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A Primer on Histamine Intolerance
Histamine intolerance is the overproduction of histamine in the body or the inability to break it down. The ingestion of histamine-rich food, alcohol, or drugs that release histamine may trigger diarrhea, headache, runny nose, blood pressure changes, hives, flushing, and other conditions in patients with 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.
Think you know dairy?
Food is not always what it seems, and this is especially true with dairy. For example, major businesses rely on customers continuing to drink milk even though the science of its nutritional value does not support its reported value to your body. In fact, contrary to the “three servings-a-day” marketing campaign, or what your grandmother tells you, dairy is not crucial for good health, nor is it the best source of Vitamin D and calcium. While it may be delicious and may have a continued place at our dinner table, the facts suggest that we should be aware of our quantity consumed and the risk we are placing on our health.
Almond milk recipe
Food is not always what it seems, and this is especially true with dairy. For example, major businesses rely on customers continuing to drink milk even though the science of its nutritional value does not support its reported value to your body. In fact, contrary to the “three servings-a-day” marketing campaign, or what your grandmother tells you, dairy is not crucial for good health, nor is it the best source of Vitamin D and calcium. While it may be delicious and may have a continued place at our dinner table, the facts suggest that we should be aware of our quantity consumed and the risk we are placing on our health.
Consider the following:
Not everyone can stomach dairy. About two thirds of the world’s population is genetically unable to properly digest milk and other dairy products in adulthood — a problem called lactose intolerance. Yes, 67% of the world’s population cannot drink it, but somehow most Americans believe it’s necessary. Also, dairy has been shown to aggravate irritable bowel syndrome.
Dairy doesn’t reduce bone fractures. Contrary to popular belief, eating dairy products has never been shown to strengthen our bones. In fact, according to the Nurses’ Health Study, dairy may increase risk of fractures. Vitamin D appears to be much more important than calcium in preventing fractures. For healthy bones, get plenty of exercise and supplement with an adequate amount of vitamin D3 daily.
Calcium from dairy may elevate cancer risk. Research shows that higher intakes of both calcium and dairy products may increase a man’s risk of prostate cancer and a woman’s risk of ovarian cancer. In addition, dairy consumption increases the body’s level of insulin-like growth factor-1 (IGF-1) — a known cancer promoter. Most scientists agree that it’s better for us to get calcium from other food sources, like dark green leafy vegetables, sesame tahini, sea vegetables, and sardines or canned salmon.
Dairy is a common food sensitivity. Different than an allergy or lactose intolerance, dairy sensitivity may be triggered simply by your body's difficulty in digesting it. Symptoms of sensitivity can range widely and include bloating, congestion, migraines or even joint pain.
Want to try an experiment on yourself? Try giving up dairy for three weeks. This means avoiding milk, cheese, ice cream and yogurt. See how it makes you feel. You may notice improvements in your energy, bowel symptoms, sinus congestion and weight. After three weeks start eating dairy again in moderation and see how you feel. If we know how our bodies react to food, we are taking the first steps to a healthier and longer life.
Need help sorting out if dairy is affecting your wellness? Come see me at Relish Health and let’s work on it together.