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MindCheck is the Weekly Wednesday Kids Mental Health series with Dr. Ray Pataracchia N.D.  MindCheck provides in depth information on the orthomolecular approach to coping with mood, behavior and psychotic disorders.  The MindCheck Health Series is endorsed by the  Mindful Network – ‘A Better Future for Children’s Mental Health’.

 Histamine Imbalances Today-  Classic Orthomolecular Subtypes with Histamine Imbalances are seen in people with Schizophrenia, Depression, Anxiety, ADD/ADHD and OCD.  

Histamine Imbalance Today: Optimal Orthomolecular Treatment

Histamine Imbalance as determined by whole blood histamine assessment can determine if you fall into either a low (histapenia) of high (histadelia) histamine subtype.  Histamine Imbalance is a classic orthomolecular category that affects the general population and a wide variety of mental health conditions including schizophrenia, ADD, ADHD, OCD, depression, and anxiety.

What is Histamine?

Histamine is well known for its role in allergic response however it is also a minor brain neurotransmitter and has an important role in balancing the electrical activity of the nucleus accumbens, an area of the brain responsible for behavioral responses, filtering incoming sensory information, and communicating with the hypothalamus, ventral tegmentum, and amygdala.

Histamine Imbalances

In the 1970’s, the role of histamine in mental health gained interest due to the work of Carl Pfeiffer who categorized psychiatric patients into biochemical groupings or subtypes; he determined that there were several subtypes of schizophrenia for example and he called this grouping ‘the schizophrenias’.

The primary biochemical subtypes that he considered included those with high histamine (histadelia), low histamine (histapenia) and pyroluria.

The secondary biochemical subtypes that he considered included those with hypoglycemia, heavy metal toxicity, iron deficiency, etcetera.

The determination of subtype determines the biochemical individuality of the patient which then dictates an optimal treatment approach – this is the premise of targeted assessment and treatment.

Histamine and Methylation

Histamine excess is potentially associated with compromised methylation of major neurotransmitters (serotonin, norepinephrine and dopamine) which could deplete their formation and reduce their activation.

It was presumed that high histamine (histadelia) cases would not tolerate vitamin B3 (a methyl acceptor nutrient that can raise histamine levels) but this was not confirmed clinically by all medical professionals, many of whom found good tolerability with B3 in this subtype.  Some high histamine cases may not have tolerated B3 for other biochemical reasons — poor excretion of B3, antagonistic nutrient opposition, allergic response issues, etcetera.

Since folic acid and vitamin B12 are involved in histamine production, it was presumed that high histamine (histadelia) cases would not tolerate methyl donating nutrients especially folic acid, but this was not confirmed clinically by all medical professionals.

Today we see folic acid intolerability in a very small group of patients; these patients often have poor track record of tolerating B vitamins and also often have multiple layers of sensitivities from other biochemical compromised states including poor thyroid metabolism, auto-immune predisposition, and heavy metal toxicity.  Today, we see a vast majority of people having high folic acid levels and this folic acid dominance may be due to a changing food supply or the use of B-complex vitamins that seem to be more dominant in folic acid than B12 or other B’s.

Histamine Subtypes – Histadelia and Histapenia

Pfeiffer found that those with high versus low histamine had different characteristics.  I have listed the primary characteristics of both subtypes below.

Histadelia Characteristics

Carl Pfeiffer determined that the histadelic subtype was more likely to have the following profile of characteristics:

– OCD or OCD-like symptoms

– suicidal propensity

– mind blanking

– seasonal allergies and autoimmune conditions (includes food allergies)

– headaches, muscle cramping, stomachaches, and profuse sweating

– elongated toes/fingers, prominent veins, and lean body build

– large ears and nose, insufficient hair

– pulse is heard when lying on pillow

– skin color same or darker/deeper than other family members

– severe insomnia or reduced need for sleep

– higher body temperatures

Histapenia Characteristics

Carl Pfeiffer determined that the histapenic subtype was more likely to have the following profile of characteristics:

– potential copper toxicity symptoms (copper is involved in histamine regulation)

– hallucinations, grandiosity, thought disorder, paranoia (often associated with excess copper)

– light skin/hair color (versus other family members)

– cyclical depression

– tinnitus (ear ringing)

– stuttering

– tooth decay

– food sensitivity (histamine immune response)

– arthralgia and pains in the upper body

– slow metabolism (which may or may not be copper excess related) and fatigue

– young looking, abundant hair

– resistant to shock

Treatment of Histadelia

The high histamine subtype is said to require methyl donating nutrients (B12, folic acid) as tolerated to help manufacture depleted major nuerotransmitters.  Nutrients for histadelia include pyridoxine/B6 (small doses), vitamin C, B5 (small doses), calcium, magnesium, zinc, manganese, methionine and glycine.

Treatment of Histapenia

The low histamine subtype has a very similar treatment approach with the exception of greater tolerability of methyl donating nutrients (with the exception of methionine). Nutrients for histapenia include B3, B5, pyridoxine/B6, vitamin C, B12, folic acid, selenium, vitamin E, zinc, and manganese.

Treatment Similarity Between Both Histamine Subtypes

The nutrients provided for both subtypes are the nutrients considered in most good orthomolecular protocols.

The tolerability of all these nutrients is quite good and both subtypes can be treated for the most part by providing a well-balanced and optimally dosed multi-mineral and multi-vitamin complex.

Drawbacks of Histamine Assessment and Treatment 

— Please note that the drawbacks listed here do not diminish the need for an assessment and treatment approach that targets other primary and secondary syndromes as described in my review on schizophrenia and in my review on mood and behavior disorders.

1) The concentration of whole blood histamine may or may not represent the concentration of histamine in the brain.

2) Methylation compromise can be assessed more directly today (homocysteine) and histamine is likely a poor functional marker of methylation status.

3) After successful treatment, the histamine level may or may not normalize which suggests that the treatment may address other layers of imbalance that are at play – for example, methylation compromise, heavy metal toxicity, etcetera.

4) It is expensive to assess a metabolite that does not necessarily determine specific biochemical imbalances; a high or low measure does not necessarily dictate treatment.

5) If a medical professional suspects high histamine sensitivities he/she can do a trial with sequentially higher doses of vitamin C as tolerated (vitamin C can help to diminish histamine related allergic components); providing high doses of vitamin C however needs to be done while respecting other antagonistic nutrients which might become depleted.

6) If a patient is sensitive to folic acid this is usually determined by questioning the patient and seeing if they have had a previous reaction to B-complex vitamins (many B-complexes today have a high folic acid to B12 ratio).  So testing for high histamine does not necessarily need to be done tto rule out this sensitivity component.

7) As an assessment tool, histamine lab findings are confusing to patients and medical professionals because there are so many implications in terms of the symptoms associated and the treatment options proposed — so the global scenarios seem to dilute its applicability/usefulness.