Doctor's Farmacy with Mark Hyman, MD

Key Takeaways

Histamine intolerance and mast cell activation syndrome (MCAS) can be the hidden drivers behind a wide range of chronic conditions, such as fatigue, brain fog, food sensitivities, and skin issues – yet, histamine intolerance is often overlooked by conventional medicine
- MCAS is a condition where certain immune cells – called mast cells – release too many chemicals (like histamine) at the wrong times
Using diet as a short-term therapeutic tool: A low-histamine diet or Low-FODMAP Dietis not a lifelong diet because tons of healthy foods have histamine in them
- Consume the freshest foods possible and avoid leftovers, as histamine levels in food rise over time after preparation
Foods that are traditionally categorized as “healthy” may be contributing to your histamine issues; these include: aged meats, cheeses, fermented foods, and dairy
- Even though they are generally healthy, consuming them is like throwing gas on your histamine fire
Implementing a low-histamine diet in three phases
- Phase 1 – remove alcohol, especially beer, wine, and champagne
- Phase 2 – remove canned and smoke fish (examples: anchovies), processed and fermented meats, aged cheese, pickled and fermented foods (sauerkraut, kimchi, yogurts, kefir, mustard, ketchups, vinegar, soy sauce)
- Phase 3 – remove plant foods such as spinach, avocado, tomatoes, pineapples, citrus foods
Treat IBS with a low-FODMAP diet, which is specifically designed to reduce the fermentable carbohydrates that gut bacteria feed on; this helps reduce: gas production, bloating, bacterial
- Foods to avoid: Garlic, onions, wheat, legumes, milk, soft cheeses, apples, honey, sorbitol, xylitol, stone fruits, artificial sweeteners
- Foods to consume: Carrots, spinach, bananas, chicken, rice, cheddar cheese, eggs
Supplement to support healthy histamine levels:Quercetin – a natural plant compound that helps people with mast cell issues, histamine intolerance, and allergies (with additional benefits to metabolic function)

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.
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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

Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance

Podcast Notes Playlist: Fitness