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Histamine intolerance
By Dr S V Bulatov - registered homeopath

People who are unable to effectively metabolize histamines must restrict their consumption of histamine rich foods that can lead to chronic health issues such as allergies, asthma, sinus problems, eczema, chronic pain, menstrual problems and much more.

Those susceptible may have problems with high-intensity exercise, especially done in a warm environment. Individuals with periods of high oestrogen may have higher than normal histamine responses and high stress increases histamine levels and decreases the body’s ability to metabolize the histamine.

Histamine is an in important neurotransmitter and immune messenger molecule. It is involved in the hydrochloric acid secretion for digestion, triaging water reserves to key areas of the body and the inflammatory response. Histamine receptors are located all over the body and have many important functions including:

  • Histamine H1 receptors: Smooth muscle, endothelial cells affecting skin, blood vessels (Benadryl and Claritin block activity of these receptors)
  • Histamine H2 receptors: Cells in the intestines control acid secretion, abdominal pain, nausea and heart rate
  • Histamine H3 receptors: Central nervous system controlling nerves, sleep, appetite and behaviour
  • Histamine H4 receptors: Thymus, small intestine, spleen, colon, bone marrow, white blood cells and inflammatory response
One of the major effects of histamine is causing the blood vessels to swell and dilate. When the body senses that it is threatened it will secrete higher amounts of histamine. This allows the white blood cells to quickly move through the blood stream and find the potential threat or infection. This is an important component to a healthy immune response.

Histamine only becomes a problem when we have metabolic disturbances that do not allow us to effectively metabolize histamine properly. When histamine is formed it is broken down by specific enzymes. In the central nervous system it is metabolized by histamine N-methyltransferase (HMT), while in the digestive tract it is broken down by diamine oxidase (DAO).

DAO is the major enzyme involved in histamine metabolism. It converts the histamine into imidazole acetaldehyde which does not trigger any sort of reaction in the body. DAO is responsible for ensuring a steady histamine level required for the balance of numerous chemical reactions taking place in the body.

Some individuals have altered DAO production due to a number of different factors including:
  1. Small Intestinal Bacterial Overgrowth (SIBO) - some gut microbes produce high amounts of histamines as a by product of their metabolism.
  2. Copper, vitamin C, B6 deficiency: copper and vitamin C are crucial components of the DAO enzyme and B6 is a key cofactor that enables DAO to degrade histamine.
  3. Leaky Gut Syndrome: intestinal permeability creates major inflammatory stress in the body which can contribute to poor DAO function.
  4. Genetic Polymorphisms in DAO enzyme: this can be seen on www.23andme.com. A homozygous DAO would make someone more susceptible to developing histamine intolerance.
  5. 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)
According to Dr. Amy Myers MD "histamine blockers, a class of acid-reducing drugs, seem like they would help prevent histamine intolerance, these medications can actually deplete DAO levels in your body".

According to Chris Kresser "Histamine is different than typical food sensitivities or allergens in that it is a cumulative problem". So we begin to have symptoms when we either take in too many histamine molecules or we reduce the DAO enzyme to the point where the histamines overload the system. These symptoms will last until the body metabolizes the histamines and removes them from the systems.

The histamine intolerance manifests in approximately 3$ of the population ( about 80$ of them women over 40). In up to 20$ of these cases the symptoms occur mostly when histamine containing foods are used in combination with DAO inhibitors such as alcohol.

The three biggest factors involved with histamine intolerance include:
  1. Leaky gut syndrome or related disorders such as Crohn’s disease, IBS, celiac/ gluten sensitivity, etc.
  2. Genetic polymorphism of DAO enzyme.
  3. Heavy alcohol and/or medication usage.
This is a challenging condition to diagnose for a number of reasons. The first is that there are so many popular foods, many of which are considered health foods that are high in histamines. Also, some individuals have a unique gut flora that is producing high histamine levels.

Most doctors are not familiar with histamine intolerance and never consider this as a contributing factor in the individual‚s health challenges. In fact, many physicians typically recommend a diet high in histamine containing foods. This includes fermented foods which have incredible health benefits for those with adequate histamine metabolism.

People react quite differently to elevated histamine making it that much harder to pinpoint. When individuals react very poorly to fermented foods it is a sign of histamine intolerance. Most people respond very well to small amounts and gradually increasing levels of fermented foods. Individuals with histamine intolerances often break out with hives, eczema, rashes, puffy eyes, headaches, etc.

Symptoms:
  • Headaches
  • Migraines
  • Difficulty falling asleep, easily aroused
  • Hypertension
  • Vertigo
  • Dizziness
  • Arrhythmia
  • Accelerated heart rate
  • Difficulty regulating body temperature
  • Anxiety
  • Nausea
  • Vomiting
  • Abdominal cramps
  • Flushing
  • Nasal Congestion
  • Sneezing
  • Difficult breathing
  • Abnormal menstrual cycle
  • Hives
  • Fatigue
  • Tissue swelling
Histamines travel throughout the bloodstream and therefore can affect the gut, lungs, skin, brain and entire cardiovascular system. This is why there is such a wide array of health problems associated with it and it is quite challenging to pinpoint and diagnose if you are not aware of the condition.

The 23andme genetic test will look at genes associated with DAO enzyme production. When an individual has a homozygous mutation they will most likely struggle with histamine metabolism. This may not occur until after a stressful season of their life when their gut barrier breaks down and their adrenal glands are unable to keep up with the demands placed upon them. This creates a vicious cycle of chronic inflammation and inflammatory stress that depletes the body of vital reserves and exposes the genetic weaknesses of the individual.

There are lab tests that can be done that analyze the ratio of histamine/DAO enzymes. A high histamine/DAO ratio indicates that one is ingesting too much histamine and is not producing enough DAO to effectively metabolize it.

Without getting the blood test you could do a histamine challenge by consuming a number of different fermented foods and high histamine foods and see if this aggravates your symptoms. If so, try a low-histamine diet for a week and if you notice significant improvements you most likely have histamine intolerance.

To improve your tolerance to histamine, it is critical to heal the gut and address the dysbiotic issues that are at the root of the problem.

Some foods naturally have more histamine content while others accumulate histamines while they age. Fermented and dried foods typically have the highest levels of histamines. A low histamine diet must be focused around getting foods at their peak level of freshness. Here is a list of high histamine foods:

  • 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
  • Processed foods of all types
Sunlight and UV light exposure also releases histamine.

These foods do not necessarily contain histamine but they block the action of DOA and therefore they potentiate the effects of elevated histamines:
  • Alcohol
  • Bananas
  • Chocolate
  • Cow’s milk
  • Nuts
  • Papaya
  • Pineapple
  • Shellfish
  • Strawberries
  • Tomatoes
  • Wheat Germ
  • Artificial preservatives and dyes
DAO-blocking foods:
  • Alcohol
  • Energy drinks
  • Black tea
  • Mate tea
  • Green tea
Low histamine foods:
  • Freshly Cooked Meat & Poultry (frozen or fresh)
  • Freshly Caught Fish
  • EV Olive Oil
  • Pasture-Raised Eggs
  • Gluten-Free Grains: brown rice & quinoa
  • Fresh Fruits: Other than citrus, avocado, tomato, pineapple, bananas and strawberries
  • Fresh Vegetables )except spinach and eggplant)
  • Coconut milk, Rice milk, Hemp milk, Almond milk
  • Coconut oil & Grass-fed Butter/Ghee
  • Organic coffee
  • Almond butter
  • Leafy herbs
  • Herbal teas
People with histamine intolerance react in a multitude of different ways. Some people cannot handle any high histamine foods while others can handle certain types but not others.

As an example, an individual may tolerate avocados, berries and lemons quite well but have significant reactions with any sort of fermented foods or wine. You will have to find the unique ways that you react and understand what triggers reactions and what doesn’t.

Overtime, as histamine content is reduced and the individual improves their gut health, reduces inflammation, improves liver function and stabilizes their adrenals they will be able to handle more of the histamines. For some, this will mean they will be able to incorporate small amounts of all the higher histamine foods. For others they will only be able to handle certain foods while others will continue to trigger reactions.

If you struggle with major symptoms listed above when you have the various high histamine foods you may have this problem. In particular, if you struggle with fermented foods and probiotic supplements that is a classic sign of histamine intolerance.

If you are suffering from an acute histamine reaction taking AllClear (6-8 caps a day) and high dose proteolytic enzymes (8-10 caps a day) can help to reduce the effects of this.

A diet rich in the flavoinoid luteolin has been shown to reduce mast cell activation. This is found in carrots, bell peppers, thyme, rosemary, peppermint, oregano, romaine lettuce, artichoke, pomegranate, chocolate, rooibos tea, buckwheat sprouts and cucumbers among other things.