A Primer on Histamine Intolerance

What is Histamine?

Histamine is a compound which is released by some types of immune cells in response to injury, allergic triggers and inflammatory reactions. Histamine is an important chemical that has a role in a number of different bodily processes. It stimulates gastric acid secretion, plays a role in inflammation, dilates blood vessels, affects muscle contractions in the intestines and lungs, and affects your heart rate. It also helps transmit messages between nerve cells and helps fluids move through blood vessel walls. Histamine is also released if your body encounters a threat from an allergen. During an allergic reaction, histamine causes vessels to swell and dilate, leading to symptoms like congestion, hives or anaphylaxis.

Histamine occurs naturally in some foods. Bacteria are also capable of producing histamine. Fermented foods and beverages (and left-overs) naturally contain small quantities of histamine due to fermenting bacteria or yeasts.

What is Histamine Intolerance?

Histamine intolerance is a disorder associated with an impaired ability to metabolize ingested histamine. In a healthy person, ingested histamine is broken down by two enzymes: DAO and HNMT. When one of these enzymes is not working correctly, histamine intolerance can occur. Histamine intolerance is not a sensitivity to histamine, but an indication that you have developed too much of it.

Symptoms of Histamine Intolerance:

When histamine build-up occurs, a variety of symptoms may be present:

• Skin: redness, rash, hives, itching, swelling and local inflammation

• Respiratory System: runny nose, congestion, shortness of breath and sneezing

• Gastrointestinal Tract: nausea, vomiting, cramping, bloating and diarrhea

• Circulatory System: low blood pressure and heart racing

• Neurological System: headache, palpitations and tingling

Main symptoms of histamine intolerance and possibly corresponding histamine receptors. Biomolecules. 2020 Aug; 10(8): 1181.

Causes of Histamine Intolerance:

Low levels of the DAO enzyme may be due to genetic predisposition or illness. DAO activity can also be blocked by certain medications and alcohol consumption.

DAO is made in the intestines. If the intestines are not healthy, there may not be enough DAO to break down histamine normally. Low DAO levels may explain why histamine intolerance symptoms are more common in people with gastrointestinal disorders such as inflammatory bowel disease, IBS, celiac disease, and small intestinal bacterial overgrowth (SIBO).

How to Diagnosis Histamine Intolerance:

Currently there are no tests that can confirm a diagnosis of histamine intolerance. Blood work, review of your medication use and allergy testing is recommended to rule out other causes of histamine symptoms. After a thorough evaluation, a trial of a low histamine diet is recommended. If typical symptoms of histamine intolerance improve after following of a low-histamine diet, a diagnosis of histamine intolerance is confirmed.

Treatment of Histamine Intolerance:

Histamine intolerance requires a whole-body approach to healing. Addressing underlying health issues and optimizing gut health are necessary.

• Diet: A low histamine diet is the treatment of choice. The tolerance to dietary histamine varies from person to person and the foods tolerated must be deduced by trial and error. Some people can only tolerate very small amounts of histamine rich foods, while others can be more liberal. An elimination diet for 3-4 weeks followed by careful reintroduction of foods is helpful. Following a low histamine diet can be challenging if you already have a restrictive diet. It is recommend that you work with a knowledgable health care provider to minimize your risk of nutritional deficiencies.

• Medications: Antihistamines or oral/topical steroids may be helpful for severe systemic symptoms.

• Supplements: There is little to no data on these, but the following are sometimes used: Vit C, probiotics, quercetin, N-acetyl cysteine, and DAO enzymes. Please use any supplement under the guidance of a practitioner.

• The basics: Sleep, stress management, and regular exercise are important parts of healing.

High Histamine Foods:

There are many lists available online to identify high histamine foods. The “Food Intolerance” app may also helpful.

Foods that may trigger the release of histamine:

• Most citrus fruits

• Cocoa and chocolate

• Tomatoes

• Egg whites

• Fish

• Peanuts

Foods that may interfere with DAO levels:

• Alcohol

• Energy drinks

• Green, black or maté tea

Some foods and drinks that are rich in histamine:

• Alcohol

• Aged cheeses

• Canned, pickled, and fermented foods, such as sauerkraut

• Smoked products, such as sausage, ham, bacon, or salami

• Spinach

• Eggplant

• Ketchup

• Vinegar

• Canned fish, such as mackerel and tuna

Curious whether you may have a histamine intolerance?

References:

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 Aug 14;10(8):1181. doi: 10.3390/biom10081181. PMID: 32824107; PMCID: PMC7463562.

Which foods are high in histamine? Medical News Today. Accessed 11/9/2022.

Homemade Coconut Yogurt

Homemade 2-ingredient Coconut Yogurt

Probiotics are all the rage in the wellness community. And for good reason, there is very interesting science about their effectiveness. Probiotics, however, are nothing new. Our grandparents and great-grandparents enjoyed them regularly as part of a common, non-industrialized diet. Making foods like yogurt and sauerkraut were simply tasty ways to preserve food. 

I recommend getting as many nutrients as possible through food, even probiotics. Yogurt is found in nearly every grocery, but few people realize how easy it is to make at home. Often the commercially available products include sugar and stabilizers that can be avoided with this DIY approach. Not everyone tolerates cow’s milk, so I’ve written a recipe below for a coconut milk alternative that I make at home.

Enjoy!

Coconut Yogurt

Ingredients:

• 1 can full fat coconut milk (Choose a brand without fillers or stabilizers in a BPA-free can.)

• 1 probiotic capsule containing lactobacillus OR ¼ cup of a prior batch of yogurt (store bought or homemade)

• 1 sterilized glass jar (I use a Ball jar that I first run through the dishwasher to sterilize.)

Directions:

1. Add the coconut milk and probiotic (or yogurt) to the clean glass jar. Stir to combine.

2. Loosely cover the jar with the lid and place the jar in the oven near the oven light. 

3. Turn on the oven light and let the jar sit overnight, but do not turn the oven on. The very low heat from the lamp is all that is necessary.

4. In the morning stir the coconut yogurt as separation is natural. Place the yogurt in the refrigerator to firm. Stir again just before using. 

Notes:

• Be sure to start with clean utensils and hands. 

• Choose a probiotic that includes lactobacillus somewhere in the range of 10-50 billion CFU. You do not want it to contain prebiotics. I use whatever I have on hand, but these are examples: Flora Advanced Adult Formula, Renew life Ultra Flora, Jarrow probiotic.

• The yogurt should have a sweet tangy smell. If it smells off or you see colored bacteria or mold on the surface, then discard it. 

• Low fat coconut can be used, however the consistency will be thin and pourable like kefir.

Check out these additional probiotic foods.

Should you be taking a probiotic?

(This blog post is not sponsored by any manufacturer. However, Relish Health may receive a commission on purchases made through an Amazon link.)

10 Tips for Starting a Plant-Based Diet

Have you made a resolution to make changes for a healthier 2020? I know many people kickstarted the year with a "cleanse" or a specific or restrictive diet. However, a healthier year usually takes a longer-term approach. I recommend setting goals that move your eating in the right direction in realistic and sustainable ways. My one size fits all advice is to simply eat more plants. Whether you are interested in a vegetarian or plant-based diet or simply adding more vegetables to your diet these strategies may be helpful. 

1. Build every meal around a star vegetable, instead of a meat or carbohydrate. How about a roasted cauliflower, veggie tagine or meaty grilled portobella mushroom with romesco sauce?

2. Embrace the 4S's. Soups, salads, smoothies and stir fries are great ways to add more veggies to our meals. 

3. Use the flavor and health benefits of herbs and spices to transform meals from bland to exciting. This Moroccan lentil soup is deliciously spiced with anti-inflammatory turmeric, ginger and cinnamon.

4. Use different cooking techniques to bring out different flavors—for example, roasting a vegetable can bring out sweetness; grilling a vegetable can bring out the smokiness. Check out this roasting guide for perfect veggies every time.

5. Use a variety of textures—build an interesting and satisfying meal by layering different textures, such as crunchy nuts and seeds, chewy shiitake bacon, or silky smooth cashew cream.

6. Add sauce- Pesto, romesco and salsa verde are some of my favorites. They are a great way to add flavor and a few more veggies to your plate.

7. Make cashew cream— many people miss the creaminess associated with dairy products when they transition to a dairy-free or plant-based diet.  Raw cashews, soaked and then puréed, make a great substitute for cream. Add a splash of lemon juice and a pinch of salt for a sour cream like flavor.

8. Caramelize or pickle onions—these make an excellent flavor addition to almost any food and keep well in the fridge for a quick way to elevate a meal.

9. Embrace fermented foods. Sauerkraut, coconut yogurt, kimchee and miso are few of the probiotic rich foods that are easily found in most groceries. They add a punch of flavor while benefiting your gut health. 

10. Make your food beautiful— Embrace the wide variety of colorful fruits and veggies available at the grocery. We also eat with our eyes, so paying attention to presentation makes your food more satisfying. Fruits and vegetables are naturally beautiful.

Here’s to healthy year. Cheers!

Natural Allergy Relief

Spring has finally arrived in the Midwest. Seasonal allergies are a common complaint that affects an estimated 50 million people in the US. Symptoms can vary, but runny nose, itchy, watery eyes, sneezing, headaches and fatigue are commonly described and can impact your quality of life. 

Conventional treatment for allergies includes antihistamine medication and nasal sprays. These medications can offer symptomatic relief, but they do not solve the problem. They can can also come with unpleasant side effects like drowsiness and nausea; or in the case of nasal sprays, dependence. 

Allergic reactions occur when your immune system identifies a normally harmless substance as dangerous. In sensitized individuals, allergens in our environment such as pollen, trigger the production of IgE antibodies. These immune molecules cause release histamine and other allergy-mediating molecules, which lead to inflammation of the nasal airways and eyes, itching, swelling and mucus production. 

Common allergy symptoms include:

• Congestion

• Excess mucus production

• Sneezing

• Runny nose

• Itchy, watery eyes

• Scratchy throat

• Irritation in the ears

• Difficulty sleeping

• Irritability

• Hives

At Relish Health I approach allergies from a holistic perspective. There are a number of natural solutions to quiet symptoms and support your immune system through lifestyle, diet, gut health and inflammation control. Consider these strategies:

1. Get your diet on point

• Diet has a direct effect on immune system function. Nearly 2/3rd of our immune cells reside in our gut. Diet can directly affect the level of inflammation and histamine in our body. Oftentimes, allergic responses are exacerbated when our body is overloaded with triggers. Diet is an obvious place to start decreasing that burden.

• Eat as clean as possible. This means removing foods that are refined, processed or high in sugar. Choose organic where you can to reduce pesticide exposure.

• Based your diet on anti-inflammatory foods. This means eating a diet rich in fruits and veggies that provide fiber and antioxidants. These foods benefits our gut and immune function. Find dietary sources of omega-3 fatty acids such as wild-caught salmon, flaxseed, or chia seed. Use herbs and spices liberally, since their content of anti-inflammatory compounds is especially dense.

• Add fermented foods like sauerkraut or kimchi to your diet for a natural dose of probiotic.

• Try an elimination diet. Dairy foods are mucus-producing for many people and can make allergy season that much worse. To decrease congestion, consider a full elimination of all dairy foods (including milk, cream, cheese, yogurt, etc.) for 30 days. Notice if any of your symptoms improve over that elimination period. After the 30 days, you can reintroduce it to see how dairy affects you.

• Stay hydrated. You should aim to consume about half your body weight (lbs) in fluid ounces, spread throughout the day. Proper hydration reduces the histamine response.

• Address potential food sensitivities.

• Familiarize yourself with foods that trigger oral allergy symptoms due to cross-reactivity with pollen from birch, ragweed, or grasses.

Need help with addressing your diet and gut health, schedule an appointment with Relish Health. 

2. Reduce your exposure to allergens

• You may have an urge to limit your time outdoors in order to find relief from your season allergies, but this is not a realistic, long-term solution.

• Use a neti pot: By flushing the nasal cavity with a gently warmed saline solution, you clear out allergens and loosen mucus. You can use a neti pot two to three times a week.

• Create a safe space: During periods of peak symptoms, keep the doors and windows of your home closed. Use an air conditioner and/or high-quality air filter to help reduce allergens in your home.

• Wash off: Showering before bed to remove allergens from your hair and skin can help reduce contamination of the bedding.

3. Have your vitamin D level checked

• Low vitamin D levels are associated with an increase in allergies. Consider taking a high-quality vitamin D supplement and increasing your exposure to sunlight to help decrease symptoms such as sneezing and nasal congestion. Vitamin D3 has been shown to naturally support immune system function, and strengthen respiratory health.

4. Add natural support

• There are a number of natural compounds in foods and herbs that can provide seasonal allergy symptom relief, including nettles, quercetin, bee pollen and honey.

• Nettles: The stinging nettle plant has been used for centuries to treat allergy symptoms. Nettle’s may reduce the amount of histamine that is produced by the body in response to an allergen. You can consume nettle as a tea or take it as a tincture.

• Quercetin: Quercetin is a flavonoid found in foods such as apples, broccoli, citrus, fennel and red onion. It’s also a natural antihistamine that works without the side effects of many medications. Start using quercetin regularly as soon as seasonal allergies hits in order to build up levels in the body and then continuing throughout the allergy season.

• Local bee pollen and raw honey: You can find bee pollen and raw honey at your local farmers market or health food store. Bee pollen has been shown to decrease the IgE mediated activation of mast cells, thereby dampening the allergic response. Local, raw honey acts similarly to a vaccine. By giving yourself a little dose of the local pollen through the honey, you allow your body to begin building a tolerance to the pollen and have a less severe allergic response. It’s best to start taking either honey or bee pollen daily at least six weeks before allergy season begins.

(Access to high quality nettle and quercetin products is available through the Relish Health online pharmacy.)

If your symptoms do not resolve with these strategies, there be more underlying factors at work. Schedule time with Relish Health, an allergist or your PCP for assistance. Targeted evaluation of nutritional and metabolic status through lab work and desensitization techniques can provide further options. 

FOODS TO AVOID IN ALLERGY SEASON

Natural Foods for Gut Health

It is true that we are what we eat, but it is more accurate to say that we are what we absorb. Our overall health is intimately tied to the health of our digestive system. Our digestive system is a complex organ that contains trillions of bacteria. This bacterial community, called the microbiome, is responsible for helping absorb our nutrients, manufacture some of our vitamins and help regulate our immune system. Keeping this bacterial community happy, healthy and diverse is vitally important for ensuring proper absorption and optimal health.

Fermented foods have been a part of cultures for thousands of years. Historically, fermentation was a way to preserve food, but as we are now learning, it is also a way to ensure a healthy microbiome. Fermented foods include live cultures that make them natural probiotics and aid our digestive and immune systems. Modern practices like refrigeration and pasteurization have made these traditional foods less common in our culture today. Reintroducing these delicious and natural solutions can help give your gut a health boost.

Try some of these favorites:

1. Kefir is a fermented dairy drink similar to yogurt. The term originated in Russia and Turkey and is translated to mean “feels good.” It has a mildly acidic, tart flavor and contains many more strains as well as higher levels of beneficial bacteria than standard yogurt. When purchasing, choose kefir with minimal amounts of added sugar. Enjoy as a drink, in a smoothie, or with granola.

2. Sauerkraut is made from fermented cabbage and other vegetables. Artisanal varieties are often flavored with beets, apples or carrots. Sauerkraut is fermented by wild strains of the beneficial bacteria, lactobacillus. It has a pleasant sour flavor that is excellent as a condiment for entrées, salads and savory toasts. When purchasing, be sure to find the product in the refrigerated section of the grocery. (The other version on the aisle shelves has been pasteurized and no longer contains the desired beneficial bacteria.) Sauerkraut can be made easily at home. 

3. Kimchi is similar to sauerkraut, but is often made with napa cabbage and radishes. It is Korean in origin and is often spicy.

4. Kombucha is made from fermented sweet tea and is thought to originate from Japan. Kombucha is made by adding a symbiotic colony of bacteria and yeast (SCOBY) into tea and allowing the tea to ferment for a few days to a week. The resulting product is effervescent and has a tangy flavor.

5. Coconut kefir is made by fermenting the water of young coconuts in a similar manner to making dairy kefir. It is not as high in probiotics as its dairy cousin, but it is very refreshing.

6. Yogurt can be an excellent probiotic food, but only if chosen wisely. Many commercially available yogurts can contain high amounts of added sugar and dyes. The quality of dairy is important to consider.

7. Raw apple cider vinegar contains the acetobacter that is responsible for making the acetic acid that gives vinegar its characteristic flavor. Research has demonstrated that apple cider vinegar can help control blood pressure, cholesterol and blood sugar. Enjoy raw apple cider vinegar in salad dressings or as a diluted beverage.

8. Miso is a traditional Japanese product. It is created by fermenting soy beans or chickpeas with a yeast called koji. Miso can be made into a soup but is also delicious enjoyed as a condiment in salad dressings, sauces or marinades.

9. Pickles made by fermenting cucumbers with salt and water are also a source of beneficial lactobacillus. They are low in calories, but eat in moderation as they may contain a fair amount of salt. Make them at home or find in a specialty grocery in the refrigerated section. (The other pickles located in the aisle shelves are made with vinegar and do not contain the necessary live cultures.) 

HOMEMADE SAUERKRAUT