Histamine Intolerance: Unmasking the Mystery Behind Your Misunderstood Symptoms!

Histamine Intolerance is frequently misinterpreted and often misdiagnosed. It is a condition where histamine builds up in the body, triggering unwanted symptoms. This can occur due to an imbalance in histamine production (or ingestion) verses histamine breakdown (by the enzyme Diamine Oxidase "DAO"). 

Histamine is released inside the body in response to many types of stimuli. Classically it is associated with allergic responses, however it is also a critical part of our body's defense (immune) system.

At healthy levels and in the right places, histamine is necessary for a normal digestive process, immunity, and sleep-wake cycle regulation. On the other hand, too much histamine can cause unpleasant symptoms ranging from rashes, itching, stuffy nose, swelling (edema), hives, heartburn, headache (especially migraines), weight gain, insomnia, anxiety, depression, rapid heart rate, and gastrointestinal complaints ("IBS"-type complaints). Most people with Histamine Intolerance will endorse at least 3-4 of these types of symptoms.

Histamine is found in many common dietary sources. Other foods, though not necessarily high in Histamine, can stimulate Histamine release and/or block the DAO enzyme. Any of these types of exposures can contribute to the body's Histamine load. See below a list of the most common exacerbating foods.

Each person’s level of sensitivity to Histamine in food depends on the amount of Histamine present and the effectiveness of the body’s natural Histamine-metabolizing mechanisms. It may seem like the only way to avoid the unpleasant side effects of Histamine sensitivity is to eliminate high-Histamine foods altogether – but such a restricted diet, when maintained for long periods, can deprive the body of balanced nutrition and make it difficult to enjoy meals. A healthy gut is a key factor in normal histamine metabolism and in maintaining healthy histamine levels throughout the body. It is important to correct GI imbalances (a.k.a. "Dysbiosis") so you can more quickly attempt reintroduction of these healthy and enjoyable foods.

Cells in the gut produce DAO (Diamine Oxidase), an enzyme that breaks down Histamine in the digestive tract. In healthy individuals, DAO is responsible for keeping most of the ingested Histamine from ever reaching circulation in the body. A healthy gut microbiome containing a balanced variety of “good” bacteria is essential for maintaining a healthy gut barrier, and healthy cells in the gut barrier are needed to maintain normal DAO levels.

The bacteria that make up the human gut microbiome serve many purposes. It is thought that selectively supplementing the populations of certain probiotic species can alter the levels of fermentation end-products in the gut and support specific health goals. While it is true that certain bacteria found in a healthy gut are responsible for converting histidine to histamine, which can be problematic in individuals with Histamine Intolerance, others may help to break down histamine and reinforce a healthy gut barrier. This can be of special interest for those with Histamine Intolerance, as increased intestinal permeability (a.k.a. "leaky gut") can allow more of the ingested histamine to pass from the gut into circulation. Having a leaky gut can also predispose one to issues with toxin exposure and inflammation, which can feel additive to the symptoms of Histamine Intolerance.

Histamine Intolerance is often associated with or occurs because of:

• Gut Inflammation (e.g. dysbiosis, SIBO, inflammatory bowel disease, yeast overgrowth)

• Intestinal permeability (a.k.a. "leaky gut")

• Food allergies and/or sensitivities

• Seasonal and/or environmental allergies

• High or low Cortisol levels (adrenal dysfunction)

• Toxin exposure (e.g. pesticides, herbicides, mold toxins) and/or problematic detoxification processes. 

• Nutritional deficiencies

• Hormone imbalances (especially estrogen dominance)

• Lyme disease

The level of histamine in foods varies, but even a small amount can cause symptoms in sensitive people. Problematic foods include those that are high in histamine, those that stimulate histamine release, and/or foods that inhibit the DAO enzyme. One recent study suggested that even the cooking method used can change the amount of histamine present. It is recommended to boil food rather than grill, ferment, or fry. In addition, food with minimal processing is encouraged.

Common Food Triggers:

• Fermented dairy (e.g. yogurt, sour cream, buttermilk, kefir)

• Aged cheeses (e.g. parmesan, Romano, Swiss, "hard" cheeses)

• Fermented or pickled veggies (e.g. sauerkraut, kimchi, pickles)

• Kombucha

• Fermented, smoked or cured meats (e.g. sausage, salami, cured ham/bacon, pepperoni, jerky, hot dogs)

• Fermented soy (e.g. tempeh, miso, soy sauce, natto) 

• Fermented grains (e.g. sourdough)

• Leftovers

  • Many foods (especially meats) contain histidine, a precursor to histamine, which, as food sits, quickly gets degraded by bacteria into histamine. 

  • Buy your meat as FRESH AS POSSIBLE. Freeze immediately (if storing).

• Alcohol (e.g. wine, beer, spirits)

• Vinegar

• Seafood

• Tomatoes and ketchup

• Avocado (note, avocado oil is ok)

• Eggplant

• Spinach

• Pineapple

• Bananas

• Citrus (all)

• Strawberry

• Cocoa/chocolate

• Egg whites

• Legumes (Note, hummus tends to be lower in histamine than other legumes)

• For comprehensive dietary details see this link: Swiss Interest Group Histamine Intolerance Food Compatibility List.

  
  

If you want to learn more about how a comprehensive functional medicine approach can help you not just manage, but THRIVE in the face of histamine intolerance, book a complimentary Discovery Call* to learn more!

*Serving Washington State

References:

1. Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT, Latorre-Moratalla M, Vidal-Carou MdC. Histamine Intolerance: The Current State of the Art. Biomolecules. 2020; 10(8):1181. https://doi.org/10.3390/biom10081181

2. Sánchez-Pérez S, Comas-Basté O, Veciana-Nogués MT, Latorre-Moratalla ML, Vidal-Carou MC. Low-Histamine Diets: Is the Exclusion of Foods Justified by Their Histamine Content? Nutrients. 2021; 13(5):1395. https://doi.org/10.3390/nu13051395

3. Son JH, Chung BY, Kim HO, Park CW. A Histamine-Free Diet Is Helpful for Treatment of Adult Patients with Chronic Spontaneous Urticaria. Ann Dermatol. 2018 Apr;30(2):164-172. https://doi.org/10.5021/ad.2018.30.2.164

4. Chung BY, Park SY, Byun YS, Son JH, Choi YW, Cho YS, Kim HO, Park CW. Effect of Different Cooking Methods on Histamine Levels in Selected Foods. Ann Dermatol. 2017 Dec;29(6):706-714. https://doi.org/10.5021/ad.2017.29.6.706