Histamine Intolerance 101: Causes, Symtoms, Diet & Management - Manjiri Nadkarni Blog

Are you itching and scratching in response after eating food?

Does wine make you sick and nauseous? 

Are you constantly stuffy, congested and suffer from recurrent sinus issues?

Well, it could be more complex than what you think. In my clinical Ayurveda and Nutritional consultation practice in Sarnia, Ontario, where I specialize in gut health and allergies, I often see that the allergies that don't get resolved with gut healing protocol can usually stem from deeper underlying issues like histamine intolerance.

So in this article I will be discussing about 

1. What is Histamine?

2. What is Histamine intolerance?

3. Causes of Histamine intolerance.

4. Symptoms of Histamine intolerance

5. High Histamine Foods to Avoid For Histamine Intolerance

6. Ayurveda and Histamine Intolerance

What is Histamine?

Histamine has many physiological and pathophysiological functions:

• regulation capillary permeability, 

• contraction and relaxation of smooth muscles and blood vessels

• secretion of hydrochloric acid in the stomach, 

• immediate hypersensitivity responses in allergic processes, 

• inflammatory processes as part of an immune response to foreign pathogens, 

• in the healing of tissues 

• promote and stabilize wakefulness

• And also as a neurotransmitter in the central nervous system.

There are four types of histamines that we know of:

• H1 histamine is known for its role in hives, allergies, and the sleep/wake cycle. (that's why over the counter antihistamines make you drowsy)

• H2 releases hydrochloric acid in the stomach (Pepcid is an H2-blocking antihistamine).

• H3 is more like a classic neurotransmitter, likely involved in OCD, sleep disorders, and ADHD.

• H4 is involved in hives and asthma.

Most histamine in the body is generated in granules in mast cells and in white blood cells (leukocytes) called basophils. Mast cells are especially numerous at sites of potential injury — the nose, mouth, and feet, internal body surfaces, and blood vessels. Non-mast cell histamine is found in several tissues, including the hypothalamus region of the brain, where it functions as a neurotransmitter. Another important site of histamine storage and release is the enterochromaffin-like (ECL) cell of the stomach.

What is Histamine Intolerance?

Unlike a typical sensitivities, where your body reacts to the food, histamine intolerance is not sensitivity to the compound histamine. Rather it is an indication that your body is unable to cope with the amount of histamine in your system - which then causes various symptoms.

There are two scenarios here

1. You could have high levels of histamine

2. You could be unable to break down the histamine due to deficiency of enzyme DAO (diamine oxidase- the enzyme responsible for breaking down histamine)

Thus, when histamine levels get too high or when it can’t break down properly, it can affect your normal bodily functions.

What causes Histamine Intolerance?

Normally, histamine intolerance is not a hereditary disease, but an accessory symptom induced by other diseases. It is caused by an enzyme deficiency which can be a consequence of inflammatory intestinal disorders, infections, or genetic predisposition.

If your digestion is optimal, then your body should be able to degrade all the histamine that you have either consumed through foods or produced. However, if your digestion is off balance, your body cannot handle the high levels of histamine and produces various symptoms like bloating, diarrhoea, skin rashes, allergy like symptoms as seen below.

There are many factors responsible for histamine intolerance but the five most commonly seen factors are

1. Exposure to foods, environmental factors that have high levels of histamine

2. Increased Bacterial Production of Histamine - Certain bacteria can convert the amino acid histidine and histamine. Bacteria that are commonly used in fermentation like Lactobacillus casei and Lactobacillus bulgaricus could also potentially exacerbate histamine production, which could also be found in your probiotics. 

3. Poor gut function: When the intestinal barrier is impaired, histamine can pass through the intestinal wall and enter the bloodstream unaltered.

4. Mast cells: Histamine is typically released from mast cells in response to allergens, but if mast cells are unstable, higher levels of histamine can be released

5. Deficiency of DAO: Histamine is degraded by specific enzymes like DAO (diamine oxidase) and histamine N-methyltransferase (HNMT). Low levels of these enzymes could interfere with histamine degradation and result in high levels of histamine in the body. 

A simple blood test can determine how much Histamine and DAO you have as well as DAO/Histamine ratio. To learn more about this test feel free to books your free 15 min appointment.

Some causes of Low DAO Enzymes

• Gluten intolerance

• Leaky gut

• SIBO

• 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.

• Medications:

  • 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 like they would help prevent histamine intolerance, these medications can actually deplete DAO enzyme levels in your body.

What are the symptoms of Histamine Intolerance?

Histamine intolerance has many body wide signs and symptoms and that is one of the reasons it is very difficult to pinpoint the issues you are facing to histamine. Most clients who suffer from digestive issues, skin issues etc suffer for years before they find out that the real cause of their health problems is Histamine intolerance. 

Digestive symptoms

• Irritable Bowel Syndrome 

• Bloating

• Diarrhoea

• Excessive flatulence

• Constipation (diarrhea is more common than constipation)

• Stomach aches or cramps (including severe menstrual cramps)

• Nausea

• Vomiting

• Acid reflux / Heartburn / Indigestion

Skin

• Rashes

• Hives or Urticaria

• Psoriasis

• Eczema

• Acne or skin breakouts

• Rosacea or redness

• Pruritus / Itchiness (also ocular pruritus or itchy eyes)

• Inflammation of the skin

Respiratory

• Congestion

• Asthma

• Runny nose

• Sneezing

• Chronic cough

• Rhinitis

• Difficulty breathing

• Wheezing

Heart 

• Arrhythmia

• Fast beating

• Fluttering

• Tachycardia

Circulatory

• Circulatory collapse

• Hypotension

• Hypertension

• Constant shivers or chills

• Dizziness

Psychological

• Anxiety

• Stress

• Depression

• Mood swings or imbalances

• Irritability

• Inattentiveness

• Lack of concentration

Eyes

• Watery eyes

• Swelling around eyes

• Eczema

Neurological

• Headaches 

• Migraines

• Tingling sensation

Other symptoms

• Fibromyalgia

• Fatigue

• Sleep issues

What foods should you avoid to lower your Histamine levels??

Food is one of the most important components of Histamine Intolerance proctol, while I use Ayurvedic herbs as well as natural supplements to help rebalance your body and gut, lowering the amount of histamine in your diet by restricting foods that have high levels of histamine or release high levels of histamine is essential. Here are the important facets of a low histamine diet plan.

1. Aged, Cultured, Fermented Foods and Leftovers: One rule of thumb is any foods with bacteria in them can create high histamine. So leftovers, anything that is out of date, spoiled, moldy, or not really fresh is higher histamine. Also the longer the food sits, the higher histamine it has. Fermenting, culturing, aging foods increases their histamine content. Foods like rotisserie chicken, meat in the refrigerator section, lunch meat, beef that gets aged for 2 weeks etc have high histamine content. at the grocery that has been sitting all day is building high  histamine levels. Alcohol also provokes the release of histamine and should be avoided.

Foods high in histamine

•         Alcoholic beverages, like wine, champagne, beer, whiskey, brandy

•         Fermented foods: sauerkraut, vinegar, soy sauce, kefir, yogurt, kombucha, etc.

•         Sour (Fermented) foods: sour cream, kefir, yogurt, buttermilk, soured bread, etc.

•         Balsamic Vinegar and Vinegar foods: pickles, mayonnaise, olives, ketchup

•         Cured meats: bacon, salami, pepperoni, luncheon meats and hot dogs

•         Aged cheese including goat cheese

•         Smoked fish, fish not gutted within 30 minutes of catch, anchovies, sardines

•         Ground meat (Increased surface area increases histamines)

•         Beef (aging process increases histamine)

•         Smoked or processed meats: salami, bacon, ham, sausage

•         Dried fruit: apricots, prunes, dates, figs, raisins

•         Uncooked egg whites (histamine liberator)

•         Leftovers

2. Fruits, Vegetables, and Nuts High in Histamines: Next look at foods which have a high histamine content or trigger the release of histamines. Even healthy foods like avocado, walnuts which are staple today can affect someone with histamine intolerance. 

Examples of high histamine fruits, vegetables and nuts:

•         Avocado

•         Walnuts

•         Cashews

•         Peanuts

•         Spinach

•         Mushrooms

•         Eggplant

•         Pineapple

•         Strawberries

•         Most citrus (small amounts lemons and limes sometimes ok)

Foods that trigger the release of histamine 

• Tomatoes 

• Bananas

• Papaya 

• Citrus fruits- lemons, limes, oranges.

• Wheat germ

• Beans

• Chocolate
  
  

3. Processed Foods and Additives: You want to avoid packaged and processed foods as much as possible. Most people think that if the label says organic or gluten free then it must be healthy, but often canned foods, boxed nut milks, cookies, prepared sauces, and protein bars are higher histamine and inflammatory too. Anything that sits in a package becomes higher histamine. Packaged foods are highly processed to make them shelf stable. This destroys the nutrients your body so desperately needs. Avoid sugar, additives, colorings, flavorings – anything artificial.

In addition to avoiding processed and packaged foods, watch out for these additives that can wreak havoc with mast cells releasing histamine:

•         Carrageenan

•         Sodium Benzoate

•         Potassium Sorbate

•         Lecithin

•         MSG

•         Citric Acid

•         Sodium Triphosphate

•         Potassium Triphosphate

•         Sodium Nitrite

•         Maltodextrin

•         Malic Acid

•         Guar Gum

•         Calcium Chloride

•         Xanthan Gum

•         Food colorings

•         Smoke Flavoring

•         Yeast Extract

Ayurveda and Histamine intolerance: 

In my practice I have often seen that histamine intolerance is common with a Pitta dominant Prakriti or body type and an aggravated Pitta dosha can manifest in the body as histamine intolerance. 

If you see the list of foods that lead to high levels of histamine in the system, they are similar to Pitta aggravating foods and hence one of the important factors in managing Histamine intolerance is to avoid Pitta aggravating foods and calm the aggravated Pitta dosha.

Since Ayurveda is a highly personalized natural healing system, it is advisable to book a consult with an Ayurvedic Vaidya (Ayurvedic doctor) who can delve deeper into your physical, mental, emotional body to find the root cause of imbalance and then help you rebalance your system.

My approach to Histamine intolerance 

1. Find the root cause of high levels of histamine 

2. Low histamine diet (most diets available online are incomplete so you want to make sure you follow one that is accurate for you)

3. Rebalance the gut with good probiotics avoiding bacteria that can release histamine

4. Support gut healing with Ayurvedic herbs, that strengthen the intestinal barrier, heal leaky gut and lower inflammation

Feeling miserable dealing with Histamine Intolerance?

Well, you don't have to struggle anymore

To Book Your Free 15 min consultation, sign up below