Histamine and Endometriosis – An Interview with Nicole Heinze (Nutritionist)

Today I am joined by Nicole Heinze, a nutrition expert from Hannover Medical School and an authority on nutrition in endometriosis. Our conversation will focus specifically on the subject of histamine and its implications for individuals with endometriosis.

Dr. Nadine Rohloff: Today, I am joined by Nicole. She is a nutritionist working at Hannover Medical School and is also an independent nutritionist. Could you briefly introduce yourself and share how you became involved in endometriosis as a nutritionist?

Nicole Heinze: Certainly. My journey into this field began through my lecturer, Dr. Iris Brandes, who has been immersed in the topic for quite some time. During my thesis, we explored ways to integrate nutrition and endometriosis. Since then, I have been actively engaged in women’s health and the nutrition-endometriosis domain. It has become my passion, and I am continuously fascinated by the subject.  Every day brings new learning experiences, and I find it immensely rewarding to work with individuals with endometriosis.

Dr. Nadine Rohloff: I understand you have recently initiated a project focused on women’s health, covering topics that may be relevant to individuals with endometriosis. Could you provide a brief overview of that?

Nicole Heinze: Yes, I am based in Hanover and have my practice in a gynecologist’s office. Together with a psychologist colleague, we decided to promote women’s health awareness through seminars in Hanover. We have planned four seminars for this year on the theme of femininity. These sessions invite women to bring their questions and concerns about nutrition, gynecology/women’s health, and psychology. We aim to cover a broad spectrum in an intimate setting, with ten to fifteen participants. The first session is scheduled for April 22, 2022, pending considerations related to the ongoing pandemic.

About Nicole

Nicole Heinze is a nutritionist with a position at the Hannover Medical School (MHH). With a research focus on diverse nutrition topics, she has authored a book.

Title: Nutrition and Endometriosis. Connections, Obstacles, and Possibilities.
Published by Diplomica Verlag GmbH in Hamburg, 2018.
ISBN: 978-3-96146-615-3

Follow Nicole on Instagram

On June 22, 2022, we will delve into the significant topic of the desire for children, aiming to foster networking and open discussions about the various aspects that come with it. This event will continue to focus on our core themes.

On September 15, 2022, the spotlight will be on pregnancy, covering considerations regarding nutrients, bodily changes, the impact on the mental well-being of expectant mothers, and addressing any fears associated with childbirth. These are vital aspects that we aim to explore.

Moving forward to November 14, 2022, the theme shifts to family life, encompassing topics such as rediscovering sexuality with a child, managing changes in the dynamics, coping with breastfeeding, ensuring proper nutrition, and maintaining personal well-being as a woman, especially when a newborn takes center stage. This comprehensive package marks the beginning of what, we hope, will be numerous informative sessions and meaningful exchanges. The entire series will be hosted at FeminityHealth.

Dr. Nadine Rohloff, MD: Very interesting! Today, we want to delve into histamine, frequently discussed in connection with endometriosis, and raising many questions. To shed light on this, we are joined by an expert. Let us start from the basics: What exactly is histamine?

Nicole Heinze: Histamine belongs to the group of biogenic amines. It is a substance that can have a hormonal impact, act within tissues, or function as a neurotransmitter. Primarily, it serves as a mediator, undertaking tasks in the body. However, quite often, it can trigger inflammatory processes. To illustrate, think of a mosquito bite: the body reacts by forming inflammation, resulting in a small, itchy bump on the skin that needs to be alleviated. Similarly, histamine can induce inflammatory processes within the body, even though it does not manifest as visible bumps.

Nadine Rohloff: It acts as a messenger substance with various functions, including triggering inflammatory processes. Now, the crucial question arises: What role does histamine play in endometriosis, and why is it essential to understand its impact on this condition?

Nicole Heinze: In endometriosis, inflammatory processes are prevalent. Therefore, individuals with endometriosis must be vigilant and keep inflammations at bay. This is especially relevant since endometriosis is often associated with allergies; in my consultations, I frequently encounter women with endometriosis who also have conditions such as fructose intolerance, histamine intolerance, various allergies, or cross-allergies. There is a significant interconnection within this entire spectrum.

Dr. Nadine Rohloff: Histamine is a naturally occurring substance in the body. How does this relate to hormones, considering they are also highly relevant in endometriosis? Is there any connection?

Nicole Heinze: Histamine functions as a tissue hormone and can be influenced by estrogen. If the histamine level in our body is elevated – due to factors like excessive intake, stress, or impaired histamine breakdown—our estrogen level also tends to rise. Therefore, there is a reciprocal relationship: high histamine levels can potentiate high estrogen levels. In theory, if not naturally reduced, this cycle can perpetuate itself. However, due to our menstrual cycle, estrogen levels eventually decrease due to the counteracting hormone progesterone. We require progesterone to lower estrogen levels and, consequently, histamine levels. There is a direct interconnection between these elements. While it cannot increase indefinitely, their levels do influence each other.

Nadine Rohloff, MD: Exciting insights. Let me summarize: Histamine is produced in the body, and its levels are interconnected with estrogen – each promoting the other. Stress can influence histamine breakdown in the small intestine, where the enzyme DAO (diaminooxidase) plays a crucial role. Stress, leading to increased cortisol production, can divert progesterone, a histamine and estrogen antagonist, into cortisol formation. This intricate relationship has complex implications for endometriosis, estrogen balance, and histamine balance. Excessive histamine, present in both the body and various foods, underscores the importance of our discussion. How does histamine factor into nutrition?

Nicole Heinze: Stress exerts multifaceted effects on our body, some of which remain elusive. Notably, stress may impact our intestinal health, where the vital enzyme DAO (diaminooxidase) operates as a histamine antagonist, breaking it down when the intestinal flora is undisturbed by stress. Optimal conditions in the gut allow for more efficient histamine breakdown. Stress, however, introduces cortisol, a stress hormone at the end of an intricate formation chain. In this chain, progesterone, the antagonist to histamine and estrogen, is present. When the body responds to stress by producing cortisol, progesterone is diverted into cortisol production, creating a deficit of this essential counterpart.

Dr. Nadine Rohloff: Certainly, this complex interplay has profound effects on endometriosis, impacting the delicate balance of estrogen and, consequently, histamine. Excessive histamine is detrimental, and its presence extends beyond the body, being found in various foods. What role does histamine play in nutrition?

Nicole Heinze: Histamine plays a significant role in dietary considerations. When discussing histamine with my clients, I often encounter concerns that they must eliminate numerous foods. However, clarifying that a balanced approach is possible while histamine is prevalent in certain foods is essential. Smoked and dried foods, such as long-hanging salami and smoked fish, are notable sources of histamine. Two common culprits causing distress for many are tomatoes, especially in the form of sauces and chocolate. Cocoa, found in chocolate, acts as a histamine releaser or supplier.

Dr. Nadine Rohloff: What would you recommend when considering alternatives to tomatoes and chocolate for those aiming to reduce histamine intake? Perhaps pesto?

Nicole Heinze: Pesto typically includes aged cheeses like Parmesan, which are high in histamine due to the lengthy maturation process lasting three to six years. Before causing undue concern, it is crucial to note that each person has an individual histamine threshold, indicating when it becomes excessive for them. The challenge lies in identifying this threshold. You might replace the tomato sauce with ajvar initially, providing an alternative. However, following a histamine-free or low-histamine diet is not a long-term solution. It is a temporary measure for individuals with histamine intolerance, affecting approximately one to five or one to eight percent of the population. During this transition, I often recommend that clients consume only white chocolate for two weeks – recognizing that it may not compare to the richness of dark chocolate.

Dr. med. Nadine Rohloff: Is that possible? That is good to know!

Nicole Heinze: Yes, because it is not the cocoa powder used, but the oil or the cocoa fat. That does not have this effect.

Dr. Nadine Rohloff: You mentioned histamine intolerance, and there is a threshold where you notice too much histamine. So, how do you begin? Should you attempt to eliminate everything with histamine? When would you say you see histamine intolerance? And for those in the minority, who should pay extra attention?

Nicole Heinze: You typically notice histamine intolerance less than lactose or fructose intolerance. The symptoms that manifest in your stomach are increased bloating and compromised digestion. Unlike lactose intolerance, which is often accompanied by diarrhea, histamine intolerance primarily exhibits symptoms in the head. Perhaps everyone has experienced this in some way: after an evening of enjoying some red wine, a delectable cheese platter, and maybe some smoked sausage, you wake up with a headache from the alcohol. For some, it might also lead to a stuffy nose or skin reactions, such as a rash on the décolleté or face with red spots. These are typical allergic reactions, indicating an excess of histamine. To address your question about when and how to manage it, histamine is usually better tolerated in the first half of the menstrual cycle when estrogen increases for ovulation. In the second half of the cycle, if you notice reactions like headaches, a stuffy nose, or a rash, it might be prudent to reduce histamine-containing foods.

Dr. Nadine Rohloff: This also relates to endometriosis, as symptoms are often heightened during the menstrual cycle. You might consider abstaining a bit more in the second half of the cycle to avoid exacerbating inflammation. So, during this period, you could experiment with replacing dark chocolate with white chocolate or opting for bell pepper sauce instead of tomato sauce.

Nicole Heinze: That is worth trying. However, it is crucial – something I consider fundamental – to focus on gut health. If you are uncertain about the state of your gut, especially if you have undergone prolonged antibiotic treatments for issues like cystitis or others, consider a course to replenish specific intestinal bacteria. This is a significant aspect. Additionally, stay well hydrated. If you wish, you can still pay attention to anti-inflammatory foods, in general, to keep overall body inflammation low, and many of these options align with a low-histamine approach.

Dr. Nadine Rohloff: That is also an important point: Histamine is not the only thing you must pay attention to. The most important thing is to maintain a healthy overall diet. One low in histamine can be beneficial if you find it suits you. And here is another suggestion: While experimenting on your own is fine, if you genuinely sense, especially with histamine intolerance, that things seem challenging, seeking in-person nutritional consultation is crucial.

Nicole Heinze: However, for your independent research, it is crucial not to overwhelm yourself. There is a plethora of information on the Internet about what contains histamine and what is considered “bad.” Conduct your exploration, and if needed, seek guidance and support. Unfortunately, histamine intolerance is not as extensively studied as endometriosis, and there are often individual opinions online. What can be helpful is to search for alternative recipes. So, do not strictly adhere to a low-histamine diet just because you feel obligated to. That usually leads to frustration and additional stress in the body – we do not need that. At some point, following a colleague’s recommendation, I obtained a histamine recipe book. I found it valuable to have some alternatives. It is pretty well-researched by Anne Kamp – “Histaminintoleranz Genussrezepte.” And that is also vital to me: Do not lose the joy of eating! I often share a lot of information, and clients can become overwhelmed, feeling desperate and wanting to overhaul their diet immediately based on what I have declared as potentially harmful. It is crucial to take it easy, take care of yourself, and remember to enjoy your meals.

Dr. Nadine Rohloff: It is crucial to emphasize that when you hear “No tomatoes,” it does not mean you can never eat tomatoes again. Instead, it is about finding a balance and understanding your tolerance levels. When you decide to cut out certain foods, it is essential to explore alternative options that are enjoyable.

Nicole Heinze: Interestingly, the fresher the tomatoes, the lower their histamine content. It is probably the case that those “water bombs” from the Netherlands, which do not taste like tomatoes and are essentially just water, have the least histamine.

Dr. Nadine Rohloff: So, less flavor equals less histamine?

Nicole Heinze: Unfortunately, that is correct.

Dr. Nadine Rohloff: Another point to consider: cooking fresh at home is generally better than using ready-made sauces.

Nicole Heinze: Yes, and an important tip is, especially in colder weather, if there are leftovers, cool them quickly by placing them outside. Slow cooling increases the likelihood of more histamine formation. So, rapid cooling and reheating are two tips that work against histamine.

Nadine Rohloff, MD: That is fascinating! Is there anything else you would like to add?

Nicole Heinze: Take care of yourself, and do not see your body as the enemy. Your body and mind are part of the same person. You do not want to be at war with yourself forever. Try to bridge the gap and bring some peace into it. Also, do not complicate the diet more than necessary. Leave the complexities to the nutritionists!

Nadine Rohloff, MD: A great way to conclude. Thank you very much, Nicole. Until next time!

If you want to share your story with us, contact [email protected].

For any questions, you can contact us via email or post your question in the Facebook group Endometriosis Verstehen.Beobachten.Austauschen.

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