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    110: Why Your Illness May Actually Be A Histamine Intolerance w/ Dr. Brooke Kalanick

    Histamine intolerance can mimic or mask other diseases and illnesses in your body. And histamine is more than just your response to allergies!  Dr. Brooke Kalanick is here to talk about what histamine intolerance is and how you can combat it in your own body.

     Or listen & subscribe for free on Apple Podcasts | Android

    Dr. Brooke is a naturopathic doctor who focuses on women’s health, hypothyroidism, and autoimmunity, especially when it relates to histamine intolerance. She’s the co-author ofHangry and co-host of Better Everyday. She explains in this episode what role histamine has in our bodies, from allergy responses to everyday chemical reactions.

    Many women have histamine intolerance and don’t have any idea. Dr. Brooke explains what some of the symptoms of histamine intolerance are and how you can spot them. A big one is if you feel like you might have another illness but your blood tests come back normal each time you test for it - histamine could actually be masking those symptoms.

    Dr. Brooke shares how she has had many patients who have histamine intolerance but feel like they can eat certain foods okay one day, but on another day they can’t tolerate it. It’s related to how full your histamine cup already is - if you’ve been eating a lot of intolerance causing foods already, your cup is already full, so that extra few bites of, for example, avocado could push you over the histamine ledge, and you’ll break out in hives or have an allergic reaction.

    So what do you do when you have too much histamine in your body? Dr. Brooke says a lot of it comes down to identifying the histamine foods you’re eating on a regular basis and cutting those out. She also explains that leftover food can also have an increased level of histamine, especially if it’s been sitting longer than a day. This might sound like bad news for batch cookers, but the key is to freeze your leftovers as soon as you can to prevent histamine growth.

    Another key aspect of histamine intolerance is related to your stress levels. Elevated stress levels have a drastic impact on how your body stores and tolerates histamine, so keeping your stress under control will help lower your body’s reaction.

    Have you had blood tests come back totally normal when you think you might have an illness? How do you handle your stress levels? Do you eat a lot of leftovers?

    In This Episode:

    • What role histamine has in our bodies
    • What the symptoms of histamine intolerance are
    • Why you might have a reaction to a certain food one day, but other days it’s fine to eat
    • What you should do if you do have too much histamine in your body
    • Why you shouldn’t eat leftovers when you’re dealing with too much histamine
    • Why you should eat, or foods you should swap, when you’re reducing your histamine level
    • How your stress levels impact your inflammation levels

    Subscribe to Couch Talk w/ Dr. Anna Cabeca on Youtube

    Quotes:

    “Can you figure out if you have any causes for your histamine intolerance. To ease your immediate suffering you can decrease your histamine intake.” (16:12)

    “My advice if you’re going to look at this diet and feel really overwhelmed: find a couple of things that work, try to think of food as just fuel, just make sure you’re nourishing yourself, and don’t overthink it.” (27:57)

    “It’s hard to sometimes acknowledge inflammation because we can’t see it. It is stressful. It is your body having an inflammatory reaction so that is going to put the heat on your adrenals and your stress response and that, of course, is going to make us hangry.” (30:01)

    Links

    Get your 20-page Histamine Guide 

    Find Dr. Brooke Kalanick Online

    Find Dr. Brooke on  Instagram |Facebook 

     

    Transcript

    Dr. Brooke:
    I call it inflammation the great hormone mess-maker because it is going to impact every single one of them from estrogen, to thyroid, to insulin, to cortisol. It gets its hand in everything. And a lot of times it's one of those things where women will say, well, I went and got my hormones checked and my levels are fine, but I have every symptom in the book. So inflammation is one of those things that you might be making enough estrogen or thyroid hormone, but inflammation is sort of blocking how that can work within a cell. It's a really good thing to look at it. If your lab tests and you aren't matchy-matchy.

    Dr. Anna:
    Welcome to Couch Talk. I am Dr. Cabeca, your host, and we are here for some intimate purely shameless conversation. Today as a guest, I have Dr. Brooke, and she is the recent author, Dr. Brooke Kalanick with Sarah Fragoso, of this awesome book, Hangry. And if any of you have ever felt hangry. Man, I know my daughters sometimes get that nickname, hangry. Like, what are your hormones? What do your hormones have to do with it?

    Dr. Anna:
    Brooke is a very like-minded practitioner. She has an amazing history as well. She's a licensed naturopathic doctor and a functional medicine specialist. She attended Seattle Washington's Bastyr University, where she earned her doctorate in naturopathic medicine and a master's in acupuncture and Chinese herbal medicine. So she speaks my language and I absolutely love her.

    Dr. Anna:
    And Brooke and Sarah have been working with women to help reset their hormones and their habits. So I'm excited to get into the discussion today, and we're going to hit on some really unknown areas of hormone balance, such as the histamine effect. And I'm really interested in this because I see women who are in perimenopause and menopause who struggle with this histaminic reaction that is surfacing or flaring at this time of their life, too, in the perimenopause-menopause, but it can be at any times of our lives. And it is often medicated with anti-histamines, with Benadryl, Claritin, Allegra. And patients are told, okay, just stay on this for the rest of your life. But you know me by now. It is better to get to the underlying, underlying reason for the issue.

    Dr. Anna:
    So let's dive in today and let me introduce you to Dr. Brooke. Here we go. Hey Brooke, how are you?

    Dr. Brooke:
    I am good. Thanks for having me on.

    Dr. Anna:
    Well, thanks for being here. Thanks for writing this amazing fun resource for women. I mean this is a great volume. This is an advanced copy that I was able to check out early enough and now it hit publications last month and is available anywhere and it's a great resource. And I love that picture of you and Sarah too.

    Dr. Anna:
    So tell us what drove you. I mean, because writing a book, as I know-

    Dr. Brooke:
    As you know.

    Dr. Anna:
    Is such an endeavor. So what's the passion behind this masterpiece?

    Dr. Brooke:
    Yeah, so Sarah is a five-time bestselling paleo cookbook author. So she had written cookbooks before. And I had coauthored a book before. And it was really kind of more of a weight loss fitness book. And I feel like as time has gone on, that has become much more of an afterthought in my work, and my work has become so much more about helping women just kind of feel at home again in their bodies. So I've kind of come away from what I was doing when I first started working in functional medicine, and Sarah really wanted to do more than just talking about paleo and food. And so we met at a conference and decided together we could help more women than we could alone. And our passions, our expertise, was slightly different, but we really felt a lot of common ground with strength training for women, with how we talk to women about their lifestyle and their stress management, and then kind of all the work that we did on mindset.

    Dr. Brooke:
    So our two expertise kind of overlap in those areas, and we decided that we wanted to help women that we see so often that are kind of just too tired to be happy. They are just worn out, spread too thin, doing too much, taking care of everything and everyone else, but not themselves. And you know, the food is a part of that, and maybe some supplements, but there was so much more we wanted to help talk to women about when it comes to where they're getting so much different information, and how is that just overwhelming them more? How do they know where this one plan might work really well for someone, how's that going to land on their current hormones? So giving them a template that was really customizable, but also getting back to that maybe we're doing all the right things, but we're still unhappy, and so we're still not dealing with the mindset and those stressors that we don't really see. Like being spread too thin, or being in an unhappy relationship, or not having a conversation you need to have. So we really wanted to dive into all of that.

    Dr. Brooke:
    So I think our real passion was about that mindset piece and helping women kind of get connected to their joy and what makes them happy. Because again, if we've got all the other stuff going, but we're still unhappy, is it really worth it that you got your green smoothie in that day?

    Dr. Anna:
    Exactly. And that's where I'm so big on the most powerful hormone in our body, oxytocin. Whatever we can do to enable, empower, and master our oxytocin.

    Dr. Brooke:
    It's my favorite one if I had to pick a favorite.

    Dr. Anna:
    Absolutely, mine too. Without a doubt. Hands down.

    Dr. Anna:
    So let's talk about the unknown disruptor that really sneaks into so many women's lives, and let's talk about histamine intolerance. So how do we know if we have histamine intolerance? What's happening? How bad is, in fact, a hormonal disruptor?

    Dr. Brooke:
    Yeah. So this is something that's becoming increasingly popular. Kind of before I get into it, I am going to go through some stuff, and I don't want every woman in the planet to think they have it, but more of you have it than you realize. And then I think women kind of look at some of the foods that might be aggravating it, and they're like, that's everything I eat. That's everything I was told was good for me. So I'll go into that in a moment.

    Dr. Brooke:
    But it's definitely becoming more common. We have more toxicity to deal with. We have more nutrient deficiencies. We have more just an impact on our system when it impacts certain systems like methylation. And we've put just a bigger burden on ourselves in this day and age. We have more exposure to endocrine disruptors. Anything that can spur your estrogen in the wrong direction can play into this. So it's becoming more common.

    Dr. Brooke:
    Histamine is one of those things we think of when we hear that, like you mentioned, antihistamines, people think of allergy. They think of stuffy nose, itchy, watery eyes, hives, maybe a bee sting. And we've really kind of got that in our mind. But histamine is one of our important chemicals that keeps us alert. That's why certain antihistamines that cross the blood-brain barrier like Benadryl make us feel sleepy and groggy. It's because it blocks histamine. So it's something that helps us think clearly, have some motivation, be alert. It has to do with libido and sexual arousal. It has to do with pain and inflammation, digestion. It's one of the things that triggers your stomach to secrete acid and your gut motility. So it's kind of an interesting chemical when you look at it. It does so much more than allergy. And anything, we know with our rampant rise in autoimmunity, anything that perturbs our immune system has a real body-wide effect on our health and our hormones.

    Dr. Brooke:
    So this was something that I'd seen a little bit in my patients but didn't really give it kind of, of course, a lot of credit until it hit me and I was dealing with it. There's various causes of it. For me personally, I did my 23andMe and pretty much every single way that your body gets rid of histamine, I have at least one, if not two, variations. So this is something that's come up a couple of times in my life, but with my lifestyle, it kind of would go away. And then there's times when it would creep up, and you know how we sometimes don't always put two and two together for ourselves, it took me a while to realize it. But then, of course, I dug into what I needed to be doing differently and learned a lot more about this. This was about seven years ago now.

    Dr. Brooke:
    With women and their hormones, this can be one of our hormone disruptors. So especially if you feel like you've kind of got a lot of other stuff dialed in, right? You're eating in a way that's more healthy, you are exercising, you're getting some sleep, you're getting some recovery, and you have anything on that histamine list of symptoms, or you're just not getting better, it's something to look at.

    Dr. Brooke:
    So as far as symptoms go, you can have the classic allergy kind of things. You know right now in the Northeast we've got a lot of pollen still, so there's a lot of people dealing with allergies. That's, of course, one find, that you're under a high histamine burden. But digestive issues, especially tending towards looser stools or IBS, acidity, headaches, migraines. You mentioned people get on medications for allergies. A lot of people, if they have headaches or migraines, are given medications for those, and we're not really looking at some of those underlying causes. Painful breasts with ovulation or with your period, really painful periods, irregular periods. Any kind of vague itching, some rosacea [inaudible 00:08:57]. It can have a role in almost anything that is inflammatory. So lots of skin and digestive stuff.

    Dr. Brooke:
    So when people see that list, they're like, oh my gosh, that is a lot of symptoms. So if you've got a couple of things on there and you're wondering if this is you, it's worth looking at. There's a lot of other things that can cause those symptoms too, so it doesn't have to be the cause. But it is sort of a sneaky thing. It's often going to come up when you have been under more exposure to stress or toxins or gone through a rougher period in your life.

    Dr. Brooke:
    This first showed up for me in medical school when I was going through a divorce. First-year of med school, just had chronic hives. And of course, they'd get worse going to anatomy lab, being exposed to all that formaldehyde. Even with [inaudible 00:09:40] I was reacting to literally everything that was touching me.

    Dr. Brooke:
    It can be present in a really big time of stress. It can be worse those different times in your cycle. It can certainly flare with hormonal fluctuations of puberty, perimenopause, or pregnancy. And estrogen has kind of a unique relationship where one of the ways that we get rid of histamine, particularly histamine that comes in in our diet, is our DAO, our D-A-O enzyme in our gut. And estrogen actually will down-regulate that. So if you notice that things get worse during your ovulation time when your estrogen is higher, and as you were saying earlier, with perimenopause and menopause. Especially perimenopause, we have all those spikes, right? You get those flares of estrogen is kind of being a little bit erratic during, well, it can last for several years for some women. And that's often a time when this will show itself.

    Dr. Brooke:
    And what's really frustrating for people, because they look at that food list, and again, there's a lot of fermented foods are high in histamine. So we're telling you to eat that for your gut. Bone broth is high in [inaudible 00:10:40], which gets converted to histamine. You know, bone broth and collagen, again, foods we're telling you to eat. Avocado, nuts, certain vegetables, spinach, shellfish, lots of things that are good for you. And you may have also noticed that it got a little bit worse when I went paleo and started doing all this bone broth. It can be something that gets triggered when we have an uptick in that. Mine certainly got a lot worse when I started doing collagen every day, so that was a supplement that was hard for me. But it's good, right? So I think there's a little bit of kind of confusion when they see that list of what the foods are that might be adding to their burden.

    Dr. Brooke:
    But the other thing is people will say, well you know, I have an avocado sometimes and it makes the back of my throat itch, or I get a little more stuffy, but then I had avocado another day and I was fine. So what is it? That obviously isn't this.

    Dr. Brooke:
    And a lot of times we think of food sensitivities as we take a food out, we put it back in, and we notice a reaction. And this is a little bit different. It's not so much that you have an allergy or a sensitivity to an avocado. It's that on that day, based on probably a variety of factors, your histamine bucket was full. So maybe you just ovulated, maybe you're going through perimenopause and you had a big spike, maybe if you look back over last 48 hours, you didn't have as much sleep, or you had some alcohol, or you had several high histamine foods for whatever reason over a 24 hour period, and that time you ate the avocado and got a little bit of a reaction. So that can be a little bit tricky, so we really want to kind of walk through that idea of can you dump your bucket and see how you do after that.

    Dr. Brooke:
    But that, I think, is one of the really frustrating things for women as they're trying to figure this out. Because they're like, these food reactions just don't seem to make a lot of sense and they're not very predictable.

    Dr. Anna:
    Right. And that's the key thing that I hear often is that it's not predictable. I mean, I ate this before and I was fine. I'm eating this now, and I'm not. What's going on? Or I've been trying to do everything so well and now I eat anything and it's creating a reaction.

    Dr. Anna:
    So what are the steps that we can do? We have these reactions, these hives. And it was interesting you mentioned the swings in pregnancy, and I remember helping clients with PUPPS, pruritic urticarial pustules, and papules of pregnancy. So itchy abdomen, chest, belly, back. I mean, it's a horrible condition to have to deal with in pregnancy, as well as to treat. So that's an extreme case but exacerbated by the high levels of hormones.

    Dr. Anna:
    So tell me about what are the things that we should do? We're getting these histaminic reactions, we're getting these rashes, these hives. Let's assume that it's a histamine reaction or a DAO enzyme deficiency. What are our first steps?

    Dr. Brooke:
    So one thing I didn't mention before is all the things that cause this, right? We talked a little bit about estrogen and environmental burden, heavy alcohol consumption. That can be something to impact it. Anything that impacts your ability to methylate can kind of work on this pathway and get things to basically back up. But other things like chronic infections, SIBO, Epstein-Barr virus, there's a lot of infections that can be causing this as well.

    Dr. Brooke:
    The other thing that can cause this is some of us are just dealing with a nutrient deficiency. Maybe we're low in vitamin B6 because we've been on the pill for a while, and that's one of the nutrients that impacts a couple of different enzymes that help you metabolize histamine. Maybe like me, I have a double SNP for DAO, so I'm probably someone who just doesn't make a lot of that enzyme sort of in general. So there can be nutrient deficiencies or some of those genetic variations or being low on certain B vitamins. Copper's really important. Vitamin A.

    Dr. Brooke:
    So nutrient deficiencies are important. Those chronic infections can kick off and trigger histamines. So sometimes you might need to look at what might be an underlying root cause of this because you don't want to just avoid histamine foods forever. That's probably not a very good way to live. It's a pretty restrictive diet.

    Dr. Brooke:
    So looking at what might be an underlying cause. So do you have a high toxicity burden? Are you nutrient deficient? Knowing your genetics, currently, 23andMe is not testing DAO or a couple of those other ones, so you can't really get a lot of that information. Are you an estrogen dominant person? Do you deal with endometriosis or fibroids or really heavy periods? You might be tending towards that.

    Dr. Brooke:
    So those are all the things that just can kind of overtime burden your histamine metabolism systems, and they can get bogged down. You get too much histamine built up and you get this spillback, and you feel agitated, stomach stuff, more painful period, more inflammation, itching, all of those. Stuffy nose, headaches.

    Dr. Brooke:
    Also, not so much dealing with just those enzymes aren't running well for one particular reason, you can be someone who has a mast cell disease. So we have certain cells in our nervous system and in our immune system that store and release histamine, and one of them in our immune system is the mast cell. And the mast cells, some people make too many. They have what we call Mastocytosis, too many of those, so they just have more cells ready to release histamine. Other people have more mast cell activation problems, where they are just too touchy and they just dump histamine too quickly. Those two, in my opinion, are a little bit not as common as what most of us are dealing with, and they're a little bit harder to treat. So if you've kind of gone through some of these other things that I can go into the steps here in a minute, maybe you need to look at working with someone who's really versed in this to see if you need to dig even a little bit deeper. So probably the first thing to think about is can you figure out if you have any causes for this?

    Dr. Brooke:
    If you are immediately suffering, there's definitely things you can do. One of them, of course, is to decrease the intake, the input, of histamine. So again, it's the fermented foods, the aged foods, dairy, grains, leftovers, anything that's not fresh. You know, if you are somebody who likes to batch cook because it makes life so much easier, you know, cook a bunch of chicken on Sunday night and eat it until Thursday or Friday, that histamine level is going to go up and up and up every single day. So that's also our fermented and aged things, packaged things. So a lot of the snacks we love for protein like beef jerky or the EPIC bars or things like that. Or, again, some of our health foods like bone broth and collagen. So looking at the list of like what's on there and trying to decrease those. Again, a lot of them are not only tasty, convenient, there are things we've all told you you should be eating more of. So yeah.

    Dr. Brooke:
    So looking at decreasing the histamine foods is a really good place to start. And then you want to kind of support your chemistry. Are you somebody who can supplement with a DAO enzyme. There's only a few companies that make that, but you can take that enzyme. It's a little bit expensive. So I usually like to try to support you in other ways as well. But that can be something that can allow someone like me to have guacamole once in a while that's got tomatoes and all those avocados and have so much fallout from it. So you can support the DAO enzyme. Make sure you have a healthy gut. Make sure you're taking some extra B6. It can be really, really helpful. Vitamin C is a good mast cell stabilizer. And then all of our natural medicine that we've used for allergies for years. So nettles, Quercetin, things like that, those herbs. There's a lot of histamine support products, and those can be really helpful to just have you feeling a little bit better, help you clear things faster.

    Dr. Brooke:
    And it's one of those super individual things. You know, I do pretty well with kind of not having histamine foods, a whole bunch of them, every day. And if I do something like go on vacation and have more wine, then I'm going to be more sensitive and I have to be mindful of that. Other people, you clear that underlying infection, clear up the chronic virus, clear up your gut, clear up the SIBO, and you really can go back to this with no really no issues. So it depends a little bit on what kind of your unique balance is. And again it's a little bit less like going through that elimination and then finding that one food or two foods that really bother you. This one's more like you've got kind of a threshold for what you can process.

    Dr. Brooke:
    I feel like this is such a good example of such an all-inclusive thing, right? So it's not just avoid the food. Like you just avoid gluten and you're fine forever. You have to kind of watch how full is your bucket getting? How much stress are you having? What's your overall toxic load? How's the last couple of days been for you? It's a really good example of how your stress, your sleep, anything that you did that maybe doesn't work very well for you, they all impact it so much. Instead of where some of us go gluten-free or dairy-free and life just gets better and all they have to do is avoid that. This one really is impacted by so many different things.

    Dr. Anna:
    Yeah, and that's what makes it really hard to understand and comprehend and even wrap our heads around. Because it is a cumulative effect as well, right? It's that concept of a little bit is okay, but a lot is not. You know? Or too much. And just understanding when and what other circumstances are contributing to that.

    Dr. Anna:
    So the first thing you had said is to decrease the intake of histaminic food, and you said packaged food. So you mean all packaged foods are histaminic, boxed and bagged? You know, it eliminates 90% of many people's food choices.

    Dr. Brooke:
    Yeah. And I think in my work I'm always trying to get people to do more protein-based snacks. And I was so excited when we had... Because a lot of bars have whey protein in them, which for one reason or another for me that's a high histamine food. A lot of bars have tons of sugar in them. So when we came out with the EPIC bars or the CHOMPS Meat Sticks, and we had these grass-fed protein choices for on the go that didn't have to be cooked, they're great. But of course, they're not fresh. So that can be a histamine aggravator for some people.

    Dr. Brooke:
    And so yeah, the snacks become, I think, a little bit harder. The batch cooking becomes harder. That's sometimes a really convenient way for people to keep food with them. One thing that works really well if you're trying to do a little work on this diet is you just freeze your food as soon as you're done. You make a big pot of soup or you make a meatloaf or whatever and you just freeze it. That'll slow that degradation down and you won't get as much histamines.

    Dr. Brooke:
    And histamines are going to be higher in some foods because either they block the DAO enzyme or they trigger histamine, like a banana, or they histamine in them, or it may just be that they're not fresh. So it can be a little bit complicated that way. And so grains and packaged foods and stuff like that, of course, become not like nice fresh vegetables, like lettuce.

    Dr. Anna:
    Yeah, yeah, absolutely. And to make this simpler, you have a 20-page histamine guide, right? So we'll give that link in the show notes and have you tell us where to get that.

    Dr. Anna:
    So with other things, you said eliminate, decrease, the intake of histamines, add in some B6, vitamin C. Really check your methylation status, too. Because that's a compounding effect. So check your MTHFR. Do a 23andMe. That can check that much more economically than many of our lab tests can. And so I like doing that. And then just increasing gut health.

    Dr. Anna:
    And one client I have, I have a client, she's in her mid-fifties, and she's been following my keto green plan, and really very, very rigidly for eight days. And then she went off the plan, she ate something, and she immediately had a histaminic reaction. She had hives and itching. And then every day since then she's had these hives and itching. So my first thing is, okay, we need to heal the gut. We need fasting. We need three days of gut rest, right? Like what's the quickest way we can calm down the GI tract, heal any inflammation that's there. And that's always with a fast. A three-day water fasts or using like the keto green or keto-alkaline shake is what I typically do. Or bone broth. And now you're saying, okay, well let's not do the bone broth. Or do we see how she reacts with it? Or just back off of homemade fresh bone broth?

    Dr. Brooke:
    I have heard that you can do bone broth in the Instapot and it's lower in histamine. I'm not sure. I haven't really seen that pan out and I haven't checked it. But you could do regular broth. It's also not quite as fresh, but there's not as much histamine in it because it comes from the collagen. And so I would say doing bone broth is such a good thing. And again, there may be a time when you can go back to it. But you can do the [inaudible 00:23:02] and your green smoothie thing would be the way to go.

    Dr. Anna:
    Yeah. Yeah. I think that that's challenging, to overcome it. And then DAO enzymes, right? I know Xymogen has a DAO enzyme. At least they have carried that in the past. And it's very hard to get. There's only a few manufacturers of it.

    Dr. Brooke:
    Yeah. Ben Lynch's company, Seeking Health, he has one too. And then there's a company called Umbrellux, which isn't associated with any more professional lines, but they do have one too. But sometimes there's a shortage. I'm not sure if it was a shortage or some sort of FDA thing, but there was a while where you couldn't get it for like six months. So you still might need to know how to manage it on your own.

    Dr. Brooke:
    But yeah, it's just kind of a sneaky thing that can really impact... You know, Breast tenderness is one of the biggest things that women will see just go away. Painful periods and breast tenderness. And acne. That can be another thing that women really feel is hormonal and they're kind of doing all the things and it's not going away. This can be a really important thing to look out for that.

    Dr. Anna:
    That's a great point because anything that's causing inflammation like on the inside is causing it on the outside as well. Hair loss is another big one. DAO enzyme, B6, vitamin C. Give us a day in the life of someone eating typically keto green, let's try to keep it keto green, Brooke, or recommend it in that way, a relatively low carbohydrate that is low in histamines. Can you give us a day in the life?

    Dr. Brooke:
    Yeah. So I would start with some sort of, like, I tend to just gravitate towards the kale or another green. Because spinach is just one of the higher ones, and I just saved spinach for if I'm going into a restaurant and maybe don't have a choice. So for me, I kind of manage it that way.

    Dr. Brooke:
    There's some stuff that's kind of an easy swap, right? Like I can throw kale in my eggs versus spinach. Not a big deal. And it kind of saves me maybe some more allowances with something else that I care a little bit more about. So eggs with some greens. There's lots of vegetables you can eat. Bell peppers, greens, cucumbers, asparagus. Spinach tends to be a higher one. Again, that may not be your biggest issue. Tomatoes are higher as well.

    Dr. Brooke:
    And so doing something like that, although it's easy for most women. Although I tend to not do very well if I do eggs in the morning. I do much better with another kind of protein. So chicken or fish or grass-fed beef or something. I just feel better. I can go a lot longer without eating throughout the day if I do that. So some sort of veggies and a fresh protein.

    Dr. Brooke:
    Now personally I have found for me, I can do leftovers for like two days. That doesn't seem to bother me. I do have patients who can't do leftovers at all. It's funny that I have so many genetic issues that predispose me to this because I've always hated leftovers ever since I was a kid. I don't know if that [inaudible 00:25:39]. It just always has kind of grossed me out. So I've always been someone-

    Dr. Anna:
    It's so telltale. It's so telltale, right? What we didn't like as a child. Mm-hmm (affirmative).

    Dr. Brooke:
    Yeah. So I tend to just kind of do stuff over a day or two anyway. But some people do, of course, need to be a little bit more careful. [inaudible 00:25:53] I would do a salad. And a salad with protein tends to be my other meals. At this point. I've got this pretty well managed as long as I watch my stress and my sleep, and I'm sort of mindful of how many things I have in a couple of days. And take my vitamins, take B6, and don't have too much wine. Wine really definitely will trigger this for me if I have wine a couple of nights a week.

    Dr. Brooke:
    So for me, I've kind of got those things managed and I make sure my B6 is good. I have MTHFR as well and make sure that the pathway is running well, and I monitor it. And so with all of those things, I can sort of stick to having a little bit of some of the things that make life a little easier if you're eating keto green or paleo green, which is having fresh lemon juice on my salads or vinegar. Because of course, those things are off on the histamine diet. So I've been able to put those things back in my life with no real issue. And then save some of those other protein choices like shrimp, which I love, to not have them all at the time.

    Dr. Brooke:
    So I really can stick with kind of meat and veggies fresher. I do a lot of breakfast soup. I just don't use bone broth, I use regular broth. That's one of the things we talk about in our book as a nice... Not so much now, because I'm sure it's hot there too. It's so hot here in New York City so I don't really want soup in the morning. But that's a really good thing for me to do throughout the other months of the year. And we put that in the book as an option for people who really don't want that heavier protein breakfast because maybe their cortisol is a little bit off right now, or for whatever reason they don't have a good protein appetite in the morning. You can do something like your smoothie or you could do a breakfast soup where you are kind of just throwing some protein in there. It just feels a little bit less heavy for a lot of people.

    Dr. Brooke:
    So I really stick with the basics of protein and vegetables. And when I was doing this more strictly, and I wasn't able to put a lot of lemon juice or vinegar or things to just like make a salad a little bit more interesting, I did a lot of chicken, like rotisserie chicken, and kind of used that over the course of 24 hours, and lettuce with olive oil and some sea salt and maybe a little bit of fresh herbs. And I kept it really simple. So my advice, if you're going to look at this diet and feel really overwhelmed, find a couple of things that work. Try to think of food is just fuel. Just make sure you're nourishing yourself. And try not to overthink it. Our guide does have, we pulled all the recipes from Hangry that Sarah made that are low histamine, so they're in that guide. So there's a lot of things you could do there. Like a really delicious carrot ginger soup in there that can be good.

    Dr. Brooke:
    So I try to keep it really simple. But it's interesting because save for the few foods that we're going to tell you to do, like bone broth and fermented veggies and stuff, a lot of it already is stuff you're probably already eating. You just kind of have to pare down some of those things. And then hopefully after a few weeks, you feel a little bit better and you can either figure out your underlying cause or go ahead and put some of those things back in and see what happens.

    Dr. Anna:
    So do people with histamine issues, histaminic reactions, are they more likely to get hangry? Hungry and hangry?

    Dr. Brooke:
    Well, here's the thing. Having a histamine reaction, having inflammation, is stressful, right? That is, of course, going put the heat on your stress response. There's two things there. I think one is bad. That anytime we are dealing with your body thinking it's being attacked, right? That's what you're histamine reaction is, it's your immune system is going after something that either is not really a threat or isn't even there. So there's that going on, and that is stressful. So anything that puts the heat on your stress mechanism, whether that's you're not eating frequently enough for you, you're over-training, you're under training, you're not sleeping, your stress load in your life is too big. You know, we forget how stressful having our biochemistry off is because we think our body can just kind of do whatever, right? Like we'll just push ourselves until we can't go anymore.

    Dr. Brooke:
    So anything that's off in your chemistry, whether it's from anemia to inflammation, and this is part of inflammation, is going be stressful. And a lot of women look at their lives, maybe they see their adrenal profile and it looks really like they're not doing well, and they're like, I am not stressed. I sleep. I'm not stressed. I feel really good. And then we look at how their inner workings of their chemistry are. Maybe their blood sugar or something like this is really one of those unseen stressors, right? It's hard to sometimes acknowledge inflammation because we can't see it. So it is stressful. It is your body having an inflammatory reaction. So that is going to put the heat on your adrenals and your stress response, and that, of course, it's going to make us hangry.

    Dr. Brooke:
    The other thing is just inflammation in general. If there is one thing you can do for your hormones, I call it inflammation the great hormone mess-maker, because it is going to impact every single one of them from estrogen, to thyroid, to insulin, to cortisol. It gets its hand in everything. And a lot of the times it's one of those things where women will say, well, I went and got my hormones checked and my levels are fine, but I have every symptom in the book.

    Dr. Brooke:
    So inflammation is one of those things that you might be making enough estrogen or thyroid hormone, but inflammation is sort of blocking how that can work within a cell. It's a really good thing to look at it if your lab tests and you aren't matchy matchy. If it looks like you have it, you have all the symptoms, inflammation has probably got its hand in there and this is just one of those growing causes of inflammation.

    Dr. Brooke:
    I had a patient yesterday and she's like, why do I still have so much inflammation? Because she's doing so many things right. She's not on dairy or gluten. She's not feeling stressed. She's getting enough sleep. And she's got raging allergies right now. And I'm like, it's this. It really is this.

    Dr. Anna:
    It's this.

    Dr. Brooke:
    It's the histamine thing.

    Dr. Anna:
    Yeah, it would be so nice if there was like a quick fix for this. But this is one of those things that are really hard. Those DAO enzymes are really such a benefit, especially when you're going out of your controlled environment, too, that you can take those prophylactically. So that is certainly one thing.

    Dr. Anna:
    So Brooke, tell our audience where they can learn more about you and even work with you directly, as well as to get your book, Hangry.

    Dr. Brooke:
    Yeah, so I'm at betterbydrbrooke.com, and I'm better by Dr. Brooke on Instagram and Facebook. I'm not really on Twitter. So you can learn more about me on my website. You can get the book anywhere that books are sold. If you want to learn more about the book or more about me and Sarah, we have another website which is sarahanddrbrooke.com. And we have a podcast, the Sarah & Dr. Brooke Show, which Dr. Cabeca has been on. We should have you back to talk about your keto green book. That's where you can find me.

    Dr. Anna:
    Excellent. All right. Well, I want to thank you so much, Brooke, for all the work you're doing, and then, again, this excellent resource, and also really talking about this very little known issue that is affecting so many people. And it's that conundrum, right? Like what do I do about it?

    Dr. Anna:
    All right, you're offering our 20-page histamine guide, and we'll put that link below, but where can they go to get that?

    Dr. Brooke:
    Right now, if they go to sarahanddrbrooke.com and click on the Hangry book tab, they can get that.

    Dr. Anna:
    Perfect. Okay, sarahanddrbrooke.com, Hangry book tab, and you can get that 20 page histamine guide, as well as where to order your book, Hangry.

    Dr. Anna:
    So I want to thank you so much. And of all the things you've learned and in practice right now, what is the one thing that you see women specifically do that really changes the trajectory of their life? What is it that you and you guide women to do that really is like that needle mover?

    Dr. Brooke:
    You know, I wish that I could say it was something magic that I was really good at clinically. Like I found their histamine intolerance. I think that the thing that helps women more than anything is figuring out how to manage their stress. Stress management is so individual. In our book, we have what we call the five pillars, and there are these five like big-picture ideas to live your life from. Be who you are, be your own best friend, full engagement living, opting out of overwhelmed, figuring out what works for you and committing to that. And those are kind of things that take time to practice, right? And start to live your life from that place and make different decisions about who you're going to be in the world.

    Dr. Brooke:
    And then we also have what we call the 12 tangible tools, which are like those in the moment stress management. I'm freaking out right now and it doesn't matter that I already meditated and I went for my walk, I'm totally losing my mind right now. And you need those stress management tools kind of in the moment as well. And I think all of that is really individual. Out of our 12 tools, there's some that Sarah loves. She loves to be in nature, she loves connecting to the big universe. And those are not the tools that work for me. So I say when women are like, well I tried this, I tried that and it doesn't help me, keep trying. And have a couple of tools in your arsenal that, A, in the moment you can use and you know that they work and they make you feel grounded and like you have some power in taking your next step.

    Dr. Brooke:
    And then working on things like those bigger picture ideas like the overwhelm and the being who you are. You know, I find, and you probably do too with the population you work with, so many women, by the time they get to me, they have put off taking care of themselves for so long their little thing of insomnia or their a little bit of PMS is now a full-blown thyroid problem or full-blown adrenal issues. Because they were like, I will get to this later, and it becomes a crisis later, whereas maybe if we got to it earlier and we took the time to take care of ourselves.

    Dr. Brooke:
    I always say your hormones are talking to you. That PMS is your hormones are like, hate your lifestyle right now. Hate the fact that you're drinking wine every night. I hate the fact that you're eating dairy because it's making me break out. It's all those little things that we sort of ignore ourselves and our symptoms and what they're trying to tell us because they're not super life-threatening and it's also so common. You know, you've talked to any other woman and they're like, of course, I have PMS. Of course, I'm bloated. Of course, I want a cookie every day at three o'clock. And it's so common, we just take it for normal.

    Dr. Brooke:
    And we're overwhelmed and just not feeling like we're able to bravely and boldly say what we mean in a kind, loving way. But be able to say no. Be able to say thank you without someone gives us a compliment. I remember I got a compliment about you, you look so great after your baby. And I was like, oh, I should look so much better and my baby's not sleeping. And we just should and excuse all over it. So just kind of like being brave enough to be who we are. Give compliments, take compliments, speak our truth, be able to say no, be able to understand why this big to-do list that we think is so important, where do the value of those things come from?

    Dr. Brooke:
    Like is a clean house worth your hormone health? Maybe it is. Maybe that was something that was really important to your mom or your mother-in-law, and it's not important to you. Being willing to kind of sort all that stuff out so that there is some room and some mental space for us to do the things we need to do, like go to the gym, and make the food that works for us, and get into bed. I think all of that, I think it's become easy for me to look at labs and know what this person needs to do. It has always remained hard to help that person do that. So I think all of these tools are what I've learned is probably the most important thing that I can do.

    Dr. Anna:
    I love that. I love talking with you, Brooke, and I thank you so much for being here as a guest on Couch Talk, and to bring up this important issue about histamine intolerance and how we can address it. And I appreciate you offering our audience the 20-page histamine guide. I think that, just because it is an overwhelming topic, just to have some food lists, some guidance, be able to take off some of the higher histamine reactive foods so that we can gain control over this while we take the time to really heal our body from it to the best of our ability. But again, knowing what's in our environment, knowing what we can do and knowing what we can't do, is a key road to healing. And so no matter what, for us not to give up. So I want to thank you so much for being here.

    Dr. Brooke:
    Yes, thanks for having me.

    Dr. Anna:
    Well, thank you Couch Talk audience. I am, again, just blessed to have you as part of my community. And I want to thank you so much for sharing these podcasts and just moving the information forward, as well as your great reviews. And your reviews on iTunes, Podcast Attic, and everywhere that our podcast is, has really helped me and helped to get the word out and making this podcast one of the top menopause podcasts in the nation. So I'm excited about that too. And so thank you very much for doing this and sharing, and I will see you next week. 

    Dr. Anna Cabeca

    Dr. Anna Cabeca

    Dr. Anna is a Triple Board Certified OB/GYN, Anti-Aging Medicine expert, and author of the best selling book, The Hormone Fix.

    Dr. Anna helps women heal the 9 most dreadful symptoms of menopause with natural, safe solutions. Follow her for content on hormonal imbalances, vaginal dryness, menopause (and more) that are medically backed, and created to empower women — not just treat them.