- Could Your Flushing be Due to Histamine Intolerance?
- If you think you may have histamine intolerance, get tested
- Everything You Need To Know About Histamine Intolerance – Amy Myers MD –
- What is Histamine?
- Common Symptoms of Histamine Intolerance
- What Causes High Histamine Levels?
- Foods to Avoid If You Have A Histamine Intolerance
- Foods to Enjoy If You Have A Histamine Intolerance
- How Do You Break Down Histamine?
- How to Test for Histamine Intolerance
- How Do You Treat Histamine Intolerance?
- Histamine Intolerance: Not As Simple As Allergies
- In the 20 years I’ve spent in functional medicine I’ve realized two things:
- What Is Histamine?
- Neurological function
- Responding to allergic reaction
- What’s Causing Your Histamine Intolerance? Histamine Etiology
- When the histamine content increases in your body, so do the symptoms – symptoms that commonly mimic those of food allergies
- Three Common Causes of Histamine Intolerance
- Over the counter and prescribed medication often have DAO blockers.
- Gut Health
- This includes IBS, SIBO, Crohn’s disease and Leaky Gut Syndrome, amongst other issues.
- Histamine Intolerance Symptoms
- These are the most common symptoms associated with the condition:
- The Difference Between Histamine Intolerance and Allergies
- Keep in mind, however, that histamine is the key ingredient in both allergic reactions and histamine intolerance symptoms
- Testing For Histamine Intolerance
- The Skin Prick Test
- Serum Diamine Oxidase Test
- Serum Tryptase Test
- Beyond Lab Testing
- Elimination Diet
- Where do we go from here?
- Learn the Symptoms, Diagnosis, and Treatment of Histamine Intolerance
- Your Mystery Food Sensitivity Might Actually Be a Histamine Intolerance
- Umm, what exactly is a histamine?
- What are the symptoms of a histamine intolerance?
- What foods are high in histamine?
- How is a histamine intolerance treated?
- How to determine if you have a histamine intolerance
Could Your Flushing be Due to Histamine Intolerance?
Do you flush in the face after eating certain foods or even after consuming alcohol?
I Chapter 1 of my book, Your Longevity Blueprint, I dig deep into histamine issues, but I’ll give you a sneak preview here today!
In my past blogs, I discussed food sensitivities. However, having a histamine intolerance is actually different than having these sensitivities.
For instance, a patient may not test positive to avocado from an IgG standpoint (an avocado sensitivity), but if they become itchy or flush after eating it, they should still avoid it.
Remember, this reaction could be separate from IgG (separate from what we call a food sensitivity). It could even be an IgE reaction.
If food testing doesn’t show any reaction, I question whether there’s a poor immune system—maybe a low total IgA, or possibly…. a histamine intolerance.
Histamine is a chemical involved in regulating physiological functions—such as digestion in the gut—as well as in immune responses, and can also act as a neurotransmitter. Histamine triggers the inflammatory response. It is produced by basophils and by mast cells found in connective tissues, and is released in response to foreign pathogens.
“Histamine causes your blood vessels to swell, or dilate, so that your white blood cells can quickly find and attack the infection or problem. The histamine buildup is what gives you a headache and leaves you feeling flushed, itchy and miserable.
This is part of the body’s natural immune response, but if you don’t break down histamine properly, you could develop what we call histamine intolerance” (Myers 2013).
In the body, histamine must be stored or broken down by an enzyme.
Histamine in the central nervous system is broken down primarily by histamine N-methyltransferase (HMT), while histamine in the digestive tract is broken down primarily by diamine oxidase (DAO).
If you’re deficient in DAO, you are at a greater lihood to have symptoms of histamine intolerance. Foods that either naturally contain histamine or block the enzyme that breaks it down (diamine oxidase) can cause symptoms in many patients.
Below contains a list of histamine-rich and histamine-releasing foods that patients can avoid if they suspect histamine is causing problems:
In my own experience, I noticed my flushing greatly reduced after I went on a strictly gluten-free diet. Why? Gluten blocks DAO. Very interestingly, although one might think that histamine-blocking medication would help prevent histamine intolerance, these medications can actually deplete DAO levels in your body, worsening the issue.
Other medications that can deplete DAO include nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, antihistamines, histamine blockers, immune modulators, and antiarrhythmics (Myers 2013). Foods that block DAO include alcohol, energy drinks, and black and green teas.
Low DAO can also be caused by gluten intolerance, leaky gut, SIBO, inflammatory diseases of the bowels, and genetics.
If you think you may have histamine intolerance, get tested
Dunwoody Labs in Dunwoody, Georgia, can test you for histamine and DAO levels. A high ratio of histamine/DAO indicates that you are ingesting too much histamine and that you don’t have enough DAO to break it down.
Also, try eliminating high-histamine foods for thirty days and reintroducing them one at a time, monitoring how you feel. Try taking DAO with meals. This may give you a glimpse into the issues, and, if your symptoms resolve, you could have low DAO.
You may have taken an antihistamine or histamine blocker if you’ve suffered from seasonal allergies. Common names for these drugs are Allegra, Zyrtec, and even Benadryl. Find out if you have gluten sensitivity or SIBO and get off drugs that can reduce DAO.
If you struggle with histamine intolerance, then what foods can you eat? Above is a list off high histamine foods to avoid and of low-histamine foods that should be safer options.
The Low Histamine Chef, Jasmina Ykelenstam, at lowhistaminechef.com, and the mindbodygreen.com website, are two excellent resources for people dealing with histamine issues.
Still not sure if you have food sensitivities? When you purchase my book you can download your free bonuses including a pdf full of questionnaires for problems food sensitivities, histamine intolerance, and even yeast overgrowth.
Claim this free bonus!
Check out my next blog on ridding your body from yeast overgrowth!
Everything You Need To Know About Histamine Intolerance – Amy Myers MD –
September 6th, 2019 • Reading time: 5 minutes
Print • Free eBook: 35 Gut Recovery Recipes
Do you experience unexplained headaches or anxiety? What about irregular menstrual cycles? Does your face flush when you drink red wine? Do you get an itchy tongue or runny nose when you eat bananas, avocados, or eggplants? If you answered yes to any of these questions, then you could have a histamine intolerance.
Histamine intolerance can be very frustrating because the symptoms often feel as though they come nowhere. Trust me, I understand. I had a histamine intolerance myself at one point, and I kept getting terrible headaches seemingly the blue. Fortunately, I was able to pinpoint a histamine intolerance as the source of my headaches, and determine what was the underlying cause.
To help you find your own answers to these questions, I’m going to walk you through what histamine intolerance is, what causes it, the best diet for it, and how to combat it.
What is Histamine?
Histamine is a chemical involved in your immune system, your digestion, and your central nervous system. As a neurotransmitter, it communicates important messages from your body to your brain. It is also a component of stomach acid, which helps you break down food.
You might be familiar with histamine in relation to the immune system.
If you suffer from seasonal allergies or food allergies, you may notice that antihistamine medications including ZYRTEC®, Allegra®, or Benedryl® provide quick relief for your symptoms.
Histamine’s role in the body is to cause an immediate inflammatory response. It serves as a red flag in your immune system, notifying your body of any potential attackers. Antihistamines prevent this inflammatory response.
Histamine causes your blood vessels to swell, or dilate, so that your white blood cells can quickly find and attack the infection or problem.
It’s part of the body’s natural immune response, and typically enzymes will break down the histamine so that it doesn’t build up.
If for some reason you don’t break down histamine properly, it builds up and you develop what we call histamine intolerance.
Histamine travels throughout your bloodstream, so it can affect your gut, lungs, skin, brain, and entire cardiovascular system. Histamine can contribute to a wide range of symptoms, often making a histamine intolerance difficult to pinpoint and diagnose.
Common Symptoms of Histamine Intolerance
- Difficulty falling asleep
- Vertigo or dizziness
- Arrhythmia, or accelerated heart rate
- Difficulty regulating body temperature
- Nausea, vomiting
- Abdominal cramps
- Nasal congestion, sneezing, difficulty breathing
- Abnormal menstrual cycle
- Tissue swelling
What Causes High Histamine Levels?
- Allergies (IgE reactions)
- Bacterial overgrowth (SIBO)
- Leaky gut
- GI bleeding
- Diamine Oxidase (DAO) deficiency
- Histamine-rich foods
In addition to the histamine produced inside your body, there are also a variety of foods that naturally contain histamine, cause the release of histamine, or block the enzyme that breaks down histamine (diamine oxidase (DAO)). We will talk more about DAO and how you break down histamine in a bit.
If you have a histamine intolerance, I recommend avoiding the following foods until you have addressed the underlying cause of your histamine intolerance.
Foods to Avoid If You Have A Histamine Intolerance
- Fermented alcoholic beverages, especially wine, champagne and beer
- Fermented foods: sauerkraut, vinegar, soy sauce, kefir, yogurt, kombucha, etc
- Vinegar-containing foods: pickles, mayonnaise, olives
- Cured meats: bacon, salami, pepperoni, luncheon meats and hot dogs
- Soured foods: sour cream, sour milk, buttermilk, soured bread, etc
- Dried fruit: apricots, prunes, dates, figs, raisins
- Most citrus fruits
- Aged cheese including goat cheese
- Nuts: walnuts, cashews, and peanuts
- Vegetables: avocados, eggplant, spinach, and tomatoes
- Smoked fish and certain species of fish: mackerel, mahi-mahi, tuna, anchovies, sardines
- Cow’s Milk
- Wheat Germ
- Many artificial preservatives and dyes
- Energy drinks
- Black tea
- Mate tea
- Green tea
Foods to Enjoy If You Have A Histamine Intolerance
That was a long list. Now you might be wondering what on earth you CAN eat, so I’ve made a list of low-histamine foods as well. Freshness is key when you have histamine intolerance.
- Freshly cooked meat or poultry
- Freshly caught fish
- Cooked eggs
- Gluten-free grains*: rice, quinoa, corn, millet, amaranth, teff
- Pure peanut butter*
- Fresh fruits: mango, pear, watermelon, apple, kiwi, cantaloupe, grapes
- Fresh vegetables (except tomatoes, spinach, and eggplant)
- Dairy substitutes: coconut milk, rice milk, hemp milk, almond milk*
- Cooking oils: olive oil, coconut oil
- Leafy herbs
- Herbal teas
*If you have an autoimmune disease and are following The Myers Way® Autoimmune Solution, avoid all grains, legumes, and nuts until you are able to successfully reintroduce them.
How Do You Break Down Histamine?
Once formed, histamine is either stored or broken down by an enzyme. Histamine in the central nervous system is broken down primarily by histamine N-methyltransferase (HMT), while histamine in the digestive tract is broken down primarily by diamine oxidase (DAO).
Though both enzymes play an important role in histamine break down, the American Society for Clinical Nutrition found that DAO is the main enzyme responsible for breaking down ingested histamine. If you’re deficient in DAO, you ly have symptoms of histamine intolerance.
Causes of Low DAO
- Gluten intolerance
- Leaky gut
- DAO-blocking foods: alcohol, energy drinks, and tea
- Genetic mutations (common in people of Asian-descent)
- Inflammation from Crohn’s, ulcerative colitis, and inflammatory bowel disease.
- Non-steroidal anti-inflammatory drugs (ibuprofen, aspirin)
- Antidepressants (Cymbalta, Effexor, Prozac, Zoloft)
- Immune modulators (Humira, Enbrel, Plaquenil)
- Antiarrhythmics (propanolol, metaprolol, Cardizem, Norvasc)
- Antihistamines (Allegra, Zyrtec, Benadryl)
- Histamine (H2) blockers (Tagamet, Pepcid, Zantac)
Although histamine blockers, a class of acid-reducing drugs, seem they would help prevent histamine intolerance, these medications can actually deplete DAO levels in your body.
How to Test for Histamine Intolerance
Remove high histamine foods for 30 days and reintroduce them one at a time by following the guidelines in my comprehensive elimination diet eCourse.
I use a test through Dunwoody labs to test for histamine levels and DAO levels. A high ratio of histamine to DAO signifies that you are ingesting too much histamine and that you don’t have enough DAO to break it down.
Trial of DAO
If testing is unavailable to you, you could try a diet low in histamine and add DAO supplementation at each meal (see more on this below). If your symptoms resolve, you could have low DAO.
How Do You Treat Histamine Intolerance?
Relieve Your Symptoms Through Diet and Supplements
If you have a histamine intolerance, step one is to minimize your dietary histamine by eating a low-histamine diet and avoiding foods that block DAO. I also recommend taking a DAO supplement such as Histazyme for immediate relief.
When I was battling histamine intolerance, this supplement was a life-saver for me. I wouldn’t have a meal without it! One or two capsules no more than 15 minutes before you eat will help your body respond to symptoms histamine intolerance.
Address the Root Cause of Your Histamine Intolerance
The key to overcoming histamine intolerance is to identify the root cause of the issue. In my experience, I find that histamine intolerance is often caused by a gut health issue, particularly one called SIBO. In fact, SIBO was behind my own histamine intolerance.
Other common culprits behind histamine intolerance are leaky gut and gluten intolerance. If you think the state of your gut is affecting your body’s histamine response, I recommend completing The Myers Way® Guide to the Gut eCourse.
It includes diagnostic quizzes, meal plans, and handy tools to help you address your gut concerns from the comfort of your home.
Join the movement that has empowered 720,000+ people in 120+ countries. You'll immediately receive a beautiful, 74-page, full-color eBook full of simple, mouth-watering recipes & full color photographs + gut health tips you don't want to miss!
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Histamine Intolerance: Not As Simple As Allergies
It’s suggested that between 1% and 4% of the population has a histamine intolerance. This condition often looks a food allergy, but most food allergy tests can’t detect it.
People with histamine intolerance deal with a barrage of unexplained symptoms, often effecting digestion, that don’t make much sense to them and their health care providers, but continue to make life pretty difficult.
In the 20 years I’ve spent in functional medicine I’ve realized two things:
- People are unaware that histamine intolerance is actually a thing (although this is slowly changing).
- Primary care physicians, on a whole, ignore or leave many people who have the common signs and symptoms of this intolerance undiagnosed because there isn’t much data on this condition.
Diagnosing histamine intolerance has become a bit Hansel and Gretel finding their way in the woods. Before a clinician can decisively say you’re dealing with an intolerance, they have to follow the trail of breadcrumbs that lead them to the source of your symptoms.
This is exactly what we do in root-cause-focused Functional Medicine.
Of course, when you’re feeling tired, breaking out in hives, having unexplained flatulence, gas, bloating and diarrhea – even headaches with greater frequency – you know there’s something wrong. If only knowing what was wrong was as easy as knowing something is wrong, we’d all be a lot healthier!
That said, without the right diagnosis, you won’t know for certain if histamine is the culprit or if it’s something else entirely.
What Is Histamine?
Histamine has 23 physiological functions in the body and is one of the most studied biomolecules. Although it has an essential role in our wellbeing it’s also starting to make us feel terrible. Why is that? To truly understand why histamine intolerance can be misunderstood and overlooked — while having such widespread (and crappy) symptoms — you need to understand what histamine does.
It is a key component in stomach acid that aids in proper digestion. Too much histmaine
Histamine acts as neurotransmitter in the brain and spinal cord.
Responding to allergic reaction
It is the first responder in allergic reactions. Histamine sends inflammation to dilate blood vessels so white blood cells can reach and neutralize invaders.
What’s Causing Your Histamine Intolerance? Histamine Etiology
Histamine intolerance isn’t actually an intolerance to histamine.
Everyone has histamine in their gut and nervous system (it’s a naturally occurring entity). It’s also common in food, so you’re ly ingesting histamine regularly.
Thus, what most doctors refer to as an intolerance could be more accurately described as an overload.
Here, your body is reacting to a build up of the biomolecule in your bloodstream and gut. It’s also not something that happens quickly. The onset of symptoms can be gradual and usually correlates with the amount of histamine in your body.
When the histamine content increases in your body, so do the symptoms – symptoms that commonly mimic those of food allergies
If you had one small rock in your shoe, it would be annoying but maybe not a big deal.
Add a fistful of tiny pebbles, one at a time, and eventually it would be super annoying and you’d have to stop and deal with the symptoms of rocks in your shoe – pain and inflammation in your poor foot.
That’s what a histamine intolerance is : kinda sneaky, creeping up on you until the symptoms are too much to handle.
Three Common Causes of Histamine Intolerance
This is where you’ve got to start looking for breadcrumbs as they’ll help you discover the underlying cause or causes of your condition. To do this, we need to take a closer look at your health and lifestyle. In most cases, histamine intolerance can be attributed to the following, as these things can trigger a build up of histamine in your body:
Yes, your meds are making the list (again).
- Side effects are common in many OTC and prescribed medications, and these can include histamine intolerance.
- The medication doesn’t directly cause an intolerance but it does decrease your capacity to degrade, or break down, histamine.
- Your body degrades histamine in one of two ways: N-Methyltransferase (HMT) for the histamine in your central nervous system and diamine oxidase (DAO) to metabolize the histamine in your gut.
- When medication blocks the production of DAO, you’re essentially causing the histamine in your system to build up which is responsible for the symptoms you’ll experience.
Over the counter and prescribed medication often have DAO blockers.
These medicines** include:
- H2 Histamine Blockers
- Antipsychotics and antidepressants
- Non-steroidal Anti Inflammatory drugs (NSAIDS)
- Immune modulators
The science isn’t definitive on whether gut health directly (or indirectly) affects histamine levels. However, the idea is starting to gain traction in the western medical world, although it could be awhile before it’s fully explored.
I do think it’s worth mentioning as the two are so closely related. As I’ve learnt over decades in my own practice, many patients who experience histamine overload will either have a diagnosed or undiagnosed gastrointestinal issue.
This includes IBS, SIBO, Crohn’s disease and Leaky Gut Syndrome, amongst other issues.
I see a lot of histamine intolerance with SIBO due to the changes in the composition of the gut microbiome. In other words, the good bacteria that help keep histamine in check are no longer able to do their work. Since the metabolism of histamine is directly affected by enzymes (DAO) in your gut, any imbalance (whether seemingly unrelated) could cause a ripple effect.
If you already have a lot of histamine in your system and add in high histamine foods that your gut can’t process out, you’re ly to have histamine symptoms. These aren’t the usual unhealthy foods you’ve been told to avoid. These can be (and ly are) food you’ve been told to eat as part of a healthy diet.
Honestly, histamine is common in most food. That’s why symptoms can persist for quite some time without any obvious “trigger.” However, diet has another role in developing an intolerance to histamine.
Certain food also has the ability to block the production of DAO. When you’re combining a diet high in DAO blockers and elevated histamine due to a gut imbalance or using one of the medications above, an intolerance is a logical outcome.
Histamine Intolerance Symptoms
The trail of breadcrumbs continues! The next thing to do is to take a look at your symptoms and see if there are any of these that could be attributed to a histamine intolerance.
These are the most common symptoms associated with the condition:
- Irritable Bowel Syndrome symptoms
- Bloating, intestinal gas, which can mimic or coincide with SIBO
- Abdominal Cramps
- Abnormal Menstrual Cycle and Cramping
- Acid Reflux
- Itching, especially if you look at the itchy skin and there’s no rash or anything visible there as the cause of itching
- Accelerated Heart Rate
- Inflammation or Swelling
- Vertigo or Dizziness
- Panic Attacks
- Difficulty Sleeping
- Sinus Issues (Sneezing, and nasal congestion)
- Low Blood Pressure
The Difference Between Histamine Intolerance and Allergies
Most individuals with a histamine intolerance may think it’s nothing more than a mild food allergy. Since so many symptoms overlap, the idea that you’re dealing with “just a food allergy” is usually substantiated by your body’s reaction to food you’re eating that have a high histamine content.
Keep in mind, however, that histamine is the key ingredient in both allergic reactions and histamine intolerance symptoms
However, those with an intolerance aren’t allergic to the food that triggers their symptoms. Instead, what they have is either a lack of DAO (the enzyme that metabolizes excess histamine) in their gut, or have far too much histamine in their body — or both.
The primary difference between the two (in relation to their symptoms) is the severity of the symptoms and for how long you have the reaction.
Histamine intolerance symptoms won’t be as severe as an allergic reaction in most cases.
Although many of the symptoms experienced with a histamine intolerance are common in typical food allergies, histamine symptoms usually persist, becoming a part of your daily life.
Testing For Histamine Intolerance
As histamine intolerance isn’t widely acknowledged, studied or emphasized in the medical community, there are few tests for an intolerance to histamine. Most tests involving histamine focus on allergies instead of build up. However, there are a few tests that can help determine with greater levels of accuracy if you are in fact histamine intolerant.
The Skin Prick Test
This simple, inexpensive test has been suggested to determine whether someone is indeed histamine intolerant.
Using a needle, an allergist will either prick or scratch the surface of the skin and then apply a histamine solution to the skin’s surface.
They then wait until a wheal (raised bump under the skin) appears, usually followed by determining how quickly it appeared and how long it remained elevated in order to diagnose an intolerance.
Serum Diamine Oxidase Test
This test measures the level of Diaminoxidase (DAO) in your bloodstream. If you have a histamine intolerance, the level of diamine oxidase (DAO) present in your blood will be lower than lab normals.
Serum Tryptase Test
Instead of determining whether you have histamine intolerance, a serum tryptase test can help you rule out other possible causes of your symptoms.
In this test, your provider will be able to rule out an increased burden of mast cells as the cause of your symptoms. Mast cells are responsible for releasing histamine. The symptoms of mast cell elevation can look elevated systemic histamine, and this test can help determine if you’re dealing with one or the other.
Beyond Lab Testing
Any test can have false positives or negatives, so it’s important for your healthcare provider to analyze your case holistically. To be real, none of these tests are a slam dunk. A smart and experienced clinician is adept at pattern recognition, a skill that I find most useful when it comes to histamine intolerance.
The best test, in my experience, is an elimination diet. This can help give us a good idea of the intolerance and its extent. Changes to your diet continue to be the most accurate method of determining whether you have a histamine intolerance. It’s the simplest (and cheapest) test of them all.
To conduct this test, you’d start by eliminating histamine rich food and beverages from your diet. Document any changes over time. In many cases, those without a histamine intolerance won’t experience any significant change in their symptoms.
Where do we go from here?
As histamine intolerance gains traction in the medical community, hopefully so too will conclusive (affordable) testing. While we wait for that to happen, making simple changes to our diet to cutback on histamine rich food and DAO blockers can be a very effective recourse.
**As always, before discontinuing the use of any of the aforementioned medication you need to consult with your PCP. There are more holistic approaches for many common medical concerns that could reduce or eliminate the symptoms of histamine intolerance without nasty side effects.
Learn the Symptoms, Diagnosis, and Treatment of Histamine Intolerance
Westend61 / Getty Images
If you find your body reacts to a diverse group of foods — say, spinach, tomatoes, wine, and sauerkraut — with symptoms that range from a stuffy nose to migraine headaches, you may not be allergic to those foods. Instead, you may have what's called histamine intolerance, since all those foods have high levels of histamine in them.
Histamine is a chemical our bodies produce naturally, and it's also found in certain foods. In situations involving “true” allergies, your body releases histamine, and that histamine, in turn, provokes the response we think of as an allergic reaction.
Histamine intolerance isn't a true allergic reaction. Instead, it refers to a reaction some people experience to foods that have high levels of naturally occurring histamine.
People with histamine intolerance often have low levels of either of two very specific enzymes—diamine oxidase (DAO) and histamine-N-methyltransferase (HNMT) — that process histamine in your body. Without enough of those enzymes to process the histamine, it can build up over time and cause symptoms throughout the body.
The most common symptoms of histamine intolerance are migraine headaches, digestive symptoms such as diarrhea, flushing, hives, eczema, and allergic rhinitis (the medical term for hay fever, although in this case it obviously doesn't involve any hay).
Histamine intolerance can also cause more severe symptoms, as well. It can trigger asthma attacks or anaphylactic shock, it can cause your heart to beat erratically, and it may be associated with serious chronic conditions Crohn's disease.
If you have symptoms regularly after eating high-histamine foods, that may lead you or your doctor to suspect a histamine intolerance. You may find that keeping a food log helps you and your doctor to figure out the problem.
In histamine intolerance, the histamine can build up over time, which can make diagnosing this condition challenging — eating a high-histamine food (or more than one at the same time) may be enough to “push you over the edge” into symptoms one day, but may not be enough to do so on a different day. If you stay away from high histamine foods, you may be able to reduce your build-up of histamine, which can reduce or eliminate your symptoms.
Traditional allergy tests — skin prick tests and ELISA IgE antibody blood tests — can't diagnose histamine intolerance. The only way you can find out if you have the condition is by trying a histamine-free diet followed by a double-blind food challenge.
Maintaining a strict histamine-free diet is the key to relief from histamine intolerance symptoms. Your doctor will discuss which foods you should avoid, but in general, fermented and aged foods, along with certain high-histamine vegetables, are most ly to cause problems.
Most foods that are high in histamine are highly processed or fermented. These include wine (especially red wine), aged cheese such as parmesan cheese, yeast-containing foods, and sauerkraut. Spinach and tomatoes also are high in histamine.
In addition, while citrus fruits are not themselves considered high in histamine, they can trigger your body to release stored histamine. Therefore, people on a strict histamine-free diet are generally advised to avoid oranges, grapefruit, and another citrus.
“Red wine migraines” are often histamine intolerance headaches, and red wine is indeed high in histamine.
All alcoholic beverages can be problematic for people with histamine intolerance because alcohol can make DAO, one of the enzymes your body uses to process histamine, less effective. Therefore, to follow a true histamine-free diet, you need to give up alcohol.
You should also let your doctor know about any medications, prescription or non-prescription, you're taking. Some medications can affect the action of your histamine-processing enzymes. If you are on such a medication, your doctor may want to adjust your dosage, switch you to a similar medication that doesn't affect histamine, or, if possible, take you off the medicine entirely.
While a histamine-free diet is the only long-term treatment for histamine intolerance, there are a couple of other treatments that may be useful. Benadryl (an over-the-counter antihistamine) may be useful if you accidentally eat a histamine-containing food or have to take a drug that can block histamine-processing enzyme activity.
There are also supplements that some doctors recommend for people with histamine intolerance.
They include high doses of vitamin C and vitamin B6 (which can stimulate the activity of those histamine-processing enzymes in your body), and capsules of the DAO enzyme to supplement the body's natural supply.
Diem Labs, LLC, is the only manufacturer that sells DAO enzyme in the U.S.; looking for the brand name Umbrellux DAO.
However, while these treatments can help, they're unfortunately not a substitute for a histamine-free diet. Talk to your doctor if you're interested in trying these supplements to see whether they could improve your symptoms.
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Kovacova-Hanuskova E, Buday T, Gavliakova S, Pleova J. Histamine, histamine intoxication and intolerance. Allergol Immunopathol (Madr). 2015;43(5):498-506. doi:10.1016/j.aller.2015.05.001
Smolinska S, Jutel M, Crameri R, O'mahony L. Histamine and gut mucosal immune regulation. Allergy. 2014;69(3):273-81. doi:10.1111/all.12330
Your Mystery Food Sensitivity Might Actually Be a Histamine Intolerance
1/29/20 in Blog Posts
If you feel off after eating avocados and chocolate, you need to read this.
By Rachael Schultz
Jan 14, 2020 @ 5:00 pm
These days, it feels nearly everyone has some kind of mysterious food intolerance. This can manifest itself in a variety of ways: You suddenly become constipated for three days or come down with a killer headache but can’t quite pinpoint what the culprit is — until it strikes again (seemingly) nowhere. An unlucky handful will break out in hives or develop a skin rash.
While it usually is an actual intolerance — or full-blown allergy — to certain foods or food groups at play, there’s another under-the-radar possibility. For some, these seemingly disparate symptoms may actually stem from a histamine intolerance, which is when your body has trouble flushing histamine compounds your system.
While the condition isn’t super common — we’re talking approximately 1% of the population — interest and awareness is increasing. Roughly a dozen books about histamine intolerance were published in 2019 alone and hashtags #histaminefree are gaining traction on social media.
It’s super hard to diagnose, perhaps even worse to live with (you can’t have avocados, booze, or chocolate!), and looks almost exactly an allergy. But if you’ve been dealing with these kind of undiagnosable issues, answers are everything. Here, everything you want to know about histamine intolerances. Starting with…
Umm, what exactly is a histamine?
Histamine is ingested via food and stored in nearly all tissues of the body.
When released, it plays a role in a ton of different actions that all keep your organs functioning and body working healthily — things helping the smooth muscle tissue of the lungs, uterus, and stomach contract (that keeps your organs working); dilating blood vessels; stimulating gastric acid secretion in the stomach; accelerating your heart rate.
Histamine is usually a good thing, says Sara Axelrod, M.D., allergist-immunologist at ENT and Allergy Associates in East Brunswick, NJ. It helps immune cells travel into injured tissue to heal an injury or infection, for example.
The problem starts when someone isn't able to metabolize the compound.
“People with histamine intolerance are low in the essential enzymes [called diamine oxidase] that help break down histamine in the body.
It starts to build up faster than it can be broken down and causes unwanted symptoms,” explains Becky Campbell, doctor of natural medicine and author of The 4-Phase Histamine Reset Plan.
It sounds (and often looks ) a food allergy or intolerance. But actually, if you have a sensitivity or intolerance to certain fare, your immune system is triggered by your digestive system, which is what causes your reaction, Dr. Axelrod explains.
A histamine intolerance, on the other hand, is specifically the build up of histamines in the body.
This distinction is important medically, but mostly, it matters to sufferers because histamines span a huge array of foods rather than being focused to a specific group, an allergy to shellfish or intolerance to gluten.
What are the symptoms of a histamine intolerance?
A histamine intolerance looks a lot seasonal allergies — if you eat histamine-rich food or drinks, you may experience hives, itchy or flushed skin, red eyes, facial swelling, runny nose and congestion, headaches, or asthma attacks. Other symptoms can be more severe, a drop in blood pressure, heart palpitations, and anxiety or panic attacks.
Gastrointestinal issues are also super common: One 2019 study in Intestinal Research surveyed some 60 sufferers on the topic and they reported bloating was the most common and serious symptom, followed by diarrhea, abdominal pain, and constipation.
We know — these symptoms are all over the place. That’s because there are histamine receptors all over the body. Because the symptoms are so random, sufferers are often sent to multiple specialists, Campbell adds.
And because of this bounce-around, histamine intolerance is usually attributed to other diseases an allergy or food intolerance, mastocytosis (a rare condition where mast cells accumulate in the skin or organs), psychosomatic diseases (physical symptoms that manifest from stress and anxiety), anorexia nervosa, or adverse drug reactions, says research Comenius University in Bratislava, Slovakia.
What foods are high in histamine?
Because histamine levels increase with maturation, fermented foods and drinks are often the worst offenders reports a landmark review in The American Journal of Clinical Nutrition. Think: aged cheeses, yogurt, kefir, sauerkraut, processed meats, canned and pickled foods, smoked meats, vinegars, and alcoholic drinks (especially wine, champagne, and beer).
Other foods high in histamine include avocados (say it ain’t so!), legumes chickpeas and lentils, strawberries, citrus fruits, chocolate, certain spices curry and cinnamon, nuts cashews and walnuts, tomatoes, bananas, eggplant, and spinach.
“Most of these foods are very high in nutritional value, so this can be confusing as to why you have to remove them. For those that can’t break down histamine efficiently, though, the risks outweigh the benefits,” Campbell says.
A life without avocados, though? There’s a whole slew of foods you can still nosh on, Dr. Axelrod reassures, including fresh meat and fish, non-citrus fruits, eggs, gluten-free grains quinoa and rice, almond milk, coconut milk, all fresh veggies (except eggplant and spinach), and olive oil.
How is a histamine intolerance treated?
There’s no reliable lab test or procedure that can pinpoint histamines as the issue. The intolerance won’t show up on an allergy test — that is, if you go to the allergist, your skin and blood test will both come back negative. (However, this is a super important step since ruling out other triggers or underlying diseases are necessary for diagnosis, Dr. Axelrod adds.)
Some medications can help. Sometimes, an OTC antihistamine is enough to decrease the histamine load in the body and relieve symptoms, Dr. Axelrod says. But often, people see months of symptoms with no relief despite medicine.
Newer research, a small 2019 study in Food Science and Biotechnology, has found when sufferers supplement with diamine oxidase — the compound that helps most of us metabolize histamine but which sufferers are low in — their symptoms improve significantly.
But really, the only way to figure out the culprit is steering clear of the offending foods — all of them, both experts agree.
“Figuring out what causes your symptoms is not an easy process. It takes a lot of trial and error and adding and subtracting certain foods in order to make sure you’re covering all of your bases and not missing anything,” Campbell says.
How to determine if you have a histamine intolerance
As with all health issues, if you think you might have a histamine intolerance, it’s best to talk with your allergist about the best treatment plan. But generally, the only way to diagnose it is an elimination diet, where you avoid all aggravating foods for a set period of time, then slowly reintroduce them one by one to see how your body reacts.
For a histamine intolerance, here’s what you can expect for the elimination diet: It takes about three to four weeks for histamines to clear out the tissue in your body, so you want to completely eliminate high-histamine foods for at least 21 days.
Then, slowly reintroduce a single food for one week at a time. If you have no reaction, add in another.
If you do have a reaction, you’ll have to detox your body again (that means spending another three to four weeks off all histamine-rich foods), then adding another back in.
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