What happens if there’s no apparent cause and effect? Or the problem is really complicated?
Over the last 20 years or so I’ve had increasingly intense reactions to what seem to be unrelated meals. For a long time the only common symptom was sudden, explosive diarrhea after eating out. There were innumerable times I’ve needed to rush to the bathroom after eating out at lunch, especially after eating soup, salads, or at a buffet. I mentioned this to a gastroenterologist and he brushed it off as something he only hears from women and implied it’s all in our heads. Dick.
Over the past five years or so, though, I’ve been having fainting episodes and vomiting in addition to the runs. These are just the most dramatic incidences:
- Passed out at a concert after eating a chicken and cheese sub and drinking a couple of beers. No, Mr. Doorman, I didn’t take a handful of drugs.
- Curled up in the fetal position on my office floor after eating saag paneer—Indian spinach and cheese. One of my supervisors kindly covered me with his jacket and didn't ask any questions.
- Almost passed out at Hampden Fest after eating saag paneer and drinking a beer. Lying on the sidewalk in Hampden, nothing to be ashamed about. Luckily, this happened the year they hid the porta-johns behind the bank building and nobody else could find them. It was nice to have some privacy.
- Passed out and ended up with stitches in my eyebrow after eating black eyed peas, collards, and a couple of beers. Happy New Year!
After the New Year's emergency room visit, I started talking to anyone who would listen. No-tech crowd sourcing. My sister, Nina, who lived in Germany for many years told me that in Germany, boxes of frozen spinach have a warning to not eat leftover spinach. It’s considered poisonous.
I consulted with Dr. Google and discovered that leftover spinach is considered poisonous in a number of cultures in Europe and Asia. The Livestrong website mentioned something called histamine intolerance. That sounded like something I could use in a PubMed search (your tax dollars at work).
I found “Histamine and histamine intolerance” by Laura Maintz and Natalija Novak (http://ajcn.nutrition.org/content/85/5/1185.long). I understood enough of this article (especially since it’s in English, most papers on the topic are in German) to know that this is probably what has been causing my problems for more than 20 years.
“The ingestion of histamine-rich food or of alcohol or drugs that release histamine or block DAO [diamine oxidase] may provoke diarrhea, headache, rhinoconjunctival symptoms, asthma, hypotension [leading to fainting?], arrhythmia, urticaria, pruritus, flushing, and other conditions in patients with histamine intolerance.”
I have to admit, I don’t understand everything in the article, but I can look at the lists of high-histamine foods and see spinach and beer. (At least ales have fewer histamines than lagers.)
Storage is also a contributing factor to histamine levels. Histamine levels rise in foods that are kept at room temperature or stored in the fridge. Spinach naturally contains high levels of histamine. If it’s eaten as leftovers, the levels are probably through the roof.
The other thing to keep in mind is it’s the cumulative amount of histamine that’s causes reactions. For example, a gluten-free beer and chicken curry won’t be problematic to me, but a GF beer and saag paneer may land me in the emergency room.
Why am I writing about this today? Last night I had another episode. We went out to dinner at a very nice restaurant and I had a glass of white wine before dinner and a Manhattan—two drinks over the course of three hours. Osso buco was on the menu. The chef said he didn’t dredge the meat in flour before he cooked it, so I really relished a meal that I thought was safe and wouldn’t make me sick. Evan doesn’t care for braised meats, so I don’t make them at home. I rarely order them out because they've been coated with flour.
We came home and I went to bed only to feel the familiar stomach rumbling and nausea. I managed to not pass out, but I was up for a good hour with diarrhea and barely managed to not vomit.
What was it about this meal? Alcohol was part of the equation. The other part was the osso buco. Well, the way it was cooked. Foods that are slow cooked like this are essentially leftovers before they get to your plate. That explains why saag paneer, soups, and buffets--even at lunchtime without alcohol--have made me sick countless times.
What are the lessons learned?
- Take the cooking method into account when trying to assess the histamine content.
- Limit alcohol more.
- Histamine intolerance is complicated. There's always something more to learn.
- Be grateful that I have the resources to figure out what’s causing the problem after all these years.
Maintz, L., & Novak, N. (2007). Histamine and histamine intolerance. Am J Clin Nutr, 85(5), 1185-1196.