Constantly experiencing problems like allergies, headaches, fatigue, itchy skin and rashes, or runny nose even though you are eating a healthy, real foods diet? The problem might be histamine intolerance, a condition which affects about 1% of Americans. (source) Really, probably even more people are suffering from histamine intolerance since the problem is so under-reported.
Histamine intolerance is something which I have personally been battling with and i mentioned in my Confessions of a Paleo Blogger post. Even after making a lot of changes to my life and diet, and experiencing amazing benefits, I am still far from “fixed”. I’ll always be a work in progress.
Unlike with food allergies, histamine intolerance is not a sudden release of histamine. I like how Chris Kresser compares histamine intolerance to a glass of water overflowing.
When the cup is very full (high amounts of histamine in the diet), even a drop of additional water will cause the cup to overflow (symptoms activated). But when the cup is less full, it would take more water (histamine) to cause a response.
This is what makes histamine intolerance so difficult to diagnose. One day, you might be fine eating a certain food even though the histamine is gradually filling up your cup. But the next day, that food is the “additional drop of water” which overflows the cup, causing anabolic shock that sends you to the emergency room (ask me how I know!).
What is Histamine?
We normally think of histamine as the chemical our bodies release during allergic reactions. Yes, this is one of the roles of histamines. But histamines also play many other important roles in our bodies. In addition to fighting off foreign invaders (even when they are really harmless invaders like with mild allergic reactions), histamine also acts as a neurotransmitter and regulates stomach acid production, muscle contractions, brain function, sleep, and more. Histamine even helps produce orgasms! (source 1, source 2
Histamine is mostly found in the skin, eyes, and stomach, hence why histamine is associated with problems like rash, watery eyes, and indigestion. Histamine is also found throughout the rest of the body too though, so it can cause a wide array of symptoms.
The body produces histamine from basophils (a type of white blood cell) and mast cells (a connective tissue cell). Histamine is then stored it in white blood cells which circulate through the body and are activated if needed. Histamine is found in many foods as well. The body also produces some histamine to digest food. “Normal” levels of histamine are about 0.3 to 1.0 nanograms per milliliter in blood plasma. Everyone has different tolerances for histamine though.
What Causes Histamine Intolerance
Histamine intolerance is caused when the body has more histamine than it can break down. Normally, the body is able to break down histamine using amine oxidases enzymes. Diamine oxidase (DAO) is the main enzyme in charge of breaking down histamine from food. If you consume too much histamine, your body might not be able to handle the histamine load. Or, if your amine DAO enzymes aren’t functioning properly, then you might not be able to handle even a little bit of histamine from food. (source)
What causes your amine oxidase enzymes to become impaired? Researchers still aren’t exactly sure but many believe that the problem lies in the gut. If your digestive system isn’t functioning properly, you will have a lot of undigested food in the gut. Bacteria then work on this food, producing histamine. (source) Certain antidepressant drugs called monoamine inhibitors (MAOS) are also to blame because they block amine oxidase enzymes and prevent histamine breakdown. People taking these drugs had all sorts of allergy-like symptoms. This is partly how researchers finally caught on to the problem of histamine intolerance.
Symptoms of Histamine Intolerance
Diagnosing histamine intolerance based on symptoms alone is really difficult. Almost all of the symptoms which are associated with histamine intolerance could also be associated with some other condition as well. In fact, if you go to a doctor with these symptoms, you will probably end up getting treatment for the symptoms or some other common ailment and not the underlying problem.
For example, if histamine intolerance is causing acid reflux, you might get proton pump inhibitors. (Learn why proton pump inhibitors are NOT the best way to treat reflux in The 30 Day Heartburn Solution) This is only compounded by the fact that few doctors and nutritionists are even aware that histamine intolerance exists.
The most common symptoms associated with histamine intolerance are:
- Skin problems like itchiness, rashes, and hives
- Swelling and inflammation
- Low blood pressure
- Fast heart rate
- Anxiety and panic-like symptoms
- Runny nose and congestion (which can lead to decongestant addiction like yours truly used to suffer with)
- Watery, red eyes
- Headaches and migraines
- Fatigue and lethargy, bad mood
- Digestive problems like upset stomach and reflux
Foods which Contain Histamine
Some foods contain histamine. Other foods obtain histamine from bacteria which feed on it and produce histamine in the process. That is why it is important to store your meat properly. But even healthy bacteria produces histamine like traditionally fermented sauerkraut, pickles and kombucha.
Certain strains of probiotics can also worsen the problem. Prescript Assist is one brand of probiotics which is okay for most people with histamine intolerance and is the brand I take. Other foods have low levels of histamine, but trigger the body to release histamine from mast cells.
The list of foods which contain histamine is really long. Quite frankly, it can be downright overwhelming. To make matters worse, good luck finding two lists of histamine foods which actually match! For example, some lists will say that citrus fruits are a no-go, whereas others say they are okay. The reason for this discrepancy in histamine food lists is because everyone reacts to histamine in foods differently. Some people don’t have problems with citrus fruits but fermented foods might cause serious problems. (source)
Unfortunately, customizing your list of yes/no foods will require some trial and error and some time and patience.
Foods Rich in Histamine
- Alcohol (red wine is the worst offender)
- Other fermented beverages (yep, unfortunately this includes kombucha!)
- Fermented vegetables (pickles, sauerkraut, etc)
- Most cheese
- Vinegar (although Apple Cider Vinegar seems to be less problematic)
- Processed meats like bologna and salami and, sadly, bacon
- Nightshade vegetables (tomatoes, eggplants, etc)
- Some spices (cinnamon, anise, chili, nutmeg, curry, cayenne, cloves)
- Leftover meat (because bacteria growing on it produces histamine; eat your meat as fresh as possible and store it carefully!)
Foods which Trigger Histamine Release
- Alcohol and other fermented beverages like kombucha
- Citrus fruits
- Dairy products
- Wheat germ
- Artificial dyes and preservatives
Foods which Block DAO
- Alcohol and other fermented beverages
- Tea (mainly green and black tea)
- Sugary soft drinks
How to Treat Histamine Intolerance
The good news is that you don’t have to suffer from histamine intolerance symptoms forever! The bad news is that it can be a bit tricky to diagnose histamine intolerance and you will have to be very careful about your diet for a period of time if you want to keep symptoms at bay.
Low Histamine Diet
The easiest method for diagnosing and treating histamine intolerance is to put yourself on a rigid low-histamine diet. You will need to avoid ALL foods which contain histamine, cause histamine to be released, or inhibit DAO. If your symptoms go away while on this strict diet, then you likely have histamine intolerance. Since everyone has different tolerances to histamine, you can gradually introduce one food at a time back into your diet and see how you feel.
If you can tolerate small amounts of histamine, then you might still be able to eat foods like citrus, spinach, and nuts. Be warned though that histamine builds up in the body over time, so you might want to also take steps to improve your DAO activity so it can break down histamine better. This requires gut healing. Even if you don’t tolerate large amounts of gut healing foods like bone broth and gelatin, consuming an anti-inflammatory paleo diet and incorporating even small amounts of broth and gelatin can help heal your gut over time.
If bone broth and gelatin are well tolerated, I recommend you read The Gelatin Secret to learn more about how these healing foods can help you heal your gut and ways to incorporate them into every meal.
Another Rabbit Hole…. the SIBO link
As with all complex health situations, histamine intolerance has several other components is closely linked to SIBO (small intestine bacterial overgrowth). Since gut bacteria producing histamine might be one of the causes of histamine intolerance, curing SIBO could cure your histamine intolerance. (source) You can take a breath test for SIBO thru Commonwealth Labs thru your health care practitioner. This is the test I took which confirmed my case of SIBO.
If you do indeed have SIBO you’ll need to switch up your diet yet again or perhaps restrict it even further combining a specific carbohydrate diet with a low histamine diet while also treating your SIBO with either antibiotics or other more natural remedies. You can also use detox protocols like dry brushing, oil pulling, and clay baths.
Improve DAO Activity
The nutrients B6, copper, and vitamin C can all help improve DAO activity, thus helping your body break down histamine better. Some supplements that I have found especially helpful are:
- Nigella Sativa Oil, especially if you’re dealing with congestion
- DAO enzymes
- Ubiquinol CoQ10
Please consult your healthcare practitioner to determine which supplements and doses are the best for you.
You will also need to work on healing your gut. A healthy gut is better able to produce DAO to flush histamine out of the body. Read on for more about gut healing and histamine intolerance.
The Catch 22 of Gut Healing with Histamine Intolerance
Histamine intolerance is ultimately a gut problem. If your gut is damaged, it won’t be able to produce the DAO needed to flush histamine out of the body. Since digestion itself releases some histamine, then even adhering to the strictest low-histamine diet won’t solve all of your problems. You’ve got to heal your gut!
Here is the Catch 22: A lot of gut-healing foods are also histamine foods. Kombucha is the big one but people with severe histamine intolerance might even react poorly to gelatin or bone broth (which are gut superfoods!). That is because digestion itself causes histamine release! Yes, that’s as frustrating as it sounds.
So what can you do? The Low Histamine Chef recommends eating a diet which is easy on digestion. She recommends that you get your nutrients from juicing, smoothies, and soups. These liquid meals require less gastric juices to digest and thus less histamine. I’m not normally a fan of juicing (read why), but this is one case when juice can help. Just go easy on the fruit so you don’t mess up your blood sugar regulation in the process! If juicing and other easy-to-digest meals are all you can handle for a while, don’t fret, it’s just the first step in your healing journey.
Probiotics can also help heal the gut and improve digestion. Unfortunately, most probiotics can also trigger histamine intolerance problems (remember, even healthy bacteria can produce histamine!). The exception to this is a probiotic called Prescript Assist (which you can buy here). It is made from a soil-based organism and does not cause histamine to be released.
What About Antihistamines for Treating Histamine Intolerance?
Antihistamines might be able to temporarily get rid of your symptoms and they’ve saved me of additional trips to the emergency room on more than one occasion but, in the long term, they are a bad choice for people with histamine intolerance. In the next few days I will publish a post about why antihistamines are not the best treatment for histamine intolerance.
Yes, I know that it is frustrating and adhering to the ultra-strict low-histamine diet is annoying. But be patient! Healing takes time. Once you remove the histamine buildup from your body and get your gut healthy, you will probably be able to start consuming some small amounts of histamine foods again.
A bit of hope…
I’ve struggled with histamine intolerance my whole life. I’m still in the process of eliminating SIBO and I’m far from being completely healed but I can now consume just about every high histamine food again in small amounts without dramatic reactions.
Don’t give up. You, too can heal your histamine intolerance.
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