Is Histamine Behind Your Symptoms? MCAS, Hormones & Inflammation Explained with Dr Krista Moyer, ND
Off The Charts Podcast
Hosted by Dr. Bobby Parmar
[Dr Krista Moyer, ND] (0:00 - 0:05)
It's an annoying diet. Every patient tells me that. I agree, I went on it.
[Dr Bobby Parmar, ND] (0:05 - 0:18)
I feel guilty every time I tell somebody you're gonna go on this diet that I really wanted to try just for the next four weeks. You will be cursing me at the grocery store as you're cooking, as you're chopping, but like just please, it might be life-changing for you.
[Dr Krista Moyer, ND] (0:18 - 0:35)
I always just say it's a spiderweb where the histamine receptors are and they're everywhere in the body and that's why it's such a domino effect, which is exciting for me. Like I nerd out on it to be like all of these symptoms could be coming from histamine. So if we temporarily lower histamine activity, many of these symptoms may improve.
Like, let's see what happens. That's really exciting.
[Dr Bobby Parmar, ND] (0:36 - 1:37)
Hello, everybody. Welcome to Off the Charts. I have a very near and dear person in my life with us today.
I'm so grateful that she flew in for this podcast episode and she was all over the place. Weren't you? I'm terrible.
I'm terrible, as we say. Anyway, this is Dr. Krista Moyer to my right. Dr. Krista Moyer has been practicing for a Jurassic length of time and most of that time she spent dedicated to histamine and histamine related conditions and that is everything right now and has been for like a good year or two. I think histamine just came out of nowhere. I mean, not to my own faith, cue the picture. There's my histamine face.
Oh, yes. We lovingly call her Dr. Krista-meme. She just knows so much about this topic and it's such a hot topic on TikTok and everything right now.
So I really want her on for us to discuss this across the board. So welcome.
[Dr Krista Moyer, ND] (1:37 - 1:38)
Thanks.
[Dr Bobby Parmar, ND] (1:38 - 1:47)
Okay, so tell me about why histamine matters to you. What do you see in the world? And why do you think it's important?
[Dr Krista Moyer, ND] (1:48 - 1:49)
You want my origin story?
[Dr Bobby Parmar, ND] (1:49 - 1:50)
Sure.
[Dr Krista Moyer, ND] (1:51 - 2:12)
Well over 10 years ago, so maybe like 2014-2015 ish. Another friend, colleague of mine was, I think I told you this story. She was so very kind and always hard to figure out.
My health issues, as you know, are very like numerous and ongoing. She's like, I wonder if you have a histamine issue, like send me your genetics. So she looked at my genetics and I had an issue with the HNMT enzyme and the DAO enzyme.
[Dr Bobby Parmar, ND] (2:12 - 2:15)
So, I mean, we'll make those clear in a minute what they are.
[Dr Krista Moyer, ND] (2:15 - 2:25)
Yeah, so these are the genetic enzymes that break down histamine. She was like, fucking histamine. And I was like, I don't, I don't get it.
I don't have allergies.
[Dr Bobby Parmar, ND] (2:25 - 2:26)
We do not know.
[Dr Krista Moyer, ND] (2:26 - 2:28)
That's not a thing for me. I don't get seasonal allergies.
[Dr Bobby Parmar, ND] (2:29 - 2:29)
Hives?
[Dr Krista Moyer, ND] (2:29 - 2:48)
Yeah, and so the main thing was just like fatigue. I had digestive issues ongoing. And so she was like, try the anti-histamine diet and take anti-histamines and like see what happens.
And I hated my life when I first went on it because it was “no coffee”. I survived off coffee. So that sucked.
And then I felt so much better, probably about like week three.
[Producer] (2:49 - 2:49)
What felt better?
[Dr Krista Moyer, ND] (2:50 - 3:14)
The fatigue, the digestion. There was like this heaviness that just seemed to be lifted. And a lot of my fatigue comes like mental fatigue.
It's like a physical fatigue, but then it would be like such a heaviness and always like fighting to get through the day. So I just felt that lift. And then I was like, what is this?
So I started researching histamine, histamine intolerance. I did not know what MCAS was a day ago.
[Dr Bobby Parmar, ND] (3:14 - 3:18)
Can't imagine that long ago anybody really knew much?
[Dr Krista Moyer, ND] (3:18 - 3:19)
Very, very little.
[Dr Bobby Parmar, ND] (3:19 - 3:21)
Oh, OK. So you were researching into the abyss?
[Dr Krista Moyer, ND] (3:22 - 3:55)
Yeah, very much so. Like, what is histamine? Where is histamine found?
What does histamine do? And that's when I figured out like histamines in the digestive system, the brain, the skin, obviously. And that's what kind of led me to be like, oh, oh, histamine is a thing.
And then when I started seeing patients, I had this mental checklist of all the different things that histamine could do. And that's when I was like, oh, I wonder if so many people had issues with histamine. Why don't we try?
Because there was no diagnostic criteria like MCAS criteria like that.
[Dr Bobby Parmar, ND] (3:55 - 4:11)
MCAS is a condition called mast cell activation syndrome. We'll get into that, too. It's a histamine related condition that's also blown up recently.
Like everybody also on Instagram and TikTok is talking about this, asking people to explore whether or not it's a thing that they might consider for themselves. But go ahead.
[Dr Krista Moyer, ND] (4:11 - 4:37)
I just had this mental checklist and people would always say, like, my labs are fine. My doctor says I'm fine. No one understands why I have this symptom, this symptom.
And I would say, well, there's this thing called histamine. It can really annoy certain people. Sometimes people don't break down like enough of it.
Why don't we just try and see how you feel? And it even was shocking to me, like so many people would come back after four to six weeks and be like, oh, my God.
[Dr Bobby Parmar, ND] (4:37 - 4:41)
I mean, you were learning it on your own with your own patients to be like, what does this touch?
[Dr Krista Moyer, ND] (4:42 - 5:17)
Yes, very much so. And then people were showing me like my fibromyalgia is better. I don't, I don't get it.
Like my chronic fatigue is gone. My insomnia is gone. I don't have anxiety anymore.
My menstrual cramps are better. And I was like, oh, my gosh, Eureka. Yeah, no, it was very cool and fascinating.
But I was very much like always just trying to collect these little morsels of like what can help histamine? What is caused by histamine? OK, well, what symptoms were helped with histamine?
But OK, well, how can we get out of this? Because a low histamine diet is not like a life sentence.
[Dr Bobby Parmar, ND] (5:17 - 5:31)
You're looking for patterns and you're looking for ways to identify who fits what pattern and then how you are going to navigate. Is this going to be something that they're going to be on forever? Are they having to go super strict on this?
Do you have to find like the shampoo that might be causing something like for everybody is kind of different?
[Dr Krista Moyer, ND] (5:31 - 6:04)
A hundred percent. And I always tell people it's not about just the ingredient in that shampoo. That might be for some people, but generally it's about a histamine load.
And so if we just lower that like a proverbial bucket, then generally people feel so much better. It's just that they're always spilling over with histamine, histamine, histamine, histamine. And so they're just like flooded in histamine.
And then I always say histamine is really irritating to an irritated system. So I always like to do it. If you have a cut in your arm and you get lemon juice, it doesn't hurt.
But if there's a cut, it hurts like a son of a gun. So that's histamine to an irritated digestive system, to an irritated brain, skin, like et cetera, et cetera.
[Dr Bobby Parmar, ND] (6:04 - 6:05)
Irritated by something else?
[Dr Krista Moyer, ND] (6:06 - 6:12)
Irritated by histamine. So histamine normally floating around is fine. Histamine is not a jerk, it's not a devil.
[Dr Bobby Parmar, ND] (6:12 - 6:18)
Are you guys like, I know this stuff already. I'm just acting like I don't know this stuff because I really want her to reveal all her teeth. Go ahead.
[Dr Krista Moyer, ND] (6:19 - 6:24)
I would just like to highlight everyone for the audience that we would talk about cases.
[Dr Bobby Parmar, ND] (6:25 - 7:13)
Four or five years ago, I was like, huh, I think there might be something to this. How come that lady I gave Benadryl to feels so much better with her period pain? That's weird.
Why did the person that I gave Cetirizine to all of a sudden feel like their brain fog lifted? That's weird. I was sitting in the back, um, judging.
There she does. Although. As you do.
OK, so can I ask you a question about the diseases or the other conditions, because obviously you're saying things like rashes and hives and allergies and those kinds of things are what you would typically associate with. What are and this is I'm so curious with your kind of experience, I'll tell you mine, over the years.
What conditions are you more confident will be histamine related, if that's true for you?
[Dr Krista Moyer, ND] (7:13 - 7:21)
It's a good question. And I wouldn't say it's like, oh, this condition, this condition, other than like skin stuff. Like you said, like if someone's really rashy.
[Dr Bobby Parmar, ND] (7:21 - 7:24)
I'm sorry, I'm going to get you right now. I don't know why.
[Dr Krista Moyer, ND] (7:24 - 8:17)
I find when people do have a lot of. My skin's so reactive or I broke out in hives or every time they get a spider bite, like it's like an insane amount of swelling or mosquito bite or, you know, they really have to watch the skin care products they use. Like they just seem to be really easily reactive, high histamine foods.
Like I went out the other night and had a big reaction than that. I'm like, OK, this sounds a lot like histamine. And often that's what's leading patients to like originally like back over a decade ago when patients would come in, I was the one going, gosh, have you ever heard of histamine?
And they're like, I love allergies. And then they wanted to be like, see on that. And so it was me going like, well, there's all these receptors and all these conditions.
And now more so it's people that have found me via their own Reddit pathway, ChatGPT…
[Dr Bobby Parmar, ND] (8:18 - 8:19)
And her brand spanking new website called The Histamine Code. I helped make it.
[Dr Krista Moyer, ND] (8:20 - 8:24)
Rob Larkin, thank you, we love you, genius, so beautiful.
[Dr Bobby Parmar, ND] (8:25 - 8:45)
Thanks, District Media. Anyway, so like originally you were the one pushing it and trying to figure out if that work was the thing that the person needed to do. And they were lukewarm about it because they had a really familiarity with it.
But like, you're the only person who has brought this up. Why haven't I heard this before? I heard that.
I'm not coming.
[Dr Krista Moyer, ND] (8:46 - 9:25)
But it was more so like their doctor saying like, why hasn't my doctor ever said this? I've never heard of this before. I've seen an allergist.
Why didn't they tell me? So a lot of skepticism for sure. And back to your earlier question, like what condition?
It wasn't like that for me. It was more like this checklist of, okay, histamine can cause diarrhea and cramping and not feeling great. Or like these foods, do you eat a lot of these high histamine foods?
And do you have an issue? Or do you like never eat high histamine foods? Even like the menstrual cramp stuff, the insomnia and anxiety, I sort of seen that a lot.
And then as you well know, perimenopause, they just like, like they really increase each other.
[Dr Bobby Parmar, ND] (9:25 - 9:26)
Now why is that?
[Dr Krista Moyer, ND] (9:27 - 10:26)
About to tell you. Thank you for asking. So during perimenopause, estrogen was kind of floating around in our 20s and 30s.
And then in perimenopause, we had these really, really big spikes in estrogen and then really big falls in estrogen. We also have progesterone that is for the most part face planting. So it's not doing great.
Estrogen rises up histamine and histamine rises up estrogen. So they're just like high fiving each other. But progesterone is an antagonist meaning it helps bring down histamine.
So you have this like estrogen going on this roller coaster plus progesterone face planting. But really, I see this a ton in practice where histamine issues where people are like, oh, yeah, I used to be a little reactive in my 20s and 30s. But now it just really amplified or my anxiety is way worse.
I have reasons for that. But my digestion is worse or like my skin stuff is so much worse. So I see that now be like, oh, this is perimenopause.
You're really just turning up the volume on what was already preexisting, but to an extreme degree.
[Dr Bobby Parmar, ND] (10:26 - 10:40)
So you're seeing a lot of perimenopausal women expressing histamine symptoms. They always had something that may or may not have been like a symptom they would have complained to somebody about. But then it just exploded.
[Dr Krista Moyer, ND] (10:40 - 10:40)
Yeah.
[Dr Bobby Parmar, ND] (10:41 - 10:56)
What's the number one way that shows up for you in your patients? What's their main thing that sets you off? Not as a constellation of like these hundred things or like 50 of the hundred things.
What's the one thing that keeps showing up in that group specifically? If there is.
[Dr Krista Moyer, ND] (10:56 - 11:02)
Yeah, I don't know that there's just one thing, but I do see a ton of skin stuff and also you and I tell you what I think and you tell me what you think about it.
[Dr Bobby Parmar, ND] (11:03 - 12:12)
Heavy bleeding, like super heavy bleeding seems to really respond to this and pain like uterine pain, like cramping pain. Those two things. And I think that's an extension.
This is my theory. I think that's an extension of the fact that they probably have endometriosis that nobody figured out. And that it's showing up now as this like very neuroinflammatory histamine response and that you're like, wait, have you had endometriosis this whole time?
And I keep seeing and all the tick doctors are all over that. There's just like my endometriosis symptoms or my significant PMS or my potentially even like really bad PMS like PMDD. I took Pepcid.
I took over the counter antihistamines like H2 blockers, which I'll ask you about in a second. And why did I have no PMS? Why was my pain so much better?
They don't even go on the diet. They just do a blocker. It doesn't usually last.
But I feel like there's something very strongly connected there in perimenopausal women that could have been identified before. It's just, you know, we don't, we're not really great at identifying that.
[Dr Krista Moyer, ND] (12:13 - 12:32)
I mean, I don't see that personally. I don't see a ton of endometriosis, but I do see some. But I do find in perimenopause that women get crazy heavy menstrual flow.
Progesterone matures and stabilizes that lining. Ferritin is dropping like crazy. That I find when you help with progesterone, get an iron infusion.
[Dr Bobby Parmar, ND] (12:33 - 12:35)
Sorry, just something in my eye.
[Dr Krista Moyer, ND] (12:36 - 12:48)
That is really helpful. And then, yes, some of my endometriosis patients, which, like I said, I don't see a ton of that, they're like my pain is actually way more manageable and they're not better. Gone.
But I do find that it's a lot better.
[Dr Bobby Parmar, ND] (12:48 - 12:59)
You're not going to like abracadabra away those weak gins. You're just going to make their nerves, in my opinion, feel way less reactive. Maybe they're like limits in the wound.
[Dr Krista Moyer, ND] (12:59 - 13:00)
Yes, exactly.
[Dr Bobby Parmar, ND] (13:01 - 13:03)
To their own pain.
[Dr Krista Moyer, ND] (13:03 - 13:13)
Yes. It's turning up the volume. It's like histamine is not this jerk.
It's going to be irritating to that irritated system. And so if the nervous system is irritated, histamine is really irritating to the nervous system.
[Dr Bobby Parmar, ND] (13:13 - 13:26)
Tell me about the diet, because a lot of people listening are going to be like, what are you talking about? The diet? Tell me about the diet.
I mean, you have to get into very particular if just an overview of what that kind of looks like and how challenging it is?
[Dr Krista Moyer, ND] (13:27 - 13:36)
It's an annoying diet. Every patient tells me that. I agree.
I went on it without ever recommending it to a patient.
[Dr Bobby Parmar, ND] (13:36 - 13:54)
I feel guilty every time I tell somebody you're going to go on this diet that I really want to try just for the next four weeks. You will be cursing me at the grocery store as you're cooking, as you're chopping. But like, just please, it might be life changing for you.
And honestly, often is more so.
[Dr Krista Moyer, ND] (13:54 - 14:25)
Yes. So the main thing is there are certain fruits and vegetables that are high in histamine. So like tomatoes, eggplant, bananas, spinach, anything fermented, citrus, vinegar, leftovers.
And then that's when I always go through the person's diet to see how often they're eating these. And then I find for the first like two weeks, patients often tell me afterwards. They're like, yeah, I really didn't think it was working and I really didn't want to keep going.
But by week three, it's like, oh, this might actually be doing something.
[Dr Bobby Parmar, ND] (14:26 - 14:27)
I'm actually learning this from you.
[Dr Krista Moyer, ND] (14:27 - 14:27)
Yeah.
[Dr Bobby Parmar, ND] (14:28 - 15:10)
I used to say, do it for two weeks, let's see how you do. And people would say that. They’d be like, 20 percent?
Maybe? I'd be like, not good enough. Maybe this isn't the case.
And then I would load them up with medications. I'd put them on antihistamines. I'd be like, OK, let's round two.
Because I'm also not like a big diet guy. Like I'm not a huge foods as a medicine knower in the sense of like, I'll know that a diet is helpful for a person. But I won't know the specifics about the diet to be like coaching them on.
You had half a cup of lemon yesterday. Oh, what have you done? I don't know.
Heather, you come to play, obviously. And then you said they got a longer.
[Dr Krista Moyer, ND] (15:10 - 15:38)
Well, when patients would come to see me and they were on four different antihistamines and they were still having histamine symptoms. I was like, OK, well, we clearly the antihistamines are just like taking down like the tornado that's histamine around in them. So that's where I was like, we have to clearly do both.
If we're on four different antihistamines and you're still symptomatic, but you go off the antihistamines and you're way worse, then clearly something else is going on.
[Dr Bobby Parmar, ND] (15:38 - 16:04)
Yeah. And how the likelihood of somebody needing longer than a month is low. Because I just want people to know, like if they're going to go, we're going to show them like, oh, go here to see the diet.
And I was like, yes. And if they want to try it for themselves in order for them to even know before they even speak to a clinician or anything, just be like, I wonder how long is the longest? You would actually suggest they should go before they actually say, you know, it's not for me.
Six weeks. Oh, OK.
[Dr Krista Moyer, ND] (16:05 - 16:44)
I find that by two weeks, people are saying like maybe this isn't helping. And often people within like the first three days, they're like, oh, my God, I already feel so much better. But I find that by week four, people are like, I think this is helping.
But I want to know, like, for sure, especially with certain symptoms, especially with women and like cycling that like PMS and like cycle irregularities. Hep B, menses, all that kind of stuff that they may not be able to see the changes to see if that's helpful. So maybe they have more energy, they're sleeping better and things like that.
But then during their luteal phase, they always get headaches or they always have anxiety or insomnia. It's like, OK, well, that's at least breeze through a part of that section as well.
[Dr Bobby Parmar, ND] (16:44 - 17:52)
I think you also touched on the idea that there's these other things that are going on at the same time. A lot of the time, histamine isn't just showing up as this like rash or brain fog or any of those kinds of things. It's like, oh, the thing that they're reacting to is making their body process and spill out a lot of other chemicals.
Histamine is one of them, along with a lot of other chemicals. Some of those are like things that make your blood thinner, some that make you bleed more. So you have heavier periods and then you're iron deficient or you're anemic.
And then the person is like, oh, great, I'm on the diet. I'm on these antihistamines, but also like I'm still feeling tired because you didn't fix that other thing that was also probably part of the case. And then you end up giving them iron infusion and then that iron infusion causes them to then feel that much better, but it does not directly reduce bleeding.
And then it's just this big sort of soup of things all happening at the same time. Do you feel like people are getting more comfortable with wanting to adopt the diet or are they saying that's really hard? Can you just give me drugs or can you give me supplements to replace the thing that you think the diet is going to do?
[Dr Krista Moyer, ND] (17:53 - 18:01)
Well, I would say the diet's not a life sentence. So I don't ever put people on this diet forever, never, ever. Like, are you meaning right from the get go?
[Dr Bobby Parmar, ND] (18:01 - 18:11)
I mean, my patients and a lot of people out there, whenever I tell them to go on a diet, they're just like, you fucker, are you joking? And then I show them the diet and they're just like, that's everything I eat.
[Dr Krista Moyer, ND] (18:11 - 18:12)
Which is promising.
[Dr Bobby Parmar, ND] (18:13 - 18:33)
I tell them that too. I'm just like, oh, then clearly. Yes.
Two and two. But how do you answer the people who say I'm trying, life is stressful. I have so much going on.
How much importance are you having to put on the diet? And if they're just like, “I can't.” But you're really convinced that they have a histamine issue.
What else would you do?
[Dr Krista Moyer, ND] (18:33 - 19:10)
So then I tell them to watch the histamine load per meal. So I'm like, OK, you can't give up your avocado. You can't give up your banana.
OK, let's not have avocado and banana and spinach and citrus all in the same meal. Try just watching the low per meal.
And then, yes, we're loading on antihistamines. And then whatever symptom is really lingering. So they have a ton of stress and insomnia and anxiety.
Like I'm helping support those symptoms. If they have a ton of digestive symptoms. OK, maybe we're also adding in a tool for that.
So I'm a realist. I always tell patients that. It's like I just give the information.
I'm not like you do it my way.
[Dr Bobby Parmar, ND] (19:10 - 19:23)
There are a lot of doctors who are like that, right? So you want to be clear with people, because there are a lot of clinicians who are like, if you don't go on this diet, I can't help you. No, I'm not.
Because there's other ways to get to the root, in your opinion.
[Dr Krista Moyer, ND] (19:23 - 19:31)
But also try. Like if you just love drugs so much, if you just try the drugs and you get better, who cares?
[Dr Bobby Parmar, ND] (19:32 - 19:40)
Listen, I don't have a cartel. I'm not. I mean, I just very much like standard of care and I very much like medications because they work fast and they work effectively.
[Dr Krista Moyer, ND] (19:41 - 19:42)
I like to bridge them together.
[Dr Bobby Parmar, ND] (19:42 - 20:45)
And so let's talk about that. Medications. Yes.
I love using a block of antihistamines together, like H1 blockers. And when I choose an H1 blocker, that means like a certain receptor called an H1 receptor in the body gets blocked by a certain medication. You consider Benadryl and Claritin those.
There are different generations of different side effects. And so you would obviously talk to your clinician about those kinds of things. The second is H2 blockers.
The most popular one is Pepcid, Famotidine. But that receptor is sort of like over here. They're all over the body, but they are more concentrated in different parts of the body as well.
Then there's H3, there's H4. But normally then I'll add in like natural antihistamines. Our beloved Queen Q, Quercetin is very important.
So like put them all together and say, like, here's this little care package. I want you to take this alongside the diet for some time to really get as much histamine influence out of your system as possible. Do you like that approach?
[Dr Krista Moyer, ND] (20:46 - 21:06)
I often start with a lot of the Quercetin right away if they're feeling really overwhelmed or there's any sort of like cost, you know, concern or something, then maybe I don't add in the Quercetin. But I always say Quercetin is a mass health stabilizer and it's an antihistamine and it's anti-inflammatory, especially in the gut. I love Quercetin, the right form of Quercetin.
[Dr Bobby Parmar, ND] (21:07 - 21:22)
At first, do you think that people should on their own just start taking a bunch of antihistamines and for some time and see if it does anything, or do you feel like it's really important for them to talk to somebody who knows about this in order for them to be like guided and coached properly?
[Dr Krista Moyer, ND] (21:23 - 21:25)
I mean, I see a lot of people that have tried it on their own.
[Dr Bobby Parmar, ND] (21:25 - 21:26)
Do you ever, people?
[Dr Krista Moyer, ND] (21:27 - 21:37)
I find that they're struggling. Or it's already helpful. Sometimes they come to see me and then they're on the diet and they're on the antihistamines, but then they can't figure out how to get off.
[Dr Bobby Parmar, ND] (21:37 - 22:08)
The reason I ask that question is because so many people come to me and have taken them and they're just like, that sucked. I was so tired. That sucked.
I was drowsy. That's and it's like you just they're not all the same and they're not all the same for every person. And just because you took this group of things and it didn't work out for you doesn't mean that there isn't a combination that won't work for you.
And I think that's very important, too. Like at home stuff is fine. So you can get an idea if you can ever say anything on your own.
But have somebody help guide you here.
[Dr Krista Moyer, ND] (22:09 - 22:35)
Yeah, I mean, I think we do this for a living. So honestly, we know how to help support people. But I totally get that when people are feeling desperate and they've seen many M.D.s even before, but M.D.'s, especially allergists, immunologists like no one sometimes, a lot of people are dismissive of MCAS. And so sometimes when people are feeling desperate with MCAS. Oh, sorry. Mast cell activation syndrome.
Do you want to talk about that?
[Dr Bobby Parmar, ND] (22:35 - 23:58)
I love MCAS. I mean, I hate it, but I love identifying it. I love treating it.
Mast cell activation syndrome was essentially like we have all these cells in our bodies, they're immune cells that just burst open either really easily when triggered by something or they don't. And people with allergies, like true allergies to things, they just go and then they show us that you're allergic to that thing, usually within a very short period of time. And then that's it.
You can go from having a mild reaction all the way to having an anaphylactic reaction. Mast cell activation syndrome is when a person's mast cells that have all of these chemicals in them are much more easily released and the degree to which those mast cells can be degranulated varies from person to person. It's called burst open and let loose.
All of this soup is different for everybody. And so one person could be like, I don't have that happen when they eat this thing or are exposed to this thing. But another person would be like, I actually do.
So everybody's very different in what their threshold for what crosses it. And these aren't allergies. That's the difference.
They're not allergic to these things. You don't poke those things into them or take their blood and identify that they're allergic to them, but their mast cells are released anyway. And it could be from A to Z, whatever.
It could be from a blueberry to sodium lauryl sulfate in something.
[Dr Krista Moyer, ND] (23:59 - 24:02)
Vibration, the wind, the wind, the fricking wind, the wind.
[Dr Bobby Parmar, ND] (24:03 - 24:04)
Yeah, good luck to people in Chicago.
[Dr Krista Moyer, ND] (24:04 - 24:29)
I remember you know, the vibration plates. It's and I remember years ago, like trying one. And then I walked her there and I was like, I was itchy all over and I was like, I think I've reacted to something.
And I was itchy for hours. And I was like, I think my lymphatic system must have like you know, dumped something or had a reaction. But like, obviously, now in retrospect, it was like fricking has to be.
[Dr Bobby Parmar, ND] (24:29 - 25:14)
Yeah, because it can be a physical trigger and it can be a chemical trigger. It can be a food trigger. It can be any kind of trigger that just makes the cells that are lining everything.
Emotions, emotions, stress, everything. People, whenever you're like, oh, I have chronic hives and I'm itchy all the time. And somebody told you it's a stress response.
That doesn't mean it is a stress response and that you rest on that answer. You have to figure out if this is like a histamine problem, where it's but stress could be doing it. Absolutely.
It could be doing it. And then people like, oh, I finally broke up with my dick[a] of a boyfriend and I don't have hives anymore. Look at that.
It's only that you were allergic to him. You're just making little kind of a. I mean, could you poke him at your skin and see what happens?
How do people identify whether or not they have MCAS?
[Dr Krista Moyer, ND] (25:15 - 25:38)
Do I talk about like, how do I identify that? Like me personally versus you? Sure.
I do an experiment. And so I say, like, I think this might be histamine because of this symptom, this symptom, this symptom. You have a lot going on.
Now patients are coming to see me and they're like, I found you on ChatGPT. I plugged in all my symptoms and ChatGPT. Said it could be MCAS, which is a really cool thing.
[Dr Bobby Parmar, ND] (25:38 - 25:39)
ChatQueen says it's you.
[Dr Krista Moyer, ND] (25:40 - 25:42)
Yeah. And then ChatGPT was like, “Go see her.”
[Dr Bobby Parmar, ND] (25:42 - 25:47)
I was like, can we start calling it ChatQueen? ChatGPT is so long and boring.
[Dr Krista Moyer, ND] (25:47 - 25:48)
And what do you want to call it?
[Dr Bobby Parmar, ND] (25:48 - 25:49)
ChatQueen.
[Dr Krista Moyer, ND] (25:49 - 25:49)
ChatQueen. Yeah. All right.
[Dr Bobby Parmar, ND] (25:50 - 25:53)
May it catch fire.
[Dr Krista Moyer, ND] (25:54 - 26:49)
So I do it as an experiment. And like, let's just see. I used to, as you know, used to think it was just all like histamine intolerance before I even knew what MCAS was.
And then the more I started learning about MCAS, I'm like, that's what it is. It's not just this like dietary piece of the puzzle. And so I do the experiment where I do the low histamine diet.
I do the antihistamines at the quercetin, depending on what else is going on with the patient. And then after four to six weeks, like what's going on? Like, are you 10 percent better?
Are you 80 percent better? What symptoms are gone? What symptoms are less?
When did they start being less? Did you challenge anything? Like sometimes people were like, oh, I went out for a seafood dinner and had a glass of wine and then had chocolate cake for dinner.
And my digestion was horrible. I didn't sleep that night. I had anxiety for a week.
I had a migraine for the next three days. And I'm like, oh, so you took it all away. You had this lovely reprieve and now all of your symptoms have come crashing back.
You have MCAS.
[Dr Bobby Parmar, ND] (26:50 - 26:55)
Talk about histamine intolerance. What is that? You're like, that's different.
Yes.
[Dr Krista Moyer, ND] (26:55 - 27:03)
So histamine intolerance is similar to lactose intolerance in that reduced enzyme activity can impair histamine breakdown. DAO primarily degrades dietary histamine in the gut, and HNMT primarily metabolizes intracellular histamine.
[Dr Bobby Parmar, ND] (27:03 - 27:04)
How do we circle back to that?
[Dr Krista Moyer, ND] (27:05 - 27:41)
But then there is the DAO or the diamine oxidase enzyme. And that's the main enzyme that breaks down dietary histamine. So that's if you have any sort of the genetic down regulations of the DAO, then you can't break down the dietary histamine.
So it's not the same as systemic levels of histamine. If dietary histamine intake is high and DAO activity is reduced, systemic histamine burden may increase, which can affect other breakdown pathways. So it can be one or both.
So then it just accumulates. And so by avoiding the high histamine-containing foods, if you have low DAO then or even down regulations, the HNMT, then that's where you get the intolerance.
[Dr Bobby Parmar, ND] (27:41 - 27:45)
Can you take that enzyme like lactase for lactate?
[Dr Krista Moyer, ND] (27:46 - 28:05)
Yeah. So there's a DAO enzyme. It's really hard to get.
It comes and goes off the back order. I find it really challenging. I have a lot of patients that take it and find reprieve and a lot of patients that are on it and it's just like not quite cutting it, but it decreases symptoms.
So that helps with the DAO enzyme. There's no enzyme that you can take for the HNMT.
[Dr Bobby Parmar, ND] (28:05 - 28:21)
It's really helpful to explain to people that lactose intolerance is like you're born with it and you just don't have the enzyme to break down dairy. And this is really no different. It's just exactly another protein that doesn't get broken down easily because you're missing the kind of thing.
And how do you know that?
[Dr Krista Moyer, ND] (28:21 - 28:49)
I mean, I do genetics. And so I can tell to see how many people like if there's heterozygous, homozygous, so a major downregulation or just a slight downregulation of that enzyme. If you have certain variants affecting these enzymes, their activity may be reduced.
Yeah. So the HNMT enzyme or just the DAO, if you have something heterozygous to one DAO gene and you have no other genes to that, probably is not histamine intolerance.
[Dr Bobby Parmar, ND] (28:49 - 28:59)
And that means when you say doing genetics is like in order for you to understand somebody's constitution, you get them to do a genetic test.
[Dr Krista Moyer, ND] (29:00 - 29:00)
Yes.
[Dr Bobby Parmar, ND] (29:00 - 29:05)
And then you read that result and interpret these specific things.
[Dr Krista Moyer, ND] (29:05 - 29:05)
Yes.
[Dr Bobby Parmar, ND] (29:05 - 29:08)
And then a lot of the times you're like, ah, there it is.
[Dr Krista Moyer, ND] (29:08 - 29:21)
Yeah. And every once in a while, it's the FMO3 gene and that they piggyback on each other. And so one can worsen another one.
So every once in a while, I'm like, oh, it's tyramine. That’s the amine that doesn't agree with me.
[Dr Bobby Parmar, ND] (29:21 - 29:26)
Yeah. She got me to do my genetics or at least I did them. And then she saw the results and she was like, I knew it.
[Dr Krista Moyer, ND] (29:26 - 29:27)
Histamine.
[Dr Bobby Parmar, ND] (29:28 - 29:30)
It's like, oh, it's actually Histamine.
[Dr Krista Moyer, ND] (29:31 - 29:35)
Oh, that. How are you not like bleeding every day?
[Dr Bobby Parmar, ND] (29:38 - 29:49)
I want to talk a little bit more about what you just said. Like when you said about the diet and histamine intolerance, is there something that's digestively obvious for people?
[Dr Krista Moyer, ND] (29:50 - 29:51)
Tell me more what that means.
[Dr Bobby Parmar, ND] (29:51 - 29:55)
Bloating, pain, diarrhea. Well, what are they?
[Dr Krista Moyer, ND] (29:55 - 30:12)
Diarrhea is the big one. Way more common. But you can have alternating diarrhea, constipation.
Every once in a while I see constipation, but diarrhea is pretty common. So like the bloating, the irritation, not feeling great. And then also GERD.
So those are like the main digestive symptoms.
[Dr Bobby Parmar, ND] (30:12 - 30:16)
Like heartburn or reflux? Yes. OK.
You're speaking very much like a doctor.
[Dr Krista Moyer, ND] (30:16 - 30:20)
Well, I'm a doctor in the world. We have the most educated doctor in the world.
[Dr Bobby Parmar, ND] (30:21 - 30:37)
I see a lot of people with irritable bowel syndrome, especially type D, diarrhea type or like just mixed type, respond to the histamine diet. Like it's mind-blowing.
[Dr Krista Moyer, ND] (30:37 - 30:39)
When nothing else has worked.
[Dr Bobby Parmar, ND] (30:40 - 30:54)
And they'll say things like, oh, I tried the low FODMAP diet. It was like 40% effective. And you're like, the low FODMAP diet is partially an anti-histamine diet.
I wonder if you just need to go that one further step and see if it made a bigger difference for you.
[Dr Krista Moyer, ND] (30:54 - 31:06)
Yeah. And patients are often annoyed, right? Like, why has no one told me this?
And also, ugh, do I have to be on this diet forever? Which, no. But it, yeah, like you said, it can be amazing.
[Dr Bobby Parmar, ND] (31:07 - 31:25)
I think also there's like an important part of here that we touched on, but I want to speak to, which is like the pain component of histamine. Histamine, like it's just so irritating to nerves. Irritating to the nerves in your intestines, irritating the nerves in your uterus, irritating the nerves in like your overall body tissues.
And so it causes pain.
[Dr Krista Moyer, ND] (31:25 - 31:33)
Remember we learned when we were going on the deep dive that they're actually adjacent, like the histamine receptors are right next door to the nerve fibers.
[Dr Bobby Parmar, ND] (31:33 - 32:01)
And so the nerve fibers are just like, oh, yeah. Why do you keep poking these? Because it's constantly leaking.
And that's why some people are just like, why is my pain so much? How does pain have anything to do with this? Like, imagine like the idea of you getting a histamine response to something like a bee sting.
What does that feel like? Hot, red, swollen, painful and itchy. Right.
Like it's all of those things. Histamine is very much implicated with all of that.
[Dr Krista Moyer, ND] (32:02 - 32:15)
And the brain, I just really want to hone in on the brain, like the anxiety, the insomnia, the brain fog, so much brain fog. You must see this all the time that people are like, I can concentrate again at work. I can get through work.
I'm not falling asleep in the afternoon.
[Dr Bobby Parmar, ND] (32:16 - 33:17)
And when I started learning this better, the medications I used to use, one of them is modafinil for people with brain fog as like a stimulant. It also works on histamine pathways. The number of things that we're using—GLP-1 receptor agonists like Ozempic (semaglutide) and Mounjaro (tirzepatide)—may influence inflammatory and mast cell pathways.
And you're just like, oh, that's how maybe that's how that's working for that person. There's like allergists now talking about this online, being like, oh, we just did another study. And like, there's a great allergist, you know, you follow him too.
You know that Rubin Allergy, who just a couple of days ago just said to be like, oh, look, a GLP actually really helps with people's mast cells in mast cell activation syndrome. It's like no wonder that person got so much better. It wasn't just about weight loss or inflammation.
They actually stopped getting rashes and they felt so clear once they started this, too. There's just such a broad range for how things are affected by this chemical.
[Dr Krista Moyer, ND] (33:18 - 33:37)
I always just say it's a spider web of like all where the histamine receptors are and they're everywhere in the body. And that's why it's like it's such a domino effect, which is exciting for me. Like I nerd out on it to be like all of these symptoms could be coming from histamine.
So if we temporarily lower histamine, all of these symptoms can go away. Like, let's see what happens. That's really exciting.
[Dr Bobby Parmar, ND] (33:37 - 33:47)
Do you have a takeaway for everybody to be like, what is the first thing that they could or should think about? Is there something like some questionnaire or something? Like, what should they do to be like, do I?
[Dr Krista Moyer, ND] (33:47 - 33:56)
Yeah, there's a great checklist of all the possible symptoms that could be related in all the different systems that histamine is like a piece of the puzzle. So it's like it's a checklist.
[Dr Bobby Parmar, ND] (33:56 - 34:09)
Go to the histamine code dot com. We literally got the whole website devoted to this. It's such an important thing that we want to just really get people to think about.
It's a very amazing resource and it's very beautiful. It's there. Yeah.
[Dr Krista Moyer, ND] (34:09 - 34:34)
I'll post it to a grocery list. I was very consistent on the grocery list when I was going to the grocery and I was like, I'm sorry. OK, I want to eat.
Oh, I can't eat that. Oh, I can't eat that. So I was like, I want to list so that when I open my fridge, my cupboards, it's just like safety.
So that's why I made that list of like, hey, these are the low histamine foods. Evidence shows us these are low. This is what I can eat.
And then obviously that's available for everyone on the website.
[Dr Bobby Parmar, ND] (34:35 - 34:41)
Check it out. Thank you, Dr. Moyer for joining us. I think we're going to do a little rapid fire right now.
Oh, Paige, do you have any questions for us?
[Producer] (34:42 - 34:49)
First one is histamine intolerance a diagnosis or more of a pattern you're recognizing?
[Dr Krista Moyer, ND] (34:49 - 34:53)
Is it more a diagnosis or a pattern? Well, I would look at that…
[Dr Bobby Parmar, ND] (34:54 - 34:54)
You got her on that one, Paige.
[Dr Krista Moyer, ND] (34:55 - 35:44)
Great question, because I'm just thinking, when I look at genetics, that would help me with the diagnosis. But if I don't have genetics, I can't really make that confirmed diagnosis. Like if they're homozygous, meaning more downregulated with the enzyme, especially with the DAO, then that would mean, OK, this person for life is not going to be able to break down histamine very well.
So I can't really say confirmatory without genetics. If it's really clear, then yes, without genetics, I can't really make that confirmed diagnosis. And it is more of a pattern to say, OK, whenever you eat really high histamine food.
Or meal, do you have a big reaction despite your MCAS symptoms being really well managed, then probably it is clearly just a histamine intolerance as opposed to just MCAS. Would you agree?
[Dr Bobby Parmar, ND] (35:44 - 36:29)
I would agree. Like MCAS and histamine intolerance are so different. Like we even diagnose MCAS with blood work, right?
Like you'll there's a test called a tryptase test, which is released by mast cells. If on two different occasions, one where you were at your baseline and one where you were having a reaction, like a flare. If serum tryptase rises by 20% above baseline plus 2 ng/mL during a symptomatic flare, that supports a diagnosis of mast cell activation syndrome. That is one of the current diagnostic criteria. Histamine intolerance, I think might have MCAS to a spectrum kind of like the lactose intolerance. Some people can get away with having a carton of milk and they're fine.
And other people can have a drop in their coffee and they're shitting themselves. So I think it's all across the board. So I don't think the diagnosis part of that might be a little bit too nuanced.
[Producer] (36:30 - 36:36)
Amazing. OK, next question. Can someone have a histamine issue even if they don't have allergies?
[Dr Bobby Parmar, ND] (36:37 - 36:57)
Yes, 100 percent. Yeah, that's the problem. We attach too much the word allergy to the word histamine.
And that's why a lot of people are like, why didn't I get anywhere with my allergist? And it's because you didn't have an allergy to that thing.
[Dr Krista Moyer, ND] (36:57 - 37:02)
So many of my patients obviously go to see allergists and they walk out being they tell me I'm not allergic to anything.
[Dr Bobby Parmar, ND] (37:03 - 37:40)
And with all due respect, allergists are incredible. But the breadth of this is huge and beyond allergy. It's dermatology, it's gastroenterology, it's everything.
It's every system of our body. It's gynecology. It's so if a person goes to an allergist and they get scratched even and there's a lot of positives, and they're like, oh, wow, you're really reactive to so many things.
So they just avoid them as best as you can. And it kind of ends there. Yeah, that's true.
And there's just so much more to what's happening in our bodies than that.
[Dr Krista Moyer, ND] (37:40 - 37:50)
I had a patient when she was really young. Her allergist said like, well, you're basically allergic to everything. And because you can't avoid everything and just just don't bother.
[Dr Bobby Parmar, ND] (37:52 - 37:57)
Yeah. Oh, my God. Not bubble girl.
Oh, OK. Bubble girl. Yeah.
[Producer] (37:58 - 38:04)
Is histamine itself a villain or is it only a problem when the system is inflamed?
[Dr Krista Moyer, ND] (38:04 - 38:35)
Yeah, histamine is, I always say histamine is not the devil. It is not this nefarious molecule just floating around. It's only a problem if there's some sort of injury to the tissue.
The mast cells can be more easily degranulated, like split apart. Histamine is not the problem. It's when histamine shows up to inflammation, which is great.
We want that. But if histamine sticks around your lung, it's the unwanted guest and it's just never going away ever, ever, ever. It's really annoying to that tissue.
And it's just constantly going to create that inflammation and irritation of the tissue.
[Dr Bobby Parmar, ND] (38:36 - 39:12)
And people, you come to our practices where you've been taking Benadryl for years thinking that that was the solution. That is a problem. You're not meant to just be suppressing histamine forever.
Hey, we need that. It's a chemical mediator released by immune cells that helps us fight off infections. It helps us have a robust immune response.
And then if you take specific kinds of antihistamines and you keep blocking that and they have something, another effect called an anticholinergic effect in the brain, you end up having higher risk for dementia. Like it's not just about block, block, block this histamines, this thing that we just want to eradicate in our bodies. It's way more complicated than that.
[Producer] (39:13 - 39:17)
Why does something like cetirizine improve brain fog in certain people?
[Dr Bobby Parmar, ND] (39:18 - 41:21)
There are all kinds of antihistamines, different generations in terms of what they're capable of doing in the body, and then also whether or not they cross what's called our blood brain barrier. Some do, some don't. The ones that cross that barrier, that get into our brain and become antihistamines in our brain, if histamine receptors in the brain.
Those have more impact on symptoms here, but they also might have more side effects up here. So you might be like, oh, that one, how come that one sedates me? I'll give you an example for me.
Cetirizine is a non-sedating antihistamine. A lot of people probably like, oh, yeah, like everybody says I could take that one. I am out like a light.
I took it last week because I had a reaction to something. And can I tell you for two straight days, I was brain dead. Apologies to all my patients.
All those days I told you that I was brain dead and that I wasn't working properly and that I was probably going to make a mistake. And until 3 p.m. the next day, I take Cetirizine the night before when I have a reaction to something. 3 p.m. the next day, it's like clockwork. My brain comes back online. I am gone for the morning. I've been in car accidents.
So they cross your blood-brain barrier. And for some people, they are so reactive and cause side effects. And for others, they're not.
And so for a lot of people who are really sensitive, I pick ones that don't have that effect or. Or we have to figure out whether or not the person is having a reaction not to the antihistamine, but to the preservative that the antihistamine is in. Because remember, Mast Cell Activation Syndrome is not related to an allergy, per se, to the thing, especially antihistamines.
It's potentially you're triggering those cells because there's a preservative in the tablet that you're reacting to. Rather than the drug itself. So there's a layeredness to all of this.
So preferred antihistamines don't really exist. They're very individualized for the person every single time.
[Dr Krista Moyer, ND] (41:22 - 41:26)
MCAS patients are the most sensitive patients and they can. By definition. To the sun.
[Dr Bobby Parmar, ND] (41:27 - 41:27)
Yeah, literally.
[Producer] (41:29 - 41:37)
In Bobby's example of someone using Benadryl for period pain, would that be something you would recommend or would you approach it differently?
[Dr Krista Moyer, ND] (41:37 - 42:07)
Benadryl, I mean, I wouldn't use Benadryl for that. Benadryl, what Bobby was saying, has a block of acetylcholine. And so that's where that creates more of the sedation.
So I would use Benadryl only if there was sleep disruption. I wouldn't use it during the day. You'd be real sleeping.
Yeah, I love there's just a general… you go on the antihistamine diet, you lower the histamines with antihistamines, the quercetin. And then over the next few months, patients will just say my menstrual cramps are so much better.
[Dr Bobby Parmar, ND] (42:07 - 42:19)
Like with that, are you seeing that there's another clue that helps you identify that histamine is part of the problem for PMS? Or is all PMS worthy of being put on an antihistamine diet?
[Dr Krista Moyer, ND] (42:19 - 42:22)
Oh, no, I wouldn't say that.
[Dr Bobby Parmar, ND] (42:22 - 42:23)
You need to see other things.
[Dr Krista Moyer, ND] (42:24 - 43:02)
I mean, histamine doesn't just irritate one pathway in the body. It's many. That's that you brought this up earlier.
This is why allergists don't necessarily help with MCAS or the gynecologist or the neurologist is. And yet they all should be cluing into it because that's where all the receptors are. And that's why MCAS is always alluded to is that no one was really honing in on these because the dysmenorrhea or the PMS could be coming from histamine or the insomnia and the anxiety, the migraines that can be coming from histamine.
So it's never just like, oh, this one symptom that could be potentially histamine. So, no, I wouldn't say all PMS is histamine.
[Dr Bobby Parmar, ND] (43:03 - 43:52)
I'm so grateful that Dr. Moyer is here. I kind of sprung this on her.
[Dr Krista Moyer, ND]
You really did.
[Dr Bobby Parmar, ND]
I just texted her earlier today and I was like, you're going to be on my podcast today. And her little word was, huh? She's here as available.
Thank you so much for joining us. We'll leave information on how to contact Dr. Moyer and her clinic information with the information from the podcast episode itself. So thank you so much for joining us.
I'm Dr. Parmar, and this is Off the Charts. Thank you so much for joining me today. I really had a great time and I hope you did, too.
Please share this with a friend or a lot of friends and leave me a review. It really helps promote this podcast. Thanks so much.
Disclaimer: This transcript may contain errors, omissions, or inaccuracies. It should not be considered a verbatim record of the conversation. For context or clarification, please refer to the original audio or video recording.
