If healthy foods like bone broth or avocados leave you feeling off, histamine intolerance could be to blame. It’s not an allergy - it’s your body struggling to break down histamine. Let’s explore what’s happening and how to feel better!
We’ve all been told many times that eating foods like bone broth, collagen, fermented foods, vegetables and fruits are the cornerstones of a healthy diet and will improve our overall health. But what if those same foods are what is secretly sabotaging our health? For people who struggle with Histamine Intolerance, this is an unfortunate reality. Many of these healthy foods can contain a lot of histamine, or they can trigger the release of histamine in the body. This can result in a lot of undesirable symptoms that can impact overall quality of life.
Contrary to what it sounds like, Histamine Intolerance is not actually an intolerance to histamine. Rather, it is the inability to process histamine efficiently, and that can allow histamine levels to accumulate in the body to a point where it triggers allergy-like symptoms. Histamine Intolerance can be incredibly difficult to diagnose, as the symptoms are so similar to those of other health conditions. Histamine Intolerance often gets misdiagnosed as allergies, asthma, anxiety and numerous other health conditions. Because of this difficulty to diagnose, this condition is seen as rare, only affecting 1% of the population.
Let’s do a brief deep dive into Histamine Intolerance to get a better understanding as to why this condition occurs in the first place.
Histamine is a biogenic amine that is synthesized from the amino acid histidine. Histamine is often correlated with allergies and is seen as having a negative impact throughout the body. Histamine is not a villain though. It has many important roles within the body. It regulates smooth muscle contraction, the production of stomach acid, it also is a neuromodulator and neurotransmitter, and it is important for governing the sleep/wake cycle. It is also important for immune system defense against pathogens in the body. So as you can see, histamine is beneficial to the body in moderate amounts.
However, when histamine levels in the body build up and get too high, this is when problems can occur. Histamine levels can rise when our body is producing too much histamine and the excess histamine is not getting broken down and removed quickly enough by certain key enzymes in the body. The excess histamine then triggers a cascade of symptoms that affect digestion, blood pressure, heart rate, sleep, hormones, cognitive function and many other areas of the body. Symptoms can be varied and numerous.
Why does histamine build up and reach excess levels in the body?
When we are consuming foods that are high in histamine, and our body cannot process and eliminate excess histamine, then histamine can accumulate in the body. There are two key enzymes in histamine breakdown, Diamine Oxidase (DAO) and Histamine N-methyltransferase (HNMT). DAO is produced in the intestinal epithelial cells and is important for breaking down histamine in foods. HNMT is found in the central nervous system, liver, kidneys, spleen, colon, bronchi and trachea and is responsible for breaking down intracellular histamine. So, DAO breaks down extracellular histamine, and HNMT breaks down intracellular histamine. When DAO and HNMT levels are low, histamine cannot be broken down efficiently, and this can allow histamine levels to rise. DAO and HNMT activity may be low due to genetic mutations, consuming foods that block their activity, inflammation or bacterial overgrowth in the gut, certain medications, excessive alcohol consumption and deficiencies in copper and B-vitamins. Everyone’s histamine threshold will vary. Some people can handle a bigger histamine load, and some people are very sensitive and can only handle a small histamine load.
Think of it through this analogy. You are a house. Some people are a little house, some people are a big house. Histamine is a guest that comes to visit every day, and DAO and HNMT are at the front door to make sure that not too many guests come inside, and that they don’t stay for too long. When everything is running smoothly, DAO and HNMT allow only a certain amount of guests (histamine) to enter and stay for a certain amount of time, then they escort them out. When DAO and HNMT are slacking on the job and getting lazy, an undetermined amount of guests can come in and overwhelm the home and stay as long as they like. This puts enormous strain on the house and can cause a lot of damage. Sometimes DAO and HNMT are doing their job to their full capacity, but the guest load is just too high and they are unable to control and remove the crowd quickly enough.
Not every person with histamine intolerance will have low DAO and HNMT levels. Sometimes the excess histamine levels are just due to excess consumption of histamine containing foods. Whether your DAO and HNMT activity is low or normal, reducing the amount of histamine in your diet is a must, and avoiding anything that inhibits DAO activity.
What are the key symptoms of Histamine Intolerance?
This is a tricky one, as histamine intolerance symptoms are quite similar to allergy symptoms and many other health conditions. Also, symptoms can vary from person to person. The reason for this being so varied has a lot to do with the cell type and receptor type that histamine is bound to. There are 4 types of receptors that histamine can bind with.
H1R is involved in allergies and inflammation. The H1 receptor is found in many types of cells including immune, endothelial and epithelial cells. It is also found inside the adrenal glands, central nervous system, sensory nerves, uterus and the heart. When histamine binds to this receptor, typical allergy symptoms occur such as, allergic rhinitis, asthma, hives, atopic dermatitis and conjunctivitis (1).
H2R is found in the cells that line the stomach, smooth muscles of the airway and blood vessels, on immune cells and in the brain, uterus, heart and central nervous system. When histamine binds to this receptor it can cause an excess of stomach acid (causing acid reflux) and an increase in mucous production in the airways (1).
H3R is predominantly found in the central nervous system. H3 receptors are also found in the peripheral nervous system, GI tract, cardiovascular system, airways and on mast cells. When
histamine binds to this receptor it can affect cognition, the circadian rhythm, and it also may be responsible for nasal congestion (1).
H4R is found on a wide variety of cells. H4 receptors are predominantly found on immune cells, including mast cells, and in bone marrow. When histamine binds with this receptor, it can play a role in the development of atopic dermatitis, asthma, and chronic arthritis (1).
Symptoms that may occur with Histamine Intolerance (2),
Headache
Migraine
Confusion, anxiety and irritability
Rapid heart rate (tachycardia)
Chest pain
Low blood pressure
Digestive issues (diarrhea, constipation, gas, pain, gastritis, acid reflux)
Skin disorders (atopic dermatitis, swelling, hives, itchiness, flushing)
Sinus congestion and runny nose
Irritated throat
Shortness of breath
Asthma (in severe cases)
The most effective way to manage symptoms is by following a low histamine diet alongside taking certain supplements. A low histamine diet helps to lower the overall histamine load in the body, giving the body a chance to eliminate the excess histamine that is triggering symptoms.
What does a Low Histamine diet look like?
Avoid foods that are high in histamine and contain biogenic amines, foods that are histamine liberators, DAO enzyme inhibitors, and for some people, they may need to avoid foods that are high in salicylates (3).
Foods high in histamine and biogenic amines
Fermented foods (yogurt, aged cheeses, kombucha, sauerkraut, kimchi, sourdough)
Tofu and most soy products
Foods preserved in vinegar
Canned fish or meats
Processed, cured or aged meats
Wine, beer, alcohol, champagne,
Seafood (unless fish is fresh caught and frozen or eaten soon after)
Avocado
Dried fruits
Chocolate
Bone Broth
Collagen
Gelatin
Leftover foods (especially protein rich)
Histamine liberators
Citrus
Papaya
Kiwi
Bananas
Berries (blueberries seem to be ok for many people with HIT)
Pineapple
Spinach
Pumpkin
Eggplant
Ripe tomatoes
Avocado
Egg whites
Lentils
Chickpeas
Certain nuts (cashews, peanuts. walnuts)
Pumpkin seeds
Certain spices and herbs (cinnamon, cloves, curry powder, chili powder, cayenne, paprika)
Numerous preservatives and additives. Avoid ultra processed foods and anything bleached.
DAO enzyme inhibitors
Green Tea
Black Tea
Caffeine
Coffee or Decaf (due to caffeine and/or mycotoxins)
Alcohol
Certain medications
Fermented products
Some people who have Histamine Intolerance are also sensitive to salicylates in food and medications. They will need to avoid anything that is high in salicylates. It’s important to check in with your healthcare provider to get advice on whether you need to avoid this compound that is naturally found in many plant foods.
This list of foods to avoid is not fully comprehensive. As new information about histamine intolerance emerges, the list of foods that are safe and what should be avoided will continue to evolve and change.
Safe foods to focus on,
Fresh, skinless, unprocessed meats
Make sure to remove the skin off of poultry, as it is high in histamine. Cooking methods can affect histamine levels in meat, so choose to boil or bake your meats. Grilling and frying meat can increase histamine levels.
Fresh fruits and vegetables
Prepare fruits and vegetables right before eating them, when possible. This will keep histamine levels at their lowest. Pick fruits and vegetables that are not on the avoid list.
Whole grains
Choose whole grains that have been the least processed, and when consuming flour, make sure it has not been bleached. Avoid grains that have been fermented, like sourdough bread.
Fresh Herbs
Flavor your food with fresh herbs and low histamine spices. Parsley, cilantro, basil, sage and oregano are some of the many low histamine herbs to choose from.
Reduce sugar intake
Sugar is technically low in histamine, but having unstable blood sugar can potentially increase histamine levels in the body. It can also trigger inflammation throughout the body, which can intensify symptoms.
Supplements that may help with Histamine Intolerance,
DAO supplementation can help break down histamine in the digestive tract and reduce symptoms of histamine intolerance (4).
Quercetin can help stabilize mast cells and reduce the amount of histamine being released. This helps to lower histamine levels in the body (5). If you are dealing with salicylate intolerance, then skip Quercetin, as it is high in salicylate.
B-Complex: Certain B-vitamins can be helpful for reducing symptoms related to histamine intolerance. Vitamin B6 is especially important for the production of DAO. Taking B6 alongside a DAO supplement can help increase histamine elimination (6).
Cofactors for DAO enzyme production: Being deficient in copper, zinc or vitamin C can reduce DAO activity. Lowered DAO activity means less histamine breakdown, causing symptoms related to histamine intolerance. Vitamin C can also be helpful for stabilizing mast cells.
There are many other factors that can contribute to histamine intolerance and the symptoms that come along with it. Stress and lack of sleep or poor quality sleep can play a role in worsening of symptoms. It would be helpful to seek out the assistance of a doctor who is familiar with histamine intolerance so that they can guide you towards solutions that are more specific to your health concerns and body type. Always consult with a doctor before making changes to your diet, or before starting any new supplements. The information provided in this article is for learning purposes only and is not meant to be a substitute for the advice of a doctor or any other health care professional.
Written by Jennifer Fraser C.H.N.C.
References:
1. https://lymphosign.com/doi/10.14785/lymphosign-2018-0016
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC11054089/
3. https://www.histamineintolerance.org.uk/about/the-food-diary/the-food-list/
4. https://pubmed.ncbi.nlm.nih.gov/31807350/
5. https://pubmed.ncbi.nlm.nih.gov/22470478/
6. https://academic.oup.com/clinchem/article/70/Supplement_1/hvae106.433/7760954
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