Are you suffering from ongoing gastrointestinal symptoms? Do certain foods seem to trigger these symptoms? Are you experiencing unexplained headaches, anxiety, or irritability? Do you ever feel itchy or break out in hives for no apparent reason?
If you answered yes to any of these questions, you might be experiencing histamine intolerance.
This guide will help you understand the basics of histamine intolerance, how to start a low-histamine diet to manage your symptoms, and histamine intolerance mimickers.
Table of Contents
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What is Histamine?
Histamine is a neurotransmitter and an essential bioactive compound. It plays a crucial role in the optimal function of many body systems, including the immune, respiratory, cardiovascular, digestive, and central nervous systems.
Histamine promotes alertness, increases blood flow, triggers gastric acid production, and is involved in muscle contraction, brain function, and healing during inflammation and stress.
Additionally, histamine is important in allergic reactions as it releases inflammatory mediators in response to allergens. For symptom relief from seasonal allergies, you may consider over-the-counter antihistamine medications.
While histamine is the first line of defence released during inflammation, excessive levels can lead to symptoms resembling allergic reactions.
What is Histamine Intolerance?
Histamine intolerance is characterized by the accumulation of histamine to a point that exceeds the body's capacity to eliminate it.
Where is Histamine Stored in the Body?
Mast Cells: a type of white blood that resides in the various tissues of your body, such as connective tissues, close to blood and lymph vessels, nerves, lungs, and gastrointestinal tract. They are also found in smaller quantities in the heart and brain.
Mast cells play a crucial role in protecting the body from foreign invaders by releasing histamine. However, they can become overactive, leading to reactions to harmless environmental factors like seasonal allergies.
Basophils: a white blood cell that defends and protects your body from allergens, pathogens and parasites. Basophils circulate the bloodstream, and when stimulated, they degrade to release histamine during an allergic reaction or asthma attack.
What Leads to Histamine Intolerance in an Individual?
Individuals can develop histamine intolerance if their bodies do not produce enough of the enzymes Histamine N-methyltransferase (HMT) or Diamine Oxidase (DAO).
HMT is influenced by genetics and is produced inside the cells to help break down histamine.
On the other hand, DAO is produced in the intestines and is responsible for breaking down histamine from food. Damage to the intestines can lead to reduced DAO production and increased histamine levels.
Multiple factors contribute to the accumulation of histamine in the body, beyond diet:
Genetics: Some individuals have DNA differences that prevent them from breaking down histamine levels properly.
Gastrointestinal disorders: Inflammatory bowel disease (IBD), Small Intestinal Bacterial Overgrowth (SIBO), intestinal permeability, non-celiac gluten sensitivity, parasitic infections and other conditions affecting the gut microbiome.
Infectious and autoimmune diseases: Individuals with infectious and autoimmune diseases have a reduced threshold for histamine.
Hormonal Changes: Particularly in women during different stages of the menstrual cycle and menopause.
Medications: Certain medications, including antidepressants, antiarrhythmics, antihypertensives, muscle relaxants, narcotics, non-steroidal anti-inflammatory drugs, proton-pump inhibitors, antibiotics, histamine (H2) blockers, diuretics and even excessive supplementation with vitamin C and thiamine, can interfere with or inhibit the body’s ability to break down histamine.
DAO-Blocking Beverages: Alcohol, especially wine and spirits, can increase the release of endogenous histamine and inhibit the action of diamine oxidase.
Malnutrition and dietary Deficiencies: Prolonged and unsupervised restrictive diets can result in malnutrition, leading to a deficiency of enzyme cofactors such as vitamin C, copper, and vitamin B6. This deficiency can lead to histamine accumulation and intolerance.
Mast Cell Activation (MCAS): A condition where the mast cells in your body become overactive and release excessive amounts of histamine and other chemicals in response to what they incorrectly perceive as threats.
Allergies (IgE-mediated reactions): Individuals with allergies like pollen or certain foods are at higher risk of developing histamine sensitivity.
Symptoms of Histamine Intolerance
Histamine intolerance occurs when the body has trouble breaking down histamine, causing an excess buildup of histamine. This can mimic the symptoms of common seasonal allergies, making it challenging to diagnose.
Here are the most common symptoms of histamine intolerance, listed from most to least frequent.
Gastrointestinal issues: Bloating, constipation, early satiety, abdominal discomfort/pain, gas, diarrhea, nausea, or vomiting.
Respiratory: Nasal congestion, sneezing or wheezing.
Skin: Itching, rashes, hives, flushing, urticaria, and dermatitis.
Mood changes: Anxiety, irritability.
Cardiovascular: Arrhythmia or accelerated heart rate, chest pain, low blood pressure.
Neurological: Headaches, migraines, dizziness, confusion, brief loss of consciousness, sleep disturbances, chronic fatigue, difficulty regulating body temperature.
Reproductive: Abnormal and painful menstrual cycle.
What is a low histamine diet?
A low-histamine diet means eating foods with small amounts of histamine and avoiding high-histamine foods. It also means avoiding foods that can release histamine or inhibit the enzyme diamine oxidase from breaking down histamine in the body.
Following a low-histamine diet for up to two to four weeks can help you identify potential triggers. Your symptoms may vary from season to season.
For instance, eating fresh tomatoes and strawberries may worsen your symptoms if you are allergic to pollen during the springtime. However, if you eat those same foods during the winter, you may not experience any symptoms at all.
Similarly, eating pepperoni pizza with wine or beer while eating out with friends increases the chances of accumulating more histamine than your body can degrade.
Remember: Some people will not achieve relief by diet alone because even by excluding all of the histamine-rich foods, their total level of histamine still exceeds their enzymes’ capacity to break it down. Vicherstaff Joneja, J - 2013
Here is a list of high-histamine, histamine-releasing, and low-histamine foods.
High Histamine Foods
Various foods naturally contain histamine, trigger the release of histamine, or block the production of the enzyme DAO. It’s best to determine the root cause of your symptoms before embarking on a restrictive diet.
Citrus fruits, tree fruits, fermented dairy products, fermented foods, beverages, and processed meats all consistently contain high levels of histamine. Peeled, packaged fruits, salads, and vegetables often have a higher histamine content than fresh options.
High histamine animal products
Processed, smoked, and fermented meats: bacon, salami, pepperoni, luncheon meats, hot dogs, smoked ham and cured meats.
Fermented dairy containing bacterial cultures: Aged cheeses, goat cheese, processed cheese and spreads, cottage cheese, yogurt, buttermilk, and kefir.
Seafood: Smoked fish and certain species of fish, including mackerel, mahi-mahi, tuna, anchovies, and sardines.
Leftovers: Bacteria will quickly act on cooked protein-based foods if kept at room and fridge temperatures, resulting in excess histamine production.
High histamine beverages, food additives and seasonings
Alcoholic beverages: Spirits, beer and wine.
Food additives: Tartrazin (used in candy, cube soups, doritos, nachos.
Preservatives: Benzoates and sulfites (often used in vitamin supplements)
Seasonings: Chili powder, cinnamon, cloves, curry powder, nutmeg, thyme, vinegar.
High histamine miscellaneous foods
Fermented soy products: Soy sauce, miso, tamari sauce, tempeh.
Fermented foods: Sauerkraut
Chocolate, cocoa, and cola drinks
Tea: Regular or green
Histamine-Releasing Foods
The following foods are not inherently high in histamine but can trigger your cells to release more histamine.
Alcohol
Artificial preservatives and dyes
Bananas
Chocolate
Food containing dairy (cow’s milk)
Nuts
Papaya
Pineapple
Shellfish
Egg whites (although small amounts in baked goods should be safe)
Wheat germ
Low Histamine Foods
Always prioritize freshness when following a low-histamine diet. Foods high in protein, such as raw or cooked chicken, meat, and fish, can develop higher histamine levels the longer they are stored. It's crucial to consume your cooked meal immediately.
Fresh Meat: Chicken, turkey, and beef.
Dairy: fresh milk, cream cheese, fresh mozzarella cheese (not pre-shredded).
Fresh Fish: freshly caught cod, trout, salmon, cod or sole.
Non-Citrus Fruits: Apples, blueberries, pears and melons.
Vegetables: Cauliflower, zucchini, carrots and sweet potatoes.
Legumes: lentils and chickpeas
Non-fermented Soy products: fresh tofu, edamame
Gluten-Free Grains: Rice, quinoa.
Dairy Alternatives: Coconut milk, almond milk.
Beverages: Herbal teas like chamomile and peppermint, and water.
Seasonings: Fresh herbs like basil, parsley, and cilantro.
Non-fermented bread: Freshly baked bread without yeast or sourdough.
Leftovers: Freshly cooked meals, consumed immediately or frozen promptly.
Is there a connection between histamine Intolerance and autoimmune diseases?
Mast cells are distributed throughout our bodies, particularly near blood vessels and nerves. They are most well-known for their role in IgE-mediated allergic disorders.
Mast cell activation is prevalent in long-COVID, suggesting a potential role in triggering autoimmune flare-ups. Further research is necessary, encompassing various types of autoimmune diseases.
Among all the inflammatory autoimmune rheumatic diseases, Sjogren's Disease seems to involve an accumulation of mast cells in the salivary glands and lungs, contributing to the development of sialadenitis and interstitial lung disease compared to healthy individuals.
The excessive presence of mast cells in individuals with Sjogren's Disease may lead to increased release of pro-inflammatory cytokines. It may even play a role in the development of the disease.
Final thoughts
Histamine intolerance is a complex condition, and research is ongoing to understand the various factors contributing to symptoms. Since there are no validated objective diagnostic tests, diagnosis is mostly based on clinical evaluation.
It's essential to assess the primary causes of histamine accumulation, including allergies, medications, diseases, uncontrolled inflammatory disease, and DAO deficiency.
Typically, starting with a low-histamine diet can provide relief, and it's important to consult your healthcare provider about the use of supplements and medications.
More extensive intervention studies are needed to evaluate both dietary and drug-based therapies.
I want to express my gratitude to Larissa Siravo, a future registered dietitian, for her help with the research and writing of this post.
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