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Histamine Intolerance and Food: The Whole Story

You suspect that histamine intolerance and food might be causing your uncomfortable symptoms. Or maybe you have been told by your doctor to follow a low-histamine diet. The thought of avoiding all these foods can feel confusing and overwhelming. 

You are in the right place. In this post I explain what histamine is, why it is important, how it can get out of control, and what you can do about it.

Read on to get the evidence-based facts behind this complex condition. This post is meant for general information only, not to diagnose or treat histamine intolerance.

What is Histamine?

Histamine is a substance called a biogenic amine. It has a structure similar to the amino acids that make up proteins. Biogenic means that it is formed in the body. You can also get histamine through foods that you eat. 

In the body, histamine is made from an amino acid called histidine. This is a simple process which uses the enzyme histidine decarboxylase. Mast cells, nerve cells and the parietal cells of the stomach all produce histamine.

Histamine in the Immune System

The immune system relies on histamine to function properly. When the body sees a threat, mast cells release a whole lot of protective substances, including histamine. 

Histamine contracts your smooth muscles, dilates your blood vessels, and makes them more permeable so that fluids can leak through. This increases blood flow and allows white blood cells to come in and clear up the damage. 

These changes also create the symptoms we associate with allergies, like swelling, runny nose and watery eyes. Histamine can cause a drop in blood pressure and make the bronchi in your lungs tighten up. 

Even though none of us like what happens during an allergic reaction, histamine is not your enemy. Without it, your immune system would not be able to protect you on a day-to-day basis.

Histamine in the Stomach

Stomach acid is necessary for proper digestion. Histamine helps to make this happen. Enterochromaffin-like (ECL) cells within the stomach produce histamine. It binds to a special histamine receptor called an H2 receptor. 

This sets off a series of events that ends with stomach acid being released. You may have heard of H2-blocking medications. These prevent histamine from binding to the receptor, so that you make less stomach acid.

Histamine in the Nervous System

Neurons in the hypothalamus have the ability to produce histamine. These neurons affect many of the cerebral processes of the brain, like sleep and wakefulness, memory formation, appetite and thermal regulation.

Histamine intolerance and food

When foods age or ripen, bacteria in the foods break down histidine, a natural amino acid, and produce histamine. So the older and riper your food, the higher the histamine content. (1)

This happens in fermented foods like sauerkraut or yogurt, ripened fruits like bananas, and even in leftovers that have spent a day or two in your fridge. In addition, there are some foods that are naturally high in histamines even when they are fresh. 

It is possible that some foods can cause your mast cells to release histamine. And there are even foods that block the enzymes that break down histamine. I will talk in more detail about all these foods later in this article. 

How Histamine Intolerance Happens

Most healthy people can eat a diet filled with high-histamine foods, and not have any problems. Your body produces enzymes that break down histamines and eliminate them.

However, for one reason or another, some people are unable to clear out all the histamine, and they develop symptoms of histamine intolerance.

How We Break Down Histamines

There are two enzymes that break down histamine in your body. 

Histamine N-methyltransferase (HNMT) breaks down histamine inside your cells. This is the enzyme that metabolizes histamine in the bronchial tubes. Low activity of HNMT can be seen in cases of bronchial asthma.

Diaminooxidase (DAO) metabolizes histamine found outside of cells, such as in your gut. The lining of your gut secretes DAO.

What Can Go Wrong

Poor nutrition, damage to the gut lining, genetic polymorphisms and toxic assaults from the environment can all affect our ability to get rid of histamines. 

Poor Nutrition

You need the following vitamin and mineral cofactors in order for DAO to work: 

  • Vitamin B6: found in beef, chicken, pork, chickpeas, potato, turkey and bananas
  • Vitamin C: found in citrus fruits, bell peppers, strawberries, tomatoes, papaya, cantaloupe, pineapple and camu camu
  • Copper: found in oysters, crabmeat, beef liver, legumes, cocoa, cashews and chickpeas

You also need the right nutrients for your gut lining to be healthy. A diet rich in many different types of plant foods makes a healthier microbiome. Healthy bacteria produce food for the cells in your gut.

Damaged Gut Lining

Conditions like irritable bowel syndrome, celiac disease or inflammatory bowel disease damage the gut lining. Those are the cells that produce DAO. When they don’t function properly, you can’t break down histamines as efficiently as you should.

Gut bacteria produce short chain fatty acids, and these feed the cells in your gut. As I mentioned above, a healthy microbiome needs lots of variety and especially plant-based foods.

Proteins provide the amino acids your gut needs to constantly reproduce cells. You also need vitamin A to produce the mucus that lines your gut.

Eating a poor diet or restricting your foods affects the amount of DAO you make in your gut, and your ability to break down histamines.

Mast Cell Activation Syndrome (MCAS)

Sometimes mast cells become deregulated and start producing histamines (and other substances) like crazy. This is a syndrome that affects all the organ systems in the body. It is different and more serious than histamine intolerance.

A doctor who is familiar with MCAS should provide treatment for this condition. It is important to find the root cause or trigger of the disease, which could be something like an infection, or toxic mold. When the trigger is removed, the condition can start to improve.

Genetic Polymorphisms

Genetic mutations might affect how much DAO or HNMT enzymes are produced in your body. There are also many other mutations affecting the way that mast cells work. 

You can’t change your gene structure, however if you know that you are making DAO less efficiently you can use nutrition or supplements to support the production of the enzyme.

What are the Symptoms of Histamine Intolerance

Too much histamine produces allergy-like symptoms. These include:

  • Itching
  • Hives
  • Swelling of the face, mouth or throat
  • Red, swollen eyes
  • Atopic eczema
  • Sneezing and nasal congestion
  • Asthma

Histamine dilates blood vessels and releases catecholamines. These can cause the following symptoms:

  • Low blood pressure
  • Irregular heart beat and tachycardia
  • Anxiety and / or panic attacks
  • Irritability and / or confusion
  • Disturbed sleep
  • Headache and dizziness
  • Fatigue

In the gut, histamine can cause the following symptoms:

  • Abdominal pain
  • Bloating and gas
  • Diarrhea
  • Nausea
  • Vomiting

Histamine interacts with female hormones and stimulates contraction of the uterus. This can cause:

  • Dysmenorrhea 
  • Cramping

All of these symptoms are general and found in a wide range of other conditions. You and your doctor will need more detective work to find out if histamine intolerance is behind your symptoms.

Diagnosing Histamine Intolerance

A doctor always provides the medical diagnosis, not a nutritionist or health coach. 

The first step is often keeping a food diary to find associations between foods that are high in histamine and the symptoms you are experiencing.

Your doctor will want to do testing and make sure you don’t have any other conditions that are causing your symptoms. Excluding other causes is one step in the process.

Your doctor might challenge you with histamine, followed by a blood test to see the effect it has on your system.

Genetic testing can also uncover possible polymorphisms that might be causing histamine intolerance (2).

What Foods Should I Avoid with Histamine Intolerance?

First of all, everyone is different! You may be able to tolerate some foods that another histamine intolerant person cannot. Or a food someone else does fine with might set you off. So it is always a personal exploration to find the foods that you can eat.

High Histamine Foods

Some foods naturally contain a lot of histamine, even if they are fresh. Here is a list of high-histamine foods:

  • Walnuts
  • Cashews
  • Tomatoes
  • Eggplant
  • Spinach
  • Mushrooms
  • Strawberries
  • Avocado
  • Pineapple

Do not use herbs and spices that have been sitting in your cupboard for a long time. Also, the following spices are more likely to raise histamine levels:

  • Cinnamon
  • Anise
  • Nutmeg
  • Cloves
  • Curry
  • Mustard
  • Chili powder
  • Allspice
  • Cayenne
  • Paprika

Here is a list of fermented or aged foods that are high in histamine:

  • Aged cheeses
  • Cured or aged meats, for example sausage, pepperoni, lunch meats, salami, hot dogs
  • Canned meats like tuna, sardines, anchovies and salmon
  • Most beef is aged. Try to find a butcher who can sell you fresh beef.
  • Bone broth and collagen
  • Fermented beverages like kombucha and Kevita
  • Wines, beers and other alcoholic beverages
  • Cider and carbonated drinks
  • Cultured and fermented dairy like yogurt, buttermilk, kefir or sour cream
  • Fermented vegetables, such as sauerkraut and kimchi
  • Pickled vegetables
  • Most types of fish and seafood begin to produce histamines as soon as they are caught.
  • Ketchup, soy sauce, tamari, coconut or other types of liquid amines
  • Corn syrup and artificial sweeteners
  • Vanilla extract
  • Black, green or white tea
  • Vinegar and vinegar-containing foods
  • Foods made with yeast
  • Leftover foods contain more histamine as they get older

Histamine Releasing Foods

Some foods may trigger mast cells to release histamine, even though they are not high in histamine themselves. These are labeled histamine-releasing foods.

There is actually no good evidence for this hypothesis. No one has figured out the mechanism involved, and there are no clinical studies in humans on histamine-releasing foods (3). However, here are the foods that are suspected of causing the release of histamine (4):

  • Food Additives (dyes, preservatives, stabilizers, flavorings)
  • Bananas
  • Chocolate and cocoa
  • Citrus fruits
  • Egg whites
  • Legumes
  • Licorice
  • Nuts
  • Papaya
  • Peanuts
  • Pork
  • Some spices
  • Seafood 
  • Tomatoes

Note that there is some overlap, with foods like seafood, tomatoes, spinach and strawberries both on the histamine-releasing list and containing higher levels of histamine themselves.

Alcohol and Histamine

DAO breaks histamine down into a product called imidazol acetaldehyde. The next step in the process requires an enzyme called aldehyde dehydrogenase. If you have ever studied alcohol metabolism, you will know that this same enzyme metabolizes alcohol.

Alcohol is a toxin, and will necessarily get priority when your body decides where to use its resources. This means that imidazol acetaldehyde builds up, and this creates a feedback loop that shuts off production of DAO. 

This is the reason alcohol is called a DAO blocker. Drinking alcohol is a sure way to bring on the symptoms of histamine intolerance (5).

What Foods CAN I Eat if I Have Histamine Intolerance?

Are you looking for some low histamine snack ideas? You can find them here.

At first glance the low histamine diet can look and feel overwhelming. However, there are still plenty of delicious and nutritious foods that you can eat. 

Low Histamine Foods

Fresher foods are better. If you eat whole foods instead of processed foods, you stay away from food dyes, preservatives, stabilizers, flavorings and other additives that can increase histamine levels.

Wheat is low in histamines, but the gluten content in wheat can cause inflammation and leaky gut. That is why many low histamine food lists recommend eating gluten free foods.  

Since damage to the gut might be a root cause of histamine intolerance, a gluten-free diet, at least temporarily, makes sense.

Here is a list of foods that you can safely enjoy on a low histamine diet:

  • Whole, gluten-free grain products prepared without yeast. This can include millet, rice, amaranth, quinoa or organic corn.
  • Most fresh vegetables are safe on a low histamine diet. Basically you can try any vegetable except tomatoes, eggplants, spinach, mushrooms, squash or pumpkin, or canned, pickled or fermented vegetables.
  • Fresh fruits that are not overly ripe. Try apple, apricot, blackberries, blueberries, cherries, cantaloupe, cranberries, dragon fruit, figs, grapes, guava, honeydew, kiwi, mango, nectarines, passion fruit, peaches, pears, persimmons, plantains (green), pomegranate, raspberries in small amounts, or watermelon.
  • Any meats that are fresh, not dried, cured, smoked or aged
  • Fish that are gutted and flash frozen immediately after catch. This is something you will have to experiment with to see if you can tolerate.
  • Fresh herbs and spices that are not on the high-histamine list. Buy in small quantities so you use them up quickly.
  • Cooking oils that are reasonable fresh
  • Ice cream and popsicles (not made with high-histamine ingredients)
  • Fresh cheeses like mozzarella and ricotta
  • Butter that is not aged or fermented
  • Cream, milk
  • Cream cheese
  • Fresh poultry
  • Eggs, fully cooked, if you can tolerate them
  • Beans and legumes cooked from dried beans, rather than canned
  • Most nuts, except cashews, peanuts, walnuts and dried coconut or coconut butter
  • Coffee, herbal teas and fresh juices (squeezed just before you consume them)

Foods that Break Down Histamine

Some foods contain substances that help your body to stabilize mast cells, and inhibit the release of histamines. This does not break down histamines in the foods you eat. However, it can keep you from producing as much histamine in your body. 

Quercetin

Quercetin is a phytonutrient (found in plants) that helps with allergy symptoms through a number of different mechanisms. One way is by inhibiting the release of histamines from mast cells (6).

Here is a list of foods that contain quercetin:

  • Apples
  • Onions
  • Citrus fruits
  • Olive oil
  • Parsley
  • Sage
  • Grapes
  • Dark berries and cherries

Luteolin

Luteolin is another phytonutrient that can stabilize mast cells. It inhibits the release of histamine and other proinflammatory substances (11). 

Here are some foods that are high in luteolin:

  • Celery
  • Parsley
  • Broccoli
  • Carrots
  • Peppers
  • Cabbage

Herbs and Botanicals

Turmeric contains the phytonutrient curcumin, which has well-known anti-inflammatory properties. Curcumin can inhibit mast cell degranulation and histamine release (7).

Among its many other therapeutic properties, basil can also inhibit histamine release. So bring on the pesto. Extra points if you use holy basil, which has even stronger medicinal properties (8).

Nettles prevent mast cell degranulation and block production of some prostaglandins that can set up a cascade of inflammation. Try a nettle leaf tea and see if it helps your symptoms (9)

Ginger contains natural antihistamines. In fact, in clinical trials it performed as well as Loratadine for managing allergy symptoms, and with fewer side effects (10).

Vitamin C Rich Foods

If you have been following along, you learned earlier that vitamin C is a cofactor that helps the DAO enzyme to work properly. Providing your body with enough vitamin C will make this enzyme more efficient.

Some good sources of vitamin C that are safe on a low histamine diet are bell peppers, cantaloupe, and citrus fruits if you can eat them.

You can also try camu camu. This berry comes from the Amazon, and is super high in vitamin C. You can buy it as a powder and sprinkle it in dishes like smoothies or oatmeal. 

Food Prep on a Low Histamine Diet

Some basic food preparation guidelines can help you to keep the histamine levels down in the fresh foods that you buy. 

  • Peel fruits and vegetables right before you eat them. Peels protect the produce from forming histamine.
  • If you are cutting up produce for a salad, do this right before you serve the food. Don’t let it sit for hours in the refrigerator.
  • Use a pressure cooker or instant pot to speed up the cooking process. This way you can even make lower histamine versions of things like bone broth.
  • Look at packaging dates to buy the freshest meats. Ask your butcher for meat that has not been aged.
  • Ground beef will have more histamine. Either avoid ground beef and buy whole cuts, or grind it yourself right before cooking.
  • If possible, freeze meats if you don’t plan to use them that day.
  • Freeze leftovers and thaw them out when you are ready to eat them.
  • However, freezing does not completely stop histamine from forming. Make sure to eat those leftovers and not let them sit in the fridge for a month.

Fixing the Root Cause with a Functional Approach

The good news is that you might not need to follow a low-histamine diet for the rest of your life. If you are seeing a Functional Medicine doctor, they will want to look for the root cause of histamine intolerance.

This might be a damaged gut lining, poor nutrition, exposure to a toxin, or some kind of infection in your body. When this root cause is fixed, you might start producing the enzymes you need to metabolize histamine.

Final Thoughts

Histamine is a biogenic amine that is stored in mast cells throughout your body. It is a vital part of a healthy immune system, stomach acid production and proper brain function.

You also get histamine from some of the foods that you eat. As foods get older, bacteria begin to produce histamine. Fermented, aged and over-ripe foods are especially high in histamine. 

Your body produces enzymes that metabolize histamine, and a healthy person should be able to eat all the histamine-containing foods that they want.

However, if you have genetic mutations, a damaged gut, poor nutrition, or a condition called MCAS, you might not be clearing histamine properly from your system.

Too much histamine causes allergy-like symptoms. You might also feel the effects in your cardiovascular or nervous systems. 

Females might experience dysmenorrhea related to high histamine levels. Digestive problems are a common symptom of histamine intolerance.

There is a long list of foods to avoid if you have histamine intolerance, including high-histamine foods, histamine releasing foods, and DAO blocking substances like alcohol.

However, you can still enjoy a lot of foods! There are also some plant-based foods that act as natural antihistamines and help to fight the inflammation this condition can cause.

Food preparation is especially important if you are trying to lower your histamine load.

You don’t want to stay on a low histamine diet for the rest of your life. A Functional Medicine doctor can help you to figure out the root cause of your intolerance. You may be able to go back to a normal diet once this is corrected.

Do you need help navigating the low histamine diet? Click the link below to set up a free phone call and find out how to work with me.

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