Note: This is a continuation of previous blog posts on histamine intolerance (part 1, part 2, part 3) and another one post histamine intolerance.
Short health history
- 2000–2002: Asthma-like symptoms during running, which eventually made me quit competitive orienteering.
- 2004–2009: Insomnia, mostly in winter or after alcohol (1 beer was enough).
- 2010–2012: Moved to Sweden and soon experienced migraines with aura, for which I took many different pills and all of them only made it worse. Worst insomnia and stomach problems. Spent about 3 months on sick leave. Got diagnosed with histamine intolerance.
- 2013–2014: Antihistamine medication relieved a lot of symptoms, but I had to stop taking it regularly because of side-effects. Spent another few months on sick leave. (blog post, another blog post)
- 2015–2016: Stopped seeing doctors and started experimenting on myself. No longer histamine intolerant. (blog post)
- 2017–now: Steady progress, every year I could eat more food, exercise more, sleep better, etc. I’d rate my health at 95% now.
(Non-)Measurable improvements
I prefer improvements that are measurable. Some changes might not look like improvements, for example gaining weight is considered bad, but I consider it great, as the gain has been mostly muscles. Similarly for heart rate while running, the higher the rate, the faster I can run.
| Metric | 2012 | 2016 | 2020 |
|---|---|---|---|
| Weight (kg) | 67 | 73 | 82 |
| Heart rate (BPM, orienteering race) | 150 | 165 | 175 |
| Falling asleep | 2:00 | 24:00 | 22:30 |
| Sleep length | 5h | 6h | 6.5h+ |
| Exercise per week | 0.5× | 1–2× | 3–5× |
| Podcast listening speed | 1.3× | 1.4× | 1.6× |
I’ve also experienced improvements which are hard to quantify, for example better mental focus or not being tired in the afternoon. Even though these are hard to measure, they are very closely tied to sleep quality. If my sleep is great, I can also focus. In any case, here’s a list of other improvements.
- I can now eat milks proteins and more fiber.
- I can drink alcohol.
- Better mental focus, no crash after lunch.
- No painful migraines.
Not everything is perfect, though. Instead of taking too long to fall asleep I now sometimes wake up too early. See my Last.fm 2019 music stats, they start to pick up before 5 AM. My goal is to wake up at 5:30 AM.
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| Last.fm listening statistics for 2019 |
What worked
Since the last post in 2016, I’ve changed the following.
- Moved back to Central Europe from Sweden, so I get much more sunshine.
- I take fewer cold showers, because the shower water is not cold enough in Central Europe. I also practice less intermittent fasting, as I want to weigh more.
- I’ve switched my exercise focus from cardio (orienteering, biking, ultimate frisbee) to strength training. I’ve also stopped stretching—the only noticeable change from this is more free time.
- I’m now sleeping on a Japanese futon, the hardest bed on the market. It improved my sleep times and sleep quality.
- Most importantly, I’ve made my diet more consistent thanks to a slow cooker and a big freezer. Diet makes for at least 80% of the whole improvement, so it deserves its own section.
Diet details
Through experimenting with supplements, I discovered that I need to focus on the following essential nutrients.
- Vitamins: A, B*, D, K
- Minerals: Potassium, magnesium, salt, iodine, selenium, iron
- Amino acids: glycine
- Other: nitric oxide
Getting enough (and not too much) of these from food makes for a diet very close to Perfect Health Diet. Below is a sample of my diet from the COVID-19 “lockdown”, when it was the most consistent.
- Breakfast: 5 free-range eggs with pickled or fermented vegetables. Occasionally no breakfast.
- Lunch: vegetarian meal from the restaurant downstairs.
- Afternoon snack: dark chocolate, almonds, fruits, yogurt, protein bars.
- Dinner: grass-fed beef organs or bone broth. With vegetables or potatoes on the side.
I know, I know, this diet has a lot of vegetables which are environmentally costly. They contain very few calories, require a lot of water, land and nutrients. They also require refrigeration to remain fresh. However, picking a diet which balances personal health with ethical considerations is not an easy task. I think I need to first read famous moral philosophers such as Immanuel Kant, Jeremy Bentham or Peter Singer before I can form an opinion that I can share publicly.
Ethical considerations aside, I think the Perfect Health Diet (PHD) is one of the easiest ways to get essential nutrients in optimal quantities. Some people might be able to make substitutions, but this diet should work for everyone. For example, PHD contains vitamin A mostly in the form of retinol and its esters. Another source are carotenoids, but they need to be converted first and some people have reduced conversion ability, such as myself. It’s a genetic mutation, so there’s not much you can do about it.
I wasn’t able to fix everything through the diet, though. For example, I need to supplement a lot of potassium. I went through 2.5 kg of potassium citrate in about a year, which makes for more than 2 grams of supplemented potassium per day. Some people say that modern food production reduces potassium content in our food. It could be also caused by poor absorption. It’s particularly annoying, as supplementing potassium is very tricky and cumbersome.
Histamine and methylation
I want to share one particular finding regarding histamine, perhaps it’s going to be useful to someone.
People diagnosed with histamine intolerance in Slovakia are given a brochure that emphasizes diamine oxidase (DAO) as the degradative enzyme of histamine in the body. However, other sources also mention histamine-N-methyltransferase (HNMT).
Once formed, histamine is either stored or rapidly inactivated by its primary degradative enzymes, histamine-N-methyltransferase or diamine oxidase.—Wikipedia
Consequently, flawed HNMT activity leads to chronic forms of histamine intolerance.—Wikipedia
In general, increased sensitivity against biogenic amines is due to a weakened enzymatic amine degradation caused by genetic or acquired impairment of MAO, DAO, histamine-N-methyltransferase (HNMT) function.—Histamine intolerance and dietary management: A complete review, 2016 paper by Martin, Brachero and Vilar.
Histamine is Nτ-methylated by HNMT, as the name histamine-N-methyltransferase suggests. In 2015, after reading about methylation, I have slowly made methylation-related changes to my diet with great results. Some time in 2016 or 2017 I’ve learned about the connection between methylation and histamine and made my diet even more strict, which led to even better results.
In the spirit of health bloggers, I’ll now conclude that my symptoms were fixed by methylation and HNMT. Post hoc ergo propter hoc. Haha, just kidding, I can do better!
My diet is now rich in B vitamins, magnesium, collagen, and many other nutrients. These have plenty of other effects, so it’s hard for me to judge causality. In any case, people having histamine-related problems could try it out and see if it helps. All of this made me curious why histamine intolerance patients aren’t told about HNMT but only about DAO. For example, HNMT is active in the central nervous system, where DAO is not present, so focusing purely on DAO might not improve all symptoms.
Interestingly, the histamine intolerance brochure given to patients was written by the producer of the DAO supplement, who wants people to buy their product and has an incentive to hide information about HNMT. I’d still give them the benefit of the doubt using Hanlon’s razor: “Never attribute to malice that which is adequately explained by stupidity”. In this case it could be my own stupidity, since I’m not an expert.
If you’ve made it this far and are interested in methylation-related dietary changes, check out Chris Masterjohn’s methylation guide and his presentation on Methylation, MTHFR, and Histamine.
Doubts about modern medicine
Over the years, my opinion of medicine became gradually worse. In 2011, I thought that I have a condition that’s hard to diagnose and treat. In 2014, I was questioning the Swedish public and private system. In 2016, I shared Robin Hanson’s proposal to cut medicine in half, but added that I’m not buying it yet. Well, now I’m totally buying it. We spend too much on medicine.
If you want to challenge your believes, I recommend reading Robin Hanson’s article or his book The Elephant in the Brain (together with Kevin Simler). I also recommend the article When Evidence Says No, But Doctors Say Yes by David Epstein.
The early phase of COVID-19 is a great illustration of these ideas. People assumed that enough ventilators would save us all. However, early data showed that survival rate on ventilators was somewhere between 3 to 35%. Ventilators and their operation are very expensive, requiring intensive care from nurses and doctors, but they only save few people. Ventilators are used at a very late stage of the sickness when they cannot do much. Preventive measures such as social distancing and face masks are cheaper and more effective. However, they require participation from everyone.
Most money in medicine is spent on people over 60, when it’s too late for miracles. There are cheaper preventive measures such as exercise, good nutrition, better sleep, not smoking, etc., but these require participation from everyone.
I think it’s important to spread Robin Hanson’s message, but not because it would make us spend less money on medicine. The spending will continue, but perhaps people would start taking better care of their bodies if they knew that medicine can not do much.
Recommendations
There are many people in the better half of medicine and I have to thank them for a big part of my progress. I can recommend the following people for health advice. Some of their content is not free, but I highly recommend spending some money on valuable information.
Chris Masterjohn might be the most knowledgeable person on micronutrients. I recommend his Cheat Sheet or Vitamins and Minerals 101 course/book.
Barbell Medicine is run by two doctors who are great lifters. They have great content regarding exercise, though mostly strength training. I’ve successfully used their free and non-free training programs. Also, I highly recommend watching their lecture series on low back pain (part 1 and part 2).
Slate Star Codex: Scott Alexander is a psychiatrist who blogs about a lot of topics, medicine being one of them.
Stephan Guyenet is a neurobiologist blogging mostly about obesity but also other topics. Also see his old blog.
Conclusion
I wish there was one simple trick but I failed to find it. I’ve counted about 15 micronutrients that I need to be cautious about and 5 daily/weekly habits. And all of these need to be correctly dosed, which is a lot of work.
Hopefully this is my last post regarding health. It took a few years—almost 2 decades—but now I can live life to its fullest.