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Another thing to consider is whether she's having a histamine flush, not a low-estrogen hot flash. It's something I've had forever, but I don't know why a person couldn't develop it later if their methylation slowed down. If she's not able to readily convert folic acid to active folate, she'll have trouble controlling levels of histidine from meat, which will contribute to higher histamine levels. Even slow-release niacin becomes a nightmare :) Methylfolate and methylcobalamin are crucial.