your doctor is correct in that asthma is a chronic inflammatory disorder of the respiratory system. In the bronchioles of the lungs, we find inflammation (swollen walls, increased mucus, tightened muscles), and histamine is a major mediator.  Since inflammation is generated by the immune system, asthma very often occurs hand-in-hand with other immune-mediated dis-ease in the body, especially when they have been sustained for a long time, such as environmental allergies, food sensitivity/allergy, eczema, acid reflux, arthritis, chronic sinusitis, etc.

Many common triggers for asthma are allergies, including food sensitivities. There can be a different set of underlying root causes for the asthmatic state (dynamics such as toxicity, mold, or other environmental allergies are very common root causes) vs. common triggers for a bout of asthma (e.g. specific foods, stress).  In the end, both must be addressed for sustainable wellness.
Here is a an old-but-good journal article on the specific connections between histamine and asthma (here is a more recent research summary). On that note, here are some specific recommendations which might be helpful:
• Eliminate dairy 100%. In my experience, every chronic asthma client has immune reactivity to dairy foods (including butter). Check supplement and medication ingredients to make sure they are also dairy free!
• Avoid histamine rich or histamine producing strains of bacteria in probiotics (as discussed on the case study call), including fermented foods. Here’s a list of histamine rich foods for reference. Don’t get overwhelmed by it. Take a look and see if there are any foods high in histamine that you have on a daily basis. If so, consider removing it.
• Eliminate yeast/fungus. Ongoing use of steroid inhalers commonly creates yeast overgrowth, perhaps even thrush, in the upper respiratory and/or GI tract (due to localized immunosuppression).  Over time this dynamic can create an allergy/sensitivity to yeast.  This is also a way in which chronic use of conventional medication for asthma can continue to promote immune imbalance. Because these foods also contain high levels of histamine, I would eliminate all yeast/fungus-containing or -cultured foods (e.g. beer, wine, vinegar, cured meats, kombucha, miso, tempeh).  I would also consider doing a 10-15-day round of antifungal support in order to counter what has very likely built up in your GI tract (e.g. Renew Life’s “CandiSmart”); this will not address the issue long-term but will likely provide some relief to help establish a new normal with a lower histamine burden.
• To counter histamine specifically, diamine oxidase (DAO) supplements (like Seeking Health’s Histamine Block) can be taken with meals to help the gut to break down more of what is consumed (which is shown to be quite helpful with asthma).
• Boswellia (300mg) and quercetin (1000mg) twice daily can be helpful as well. Boswellia is particularly helpful for joint pain (a good alternative to NSAIDs), but it also impairs leukotriene production and has been clinically shown to reduce asthma symptoms. Quercetin impairs mast cell degranulation directly.
• A daily probiotic with histamine-degrading species would also be beneficial (i.e. Seeking Health’s ProBiota HistaminX)
• As discussed on the call, an activated B-complex daily with food can also help with histamine degradation which requires methylation and B vitamins (particularly B6 in the P5P form).  I would check methylation status with your doctor (e.g. homocysteine, methylmalonic acid). And remember we always want to add/increase a B-complex low’n’slow to allow pathways to be supported progressively.
• Assess possibility of insufficient stomach acid (which can cause both magnesium and vitamin B12 insufficiency).  There is a very common association between chronic asthma and GERD.  Allergy can promote insufficient stomach acid.  This hypochlorhydria can then promote GERD, and frequent use of  steroid inhalers can weaken the lower esophageal sphincter, also promoting GERD.   Low stomach acid promotes more immune system exposure to allergenic proteins which can then worsen allergic hypersensitivity, creating a vicious cycle. In my own practice, every single person with chronic asthma also has had hypochlorhydria.  Certainly this dynamic can bounce back as you address upstream root causes (e.g. hypothyroid, steroid use), but supporting it in the short-term is often key to improve nutrient absorption and to reduce downstream allergenic response in the gut. Testing for H Pylori overgrowth is something I had recommended on the call as well.
• Assess magnesium status.  By promoting muscle tightness and/or spasm, insufficient magnesium might be at play in exacerbating these symptoms.  It is also important to ensure  magnesium is repleted before beginning a Vitamin D supplement (magnesium is required to convert Vitamin D to its final active form in the body).
• Work on making the bedroom (the sleeping environment, in particular!) a non-allergenic environment.  This may include investing in a hyper HEPA air filter (see recommendations here in the Beginner’s Health Roadmap), letting beloved pets sleep elsewhere, cleaning curtains/carpets, investigating sources of mold, etc..

There are many other options to consider, if necessary!  For example, proteolytic enzymes taken on an empty stomach could help to break down immune complexes (i.e. Biotics Research Intenzyme Forte).  Or if Boswellia is not enough, then curcumin might be added in combination. NAC (N-acetyl cysteine) is a precursor to glutathione (a master antioxidant). It can provide detox and lung support.

However, in my experience, the above list is typically sufficient to bring dramatic rapid relief. I will emphasize, however, that these interventions are only toward the goal of rapid relief, and the true root cause resolution remains important work!

In terms of foods that can support lung health, antioxidants is the name of the game so increasing vegetables and low-glycemic fruits (i.e. berries) is helpful! Examples:
• Berries
• Cruciferous – bak choi, broccoli, cabbage, cauliflower
• Quercetin rich foods (green tea, apple, onions, capers)
• Other things that may support the glutathione detox pathway: green tea, rosemary, rooibos, turmeric, ginger, garlic. 

Hope the above is helpful. Let me know if you have any other questions.

 I’ll reply to your questions in order below:

1. No need to go vegan and eliminate meat, only processed and cured meats. Here’s the handout again with the list of high histamine foods. You’ll see that fresh or frozen and rapidly thawed meats like chicken/eggs, sheep, goats, beef, wild boar are well tolerated. So no need to restrict animal foods. Only dairy. Here’s a handout of what those foods are.

2. As I mentioned, don’t follow the low histamine handout that I provided to a T. It will feel too restrictive. Instead, use it as a guide to help you identify which foods you’re consuming regularly in larger quantities, that might be contributing to higher histamine levels. So for example, if you’re having sauerkraut or vinegar every day, that’s best avoided. Your diet should follow the VPF principle here.

3. Coconut yogurt is not a yeast, but check the ingredients to make sure none are added for some reason. Eliminating dairy and yeast would be longer term eliminations to give your immune system a break and reduce inflammation. Typically, clients can bring back in foods they’ve eliminated for several months without any issues, but not after doing a lot of work on their gut and immunity. So for now, it’s best to eliminate these for a minimum of 4-6 months, while working on gut health/immunity.

4. DAO can be used for rapid relief when needed for as long as needed. The goal is to NOT need this support because hopefully your histamine levels will become better managed in time as you address the cause. Initially, I have clients take it regularly to see if it makes a difference.

5. I like Thorne and Pure Encapsulations for brands of boswellia and quercetin. You can find more in B Better’s Fullscript dispensary.

6. Regarding the B complex. Thorne’s B Complex #6 has a much higher dosage of B6 so I would NOT start with that. Instead, I usually start off my clients with the Thorne Basic B Complex (very low and slow) for a month or two, and then switch to the B Complex #6 for another month or two.

7. Some clients experience disrupted sleep when taking a B complex in the evenings, so I generally recommend my clients split their doses across breakfast and lunch. Vitamin D should be taken in the morning (logically we are exposed to vitamin D during the day, not at night). In fact, here’s a reference sheet about basic supplements and how best to take them (with/without food).

8. Methylation is a biochemical process that happens billions of times per second in every cell of the body. It basically adds methyl groups to a molecule which in turn tells the body what genes should be turned on and off. An indirect way of measuring methylation status in regular blood work is by measuring the marker called homocysteine. Homocysteine is part of the methylation cycle so if it’s elevated, it could potentially be indicative of methylation issues due to genetic SNPs like MTHFR or a need for B12 and/or protein absorption. Optimal homocysteine is usually between 6 & 7 for your reference. An endocrinologist should be able to order this test.

9. Be prepared to present scientific literature between asthma and GERD, and don’t feel bullied. H Pylori can be tested at a doctor’s office with stool or a breath test (considered gold standard), but I’ve seen many false negatives which is why I prefer the H Pylori stool test by Diagnostic Solutions. We can help with the requisition so you don’t need to go through a doctor for that. Another option is to go through MyMedLab.com and order it directly yourself.

10. My favorite magnesium for general support is the glycinate form. If constipation is an issue, then the citrate form can help with that as well. Pure Encapsulations is usually my go-to for magnesium glycinate, but there are so many brands on Fullscript that you can search for. I also like the emulsified vitamin D by Biotics Research (Bio-DK) and liquid vitamin D by Seeking Health (D3/K2).

Let us know if you have any other questions. I’m so glad you’re finally getting answers. This is the exact reason I created B Better so thank you!