Histamine Intolerance is a condition where histamine is poorly broken down or poorly cleared from the body; resulting in allergy-like symptoms to foods (and substances) in the diet. It can also manifest as gastrointestinal symptoms like gas, bloating, abdominal pain, and constipation/diarrhea. Further, histamine intolerance can affect other systems including neurological function (brain fog, mood problems, headaches) and endocrine function (menstrual issues, fatigue).
Before we can truly understand Histamine Intolerance, we need to back-up and learn about histamine.
What is Histamine?
Histamine is a compound (biogenic amine) made by the immune system meant to protect us from ‘threats’ in our environment. Histamine is produced and stored in mast cells and gets released during allergen exposure. When released, it dilates blood vessels, increases mucus production, and causes broncho-constriction (all mechanisms meant to protect us from this potential “threat”).
The release of histamine results in symptoms such as itching, sneezing, headache, and rash. This is why we turn to anti-histamine medications when we experience these types of symptoms!
Under ‘normal’ circumstances, histamine is quickly broken down by enzymes (primarily DAO). Cases of histamine intolerance are often tied back to inadequate DAO enzyme function. An overabundance of histamine, either from poor clearance or overconsumption can lead to ongoing reactions.
Symptoms of Histamine Intolerance include:
abdominal pain, diarrhea, headaches, fatigue, hives, puffy eyes, sinus issues, menstrual problems, heart palpitation, low blood pressure, mood dysfunction, and more.
Why Low DAO-Function?
In Functional Medicine.. we’re always looking for a root cause of dysfunction. It’s not enough to say, “You cannot tolerate histamine.. avoid it as best as you can.” There are a number of primary drivers of histamine intolerance (and low DAO-function) that we consider:
- Mast Cell Activation Syndrome
- Gluten Intolerance
- Intestinal Permeability (“Leaky Gut“)
- Nutrient Deficiencies
- Genetic Mutations (SNPs)
- Certain Medications (NSAIDs, Immune Modulators, AND Anti-Histamines)
CONSIDERING DIETARY HISTAMINE
Histamine occurs naturally in many foods and certain foods/food additives prompt the release of histamine from mast cells. Therefore, not only can you introduce histamine directly; but also indirectly by stimulating the immune system. For sensitive individuals, high-histamine foods as well as histamine releasers create the same ‘allergenic’ symptoms.
Further, the histamine content in food varies markedly according to storage and maturation. Proteins that may normally be low in histamine will have increasing amounts of histamine as they age (e.g. ground beef). Similarly, fruits will have increasing amounts of histamine as they ripen. As a rule, ANY leftover food will accumulate more histamine over time.
ENTER: THE LOW-HISTAMINE DIET
There is no such thing as a “histamine-FREE diet” – instead, it’s about managing intake of histamine according to your own threshold. Using a high- to low- spectrum, you can be diligent about avoiding the foods highest in histamine as well as those demonstrated to be histamine releasers.
In general, fermented, pickled, and aged foods such as sauerkraut, cheeses, soy sauce, vinegars, canned fish and smoked meats tend to be highest in histamine content. Certain fruits and vegetables, as well as food additives and preservatives such as tartrazine, food colors, benzoates, BHA, and BHT can prompt histamine release.
A low-histamine diet is one built around the following principles:
Eat Whole Foods
Most fruits and vegetables are protected by their peels or skins from germs, and therefore histamine production. Eat whole, unpeeled fresh fruits and vegetables since the early removal of skins or peels on produce can increase their histamine content. Peel and prepare your own fruits and vegetables close to eating when you can.
Avoid Fermented & Aged Foods
The presence of histamine and other biogenic amines increases with time. The fermentation process can also lead to high histamine levels. Dietary sources that are high in histamine include many aged and fermented foods and beverages such as cheeses, yogurt, processed meats, alcoholic beverages, sauerkraut, and soy.
Opt for Fresh Protein
Freshly cooked meat, poultry, and fish are safe to eat on a low histamine diet. Avoid shellfish and frozen, processed, fermented, pickled, smoked, or salted/ canned meats as these foods are high in histamine.
BEST practices for minimizing histamine include:
- As much as possible, eat FRESH food. Peel fruits/vegetables just prior to eating and enjoy freshly cooked meat, poultry and fish.
- Avoid leftovers. However, freezing halts histamine formation. Immediately freeze any uneaten portions and consume within 1 month of freezing.
- Avoid/reduce canned, processed, and packaged items.
- Get familiar with high-histamine foods and avoid them as much as possible.
- Focus on the wide variety of foods LOWER in histamine!
Foods lower in Histamine:
Foods that have been reported to have lower histamine levels and are thus to be preferred:
- Fresh cooked meat, poultry, and fish
- MOST Fresh fruits – with the exception of citrus, bananas, and other histamine-releasers listed in chart
- MOST Fresh vegetables – with the exception of tomatoes, eggplant, and other histamine-releasers
- Grains, and grain products
- Fresh, raw milk and non-fermented dairy, including butter
- Cooking oils and fats
- Herbs and Spices
NUTRIENTS & Supplements to MANAGE HISTAMINE INTOLERANCE
Certain nutrients including Copper, Vitamin B6, and Vitamin C can be helpful for increasing degradation of histamine in the body. Often, those who struggle with histamine intolerance are lacking in these things!
Phytonutrients like quercetin have been shown to increase activity of the DAO enzyme and promote histamine clearance. Include onions, garlic, ginger, nettle, and holy basil in your diet.
Other foods like black rice, apples, and pomegranate have anti-histamine benefit as well!
–Learn more in my ESSENTIAL GUIDE TO HISTAMINE INTOLERANCE
WHAT TO DO IF YOU SUSPECT A HISTAMINE INTOLERANCE
Managing Histamine Intolerance starts with a Low-Histamine Diet. This is a safe nutritional strategy to implement while investigating other root causes.
Get familiar with a Low-Histamine Food List. Fill your shopping cart with primarily ‘low-histamine’ foods and begin adjusting your cooking & eating habits. Looking at a comprehensive list of healthy foods to INCLUDE in your diet reframes the lifestyle shift into one of abundance rather than thinking about what you must restrict.
Spend four to six weeks in this pattern before considering reintroducing foods to assess your tolerance. I recommend working one-on-on with a nutritionist to develop a personal eating strategy. Most individuals will be able to tolerate histamine-releasing foods, moderate-histamine foods, and tiny amounts of high-histamine foods after a strict period of avoidance alongside correcting underlying issues.
WANT TO LEARN MORE ABOUT HISTAMINE + HISTAMINE INTOLERANCE?
Download Kate’s Essential Guide to Histamine Intolerance. Inside you’ll get:
- More background information on Histamine, Histamine Intolerance, and DAO
- Complete Low-Histamine Food List
- Practical tips for managing dietary histamine
- FOUR WEEK Low-Histamine Meal Plan + Recipes
- How-to guide for reintroducing foods
- Foods/Herbs/Nutrients to include in a low-histamine diet
- Supplement recommendations for managing histamine intolerance