5/17/24 - Histamine intolerance & Low Histamine Diet: Hype or Helpful?; Spotlight: Blake Metcalf; Question from our CLINICAL group; 4 Things You Don't Want to Miss

❓Histamine Intolerance & a Low Histamine Diet

Recently we’ve seen some posts and gotten some messages from dietitians who are getting referrals from MDs to put patients on a low-histamine diet due to histamine intolerance. If you search on the terms “low histamine diet” or “histamine intolerance” (HIT), the first results that come up are often from 🚩sketchy sites and providers like chiropractors, integrative and functional medicine docs (like Mark Hyman) and people and sites selling supplements…all 🚩red flags of quackery.

Here are some science-based resources to learn more about histamine intolerance, what a low-histamine diet is and when and whether it is needed:

• Podcast: #70 - How do low histamine diets and stress impact mast cell disease? - The Itch: Allergies, Asthma, Eczema & Immunology | Podcast on Spotify - for a good overview on testing and treatment and cautions.

• Article: Histamine intolerance: fact or fiction? (aaaai.org)

Main symptoms of histamine intolerance and possibly corresponding histamine receptors.

• Article & Research Summary: Histamine Intolerance: The Current State of the Art - PMC (nih.gov) -

“…However, there is not a single dietary recommendation of a low-histamine diet….Despite the promising results of a low-histamine diet for the treatment of dermatological conditions, scientific societies of dermatology still consider this exclusion diet of unproven utility pending randomized, double-blind, placebo-controlled clinical trials to confirm its effectiveness…”

• Comments from Dietitians Who Work in the Gastro Space

-Carol Ireton Jones - “The low histamine diet seems like a good idea, but the data are lacking as to diets' role in making a substantial difference in histamine production. It is restrictive - and truly time limited.” 

-Tamara Duker Freuman - “….the best evidence for it is for managing chronic idiopathic urticaria, but there may be a role for this diet in a small subset of people with chronic diarrhea that seems IBS-like in nature but doesn’t respond to any IBS interventions and who seem triggered by high histamine foods.
There is no test for histamine intolerance, but once in a while I will try this diet for people whose presentation raises index of suspicion (often they have a generally highly allergic phenotype but not always.) sometimes the diarrhea is accompanied by other symptoms like heart racing, reflux, rashes, itching etc. which can be a tip off.” 

-Wendy Busse - “The low histamine diet is an educated guess, not a definitive diet. “Foods that have been reported to increase histamine-like symptoms” would be a more appropriate name for these lists.” See: Practical Guide to the Low Histamine Diet - Wendy Busse

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Bottom Line: As with many things, there’s a little bit of truth behind medical conditions that might warrant a trial of low-histamine diet. The caveat is that this sort of diet is not intended to be a permanent elimination diet, needs to be individualized so a patient/client meets their nutritional needs and should only be used after other causes of symptoms have been excluded by a PHYSICIAN —not by a dietitian, chiropractor or wellness coach.

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💡Spotlight:2️⃣ Questions for Blake Metcalf DCN, RD, LD, CCMS, FAND

Blake Metcalf, Assistant Professor, Director of Community/Clinical Nutrition, Arkansas Colleges of Health Education

LinkedIn: (2) Blake Metcalf | LinkedIn

Q1: What made you want a career in nutrition?

“I think even as a child I noticed that people were obsessed with nutrition, yet everyone was confused about what to do. As a teenager, I found myself religiously following whatever the latest magazine article told me to do and that trend continued until I got into my nutrition courses in undergrad. It wasn't until then that I realized that almost everything I had been told up to that point was either wrong or at least exaggerated. I think from there I just wanted to do whatever I could to stop misinformation and snake oil salesmen.”

Q2:  How would you define "culinary medicine" and why do you think this is an important area for dietitians to be aware of? 

“Although I wish it had a different name, I define "culinary medicine" as the bridge between educating patients in an office/hospital/clinic and building good habits at home. It's a way for patients/clients/students to experience cooking affordable, nutritious food that tastes great too. From my experience it isn't a "food is medicine" field, but there are some well-meaning practitioners out there that have fallen prey to pseudoscientific thinking. In general, I am optimistic that this field will continue to grow as an evidence-based practice, but we certainly need more RDs that stand for science getting involved.”

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🙋‍♀️🙋‍♂️Question from Build Up Dietitians CLINICAL group

Answers:

Candance R. “A handheld device that weighed the residents accurately.”

Brittany P. “A platform to share new research with MDs”

Jennifer W. “Star Trek style tricorder to perform NFPE”

Laura O. “Magical wand to make certain providers actually hear and understand what is being said.”

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