HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

What Is The Association Between B-12 Deficiency And Inability To Tolerate Histamine?

Posted on Tue, 10 Dec 2013

Question: Hi, I've had long-term difficulty with megoblastic anemia (B-12 deficiency) combined with high histamine levels. If I take B-12, I get some energy but it brings on mental problems (associated with histadelia.) Right now I have to decide between having energy with mental distress (by taking iron and B-12), or having no energy with a clearer mind (by avoiding B-12). Oh, how I wish I could have both energy AND a clear mind... What is the association (if any) between B-12 deficiency and inability to tolerate histamine??? I have many God-given talents that I really would love to use to potential, but extreme fatigue along with mental excitability make this impossible. Thank-you very much for your advice!! XXXXX

Answered by Dr. Sudhir Kumar (10 hours later)

Brief Answer: My reply is below. Detailed Answer: High histamine levels and vitamin B12 intake may not be directly linked. This is because I see and treat several patients with vitaminB12 deficiency with very high doses of vitamin B12 and they do not get any symptoms of high histamine levels. However, if someone has a deficiency of diamine oxidase, an enzyme that metabolizes histamine, then, high histamine levels may occur. Following strategies would be helpful for you: 1. avoiding histamine fish foods such as cheese, high protein diet, etc. 2. Intake of vitamin C, calcium, vitamin B6. 3. use of anti histaminic drugs such as fexofenadine. These strategies would ensure that you do not get the symptoms of high histamine when you take iron and vitamin B12. So, you can have the best of both. Best wishes, Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (38 hours later)

Hi, Thanks for your valuable reply. Regarding taking the drug fexofenadine: could I not just take the enzyme (diamine oxidase)? I notice it's available as a supplement, either the DAO itself, or a natural supplement called Histame. I can't absorb B-12 so I take it intravenously...I'm wondering: could it be the lack of the enzyme DAO that causes the inability to absorb B-12? Medical literature says that some people lack the 'intrinsic factor' that the body needs to absorb B-12...could this intrinsic factor be related to lack of DAO? It would be very useful to know this in trying to arrive at a solution. Thanks very much once again. Sincerely, XXXXX

Answered by Dr. Sudhir Kumar (1 hour later)

Brief Answer: Thank you for getting back. Detailed Answer: Yes, you could take the diamine oxidase (DAO) supplement. If it does not work, then, fexofenadine may be used. You could take vitamin B12 intra-muscularly also. Most often, the inability to absorb vitamin B12 is due to the presence of anti-intrinsic factor and anti-parietal cell antibodies. These antibodies can be checked in a blood test. Also, you can undergo an upper gastrointestinal endoscopy and gastric (stomach) biopsy, which may show features of chronic atrophic gastritis, if there is a problem of poor absorption of vitamin B12. Intrinsic factor is not related to DAO. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (21 hours later)

Thank-you; this is very helpful. Sorry, I did not see your reply right away. What advantage does the fexofenadine have over the DAO? And are there any severe side effects? Will it conflict with the other meds I'm on (Zoloft and Remeron)? And...one last question: A lot of people who have toxic histamine levels find that B-12 and folic acid really aggravate their symptoms. Do you have any idea why? Thanks again!! XXXXX

Answered by Dr. Sudhir Kumar (3 hours later)

Brief Answer: Thank you for posting your query. Detailed Answer: I think it is mainly about the availability of DAO, which is not freely available, whereas fexofenadine is more widely available. Use of DAO is more efficacious, as it is like treating the problem directly, and not indirectly what is achieved with fexofenadine. Vitamin B12 and folate interfere with the metabolism of histamine, leading to an increase in the levels of histamine in some people, leading to aggravation of symptoms. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (18 minutes later)

Thanks very much! Any final recommendations? XXXXX

Answered by Dr. Sudhir Kumar (5 minutes later)

Brief Answer: Thank you for getting back. Detailed Answer: My recommendations would be the same as I advised in my first response. I wish you get well soon. Best wishes, Dr Sudhir Kumar MD DM

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar