could your allergies be the culprit for stubborn perimenopausal weight gain?
Along with unwanted weight gain, another common finding with the hormonal changes of perimenopause is allergies with some thought that medications used to alleviate symptoms can indeed contribute to weight gain.
For many women, this will be the resurfacing of hayfever that had, for many years, remained a relic of childhood. For others, the onset of allergies is seemingly ‘out of nowhere‘ with no previous allergy history to speak of.
For a little background, histamine is commonly known as the ‘hay fever‘ & allergy molecule responsible for a cascade of immune-type events that are both protective (helps wider immune system to protect you from infection) & (potentially) life threatening, such as anaphylaxis. Common symptoms of higher histamine include sneezing, coughing, watery & itchy eyes, skin flushing, rashes, reflux / heartburn (sometimes requiring long term PPI use, which also has a relationship to weight gain), stomach cramping, vomiting & diarrhoea, headaches, menstrual cramping etc.
Histamine is also a monoamine neurotransmitter which performs many further jobs throughout the body, some of which are within the brain, including serotonin signalling which can affect anxiety, sleep patterns & hunger signalling.
Why is histamine such an issue for some ?
Histamine requires a delicate balance between histamine coming in vs detoxification & elimination of histamine (histamine out); imagine histamine being contained within a bucket, as long as the bucket has enough histamine within it, but is not at the stage of ‘overflow‘, then the overall amount of histamine is likely to be appropriate & well controlled by the body. What if it overflows? then there is excessive histamine & it becomes very apparent in the presentation of symptoms.
The relationship to preimenopause…
When it comes to the breakdown & elimination of histamine, 2 main enzyme pathways are involved:
Via HNMT (histamine N-methyltransferase), a methylation pathway predominantly in the liver
Via DAO (diamine oxidase) found in many tissues of the body but is predominantly located in the lining of the intestinal tract.
Here’s where it gets interesting, there has been clearly observed role of oestrogen stimulating release of histamine from mast cells, down regulating DAO clearance of histamine & the rise of histamine may stimulate further oestrogen production via the ovaries. Conversely, the decline in ovulation and progesterone production during perimenopause, further adds to this ‘relative oestrogen dominance‘, hence the cycle continues. The higher your oestrogen is in comparison to progesterone may make you susceptible to a rise in histamine.
Now on to the weight gain.
When it comes to the weight gain, this is down to the medications used to manage symptoms.
So which ones are related to weight gain & how does this happen?
Antihistamines are at the top of the list, for very obvious reasons; this includes all antihistamines, including Restavit, commonly used by perimenopausal women to assist with sleep issues (which is a big clue for any of you struggling with sleep). Some of the main ways antihistamines can contribute to weight gain include:
H1 Receptor Antagonism: Antihistamines that block the H1 receptor are strongly associated with weight gain. This is because H1 receptor antagonism can lead to increased appetite and subsequent weight gain, as seen with both antidepressants and antipsychotics that have antihistaminergic properties (please, never stop CNS medications without medical supervision)
Increased Appetite and Caloric Intake: Some antihistamines, like cyproheptadine, have been shown to increase hunger and food intake, leading to weight gain. This is likely due to their antiserotonergic effects, which can stimulate appetite; low serotonin can also be linked to food cravings, especially carbs because carbohydrates support serotonin production
Metabolic Changes: Antihistamines can lead to metabolic changes such as increased insulin concentration and altered lipid profiles, contributing to obesity and metabolic syndrome. This has been observed in both human and animal studies
Changes in Adipose Tissue: Prolonged use of antihistamines like desloratadine can alter the composition and function of adipose tissue, increasing lipid content and affecting tissue elasticity. These changes can contribute to weight gain and metabolic disturbances
Lymphatic System Dysfunction: Antihistamines may impair the function of mesenteric lymphatic vessels, which can lead to increased fat accumulation and metabolic syndrome. This dysfunction is associated with prolonged antihistamine use
Common over-the-counter H1 blocker antihistamines include:
Zyrtec
Benadryl
Telfast
Restavit
Claratyne
Demazin
Another common finding in clinic is the use of PPI (proton pump inhibitors) used to control the symptoms of GORD & heartburn. There is evidence suggesting that long-term PPI use may be associated with weight gain, although the mechanisms are not fully understood.
Potential Mechanisms of Weight Gain from PPI Use
Energy Intake and Expenditure: Studies have shown that PPI users do not significantly differ from non-users in terms of daily energy intake or overall energy expenditure. However, PPI users may consume a slightly higher proportion of calories from fat, which could contribute to weight gain over time
Physical Activity: PPI users report similar levels of physical activity compared to non-users, but they are less likely to engage in muscle-strengthening activities. This reduced engagement in muscle-strengthening exercises could potentially contribute to weight gain
Gut Microbiota Alterations: PPI use has been associated with changes in gut microbiota, which may influence weight regulation. Alterations in the balance of gut bacteria could potentially affect metabolic processes and contribute to weight gain
Long-term Use Effects: Long-term PPI therapy has been linked to increases in body weight and body mass index (BMI) in patients with GERD. This suggests that prolonged use of PPIs might have cumulative effects on weight gain, possibly due to metabolic changes or lifestyle factors associated with chronic conditions
So what do you do if this sounds like you?
Reduce intake of high histamine & histamine releasing foods/drinks such as:
Alcohol (beer, wine, champagne)
Processed meats, canned fish
Aged cheese
Fermented foods, including sauerkraut
Chocolate
Additives & preservatives
Some fruits & vegetables including strawberries, tomatoes, eggplant, spinach, pineapple, bananas, papaya and citrus fruits
The goal is not complete elimination (especially the healthier items), simply reducing an excessive intake to help manage ‘the bucket‘.
What about supplements?
Quercetin helps stabilise mast cells, reducing the release of histamine, as does Bromelian & Vitamin C
Black Seed (Nigella) Oil has also shown histamine inhibiting effects
Strategies to help detoxify relatively excess oestrogen can be helpful, however professional guidance is recommended as an overzealous approach can drop oestrogen too low, which comes with its own potential multitude of downsides; including some broccoli & other cruciferous vegetables daily is a great, safe start
Note: please check any supplements for interactions with medications & seek professional advice for adverse effects in diagnosed conditions.
One final note:
Gut issues can be closely linked to allergies & histamine presentations due to the ability of some species of some species to produce & stimulate the release of histamine; some key species are Candida, Kelbsiella & E.coli. A few common & main drivers of gut issues are chronic stress, hypothyroid, low stomach acid / chronic PPI use, infections (such as travellers diarrhoea, gastro), excessive alcohol intake, diet high in refined food (lacking fibre) & antibiotic use.
There are lots of great sounding solutions online for gut issues, some can be effective, many miss the mark; this aspect is best approached with testing to be sure treatment is targeted & nothing is missed.