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Could Your Histamine Intolerance Really Be Mast Cell Activation Disorder?

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Reviewed by Laura Beth Schoenfeld, RD, MPH

Do you have trouble with histamine? Have you struggled to get a diagnosis? In Mast Cell Activation Disorder (MCAD), part of the innate immune system becomes hyperactive, releasing histamine and other chemicals that affect every organ system in the body. Read on to learn more about MCAD, and how you can address the root cause.

Histamine intolerance
Do you have trouble with histamine? Mast cell activation syndrome can contribute to the release of histamine. istock.com/Ugreen

Histamine intolerance has become a popular term in the natural health community.  Characterized by symptoms that appear to worsen with the intake of foods that are high in histamine or that stimulate the release of histamine, histamine intolerance is not really a diagnosis as much as it is a description of symptoms.

Most clinicians, including myself, now believe that Mast Cell Activation Disorder is a more accurate description of what patients with so-called “histamine intolerance” are suffering from. There are a number of factors that can contribute to, or cause, histamine intolerance, including excess histamine production, diamine oxidase (DAO) enzyme deficiency, HMNT mutation, and poor methylation in the liver; however, my experience has been that MCAD is responsible for a large number of cases of histamine intolerance. This article will serve as an introduction to MCAD – what it is, what causes it, and how to treat it.

Mast Cells: Sentinels of the Immune System

Mast cells are white blood cells found in all human tissues, especially at places where the body interfaces with the environment, like the gut and skin. Though best known for their role in allergies, mast cells are also involved in the formation of new blood cells, wound healing, the development of immune tolerance, defense against pathogens, and the maintenance of blood-brain barrier function. (1, 2)

Mast cells are the sentinels of the innate immune system, on the lookout for environmental changes or insults to the body. They respond by releasing mediator molecules that influence the behavior of other cells and tissues in an effort to maintain normalcy, or “homeostasis.”

There are over 200 of these mediators stored within the granules of mast cells, including tryptase, prostaglandins, leukotrienes, and histamine. (3)

Histamine often gets a particularly bad rap, but it has many important physiological functions in the body: acting as a neurotransmitter, regulating stomach acid secretion, and playing a role in the local and systemic immune response. (4) The key takeaway here is that we need mast cells and their mediators for normal body function. The issue arises when these cells become overactive, as they do in individuals with MCAD.

Mast Cell Activation Disorder: The Hidden Diagnosis

Mast cell activation disorder is characterized by the accumulation of mast cells that are genetically altered (mastocytosis) and/or the abnormal release of mast cell mediators (Mast Cell Activation Syndrome). Because mast cells are found in all human tissues, and mast cell mediator receptors are found on almost every cell in the body, MCAD has the potential to affect every organ system. (5)

MCAD presents clinically as a chronic, multisystem pathology of a generally allergic and inflammatory theme, and has been associated with obesity, diabetes, skin conditions, irritable bowel syndrome (IBS), depression, and more. (6) MCAD does have a genetic component, and tends to cluster in families (7), though related individuals may present with very different symptoms. (8)

Trouble with histamines? Get to the root of the problem.

MCAD is estimated to be more prevalent (9) than other diseases of mast cell dysfunction, but also more difficult to recognize. This is at least in part due to the fact that it often does not cause abnormalities in routine lab testing. MCAD was not named as a condition until 2007 (10) and diagnostic criteria weren’t proposed until 2010. (11)

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Finding the Root Cause of MCAD

In the functional medicine model, we always seek to address the root cause of disease, as opposed to just treating symptoms. We still have a lot to learn about MCAD, but I believe it is likely the result of deeper pathologies, including:

Heavy metal toxicity: Heavy metals like aluminum and mercury have been shown to destabilize mast cells. This makes sense, as the very purpose of using these as vaccine adjuvants is to elicit a heightened inflammatory immune response. Lead, cadmium, and bismuth have also been found to activate mast cells and cause mast cell mediator release. (12)

Infections or gut dysbiosis: The gut is home to 70% of the immune system (13), including a large number of mast cells. Parasitic infections, bacterial/viral infections, or bacterial/fungal overgrowth activate mast cells. (14) Helminth parasites and Candida have been shown to be potent stimulators of mast cell activation. (15, 16) Mast cells regularly interact with microbes, and gut dysbiosis itself may lead to MCAD. (17)

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CIRS: Chronic Inflammatory Response Syndrome could also play a role. Those who are particularly susceptible to mold and have a reduced ability to clear mycotoxins from the body, which leads to a constant activation of mast cells.

Nutritional Deficiencies: Some nutrient deficiencies can trigger MCAD. Vitamin D is required to maintain the stability of mast cells, and a deficiency has been shown to activate them. (18) Zinc is involved in regulating mast-cell function, and there may be a link between magnesium deficiency and inflammation. (19, 20)

Treatment for MCAD

Conventional treatments for MCAD are pharmacological agents that block the action of mast cell mediators. While these may provide much-needed relief to patients, they are not a long-term solution and can have unwanted side effects. Safer short-term action steps that you can take to provide some relief include:

  • Adopting a low-histamine diet: For some people with MCAD, a low-histamine diet provides significant relief. Supplemental diamine oxidase can also help by increasing histamine breakdown.  But, it’s important to keep in mind that this is only reducing exogenous (outside) histamine, and not altering the amount produced by your mast cells endogenously (within the body). Histamine is also only one of many mediators produced during mast cell degranulation.
  • Focus on nutrients and foods known to stabilize mast cells: Many nutrients, including selenium (21) and vitamin C (22), have been shown to stabilize mast cells. A number of herbs and spices, like holy basil (23), peppermint (24), ginger (25), thyme (26), and turmeric (27) also have this effect. I have also seen good results with supplemental forms of quercetin (28), bromelain, nigella sativa (29), nettle (30), and butterbur. (31)
  • Reducing stress: Corticotropin hormone, released in response to physical or psychological stress, destabilizes mast cells and causes them to release their mediators. (32)
  • Entraining circadian rhythms: Mast cell activity closely mirrors circadian rhythms (33), so getting enough sleep and avoiding blue light at night is crucial.

Ultimately though, we need to address the root cause:

  • Remove heavy metals from your system: Chelating agents can help to remove heavy metals from your system. This is best done under the guidance of a healthcare practitioner. Removal of old mercury fillings by a trained professional can also reduce the burden of heavy metals in the body.
  • Treat infections: A comprehensive stool test can help identify parasites and other infections that could be contributing to mast cell activation.
  • Heal your gut: Remove inflammatory foods and focus on nutrient density. Include plenty of probiotic, prebiotic, and healing foods in your diet.
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345 Comments

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  1. I’m glad to see you blogging on mast cell disorders. Joshua Milner from NIH recently published a study on familial hypertryptasemia, showing a duplication in a gene that codes for tryptase. The condition appears to be autosomal dominant, and overlaps with Ehlers-Danlos hypermobility type and dysautonomia.

    One quibble with your article. Parasites get a bad rap. I think it’s important to point out that evolutionarily speaking, our species was nearly ubiquitously colonized with helminths, which strongly modulate the immune system, downregulating inflammatory cytokines like IL1 and TNF alpha, and upregulating others like IL10. Some parasites are nasty, but some are more accurately classified as mutualistic, and their lack within the modern world human ecosystem is a potent driver of systemic inflammation.

    Great read. Keep up this important work!

  2. Could this disorder be revealed through a routine blood test that identifies levels of various immunological markers? It seems that identifying food sensitivities and piecing it together to figure out exactly what’s going on continues to become increasingly difficult. I’ve been in the health industry for many years now and with people becoming more and more sensitive to foods histamine intolerance appears to be another factor in addition to other health problems as opposed to the sole issue itself.

  3. Definitely MCAS has to do with stress en gut disbiosis.
    Would be interesting to check on products lowering NMDA-stress axis in the body and PDE (fosfodiesteraseblockers). Check out http://www.exendo.be. They have also a specific probiotics infantis for HI en a new special product against candiasis. Interesting to explore!
    For SIBO as for gut disbiosis, first step is to check not only what you eat but also when and how, as stomach (acid) is the gate of further gutflora (and negatively influenced by stress). So don’t eat in between, don’t eat late in the night, supply stomach acid, combine well, and fast from time to time! Hope these suggestions might help.

  4. Chris — can you suggest any treating MDs or specialist type in San Francisco/Berkeley for Mast Cell Activation Disorder. Am needing this for dx/documentation, etc.
    Thank you for all that you do!
    Merritt

    • Hello

      Also looking for someone treating MCAS or a MCAS nutritionist/dietician in the San Francisco Bay Area. Or actually anywhere, if they’ll skye. Thank you

  5. For many people with MCAD medications and vitamins/supplements are triggers. Often we get sicker from the very things that the medical/holistic community give to “help” us. Foods in natural state and avoidance of additives, preservatives dyes etc. are key

  6. I have a bad histamine reaction when drinking certain types of wine while eating certain types of dessert. I say dessert because it only happens if and when I eat dessert, although it doesn’t happen each time I do. It’s an anaphylactic reaction where my chest gets tight, and my face and neck get very blotchy and red. I’ve been to several allegists with no clarity and have tried to journal what I ate and drank but it seems to be a very random reaction. I wish I could pinpoint it as it sometimes is a very difficult reaction, sometimes very mild and sometimes so bad I need to immediately take Benadryl because breathing is so difficult.

    Any advice?

      • I recently tested positive to artificial flavorings on a skin patch test-after a very immediate reaction while making cotton candy with my son where he used jolly rancher hard candies. My skin became immediately blotchy and irritated. I had my dermatologist at Mayo Clinic include the info for skin patch testing and artificial flavorings showed up as a positive reaction. I believe the specific reaction is to Balsam of Peru- which has quite a few “dessert like” ingredients. (Vanilla, cloves, cinnamon, ginger …. there’s a very long list in fact. Just thought I would share.

    • Chocolate and wine are both high histamine. I once almost went to the ER for eating the combo and reacting.

  7. I have had very high levels of inflammation in my body noted by blood tests in 1998. Before this I had had signs of arthritis in my 20’s and 30’s, but didn’t get x rays and scans for some years. My joints are so bad I was offered knee replacements at 49.

    In 1998 I had a hospital infection after a hysterectomy and pelvic repair, it was a urinary tract infection that wasn’t treated for around a month. I ended up as an emergency admission with heavy bleeding 10 days post op. Within 12 months I was showing signs of interstitial cystitis (IC), although I wasn’t diagnosed until 5 years later when I found my own urologist who is an expert in IC. During bladder biopsies high mast cells were found. I also now have hashimotos thyroiditis, low B12, Low iron, Low Folate, low B12. I have a diet rich in all these nutrients but absorb them badly. My hand and wrist consultant always said that my arthritis is a systemic one, but I’ve never had a firm diagnosis in all these years.

    Could the high inflammation, IC and Hashimotos be linked to Mast Cell Activation Disorder?

    • IMHO, investigate the oxalic acid/oxalates in your diet and the possible relationship to your IC and arthritis symptoms. The inflammation generated by the oxalates can/may be contributing to the autoimmunity as well. Address the oxalates and you may see an impact on your symptoms. Remember to stay hydrated.

      • Hi Mark, thank you very much for your reply. I steer clear of oxalates as they cause me more bladder pain, the same with acidic foods. I follow a strict IC diet and can only drink water, which I have done for 13 years now. My sleep is very interrupted with going to the bathroom every hour at night, and I know lack of sleep can increase inflammation. My most recent bloods my ESR and CRP are the highest they have ever been. My GP agreed with me years ago that my body has never switched off with dealing with the hospital infection I had. My health literally feel apart, my mobility was affected and muscle and joint pain increased enormously, I felt like I was walking through thick porridge, and fatigue was and still is very bad. No doctor has ever put all my symptoms together in order for a treatment plan. Now as I know I have high mast activity in my bladder, I wonder if this is a widespread problem for me. One other thing, my adrenal function not surprisingly is now very poor. I did 2 adrenal stress tests a year apart and I’m producing very little cortisol, and DHEA was flagged as low.

        • my thoughts- have you had a genetic test done for MTHFR? I have mutations that basically don’t process foods. Also, you should see a Mast cell specialist and have labs done.

        • What antibiotic were you given for infection od prophylaxis for the op. Many of the symptopms of MCAS overlap with those of Fluoroquinolone Toxicity Syndrome and it is possible that exposure to an antibiotic of this class such as Cipro or Levaquin could trigger mast cell reactions. Fluoroquinolones also cause widespread tendonitis as well and peripheral neuropathy.

        • Helen,

          “I did 2 adrenal stress tests a year apart and I’m producing very little cortisol, and DHEA was flagged as low.”

          This is serious! You likely have Addison’s Disease and need to be treated accordingly. I have AD and can tell you low cortisol, by itself, causes inflammation body-wide. Untreated AD is life-threatening. Low DHEA, produced by Adrenals, is also classic AD. You need to demand to see an endocrinologist and be taken seriously. Your illnesses are not causing your low adrenal functioning. It’s the reverse. Your adrenal insufficiency if contributing/causing many of your concerns. Also, NEVER EVER have surgery again until you are on replacement cortisone. Please do some research. I still don’t know the cause of my Addisons but was sick for years until I finally demanded testing – my symptoms were becoming severe – and got the diagnosis in my 40’s.

  8. Hello, I was dx with Dermatographia (by dermatology and allergists) and have suffered from it on a daily basis for 3 years but I stopped having “scrubs” at spas 8+ years ago because my skin would become severely itchy. I don’t get a rash all the time that I can see (I have lots of freckles). I have since by identified with MTHFR double mutation, a metabolic disorder/insulin resistance. I have been trying to follow the AIP program. Gluten and nightshades have been identified as triggers. I have not heard of Mast cell activation syndrome mentioned on your website.

  9. I actually suffer from mast cell activation disorder. In my area, I’m the most significant and through social media have connected with others with mast cell. Some aren’t as severe as me, some are the same, and a very few are a but worse. My treatment plan involves many h1/h2 blockers along with a chemo pill. We have had to do a variation of the histamine diet but my list of food I can safely enjoy is very little. And due to my MCAD I also suffer from Dysautonomia/POTS (postural orthostatic tachycardia syndrome) along with Gastroparesis and undiagnosed (at the moment) Ehlers Danlos Syndrome.

  10. The subject of the article deals with the immune system. But both the article & the posted comments do not bring up the possible connection with vitamin D deficiency which is a widespread condition in the general population. The action or vitamin D as an hormone is said to be of regulating an underactive or an overactive immune system. Vitamin D deficiency is associated with many disorders & diseases including autoimmune diseases. In fact it may be more than an association as studies start to show it is a cause or an aggravating factor in some cases.
    For instance this recent trial demonstrated that Hashimoto can be treated with moderate vitamin D supplementation (4000 IU):

    Is vitamin D related to pathogenesis and treatment
    of Hashimoto’s thyroiditis?
    http://nuclmed.web.auth.gr/magazine/eng/sept15/07.pdf

    As thyroid problems (from any cause) are affecting multiple illnesses, it seems a good idea when suffering from a difficult to diagnose health issue, to start by having blood tests for vitamin D & thyroid markers.

    P.S.
    An other recent example showing vitamin D, beside its preventative role in reducing the risk of many diseases, being used for treatment :

    Vitamin D Supplements May Improve Cardiac Function in Heart Failure Patients
    http://tinyurl.com/jz8jmlg

    • My vitamin d level is basically nonexistent. I’m in the process of labs for Mast cell disorder diagnosis. I do think the vitamin D deficiency is a part of the problem for me, but I doubt that every Mast cell disorder patient has low vitamin D, if it was that obvious they would’ve figured it out already. Many people find that their Mast cells greatly react to fluctuations in hormones, for example, menstural cycles.

    • I would have to agree on this possibility, there has been so little research towards what causes issues. Vitamin D is linked to so many of our processes; with us using up what our bodies have stored and not replenishing it, in our 30’s is when these symptoms start appearing (when there are no other underlying conditions).

  11. My husband had histimine intolerance following antibiotic treatment for lyme. From my research, I believe he developed SIBO after the antibiotic (had been on a probiotic, but not a histimine friendly one because we didnt’ know better.) He broke out in a rash daily after that. He has a long history of migraines and what I call “crash and burn days” (just feels awful!)… he can’t tolerate any alcohol, whereas he used to only seem to be sensivitive to beer for years. He has been eating clean, taking soil based probiotics (from Chris Kresser online store), avoiding high histimine foods,.. it’s been almost 2 years, but his symptoms are much better. No more rash, few headaches. Sometimes it feels like he’s teetering on the edge, though, and a bad cheat day or extra stress will throw him back over. We haven’t been able to afford a full-blown functional medicine workup, so I’m reading a lot and trying to educate myself.

    • Both Prescript Assist and Primal brand probiotics cause histamine hives to appear on my face. I’ve heard that histamine-free probiotics are available but I’ve not tried them because I’m a bit distrustful at this point.

    • Careful, some probiotics are “histamine producers”. You wanna take the critters that are “histamine reducers”. Google them.

    • Hey there,

      I also had antibiotic treatment for lyme disease and now have high tryptase indicating some kind of mast cell disease. My doctor is an immunologist who has me on a number of histamine and other type of allergy medicines. I am (trying) to follow a low histamine diet, but it is hard. I have the history of headaches and good/bad days and poor reaction to stress that you mention in your husband. This sounds so alike…hmmm.

    • If you’ve got health insurance, I recommend finding a doctor who specializes in MCAD. I’ve got MCAS, and I can reduce my symptoms substantially with “natural” methods, but sometimes drugs are needed. Also, there’s not cure for MCAD, and I haven’t heard of anyone feeling 100% better. Its more of a management thing.

      • I agree with your comments. I, too, have MCAS but I can’t imagine an unmedicated life anymore, despite following a strict low histamine diet. I have recently returned to work full-time, and I don’t think that it would have been possible without my medications.

        My mast cell specialist told me that if you have a mast cell problem you never really feel well again. I concur. It is a highly management intensive illness.

  12. While this article gives some terrific information in typical Chris Kresser fashion, there are still inaccuracies. Not even functional medicine knows the root cause. And if you’re a practitioner, you know that not everyone who has heavy metal toxicity or gut dysbiosis or CIRS have histamine or mast cell issues. The root cause has to be true for 100% of the population for it to be entirely valid, according to the Journal of Theoretics (2003). Chris, please learn German New Medicine! Once you do, you’ll understand the real role of heavy metal toxicity, gut dysbiosis and chronic inflammation and you’ll be able to educate – and help – many, many more people.

  13. After struggling for 2 years with severe localized headaches, leading to a bout of intense diarrhea and vomiting and losing 20 lbs. I was finally diagnosed as having histamine intolerance and I have noticed amazing improvement by avoiding histamine rich foods but there are times when I still suffer from symptoms and I am at a loss to know the cause.
    I am writing from a medical suppervised fasting clinic in Germany, the Buchinger Wilhelmina , where last year I underwent a 21 day fast with amazingly results! When I returned home I was symptom free for a full 3 weeks eating pizza, cheeses and drinking red wine! I really thought that I was cured but then I became sensitive to histamine again but not to the extent that I was before. This time I am here for a 10 day fast and I plan to be much more careful upon my return home. I will let you know my results.

    • Check out the fasting mimicking diet, I heard about it on Yasminas Healing Histamine website. I do my own version. Much easier and cheaper than a full supervised fast ?

  14. Every single diamine oxidase supplement available contains sugar and other junk. Has anyone found a clean source?

  15. MCAD may be the explanation for my itchy skin and the raised brown spots that erupt mainly on my back, but also on belly and upper legs, and a few around the hairline on my face.
    I thought it might be dry air in Ontario winter, because when I escape the cold into warm tropical heaven the itch goes away. The spots remain however. The dermatologist says it is genetic and that removing them useless because they come back. A red spotty rash appears and skin is itchy again.

  16. I was born with urticaria pigmentosa, which I’ve always understood to mean that I have overactive histamines, which usually results in bad reactions to big bites (my whole life). My doctors, including my allergists, have never connected urticaria pigmentosa with any other health problems. I’m wondering if the condition you describe in the article is almost the same as UP? I have suffered from extreme seasonal allergies which began after I turned 30, as well as exhaustion and depression. I started eating whole30 this summer and have more or less kept it up because it makes me feel so much better. I more or less eat paleo. I still have depression, allergies and exhaustion, just on a much smaller scale than before changing my diet. I feel I need to address my problems more deeply and this seems like a good avenue to pursue. Would an MD recognize mast cell disorder? I want to know more! Thank you for this article!

    • If you adopt a Low Histamine diet/lifestyle you’ll be able to discern for yourself whether histamine inducing foods, enviroment, supplements and stress you generate is an issue for you. The stress you generate contributes to yer histamine load. Try it! It’s A LOT of work and discipline but worth the effort.

    • Yes, I can recommend one in particular. Dr. Afrin is who I saw to get diagnosed. Unfortunately, he lives in Minnesota. There are other doctors who are learning a lot about it, you just have to search for one. Urticaria pigmentosa is indeed associated with MCAD. Most people have seemingly “unrelated” symptoms.

  17. Hi,
    I’m allergic to tree pollen (birch and alder). In early Spring, when the trees are pollinating, breathing the air will cause my histamine to overreact.

    However, while I’m sleeping, breathing the same air, my body is calm. Within 5 minutes of waking up, the histamine will overreact. Even though I was breathing the same air 5 minutes earlier.

    So, the question is… What is the difference between sleeping and waking up? Why does histamine not overreact while I’m sleeping yet the histamine does overreact while I’m awake. Remember, I’m breathing the same air.

    While I’m sleeping, something (or lack of something) controls histamine levels.

    When I’m waking up, something (or lack of something) enables histamine to overreact and inflame.

  18. I stumbled on the whole histamine disorder when getting ready to do an elimination diet this summer. I felt lousy, had frequent headaches and recently realized my heart was racing and I was out of breath with the slightest exertion. I am borderline prediabetic as well. The elmination diet was helpful but I did not find any overt allergies. I did however notice that I could tell a difference when I eliminated sugar, caffeine and histamine producing foods. I have never had a proper diagnosis though.

    • Histamine Intolerance is cumulative. Overload yer system’s ability to degrade it and it’ll whack you. The more you overload yer body’s ability to process H the lower the threshhold becomes.

  19. You mentioned the important use of hitamine in the body. I work for a mental health team where the psychiatrists often prescribe phenergan (an antihistamine) to help people sleep. What do you see as the dangers in doing this given the importance of histamine in the body?

    • The only anti-histamine that conserves DAO is “Benadryl”. (Benadryl has been found to actually enhance DAO production) All the others deplete it. You wanna do everything possible to preserve and enhance DAO production.

      Alison Vickery does a good job of explaining HI and offers a thorough discussion of how to deal with it in her blog.

    • Plenty of MD’s are aware of histamine’s ability to reduce anxiety.

      On the other hand…

      ” Histapenia is characterized by low blood histamine levels (<40 mcg/dl). The neurotransmitter dopamine tends to be high. About 1/3 of these patients experience anxiety disorders. They react badly to antihistamines and generally don't have seasonal allergies, but have many food and chemical sensitivities."

      http://carriagehousemedicine.com/services/ease-anxiety-depression/

  20. I was diagnosed with Mast Cell Activation Disorder by the allergist at the local hospital about 4 years ago, but now rarely experience any symptoms since taking two rounds of high-dose garlic about two years ago.

    Prior to diagnosis, I had been eating paleo for a couple years and had also tried Whole9 and not gotten relief from the symptoms of mast cell activation (similar to low-grade anaphylactic shock multiple times a week). A low-histamine diet helped some. It seemed that I was sensitive to any foods high in histamines or sulfites. (“Fresh” fish was especially potent.) I was prescribed daily over-the-counter ranitidine and cetirizine which mostly controlled the symptoms but I was still feeling mildly ill most days and had gained 15 pounds in a year.

    I went to a naturopath, who diagnosed SIBO. She prescribed a round of high-dose garlic followed by re-introduction of probiotics. I began to feel ill again and did a second round. That was almost two years ago, and I have felt ill only about a dozen or so times since. (When I do have symptoms, Benadryl stops them.) I have been trying to re-introduce probiotics with mixed success, and I continue to slowly increase my consumption of fermented foods. I’ve gained about 30 pounds since taking the garlic, but I’m very much happier with not being sick anymore.

    Interestingly, my circadian rhythms were very much out of sync before taking the garlic. Within three days of starting the garlic each of those two times, I suddenly began waking up naturally at 7am. I’m still a bit slow moving in the mornings, but usually wake up naturally between 7 or 8am. Also, I had been anemic for decades despite eating meat and taking iron and B12 supplements, but last year tested as no longer anemic despite no longer taking supplements.

    Just thought I’d throw my experience out there if maybe it could help anyone else.

      • Thanx Elizabeth
        Do u recall wot was the amount of garlic u used high dose of & also which form?
        Thanx

        • In the form of capsules, from Allimed. The label says “stabilized Allicin extract.” I don’t remember anything about the neem, other than I vaguely recall that it was in the form of capsules.

    • Some probiotics actually produce histamine. Other degrade it. You wanna stick with the critters that are working for you rather than against you. Google “histamine degrading probiotics”. Dr. Janice Joneja has done some excellent work in this regard.

      • I have had really good luck with Probiota Bifido from Seeking Health. It was the first probiotic I’ve taken where I actually noticed a difference within a few days.

      • Unfortunately there is no recommendation of specific strains on her site, rather she states that the use of probiotics as a management strategy for histamine intolerance is a hit and miss situation.

      • It was 450mg capsules, but I don’t remember if it was multiple capsules or multiple times a day. It was two years ago.