We hear the word histamine and the first thing that comes to mind is antihistamines and allergic presentations. And we aren’t mistaken, although its role goes much further. It is a molecule that the body produces naturally. It also arrives to us through certain foods, and it is stored in the cells of our immune system (mast cells and basophils). To keep its levels under control, the body breaks down histamine using enzymes (DAO and HNMT). When they don’t work well, especially DAO, histamine accumulates. This is known as histaminosis or histamine intolerance and it is accompanied by diverse symptoms: migraines, itching, congestion, inflammation, hot flashes, anxiety, insomnia, tachycardia, hypotension or digestive problems, among others. These could be exacerbated in perimenopause.
And histamine intolerance could form odd alliances with perimenopause symptoms. It is the conclusion of part of the scientific community reached by observing that this problem affects more women than men (studies speak of 80% versus 20%). And this suggests that hormones might have something to do with it.
Snoring, Sneezing… What’s Happening to Me?
The accumulation of histamine in the body is not exclusive to perimenopause, but there are many hormonal factors that could (we say could because this link is still being investigated) make a woman more susceptible at this life stage. The problem arises when it comes to making the diagnosis.
Since the symptomatology is dispersed and can affect several systems (digestive, neurological, skin…) identifying it is not always easy. Blood tests appear normal, but the body does not say the same. Visits to allergists or dermatologists for urticaria without finding the cause, the neurologist failing to pinpoint the reasons for migraines, and of course referrals to the gastroenterologist because of the ever-present bloating. Although part of the medical community asserts that there is no scientific evidence certifying the link between estrogens and histamine, many clues encourage thinking they are interrelated.
What’s more, it’s being seen that when this connection is well understood, many of the unexplained symptoms begin to make sense.
Perimenopause: the Perfect Storm
Not all women in perimenopause have histamine intolerance, but hormonal fluctuations can make the body more reactive. In her podcast The Dr Brighten Show, Dr Jolene Brighten, a specialist in hormonal irregularities and author of bestsellers such as After the Pill or Is This Normal? asserts that “perimenopause is a perfect storm for histamine problems.” In this stage a scenario particularly conducive to histamine-related issues is created because progesterone tends to decrease first, while estrogen continues to fluctuate in a strong and unpredictable way. “This combination favors histamine release and lowers the body’s tolerance threshold, causing substances or situations that were previously well tolerated —such as wine, aged cheeses, fermented foods, or even stress— to start triggering symptoms.”
Brighten also describes a feedback loop between estrogen and histamine: the increase in estrogen stimulates mast cells (the cells that release it) to release more histamine. That histamine, in turn, drives greater production of estrogen which, in turn, makes the mast cells release histamine, and the rise in histamine stimulates the ovaries to produce more estrogen.
All this hormonal interplay can cause some women to develop or worsen histamine intolerance symptoms during perimenopause, even if they previously had no problems. We are talking about migraines, more intense hot flashes, palpitations, anxiety, insomnia, nasal congestion, urticaria and redness, swelling, etc…
A Key Factor: the Connection with Digestion
In a recent video posted on his social networks, the psychoneuroimmunologist Xevi Verdaguer uses a metaphor to explain how the body fills up with histamine. “The body is like a bucket. It accumulates this substance from 3 sources: what the body itself manufactures (in the morning it is usually higher than at night, unless one has chronic stress), what comes from foods (especially blue fish, fermented foods, citrus fruits, vinegar, tomatoes, alcoholic beverages) and what is released through immune cells (either because there is an infection in the body, with the presence of bacteria and viruses, or imbalances of the intestine such as SIBO).”
This latter source of histamine accumulation is important, because when the intestine is damaged, the enzyme responsible for degrading histamine that comes with foods (DAO, Diamine Oxidase) cannot perform this function. On the other hand, the liver’s methylation (key to detoxifying the body and, therefore, another pathway to eliminate histamine) depends on being well-nourished, not lacking essential micronutrients such as vitamin B12, folic acid or magnesium.
Time to Change the Shopping Basket
The first tool to alleviate the symptoms of histamine excess is to modulate the diet, reducing those foods high in this compound. Verdaguer offers additional advice:
- Reduce or avoid the intake of fermented foods, such as yogurt, sauerkraut or kombucha, very aged cheeses, such as blue cheese or Parmesan, and cured or smoked meats.
- Take care to prevent infections and intestinal imbalances.
- Improve lifestyle habits, aim to reduce stress levels and maintain a regular eight-hour nightly rest.
- Provide the body with the necessary nutrients.
A Complex System Still Not Fully Understood
For some scientists, the relationship between estrogens and histamine remains a marginal hypothesis and needs further investigation. However, many, many women are demanding a solution for the symptoms caused by histamine intolerance and perimenopause.
The fundamental point in this whole puzzle is to understand that the hormonal transition can act as a trigger for an underlying histamine sensitivity. And, in turn, poor management of histamine can intensify symptoms typical of perimenopause. Furthermore, the activity of DAO depends on multiple factors: genetics, intestinal state, nutrition, medications and hormonal state, a combination that makes each case an individual scenario requiring a tailored approach.
