EP.357/ How the low FODMAP diet helps you manage histamine intolerance/mast cell activation syndrome

Podcast

1 Aug

Today I wanted to talk about the low FOMDAP diet, but not for the reasons you may think.

For those who aren’t familiar, let’s do a basic overview of the low FOMDAP diet. The low FODMAP diet is a therapeutic diet prescribed to those with IBS and/or SIBO, which reduces for a period of 2-6 weeks, foods high in fermentable carbohydrates. Fermentable carbohydrates, like inulin, which is found in garlic and onions, help feed our good gut microbiome, which is known as the process of fermentation. This process creates gas, and this triggers in some sensitive individuals, IBS-symptoms or SIBO flares. Once the restriction phase is over, each FODMAP group (as there are different types) are reintroduced to test tolerance, and from there, people are able to create a personalised nutrition plan that is unique to their individual FODMAP tolerances.

In people with IBS, research has found up to 86% experience symptom improvement with the low FODMAP diet. In SIBO, it’s a bit more nuanced, but I’ll be doing another episode on that soon.

Today, I don’t actually want to talk about it specifically for IBS/SIBO (though we will touch upon that again), I want to talk about its benefits for histamine, because the low FODMAP diet can actually be a way to lower histamine levels.

So, what is histamine? Histamine is a natural immune chemical in the body that is released from mast cells when triggered by something like an allergen. It is responsible for immune reactions in conditions like hayfever, but it also has a much wider role in the body and is even involved in the onset of menstruation.

For us endo peeps, histamine can be a bit of a problem. Research has shown mast cells are both elevated and over-active in endo lesions, and are key drivers in endo pain and progression.

But that’s not where it ends. There is an emerging link between endometriosis and Mast Cell Activation syndrome, a condition that I was diagnosed with several years ago and is, just like we see in endo cells, characterised by over active mast cells in our body releasing histamine and inflammatory immune chemicals. These mast cells are particularly hyper sensitive, and are triggered by every day occurrences from exercise, to foods, to stress, scents and so on. The symptoms of MCAS are wide and far reaching, but some symptoms include:

Dizziness
Heart palpitations or a racing heart
Chest pain
Extreme or constant anxiety
Irritability
Sleep issues
Shortness of breath
Feeling faint
Bloating, diarrhoea, nausea and other IBS symptoms - in some cases, even vomiting
Rashes and hives
Itching

Now I have reported on the connection between endometriosis, Ehler’s Danlos Syndrome, Postural Tachycardia Syndrome and Mast Cell Activation Syndrome before, and I’ll link to a few episodes in the show notes, but what I have observed, what other colleagues have observed and what researching is starting to see is that the following conditions often occur together:

Endo
POTS
hEDS
MCAS
SIBO (small intestine bacterial overgrowth)
Interstitial cystitis

Now, that doesn’t mean you have all of them, but you may have a few or perhaps two of these conditions occurring together - and histamine is a common thread that runs through them all, and again, I’ll share some episodes and other articles on this, but here’s why the low FODMAP diet might help.

MCAS is a complicated condition to calm down, and it often requires a multi-faceted approach to resolve or manage symptoms, and whilst diet won’t solve the root cause of MCAS and should only be used temporarily, many specialists like Dr Afrin and Dr Weinstock do recommend some sort of lower histamine diet whilst addressing MCAS and resolving the root causes. This is because histamine isn’t just present in the body, it’s also present in certain foods, and some foods can also increase histamine release in the body.

Now, there are a variation of low histamine diets out there, and they can get really quite restrictive and can be pretty disheartening - I’ve done two and even as a health coach I found them very hard to do.

But if you’re someone who does have endo belly/IBS symptoms and/or SIBO, you might find that the low FODMAP diet is more sustainable alternative. In multiple studies, the low FOMDAP diet was found to be effective for those with endo who also have gastrointestinal symptoms, and it’s a commonly prescribed, effective treatment for IBS, which many of us have, and we also use it with some SIBO cases, which many of us also have.

So, in that sense, by doing the low FODMAP diet, you can identify some of your key endo belly/IBS/SIBO triggers.

And here’s where it gets really good. The low FODMAP diet has been shown to reduce histamine levels eight fold, which may well be enough to reduce your symptoms or some of them. In fact, many MCAS specialists recommend the low FODMAP diet and research has shown that in those with IBS, 58% experience GI reactions to histamine foods.

Now, there’s more benefits. The low FODMAP diet has also been shown to improve the microbiome and leaky gut, and both leaky gut and gut dysbiosis are implicated as being potential triggers and root causes of MCAS. SIBO is also another root cause and so by calming SIBO flares down, we may also calm down MCAS flares.

Does this mean that the low FODMAP diet will solve your MCAS? Unfortunately not. But it could help you on your way to calming down intestinal inflammation driven by leaky gut, SIBO and/or dysbiosis, making your MCAS symptoms more manageable both short-term and long-term. It could also help you identify SIBO/IBS triggers that could be further exacerbating your MCAS. Finally, whilst it certainly won’t be the treatment for SIBO, a low FODMAP diet can be part of the protocol for treating SIBO.

Now, here’s a few things to be mindful of. With the low FODMAP diet, there’s some foods you have to avoid completely, like garlic, onions and cashews, but mostly, it’s just about smaller servings, so you have to weigh every ingredient to ensure you’re getting the right servings. This sounds like a lot, but I prefer it to the low histamine diet because the low histamine diet just cuts out huge categories and types of foods, and the list of foods you can eat is very limited. However, some people may find the low FODMAP diet very restrictive and triggering.

Now, the benefit of the low FODMAP diet is that you’re not just lowering histamine, you’re also lowering endo belly/IBS/SIBO triggers - that’s not necessarily the same with the low histamine diet. You’re not restricting FODMAPS or fibre types, so you could still find yourself with bloating and IBS issues if they’re driven by more than just histamine.

However, the drawback of the low FODMAP diet is that whilst yes, it significantly reduces histamine levels, it doesn’t eliminate them to the degree that a low histamine diet does, so you might find it’s not enough for you when it comes to managing MCAS.

Ultimately, you have to work out what’s right for you, and you also have to discuss the low FODMAP diet with your doctor, because it’s typically a diet that is prescribed for IBS rather than one you just put yourself on and ideally, you’re supported by a dietician. But, in my personal opinion, and this is just my opinion based on my work with clients and my own experience, I think that the low FODMAP diet has more far reaching benefits for our demographic, so I recommend giving that a go first, before pursuing a more restrictive low histamine diet. Now, there are caveats to that of course - for example, like really extreme MCAS cases, but that’s just my general opinion and without working with you directly, I can’t know exactly what’s best for you. However, I hope that this information has helped you to go away and make an educated decision, if MCAS or histamine intolerance is something that has been an issue for you.

Show notes

Low FODMAP diet info

https://www.monashfodmap.com/about-fodmap-and-ibs/

https://pmc.ncbi.nlm.nih.gov/articles/PMC4918736/

Endometriosis and histamine/MCAS

https://pubmed.ncbi.nlm.nih.gov/22332753/

https://www.emjreviews.com/reproductive-health/article/targeting-mast-cells-as-a-viable-therapeutic-option-in-endometriosis/

https://pubmed.ncbi.nlm.nih.gov/31998139/

https://www.eds.clinic/articles/the-role-of-mast-cells-in-endometriosis

https://www.gynecologiconcologyinstitute.org/news/endometriosis/endometriosis-news/mast-cell-activation-syndrome-and-endometriosis-a-potential-link-for-unexplained-symptoms-in-women/

MCAS

https://www.degruyterbrill.com/document/doi/10.1515/dx-2020-0005/html