Clinically speaking, histamine intolerance seems to be on the rise. But does this diagnostic label lead to complacency and getting caught in a cycle of symptom management instead of uncovering the triggers?
Today we are joined by Amie Skilton who shares with us the underlying physiological mechanisms driving histamine intolerance and asks an important question; Do we need to be paying better attention to the health of the environment we live and work in to get on top of runaway histamine?
Covered in this episode
[00:39] Welcoming back Amie Skilton
[02:40] What is histamine intolerance?
[05:49] Histamine: it's about more than allergies
[07:40] Identifying histamine problems in patients
[12:23] Histamine metabolism and clearance
[20:54] Gut and dietary connections
[32:25] The role of genes in histamine metabolism
[34:48] Environmental causative factors
[44:34] Prioritising testing
Amie Skilton is a qualified naturopath, nutritionist, medical herbalist, and aesthetician. She's been in clinical practice for more than 16 years and worked concurrently for the BioCeuticals technical team for 13 years as a presenter, educator, and writer. She specialises in several areas of integrative medicine, including women's health and hormones, natural fertility and healthy child development, gut restoration, as well as her favourite subject, skin health.
Author of the book, Clear Skin Secrets, Amie's a truly holistic skin specialist who helps women struggling with acne, achieve healthy, clear, beautiful, vibrant skin naturally. Amie is the founder of whatthenaturopathsaid.com and the clearskincoach.com. And you can also connect with her on Facebook, Twitter, and LinkedIn.
Welcome back to FX Medicine, Amie, how are you going?
Amie: Thanks, Andrew. It's a please to be here. And I'm great. Thank you.
Andrew: Yeah, well, I'm surprising you’re great, given what you've been through. You gave a rousing lecture at the Australasian Society of Building Biologist's 2018 conference, not the least of which I was, perturbed doesn't cut it. I was disgusted in the building quality. You've been through the wringer.
Amie: Yes, I certainly have. I've unfortunately become a very reluctant expert in all things CIRS, and mould illness, and sick building syndrome, mostly out of self-preservation and ensuring that never happens to me again. And also really trying to turn what was an ultimately, a life-destroying event into an opportunity for me to prevent anyone else having to go through what I went through last year.
Andrew: What is it?
Amie: You know, that's a great question. Histamine intolerance is a term that is used to describe, really, a collection of experiences someone will have as a result of a disequilibrium of histamine in the body. Whereby there is either a build-up of histamine or perhaps an overexposure of histamine or an overproduction and/or a reduction in the capacity for them to break histamine down and clear it out of the body.
And it's certainly, I guess, a term that is becoming more and more widely known, I think, in part because it's becoming a more common experience for people as well. But what I want to, I guess, say from the outset is it's one of those things that is used to describe experiences and observations. But, unfortunately, it's being used, I think in sort of the general sense, as a way to describe it as a condition or a disease.
And so, I hear people say, "Oh, I have histamine intolerance," or, you know, an extreme presentation of it is mass cell activation syndrome. So, you know, “I have MCAS." No, actually, you don't. You have a condition underneath that is causing that to be apparent.
Amie: And for you to have this experience. And I guess if it sounds like I'm standing on a soapbox here, because I’ve just realised it's coming out of my mouth, like a bit of a rant, it's that, as a practitioner, it's frustrating to see people give names to these things they're experiencing and then just simply stop there and remain trapped in treating the symptoms as opposed to looking at the cause, or perhaps more accurately, the cause of the cause. Their symptoms are being caused by an issue with histamine, sure. But what is causing the histamine issue, I think, is a much more pressing question that needs answering.
Andrew: So, it's kind of like, "I've got an iron deficiency," leave it at that and just treat them with iron.
Andrew: Rather than searching for the reason that you're iron deficient.
Andrew: Is that right?
Amie: Yeah. You can't just put on a badge and say, "Oh, I'm an anaemic."
Andrew: Yeah. I'm an anaemic.
Amie: I'm an anaemic, everyone.
Andrew: And proud of it.
Amie: Anaemia is all about as load iron, you know, and I have to take iron and it's like, "Okay, well, that's cool, but you've only done half the work there."
Andrew: Yep, yeah.
Amie: I'm saying this because for the practitioners that are listening, any of your patients that are, you know, who have, in air quotes, "histamine intolerance" or "MCAS," there's something underneath that that is causing that. And you really need to be looking deeper as to what's going on underneath the surface.
Andrew: So when you're talking about histamine, most of us think about histamine being an immune reactive sort of complex, especially with allergies. The mass cell degranulation and you get a sneeze. You get the itching eyes, and the pruritus and the erythema, that sort of thing. But it's also a neurotransmitter inside the brain with a totally different action.
Amie: Yes, it is. It's quite funny, isn't it? For I guess probably the general public, the perception would be it is a pesky compound in the body that is released in response to, you know, allergenic provocation or some sort of immunological response. And so, it's got a bit of a bad rap, but, you know, histamine is actually vital for alertness, and learning, and cognition, and as part of the sleep-wake cycle and plays numerous roles in the brain as a neurotransmitter and as a chemical messenger throughout the body, actually regulating blood flow as well.
And so, it's not something that is inherently bad, at all. And it's not something we want to get rid of entirely or can ever downregulate to a point where it's imperceptible or undetectable. So certainly, an appropriate level is required for healthy functioning. But the issue becomes apparent when the body is either not clearing it efficiently, and there's a number of reasons that that can happen. Or there is an excess of histamine production in response to something, usually from the environment, although not always. And it's really looking at those things to, I guess, bring it back into balance. That someone isn't suffering from the symptoms that we associate with excess histamine.
Andrew: Well, let's go into these symptoms then. I would imagine that there'd be a whole list and they'd be varied because you've got different histamine receptors in the body, H1 to 4. Take us through that.
Amie: So I guess for anyone who's listening that is maybe not a medical practitioner, the symptoms that would probably spring to mind would be those of typical allergic reaction-type symptoms. So, you know, runny nose, watery eyes, itchy nose and throat, sneezing, issues like urticaria or hives, itchy skin, swelling, redness, and also conditions like asthma. But it certainly extends a lot further than that. And for anyone with gastrointestinal issues, they might be aware of the connection there and the triggering of diarrhoea. For those who suffer from migraines, there's a connection with histamine there as well.
Andrew: Ahh, okay.
Amie: But actually, it's full system-wide because we do, as you mentioned, have four classes of receptors, and these are located in different organs and tissues. So our H1 receptors are found in smooth muscle and endothelial cells and these affect blood vessels and skin. And so, medications like Benadryl or Claratyne can certainly block the activity of these particular receptors. And these are the ones that we really are aiming at when it comes to things like hay fever, for example.
But further to that, we have H2 receptors in the intestinal tract. And so, these can, when they are stimulated, they control acid secretion and also right through to abdominal pain and nausea. They also have a role with the heart rate as well, via the vagus nerve there.
Then we've got H3 receptors, which are found in the central nervous system. And I guess this is where the histamine's roles and neurotransmitter comes into play. Because this is where it connects into impact nerves, our sleep, our appetite, and behaviour. Just to give you one example, in anorexic patients, they have much higher levels of histamine and this can actually down-regulate appetite, make them feel not hungry at all.
And then with H4 receptors, we have those in the thymus, in the small intestine, spleen, large intestine, also in the bone marrow and white blood cells. And there's a very close connection here with inflammatory responses from the immune system. So when you think about each one of these organs and tissues and glands, under the influence of histamine, could create all kinds of symptoms. And I think this is why it can really be a bit difficult to pin down, especially if those allergy-type symptoms don't appear to be so prevalent or marked.
Andrew: Forgive me if my understanding is that you've got a couple of them as well, H1 definitely, and another one where, with regards to each perception. And this is something I just don't understand is, if you're getting that receptor relevant for itch perception and it's found in the CNS, why doesn't your brain itch?
Amie: Well, our brain is missing a number of those sensory nerves. And so, there isn't pain and there isn't itchiness to be detected by the brain. And thank goodness for that because it'd be quite difficult to scratch, right?
Andrew: You know, I've often thought actually about the sensation of itch. Like it's a weird thing. We don't like it, but I'm just wondering if it's sort of this primordial, evolutionary way of getting rid of a noxious agent through the skin. By scratching and causing breakage of the skin, leaking of fluid, which will hopefully carry that antigen away from you.
Amie: Yeah. Well, I think that would absolutely be part of it. Not to mention that the physical sensations on our external organ, that is the skin, are designed to draw our attention to something that is bothering us.
Amie: So, you know, if you are starting to scratch at something, naturally, you might be prompted to wash that area or apply something soothing to it to calm it down. And certainly, in the case of something maybe coming through from the body, yes, actually increasing that circulation and allowing the immune system to clear it more quickly could absolutely be a possible mechanism as well.
Andrew: So can we talk a little bit about why that's such a big issue? What's controlling that, or what's gone wrong?
Amie: Okay. Well, there's lots of things that can interrupt normal clearance of even normal histamine levels, although this must, will most commonly become apparent when there is an overproduction of histamine from some sort of environmental trigger. And what we need to look at when you're assessing someone's clearance rate are, of course, the two major enzymes that move histamine out of the body, or rather metabolise it, so that it can be eliminated via the bile, through the faeces and, of course, through the urine. And those two enzymes are diamine oxidase, DAO, for short, and histamine N-methyltransferase or HNMT. And there can be a number of factors that can contribute to the inhibition of the enzyme activity of either one of these. But, of course, if there are things going on that are affecting both, you're going to have an even more difficult time clearing histamine out of the body.
So, if we start with DAO, diamine oxidase is really the main enzyme responsible for degrading free histamine or that which is found in the extracellular space. It's also responsible for clearing histamine from the diet that's coming in from the gut and reducing how much of it is actually up-taken into the body when we eat higher histamine foods or histamine-provoking foods. So DAO is particularly found in the intestinal mucosa. Now, what this means is anything that affects gut health is going to automatically impact diamine oxidase activity.
Amie: So, first of all, gastrointestinal inflammation. So you might see a temporary reduction in DAO activity as a result of gastroenteritis, infectious gastroenteritis, particularly. We also know that gastrointestinal inflammation down-regulates phase two liver detoxification, which then also limits histamine metabolism.
So, knowing what we know about the general populations, micro-flora, and gastrointestinal integrity, we can see that a lot of people are probably walking around with suboptimal diamine oxidase activity because their gastrointestinal health is not where it should be.
Having said that, that I don't believe is enough to create a state of histamine intolerance or MCAS. Although that, obviously, will feed into it and then with other environmental triggers on top will absolutely be problematic. And I guess you can't consider the state of the gut without also looking at people's stress levels. We know that under the influence of adrenaline, circulation is diverted away from the gastrointestinal tract to other more vital organs, those that are crucial for survival when we are in danger or under imminent threat. Now, most of us aren't, you know, walking down, you know, King Street in the city being chased by a tiger. And, you know, so we're not having these extreme experiences of adrenaline and then clearing it and going back to a parasympathetic nervous system state. Most people are walking around with some degree or another of a sympathetic nervous system activation. And, therefore, our digestive system is already compromised as a result. Which means gut inflammation, low DAO activity, and a down-regulation of phase two detox in the liver as well.
So there's that. So you can already see there that, you know, most people will have some element in their lifestyle that is already down-regulating DAO activity. But when we add into that nutrient deficiencies, diamine oxidase requires Vitamin C, B6, B12, iron, and copper to function properly. We touched on anaemia just before. Iron deficiency is particularly common in women. And, of course, women on the pill will also be deficient in Vitamin C, B6, and B12. And so, we start to see the odds stacked against someone nutrient repletion as well.
But if you layer on top of that medications that affect the production of diamine oxidase, we can also see issues are being, you know, stacked on top of those other factors. So, alcohol, antibiotics, nonsteroidal anti-inflammatory drugs, certain antidepressants, anti-histamines also, ironically, down-regulate diamine oxidase, which is designed to clear histamine, which I find quite bizarre.
Andrew: That's the perfect drug. Treat a symptom and make you need it more often.
Amie: Yes. Yes, which could also account for that rebound histamine response when you come off anti-histamine drugs. And also certain anti-arrhythmic medications and immune modulators.
So there's a lot going on there, which would impact diamine oxidase. But that's just really one part of the equation because you've also got its teammate, histamine N-methyltransferase, or HNMT. And HNMT inactivates histamine via a different method and it does that in the intracellular space. And so, it's expressed in many human tissues. But the highest levels are found in the liver and kidneys, which makes sense, our major detoxification organs, but also in the bronchi and trachea. So those incoming food pipe windpipe areas where, of course, provocative antigens would present very easily and could very easily trigger histamine when the immune system is unhappy with what's coming in.
Further to that, it would be remiss of me to talk about HNMT without also referring to its deputy; monoamine oxidase B.
Amie: Because it's actually a bit of a two-part metabolism here where HNMT adds a methyl group onto histamine and then MAOI also then further breaks that N-methyl histamine compound down into other metabolites. MAOI, just as a side note, needs B2 to function, so, again, a B2 deficiency, irrespective of DAO activity and HNMT activity, could certainly see, I guess, a bottleneck where histamine clearance occurred.
But coming back to HNMT for a moment, there are certain things that will down-regulate its activity as well. So, like with DAO, it requires a number of nutrients to function effectively. And in the case of HNMT, as the name suggests, it requires methyl groups in order to be able to conjugate or transform histamine with that particular compound. So choline, whether it's dietary or endogenously manufactured, and, of course, if S-adenosyl methionine is going to feed into that as well. And a deficiency in either of those is going to reduce the amount of methyl groups the body has to pull from in order to methylate histamine and then for a further breakdown.
Further to that, we also know there are medications that inhibit HNMT just like there are medications that inhibit DAO. So there's an anti-malarial drug, chloroquine. Chloroquine, sorry, that will actually down-regulate HNMT. There are a number of other medications, including H1 anti-histamines, which, again, funnily enough, down-regulate histamine-clearing enzymes. Folate antagonists will also impact, of course, HNMT because it's going to impact methyl group production. And there's an Alzheimer's drug that also inhibits HNMT. So, there's a lot really feeding into those two major enzymes.
Andrew: Can I just ask a question about the sort of purported treatment. When you talk about inhibition of phase two and things like that. Naturopathically, you'd be thinking about treating the liver and the gut. The sort of term attributed to that is leaky gut or intestinal permeability, which affects the liver.
Andrew: So the treatment is really the same, isn't it?
Amie: Yes. Yes. Absolutely, it is. You know, they are really a tag team and the health of the gut drives the health of the liver and health of the liver, of course, can’t not impact the gut. And so, you absolutely can't just focus on one over the other. And that's why, you know, I always say with detox, not just the fact that 25% of it occurs in the lining of the gut itself, but you cannot touch the liver and try and encourage detoxification processes there unless you have sorted out the gastrointestinal tract first.
So, you know, certainly, when you're looking at something like this, the same rules are going to apply. And, of course, you want to be looking at the context of gastrointestinal health in terms of the microflora as well. Because there are some bacterial species that do produce enzymes that convert histidine to histamine and, therefore, can also be a source of exogenously-produced histamine, if you're looking at the lumen of the gut as outside of our ‘system’.
Andrew: Okay. So if we're talking about let's say the leaky gut treatment diet, so a low-reactive diet being advocated in this, do you have to be cautious about certain foods?
Like, for instance, you know, avocados, for instance, would normally, you know, in a paleo lifestyle, it would be heralded as one of the great foods. Eggplant, certain shellfish. Obviously, you're going to avoid alcohol if you're going to be doing this, but what about fermented foods? There you go. They're high in histamine.
Andrew: So, you know, normally we'd be going, "Oh, great. Get some fermented foods in you." Maybe not.
Amie: Yeah. You know, it, of course, always comes back to bio-individuality and everyone is going to be different.
But certainly, when you're looking at dietary management, there are a couple of things to keep in mind. And number one is that any diet, whether it's a FODMAP diet, or a low histamine diet, or insert whatever diet here, anti-candida diet, they are designed as interim management systems whilst the underlying cause is being treated.
Andrew: Yeah, hear, hear.
Amie: And so, you know, a low histamine diet is not long term or even medium term. And yes, it does mean if you are going to lower your dietary histamine intake in order to relieve your symptoms, there are going to be things in there that you would have otherwise considered healthy or, in the case of fermented foods, good for gut health that would be really problematic for you until your body can kind of catch up.
So, I guess on that note, you would be… it's pretty easy to find on the internet a list of high-histamine foods. But obviously, fermented foods are number one because the microorganisms that are doing the fermenting produce histamine as a metabolite. So, unfortunately, wine, champagne, beer are all in there. I know. I'm so sorry. Alcohol is a by-product of microbial fermentation. And so, that's...you are going to find high histamine levels in there.
Other fermented foods like vinegar, and sauerkraut, and soy, and kombucha can also be problematic, but so too can things like cured meats, soured foods, which have had some fermentation occur, dried fruits, aged cheeses, certain nuts, and vegetables, like you mentioned, avocado, eggplant, spinach, and tomato. Smoked fish and also certain species of fresh fish as well. And, of course, processed foods of all types tend to be an issue because preservatives tend to be high in histamine.
So as you are supporting your body to clear histamine more effectively and you're looking for the underlying causes, yes, reducing these things can certainly help to, I guess, take a bit of a load off the body. The other things to be mindful of, there are foods that don't actually contain histamine itself but can inhibit the action of diamine oxidase. And because diamine oxidase is the enzyme in the gut wall that is designed to really transform histamine from foods coming in from the diet, are going to be a problem. So look, alcohol also falls into that category, but so does cow's milk, and pineapple, and shellfish, and strawberries, and tea, green tea, and black tea.
Amie: And so, these things, whilst they're not high-histamine foods themselves and some of them don't contain any histamine at all, they do inhibit DAO's function.
Amie: And, therefore, the ability of the body to clear histamine that way.
Andrew: Is there, therefore, a histamine-intolerance diet, dare I say the term?
Amie: Yeah, look, there is. There absolutely is. And a quick Google will find lots of recipes for low histamine foods and meals and, obviously, a list of things to avoid. But it is important to be mindful that it is for a temporary purpose while you're dealing with what's underneath. Having said that, there are also things that can help increase the activity of diamine oxidase. And so, including things that we know are going to up-regulate DAO's activity is going to be an important part of that as well.
So we've talked about some nutrients already and how the enzymes that clear histamine require those nutrients to function. So, Vitamin C is one of those that supports diamine oxidase activity. It has a well-documented history of increasing DAO activity and lowering blood histamine levels. Copper and zinc, interestingly enough, also have a relationship with DAO and we know that insufficient levels of either of those decrease DAO activity. Now, it is far more common to have a zinc deficiency and, in turn, a copper excess, than a copper deficiency, although I'm mentioning both because that isn't always the case. Magnesium, interestingly enough, has a relationship with DAO activity as well. And animal studies found that a deficiency decreased the enzyme activity and increasing magnesium levels ramped it back up.
But further to that, there's a relationship there with fibre. In particular, one human study found that galactomannan significantly increased serum diamine oxidase activity. And this may be because of the way it helped, you know, clear metabolites through the gut, maybe through the feeding of microflora? And maybe as a result of feeding the microflora, there were more microbial metabolites produced that improved gut health. Currently, the mechanism of action is not understood, but there was definitely a relationship there.
And also long-chain fatty acid intake. So things like olive oil, also significantly increased diamine oxidase activity in a dose-dependent manner also for that matter. So there are certain things you can be, I guess, increasing in your diet that are going to really just ensure that those enzymes have got sufficient nutritional repletion to function properly.
Andrew: Therapy-wise, if you're thinking about these galactomannans, do you have purified galactomannans or do you use, you know, like fenugreek tea or guar gum or stuff like that?
Amie: Well, certainly in this particular study, they used seven grams a day of pure galactomannan.
Andrew: Right, so purified.
Amie: Yeah. But I think if you're using herbs or food sources of galactomannan, albeit probably not at the same level, you are going to be just offering your body just another element in order to be able to function optimally. And I guess bringing it back to the underlying cause, no one has a histamine intolerance because of a galactomannan deficiency and so, it's not a secret pill that everyone needs to rush out and find.
Andrew: Yeah, it's a tool.
Amie: It's a tool. Absolutely. It's a tool. And I guess when you look at how is it helping, what is its mechanism of action? You kind of circle back around to the role of a good healthy gut is required for good healthy diamine oxidase activity. And that's why you also see low DAO function with leaky gut, Crohn's disease, IBS, ulcerative colitis, Coeliac's disease, non-coeliac gluten intolerance, and, of course, any form of dysbiosis, especially SIBO.
And so, if those things are going on, then obviously, we're going to have compromised DAO activity and a low histamine diet is not going to sort that out for somebody.
Andrew: Can I ask a question regarding stewed apples rather than apples?
Andrew: Mike Ash talks about an immunomodulatory diet where he uses stewed Bramley apples. Now, I haven't looked at the equivalent in Australia, but I think it's high raffinose? And it's stewing them and he put cinnamon with them and things like that.
Andrew: And then portions of them out into these little ramekins and, you know, has these throughout the day. Hardly a low-carb diet sort of thing and yet, it heals the gut.
Andrew: Can it heal this or do you worry about the histamine or the stewing take... Like where do you go with this sort of dietary intervention?
Amie: Look, the stewed apples and the raffinose content we know to be incredibly healing to the gastrointestinal tract. And as far as the type of apples go, I think the biggest thing is just making sure they're organic.
Amie: Especially if that's something you're going to be having every single day. I certainly think that many people, even with histamine tolerance, would be able to tolerate this very easily. But, again, everybody's different. Everybody's body burden is different, everybody's, I guess, compromised enzyme function varies from one degree to another. And it is certainly something that I wouldn't hesitate to recommend on a regular basis, but it is something that I would get them to start off with very small amounts and sort of titrate up to that daily dose that he recommends, which isn't huge, but just to test for their own individual tolerance and see how they go.
It's always, you've got to look at the risk versus benefit, how much is going to contribute to the problem. And again, it really comes down to what is triggering the overproduction of histamine?
Andrew: Are there certain people who they've always been sensitive to histamine overproduction or under-clearance? They've just been that sort of, you know, do I say it; ‘sickly’? Have they always had...
Amie: Yeah. I know what you mean.
Andrew: You know, which I guess would allude to a genetic makeup, a SNP or something like that.
Amie: Sure, yes, yes.
Andrew: But are these sorts of people chronically unwell or is there people who are usually robust and then some assault happens, and bang, they fall?
Amie: There's a few different scenarios where histamine intolerance can show up. And certainly, we probably all know that kid at school we grew up with who had allergies, right? Who had constant allergies. And certainly, there are genetic polymorphisms that will impact histamine clearance. Of course, anything in the gene that codes for diamine oxidase or HNMT or monoamine oxidase production could compromise enzyme activity.
And knowing what we know about the nutrients that are required for these enzymes to function, MTHFR can be an issue. Because then we see less methyl groups being produced and, therefore, we don't have methyl groups available to metabolise histamine via HNMT. You know, there are genes that code for Vitamin C transport. If there's a polymorphism there and there's insufficient Vitamin C delivery, DAO activity won't be optimal.
And so, for someone who's perhaps got a long history of allergy-type reactions and maybe even raised whole-blood histamine, certainly that would suggest a genetic makeup whereby they have to be more vigilant with gut health and dietary intake of histamine. But for the most part, it does tend to be something that develops at some point in someone's life, usually in adulthood. And as you suggested, it's often a series of insults that occur, you know, stress, a bout of gastro when you're on holiday in Thailand, nutrient depletion plus alcohol and coffee consumption. And then, you know, maybe a really bad viral, you know, a bout of some sort of viral infection and then all of a sudden, you know, that house of cards comes tumbling down.
And so, with histamine intolerance, again, it's usually not just one thing and it's really no different to any other naturopathic approach. You're always going to look at the whole person and their whole history and see what needs to be fixed and start there. But certainly, one thing that I think practitioners are beginning to become aware of, but for the most part are still overlooking, is the environmental triggers. And what I mean by that is predominantly water-damaged buildings. Although I will also include EMFs in that as well, electromagnetic frequencies.
Together: Electromagnetic frequencies.
Andrew: Right. Got you.
Amie: Yes, yes. So starting with EMFs, because I think that's probably a smaller subject. We are becoming increasingly exposed to EMFs and RF or radio frequencies and dirty electricity in our homes. Especially with the increasing amount of smart appliances, and smart meters, and smartphones that we have.
So, you know, electromagnetic fields can be created even just from wiring in the walls. And we shouldn't be charging electronic devices by our heads, i.e. cell phones and electric alarm clocks. And then we have, you know, TVs in the bedroom now or, you know, the computer desk is on the other side of the wall of the bedroom where everything's plugged in. And then you've got the WI-FI router, and cell phone towers, and power lines. And we're becoming increasingly cooked by these frequencies, which are causing major immune damage. And as part of that, histamine production is being released. And, you know, people can experience, I think, a small fraction of that when you're talking on your phone too long and your head starts to get hot. Or you're holding your phone, scrolling through, you know, social media or reading the news and yet your hand starts to go a bit numb or a bit tingly or you might feel a hot patch in your back pocket where you've shoved your phone and it's been sitting there, you know, for half the day.
And so, when you think about all of these things and the cumulative effect that they have, we are constantly aggravating our immune system, affecting blood coagulation, affecting our central nervous system, degrading the blood-brain barrier, annoying the immune system, and as a result of that, we can see histamine being released.
And so, I think we've reached a day and an age where people really need to start being cognisant of how our built environment and all of that which it entails is having a negative impact on our health. And yes, these things are a lot of fun, and yes, they're highly convenient. And no, I don't want to go back to living, you know, in a cave myself. But we have to really start to be very responsible and stop putting our heads in the sand and pretending that we don't know that these things are harmful to us. So there's that.
But I think, on a much larger and more serious scale, is the sick building syndrome or the impact of water-damaged buildings. And, you know, we mentioned this at the beginning of our podcast in the context of what I experienced last year where I developed full-blown chronic inflammatory response syndrome.
But as a subsequent consequence of CIRS, a histamine intolerance or mass cell activation syndrome, is one of several, I guess, secondary side effects of the immune response. And when you look at what CIRS is, yes, there's a genetic susceptibility, but the environmental trigger is an unhealthy microbiome in the building or in the built environment. And I guess I'm saying it like that because it's not just the home that you live in, but it's the office that you work in, it's the car you drive in, and the carpet, and the cushioning, and the air-con. Or the public transport that you catch, or the shopping mall you do, or the movie theatre that you visit on a regular basis.
And what I want to say about that is a water event can encompass many different things. It could be a leaking pipe. It could be a roof leak. It could be a bath that overflowed or a dishwasher, you know, that has got a rubber seal that's degraded. Or it can even be just high humidity and even condensation problems. And essentially where there is water, there is life. And so, in a building, a water problem doesn't just trigger mould proliferation, but it also brings to life every single microorganism in that building, every virus, and bacteria, as well as fungi.
And so, when you think about the way in which microorganisms trigger the immune system to respond, it makes perfect sense that a water-damaged building is going to trigger histamine release. Now, in a water-damaged building, you've also got mycotoxins from the mould. You've got endotoxins or LPS from the bacteria. You've got the inflammatory cytokines that they trigger. And, then, of course, the oxidative stress and physiological stress that puts on your body and immune system, all of which will cause mast cell degranulation and, therefore, excessive production of histamine.
And so, what upsets me is the thought of the thousands of people with histamine intolerance who are finding themselves becoming more and more histamine intolerant and being able to eat less and less things and having to take more and more medication. Meanwhile, they are living in an environment that is the single biggest factor that is driving their histamine production and they don't even know it.
And so, a lot of people think about mold or a water-damaged building as something that's really obvious and you can see mould growing on a wall or a ceiling. But in my experience, 80% of the time, you can't see that mould at all. It's in ceiling cavities and wall cavities. And, of course, when I say mould, mould is a proxy for all of the microorganisms in the building. And so, we can't just think about are the microbiome in our gut. We have to think about the microbiome of our built environment as well.
Andrew: Then you go down this sort of...it sort of winds back to the question about are there people who are more sensitive. There's a slab outside our house, in one area of our house, and when it rains, I should say when it drizzles or the first sort of rain upon a hot slab, and I can immediately smell this sort of mildew smell. Now, I don't get sick from it. I don't like it. It says, "Oh, I've got to prime that."
Andrew: But I don't get sick from it. And yet then you'll get others that will just go, "Oh, yeah, whatever." And then you'll get people that will just fall flat on their face. So there's this whole variety of different canaries, you know, and...
Amie: Yes, different responses. And I think there's a combination of reasons for that. And certainly genetic susceptibility, particularly as it pertains to CIRS or chronic inflammatory response syndrome, that is, very much separates the canaries from the rest of the pack. But it also depends on where the mould is, their species of mould, the mycotoxins it's producing. And so, I think, you know, somewhere outside tends to be far less problematic than inside. And it also depends on the substrate that it's growing on and the source of the water and how, I guess, the supply of the water as well.
Part of the issue with water-damaged buildings is the substrate that the microorganisms are growing on, particularly the fungi, because as it degrades, the particleboard, and the gyprock, and the MDF, and the carpets, and the paints, all of the chemicals, and the glues, and the dyes, and the, you know, potential other contaminants that are present in those building materials, are also aerosolised and released into the breathing space.
And so, you know, if you have a slab outside with mould on it, it's really not affecting your indoor air quality too much. You're not breathing it 24/7 as you sleep at night in your bed or sit in your living room, and nor is it really degrading that concrete and releasing the chemicals in it. But when you look at the actual home you're in or the office you're in or the car, it's not just the microorganisms or the metabolites. It's the other things they are releasing into the air space as well that become really problematic.
Even then, though, I hear what you're saying, depending on your genetic capability for detoxification and breaking down histamine, and your nutrient repletion, and your gut health, and your stress levels, everyone's response is going to be different. And a single person's response may be different at different times. But rest assured, once your immune system's kind of sunk below the waves and you start to see this excess histamine production, you really need to sort the environment out. Otherwise, you will never get well and you'll never recover and you'll end up having to manage your symptoms for the rest of your life. Which I just think is a total travesty and totally unnecessary.
Andrew: How do you prioritise testing and what do you test? Like, speaking to people at the ASBB Conference 2018, one of the conundrums I keep sort of going round in my mind, I haven't reached the settling point yet, is do you test the home first or do you wait till somebody's sick and do tests on them first, until you reach a stage where you've got nowhere and then you go, "Oh, it's got to be the home?" There was this whole issue of prioritisation.
Amie: Yes, it's tricky.
Amie: It is really tricky because, commonly, what happens and certainly prior to my experience with CIRS, I would commonly operate in this way too. And that is, you know, do a thorough case take of the medical history, and the diet, and the lifestyle, and medications and, you know, family history and all of that sort of stuff. And typically, it would be maybe a couple of months into treatment if they were failing to respond or failing to respond in a manner in which would be typical, that would then lead me to ask questions about whether or not there was something in the environment that was getting in the way of recovery.
And having been through what I've been through now, I think as much as it's going to add more time and effort perhaps to the consult, it really at least needs to be in the pre-consultation questionnaire around events in the home. And there's really some obvious red flags to me now.
Andrew: I think I agree. I really do.
Amie: Yeah, yeah. Look, now that I've been through it, there are now really obvious red flags to me of an environmentally-acquired illness that I would not have otherwise been aware of. And so, I think exploring this area, if it's not something that a praccie got taught in college, it should really be a priority.
But I think it depends on the severity of the issue and, of course, responsiveness of treatment. But in the questionnaire, and this is where Nicole Bijlsma is going to be really, I think, improving things for practitioner's pre-screening.
Amie: Is a really great... The questionnaire she's designing is the perfect addition to, you know, a health questionnaire we already offer our clients-patients in order to actually see where there are things that perhaps are going to escalate the building assessment up the priority list.
Now, I've touched on some examples of water events already and so, those, of course, are included in her questionnaire. But I think, to be honest, it needs to become almost as important as everything else, if not as important from the get-go.
Now, calling a building biologist in is an investment. And I don't think people should straight out of the gate ring one up without any sort of indication, either symptom-wise or in the house history-wise that points to that. Only because you could throw away a lot of money and ultimately find nothing. Or not find anything of value, I should say.
But I think more and more this is an area that people are going to be exercising and utilising more because there literally isn't a supplement or herb or even a pharmaceutical medication that can sort somebody out to the point where they can tolerate a water-damaged building. And that's really the bottom line.
Andrew: Yeah. I mean, the thing that woke me up at that conference was to move the prioritisation about the environment, your environment, your local environment.
Andrew: From the last part of the questionnaire to, I mean, seriously the second, you know. It was basically name, age, presenting symptoms, environment...
Amie: Yes. I agree. I agree.
Andrew: ...way before labs. And my mindset is shouldn't we be trying to get rid of these as a possible cause first, not to find them, but to actually get rid of them?
Amie: Yes. Agreed.
Andrew: And then you can go, "It's not that. It's not that. It's not that. It's not that. It's not that. It's leaky gut. It's just leaky gut. Don't worry about it." You know?
Andrew: And you could save yourself a whole lot of heartache rather than going through hundreds of dollars of consultations and, you know, trying things out with therapies and only to find that there's the, you know, the rug that you had a leaked bathroom three years ago and it's been water-damaged. This sort of thing, you know, it's...
Amie: Totally. I mean, when you think about it, when we consider someone's health, we know that their daily habits, their stress management, the sleep they get, the food they eat, how much water they drink are huge factors in their well-being.
Amie: But we spend up to 95% of our time indoors making our built environment the single biggest factor, or influence, on our health. And to be honest, I think if we all revisited the health of our homes and the rest of our built environment, we would all be a lot better off anyway.
Amie: But certainly, getting that sorted out first, you know, we have so many symptoms in relationship to neurotransmitter imbalances and aberrant immune responses and hormonal dysfunction, but when you think about it, all of those things as simply a response to an environmental provocation.
And, you know, we look at, you know, our gut microflora as one of those sources, but all of these external environmental factors also influence our gut flora. And it looks like now that the microbiome of the home is a huge contributor to SIBO and dysbiosis and liver dysfunction and poor bioproduction and altered gastrointestinal pH. And so, I'm really now looking at everything that goes wrong in our body, what is it in the environment that could be causing it to respond that way?
Amie: You know, I do understand that genetic polymorphisms and our genetic makeup set us up to have a unique response to the environment, so I'm not taking away from that. Everybody is different.
But for the most, we are all designed to be healthy, and happy, and well and vital. And if we're not, what is it outside of ourselves that is causing our body to respond in a way that doesn't make us feel good?
Andrew: Amie Skilton, thank you so much for taking us through. I mean, this is...talk about rabbit holes.
Andrew: This is something you really need, I would say, to be trained in.
Andrew: Yeah. I'm sorry to say this, but I'm so glad that it's woken you up to help other people.
Amie: Yes, me too.
Andrew: I feel horrible for what you've been through. Because I've seen the before and after sort of thing and you're picking yourself up now, but you really went through hell there for months, and months, and months. So thanks for taking us through this on FX Medicine.
Amie: Thank you so much, Andrew.
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook.