The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Mon, 21 Apr 2025
Many people struggle with mysterious symptoms like fatigue, brain fog, food sensitivities, and skin issues—only to be misdiagnosed or dismissed altogether. This conversation highlights how histamine intolerance and mast cell activation syndrome can be the hidden drivers behind a wide range of chronic conditions, and why they're often overlooked in conventional medicine. From the role of gut health, food triggers, and environmental toxins to deeper root causes like Lyme disease or mold exposure, it’s clear that personalized, Functional Medicine is key to uncovering real answers. Understanding the immune system’s role in histamine reactions—and how even “healthy” foods can be inflammatory for some—is a critical step toward healing. In this episode, I talk with Dr. Todd LePine, Dr. Elizabeth Boham, and Dr. Mark Pimentel about what histamine intolerance is, how it can be related to gut health, and why it’s important to address it. Dr. Todd LePine graduated from Dartmouth Medical School and is Board Certified in Internal Medicine, specializing in Integrative Functional Medicine. He is an Institute for Functional Medicine Certified Practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. LePine’s focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring the natural balance to both the mind and the body. His areas of interest include optimal aging, bio-detoxification, functional gastrointestinal health, systemic inflammation, autoimmune disorders, and the neurobiology of mood and cognitive disorders. Dr. LePine enjoys skiing, kayaking, hiking, camping, and golfing in the beautiful Berkshires, and is a fitness enthusiast. Dr. Elizabeth Boham is Board Certified in Family Medicine from Albany Medical School, and she is an Institute for Functional Medicine Certified Practitioner and the Medical Director of The UltraWellness Center. Dr. Boham lectures on a variety of topics, including Women’s Health and Breast Cancer Prevention, insulin resistance, heart health, weight control and allergies. She is on the faculty for the Institute for Functional Medicine. Dr. Mark Pimentel is a Professor of Medicine and Gastroenterology through the Geffen School of Medicine and an Associate Professor of Medicine at Cedars-Sinai. Dr. Pimentel is also the Executive Director of the Medically Associated Science and Technology (MAST) program at Cedars-Sinai, an enterprise of physicians and researchers dedicated to the study of the gut microbiome in order to develop effective diagnostic tools and therapies to improve patient care. Dr. Pimentel has over 150 publications in many high-profile journals, and he is the author of the book, The Microbiome Connection: Your Guide to IBS, SIBO, and low fermentation eating. This episode is brought to you by BIOptimizers. Head to bioptimizers.com/hyman and use code HYMAN10 to save 10%. Full-length episodes can be found here: Is Histamine Intolerance The Cause Of Your Mysterious Symptoms? What is Histamine Intolerance? Surprising Symptoms You Need to Know IBS: It’s Not In Your Head—Advances In Diagnosing And Treating, Bloating And Tummy Troubles
What is Histamine Intolerance?
heart palpitations dizziness vertigo feelings anxiety so sometimes people will feel more anxious when their histamine levels are high chronic fatigue and so you know histamine and get a lot of nasal congestion right and sometimes even asthma symptoms and absolutely right absolutely brain fog and everything right so it got me dismissed as you know the people don't put the dots together and the doctors don't often put the dots together and
And these symptoms are often seen as disparate or not connected, but they're all really connected, right?
They are right. They are. And it is, you know, to be honest, I've often not put the dots together. Right. So it is it is not always easy. We're always like, oh, this person has headaches. Why are they getting headaches or they're having digestive issues? And and then all of a sudden you go, oh, this is all related. And I've got to be thinking about histamine.
And and so, you know, we've learned a lot over the years to to be able to help people as well. Um, so I think of mast cell activation syndrome, it's more systemic, there can be a lot more things going on. And, and, and, you know, when we say the word histamine intolerance, we're really thinking a lot about that, you know, that reaction that happens from eating a food and, and
and that histamine reaction or that histamine imbalance that occurs after a meal where there's just too much histamine around and the body's not able to break it down. But you know what, it's often a clinical diagnosis, right? So it's often based on looking at that person's story and understanding
you know, really understanding their timeline and what their symptoms are and looking for those inner connections that can really help us to determine if this is what's going on for them because the testing is imperfect.
Yeah, that's right. I mean, like in terms of traditional medicine, what would be the traditional approach to diagnostics, testing, and then treatment? And then let's sort of talk about how we would approach this from a functional medicine perspective.
Right. So, you know, you can measure histamine levels, right? So whether you can measure histamine levels in the blood, so you can measure something called histamine and tryptase in the blood. And you can measure histamine in the urine. It's a methyl histamine urine test that's done. And that test is often done both functionally and conventionally. And it can be helpful if the levels are high.
So if the levels are high, you go, oh, this person has an issue with histamine. But what's a problem with this test is that the levels fluctuate a lot during the day and depending on what you just ate and the amount of food you ate and how we'll talk about this later.
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