intolerance is your issue. Try it for 2-3 weeks and see if your symptoms get better. Below are a few lists from MindBodyGreen2 to get you started in looking at your diet for histamine levels. Click here for a more detailed look at the low histamine diet.

 

Histamine-Rich Foods:

  • Fermented alcoholic beverages, especially wine, champagne and beer
  • Fermented foods: sauerkraut, vinegar, soy sauce, kefir, yogurt, kombucha, etc
  • Vinegar-containing foods: pickles, mayonnaise, olives
  • Cured meats: bacon, salami, pepperoni, luncheon meats and hot dogs
  • Soured foods: sour cream, sour milk, buttermilk, soured bread, etc
  • Dried fruit: apricots, prunes, dates, figs, raisins
  • Most citrus fruits
  • Aged cheese including goat cheese
  • Nuts: walnuts, cashews, and peanuts
  • Vegetables: avocados, eggplant, spinach, and tomatoes
  • Smoked fish and certain species of fish: mackerel, mahi-mahi, tuna, anchovies, sardines

 

Histamine-Releasing Foods:

  • Alcohol
  • Bananas
  • Chocolate
  • Cow’s Milk
  • Nuts
  • Papaya
  • Pineapple
  • Shellfish
  • Strawberries
  • Tomatoes
  • Wheat Germ
  • Many artificial preservatives and dyes

 

DAO-Blocking Foods:

  • Alcohol
  • Energy drinks
  • Black tea
  • Mate tea
  • Green tea

 

Low-histamine foods:

  • freshly cooked meat, poultry (frozen or fresh)
  • freshly caught fish
  • eggs
  • gluten-free grains: rice, quinoa
  • pure peanut butter
  • fresh fruits: mango, pear, watermelon, apple, kiwi, cantaloupe, grapes
  • fresh vegetables (except tomatoes, spinach, avocado, and eggplant)
  • dairy substitutes: coconut milk, rice milk, hemp milk, almond milk
  • cooking oils: olive oil, coconut oil
  • leafy herbs
  • herbal teas

 

Therapeutic Options:

  • Low histamine diet: It’s a good option. I covered this above. Try it with a detailed food/symptom journal for 2-3 weeks and see if your symptoms improve.
  • Heal inflammation, leaky gut, SIBO: Duh. This is what everyone with IBD is trying to do—it’s the basis for my blog. That said, it’s still key—and the most difficult to do.
  • Supplement with DAO: There are a couple of DAO supplements available, Histame, Daosin, and Histamine Block (the most potent). Supplementing with DAO helps to break down histamine in the gut, from food, and so in theory should over time reduce your total histamine burden. My theory (caution(!) this may be blatantly wrong) is that DAO may also help with the histamine produced by taking probiotics.
  • Nutritional Support:  Supplementing with the precursors to DAO and HNMT (vitamin B6, copper, and vitamin C) will ensure your body has the building blocks for adequate enzyme production. Just one thing: don’t supplement copper without the supervision of a doctor. Also, decreased histamine has been reported with high dose vitamin C supplementation.
  • Phototherapy for dermatitis, rashes, vitiligo: Though not a root cause fix, focused UV-B is a common treatment for atopic dermatitis (aka, eczema), rashes, psoriasis, and vitiligo. Phototherapy can provide serious symptom relief for itching. In fact, phototherapy is the only effective treatment for itching from kidney disease. The light moderates the immune response in the skin. You need a dermatologist for this one.

Onward to (better) health,

 

Sources:

  1. Maintz and Novak, 2007. Histamine and Histamine Intolerance. Am J Clin Nutr;85:1185–96.
  2. Myers, Amy. October, 2013. Everything You Need To Know About Histamine Intolerance. www.MindBodyGreen.com. Accessed 4/8/14.
  3. Kresser, Chris. Headaches, Hives, and Heartburn: Could Histamine Be the Cause? www.chriskresser.com. Accessed 4/8/14.

Itching and IBD: Part 1 (of 2)

In 2009, I had my first taste of the skin manifestations of colitis. I’d just started taking probiotics. Within two or three days of taking them, I began to itch. I wasn’t tracking my symptoms or my diet at the time (see my journal template here), and had been spending lots of time in the woods. I thought I had gotten poison ivy. Over the next few days the itching got worse and worse. I was befuddled. Soon I had full-blown hives—a “classic drug rash,” my doctor called it. By the time I got to the doctor, though, I had put two and two together and quit the probiotics. It took almost three weeks for the hives to dissipate—even with a potent antihistamine cocktail.itching

But quitting the probiotics weren’t an option for me; they made me better; they, along with the SCD were my plan to stay off drugs. I could see that even in the short week or ten days I’d been taking them that they were effective for me. I was stuck—there was no way I was going back to Imuran. It made me feel terrible. After the hives disappeared, I tried increasing the probiotic dosage again with monumental slowness; I tried different brands; I tried just yogurt, both cow and goat; I tried everything in every combination I could imagine, but the itching remained. I wanted to filet my skin off. Since the itching was worse at night, I’d often wake up looking like I tried to do just that. I was tired. I was embarrassed to show my legs or arms in public. And I was nearly driven mad on several occasions from what I can only call itchiness ‘flare ups.’

In 2009, I thought I had a simple cause and effect: eat probiotics, get itchy for 3-6 weeks. However, over time, I found that it wasn’t that simple. One or two brands of probiotics helped my colitis, but which didn’t make me itch. I could go weeks on these probiotics and not itch, then for no apparent reason, I would begin itching furiously—curious and confusing. I began to look more deeply into it, using my journal and attempting (I’m human too) a disciplined addition and subtraction of foods and treatments. As I was investigating the source of the itching, I found several things which seem to set me off (mind you, it’s taken me over two years to figure this out—it was that confusing for me). None of this is yet certain, but only my best guess. I’m currently consulting with an ND to get to the root cause (which is related to inflammation and leaky gut, but I’d like to get more specific answers).

If you’ve dealt with this kind of itching, please share your experience in the comments below. Read the rest of this entry

LDN Journal 6 of 6: Informational Post

Diarrhea, vomiting and sweating ≠ colitis for me at this stage of the game. So what is it?

For half of March, and most of April, I had been completely gut-normal (hurray!). I’d even eaten (gasp) a few pieces of bread without problems—until my wife started puking last Thursday. Now, a rotavirus, for a gut-normal person, is an inconvenience. It’s an awful time of gastric upset, and then life goes back to normal, but for someone with IBD a rotavirus can wreak havoc and cause a flare up. I’m trying to avoid that. Yesterday I slept for 16 hours. I’ve doubled my probiotics, and started wild oregano (transdermally, but rubbing it on my skin. My gut can’t handle it.). I’m eating only in my food safe zone, and making sure I manage the stress (and worry) of it well. I’ll keep you posted. Darn—I was doing so well…

Below, I’ve put together an informational post on LDN as it relates to Inflammatory Bowel Disease (IBD: Crohn’s and colitis), to conclude my journal series on my experience with it. I’ll continue to uptate you on my experience, but now after more than 6 months, it’s doing the most it can do, and I’m ready to move on to another topic. So, below is the “LDN Primer” I made for my doctor. It isn’t original writing. I’ve mostly created a mash-up from the sources listed at the end of this post.

What is low-dose naltrexone (LDN) and why is it important?

Naltrexone was approved by the FDA in 1984 in a 50mg dose for the purpose of helping heroin or opium addicts, by blocking the effect of such drugs. By blocking opioid receptors, naltrexone also blocks the reception of the opioid hormones that our brain and adrenal glands produce: beta-endorphin and metenkephalin. There are receptors for these endorphins and enkephalins in the immune system.

In 1985, Bernard Bihari, MD, a physician with a clinical practice in New York City, discovered the effects of a much smaller dose of naltrexone (approximately 3mg once a day before bed) on the body’s immune system. He found that this low dose, taken at bedtime, was able to enhance a patient’s response to infection by HIV, the virus that causes AIDS[1].

In the mid-1990’s, Dr. Bihari found that patients in his practice with cancer (such as lymphoma or pancreatic cancer) could benefit, in some cases dramatically, from LDN. In addition, people who had an autoimmune disease (such as lupus) often showed prompt control of disease activity while taking LDN. Since then, LDN has shown clinical improvements in a wide variety of illnesses; most notably, HIV/AIDS, Cancer, and autoimmune conditions. Read the rest of this entry

A few weeks ago, I received a comment asking how I’m doing on LDN. The reader had read my first few posts on LDN, and wondered, “I haven’t seen any posts since [then] how are you doing? Did it kill you?”

I laughed out loud. What a great way to say, “[Ahem,] Tell us more. Why have you stopped writing?”

The truth is I lost momentum. Writing regularly for a blog takes time and energy, and my posts (at least) take a ton of research. I wrote furiously for years as I learned about Inflammatory Bowel (Crohn’s and Colitis), IBS, celiac, and the health conditions that follow with them. Writing is an outlet for me. I was angry. I felt as though my future and dreams, everything I envisioned for my life had either been stolen or been called into question. I’m not just talking about climbing mountains, or doing a 100 mile run. Those are goals. When I flared in 2008, my entire existence was called into question. Will I live to see my children get married? How many days do I have left with them, and I will I spend them all sick? Will that be my family’s memory of me—ill and weak?

On my worst days I felt as though the most simple of human pleasures (food, drink, and rest) had been denied me. So I began to write. Doctors painted for me a picture of a life of suffering. I wrote even more as I learned that the picture they painted doesn’t have to be me. I wanted (and still want) others to learn from my inner obsessive geek, the man who needs to know ‘Why’. After reading Breaking the Vicious Cycle and Listen to your Gut, I thought, “I ought to be able to figure this out. Medications don’t work for me, fine. But there are lots of other strategies that may.” That’s where I am today; still healing and still writing about the ‘other strategies’. Except, for the past year, my motivations to write have waned drastically. It wasn’t until recently that I began to wonder why. Read the rest of this entry

LDN Journal #4: First Doses and Dreams

It’s just one day after Christmas, and I would be remiss not to wish you all a happy new year before I start. So here goes… (ahem)–Happy (coming) New Year! To celebrate the Holidays, think of something for which you are truly thankful, and write it on the palm of your hand (or somewhere where you will see it all day). Each time you see it, say it out loud: “I am thankful for…(whatever is written on my hand).” Do this weekly, and you’ll be surprised how your outlook on life shifts. Okay, on to the post…

Remember, this series is written retrospectively. I suggest you read posts 1, 2, and 3 first, as they read sequentially. As of this writing, I have been on the full dose of LDN since August, 2012, and am doing well. We’ll get into that part in LDN Journal #5.

***

Mid-June, 2012:

I took my first dose of LDN tonight. Just before bed, I reached into the brown sandwich-sized baggie and pulled out a small 3 ml syringe filled with cream. It could have been anything really. They could have sold me hand lotion, and I wouldn’t know.

Sunscreen. It reminds me of sunscreen as I apply it: Cold, thick, and white. 1.5 mg is my dose, so I carefully plunge out the proper amount onto a bare spot on my belly, and gently rub it in circles with my forefinger until it’s gone. It actually never goes completely away. If I rub it too much, it dries and the residual rolls off in little rolls like eraser waste, little LDN boogers. So I just rub it until it is lightly tacky but not wet, then I lie down on the bed and wait for something to happen.

This is silly, of course. Nothing will happen, but it feels like Christmas, like I just got what I asked Santa for in the mall. I sat on the old man’s lap and asked for LDN. I want a drug, Santa baby. And I want it to make me better. Think you can handle that?

Well it is the middle of June, and Santa is on siesta as I lie in bed. I put my ankles together and watch my feet. I have a small bunion on each foot that makes my big toes angle away from each other slightly. The toes are like two fleshy magnets turned wrong-ways, pushing at each other’s tips. Away. Away.

When I alight my consciousness from my feet, nearly ten minutes has passed. My eyes are heavy and I touch my belly where the cream was. It betrays a thin film that was not there before, a translucent reminder that maybe Santa does come in summer. I rise and turn out the light. To sleep. Read the rest of this entry

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