Allergies & perimenopause.

Is histamine making your perimenopause symptoms worse? Simple ways to eat more fibre and an easy recipe for No-mato Sauce.

Over the past few weeks, I’ve heard numerous people complaining about hay fever symptoms, with some saying that they’ve noticed it’s got worse as they get older. Well, the word is that hay fever season is hitting earlier this year (thanks to a changing climate), with the first ‘pollen bomb’ of the year arriving this month as birch trees offload their spores more than two weeks ahead of schedule. This is bad news for the estimated millions of people in the UK who suffer from pollen allergies every spring and summer. Hay fever is when your body’s immune system mistakenly identifies a harmless substance (pollen) as a threat and it responds by producing antibodies. This triggers the release of histamine, causing the symptoms that we know as hay fever. But why would these symptoms seemingly get worse as we age?

In this edition of Midlife Bites, I take a look at histamine, explore its potential link with perimenopause and how it may be impacting your symptoms. If you think this is something that may be affecting you, I’ve also included a handy list of high histamine and histamine-releasing foods for you to download to help you manage your allergy symptoms.

When it comes to healthy habits to adopt this month, we turn to fibre. Do you know how much fibre you’re eating every day? The likelihood is that it may not be enough. Find out why fibre is so important, particularly during perimenopause, plus 3 tips for including more in your diet. On the theme of histamine, this month’s recipe is a low histamine No-Mato Sauce — it looks like tomato sauce but contains none; it’s also a great way to include more veg in your meals.

For paid subscribers, I explore the Mediterranean Diet, including what it is, the potential health benefits and how to get started on adopting a way of eating that’s actually less of a diet and more of a way of life.

As always, for all readers, if you you’d like to discuss your health goals — whether that’s how to ease your perimenopause symptoms, or how to wake up feeling refreshed and full of energy, or to generally support your overall health for the long term, just book a chat — I’m here for you!

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Could it be histamine?

You’ve no doubt heard of anti-histamines, but how much do you know about histamine? Produced mainly by our mast cells, histamine is a chemical involved in a number of major functions like protecting us from allergens as part of our immune response, sending messages to the brain, and triggering stomach acid release to aid digestion and absorption. There are also certain foods that either contain histamine or can encourage your body to release more of it. Histamine levels are usually kept in check by the body’s natural detoxing system — under normal circumstances, your body releases an enzyme called Diamine Oxidase (DAO) to breakdown any build-up of excess histamine.

However, if you don’t have enough DAO, or if you have more histamine than your body can handle, it may result in an excess. This is known as histamine intolerance (or histamine sensitivity/overload) and this is when problems may occur. A build up of histamine may result in symptoms similar to those seen in allergic reactions or those you may be experiencing in perimenopause; these include: hay fever-type symptoms, itchy skin, headaches, brain fog, low mood, fatigue, hot flushes, skin flushing, bloating, diarrhoea or constipation. If you’ve been noticing these symptoms getting worse during perimenopause, why is that?

While perimenopause alone doesn’t trigger histamine intolerance, there’s some evidence to suggest that hormonal fluctuations that we experience may affect histamine levels and the body's ability to metabolise it. Oestrogen, in particular, has been shown to influence histamine release and DAO activity. Oestrogen stimulates mast cells to release histamine so if oestrogen is high (or progesterone is low in relation to oestrogen, resulting in unopposed oestrogen levels), it may drive an excess of histamine. Oestrogen may also potentially decrease the effectiveness of DAO, making it harder for your body to clear histamine, leading to a build up and related symptoms.

I’ve spoken before about how perimenopause may impact your gut microbiome, but the gut microbiome may also play a role in managing histamine, where a greater abundance of histamine-producing bacteria could lead to the development of histamine intolerance. It’s also thought that there may be a link between inflammatory bowel disease (IBD) and higher histamine levels, potentially in part due to mast cell activation in the gut, the microbiome or a DAO deficiency. Other factors that may impact histamine breakdown or management include: nutrient deficiencies (vitamins B6, D, C and magnesium are all important for making DAO and managing histamine levels); inflammation; poor detoxification and liver health; and infections.

So how can we reduce or manage our histamine load? Try to reduce foods high in histamine, such as: fermented foods, aged cheese, alcohol, smoked fish, avocado; as well as foods that trigger histamine release, including: citrus fruit, chocolate, tomatoes. It’s important to aim to only eat fresh produce and avoid eating leftovers where possible (unless immediately frozen), especially if left outside of the fridge for a period of time as histamine levels may increase. There are also some nutrients and plant compounds that act as natural antihistamines and so inhibit the build-up of histamine, including: quercetin (red onions, apples); vitamin C; bromelain; curcumin. Avoiding foods that potentially block DAO (alcohol, black tea, energy drinks) may also be useful. Including healthy fats and key nutrients such as zinc, iron and magnesium has also been shown to support DAO activity. Histamine levels may also increase during times of stress, so stress-reducing activities like yoga, meditation, or deep breathing exercises may help reduce histamine levels and potentially alleviate symptoms.

For further information on high histamine, histamine-liberating foods and the alternative foods to include in your diet, download the guide* below.

*Most of the high histamine (or histamine-liberating) foods on this list are also ones which are very beneficial for our diverse gut microbiome and to support good health. Completely avoiding these foods long term may lead to nutrient deficiencies, so it’s important to not completely cut out food groups from your diet and instead focus on balance. If you’d like to chat about whether histamine may be linked to your symptoms, why not go book a complimentary call — I’d love to hear from you.

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To eat more fibre

Government guidelines recommend that we eat 30g of fibre every day, as part of a healthy diet. But most people are only getting around 18g per day, 60% of where we should be. Fibre is a carbohydrate naturally found in plants. When we eat it, it’s not digested in the small intestine and reaches the large intestine intact, where it’s completely or partially broken down (fermented) by gut bacteria. It’s important to eat a variety of fibre-containing foods as it helps to keep our digestive system healthy, can prevent constipation and may also help to reduce our risk of some diseases. During perimenopause, fibre plays a crucial role in supporting overall health and wellbeing by aiding the metabolism and elimination of hormones, supporting digestive health, helping with weight management, improving heart health and regulating blood sugar levels. 

So how can you include more fibre in your diet? Firstly, if you’re eating more fibre, remember to increase it gradually and ensure you’re drinking plenty of water. Choose fibre-rich foods from a variety of sources including wholegrains, fruit and vegetables, nuts and seeds, beans and pulses. When you read food labels, check for the grams of fibre per serving or per 100g: a source of fibre will have at least 3g of fibre per 100g and a food that is high in fibre will have more than 6g per 100g. Here are 3 simple tips for getting more fibre into your diet:

1. Leave the skins on your veg. Whether it’s potatoes for dinner (baked, boiled or mashed), carrots with your Sunday roast or a kiwi with your breakfast, get into the habit of leaving the skin on — up to 31% of the total amount of fibre can be found in the skin.

2. Snack on nuts and seeds. If you’re feeling peckish, try opting for foods like nuts — a small handful of almonds (30g) can have around 3.8g of fibre, team that with a skin-on apple and you have the makings of a winning afternoon snack.

3. Incorporate more wholegrains. Make the switch to wholegrain or seeded wholegrain breads or crackers; and choose wholewheat pasta, bulgur wheat or brown rice.

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No-mato Sauce

Serves: 4 (as part of a main meal) | Time: 45 minutes

In clinic, when I suggest reducing high histamine foods, there’s often an initial panic from clients about how to survive without tomato sauce (especially if mealtimes are shared with kids). Well, this is where my easy No-mato Sauce comes in. Firstly, it’s vibrant red, thanks to the beetroots and carrots, which goes a long way to making this a suitable substitute for many a dish — after all, first taste is with the eye. It’s packed with a variety of veg, which helps with upping those plant points, or when feeding kids. Plus, it’s thick and sweet as if it’s been simmering away for hours, but most importantly there’s not a tomato in sight, which makes your histamine load just that little bit lighter.

This recipe is super simple; to limit the mess, I recommend grating the vegetables using a food processor. Serve with pasta, on pizza, or with beans and eggs as shakshuka for brunch.

INGREDIENTS

2 large beetroots (or 3 small)
3 large carrots
1 large courgette
1 teaspoon olive oil
3 cloves garlic, roughly chopped
1 teaspoon dried mixed herbs
500ml vegetable stock
pinch of sea salt & black pepper

METHOD

1. Peel and coarsely grate the beetroots, carrots and courgette.

2. In a large frying pan, heat the olive oil and then add the grated vegetables. Sweat on a low heat for 10 minutes until soft.

3. Add the garlic and herbs to the pan and season. Cook for 5 minutes.

4. Add the stock and bring to the boil. Then reduce the heat, cover with a lid and leave to cook for 25 minutes.

5. Blitz in a blender (or with a hand blender) until smooth.

6. Serve as part of any recipe that uses tomato sauce.

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If you’re interested in working with me on a 1-to-1 basis, why not book a complimentary chat to find out more about how I can support you through perimenopause. And if you’re on Instagram, come and say hi.

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