Everything You Need To Know About Histamine Intolerance

February 5th, 2016

Histamine Intolerance

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.

Having a histamine intolerance can be very frustrating, because the symptoms often feel like they come out of nowhere. Trust me, I understand! I had a histamine intolerance myself at one point, and I kept getting these terrible headaches seemingly out of the blue. So I jumped into functional medicine detective mode, and fortunately I was able to pinpoint a histamine intolerance as the source of my headaches, and then determine what the underlying cause of that histamine intolerance was.

To help you find your own answers to these questions, this week I’m going to walk you through what histamine intolerance is, what causes it, the best diet for it, and how to treat it.

 

What is Histamine?

Histamine is a chemical involved in your immune system, proper 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 is what helps you break down food in your stomach.

You might be most familiar with histamine as it relates to the immune system. If you’ve suffered from seasonal allergies or food allergies, you may have noticed that antihistamine medications like Zytrec, Allegra or Benedryl provide quick relief of your symptoms. This is because 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.

Histamine causes your blood vessels to swell, or dilate, so that your white blood cells can quickly find and attack the infection or problem. This is 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 begins to build up and you develop what we call histamine intolerance.

Because it travels throughout your bloodstream, histamine can affect your gut, lungs, skin, brain, and entire cardiovascular system, contributing to a wide range of symptoms, and often making a histamine intolerance difficult to pinpoint and diagnose.

Common Symptoms of Histamine Intolerance

  • Headaches/migraines
  • Difficulty falling asleep
  • Hypertension
  • Vertigo or dizziness
  • Arrhythmia, or accelerated heart rate
  • Difficulty regulating body temperature
  • Anxiety
  • Nausea, vomiting
  • Abdominal cramps
  • Flushing
  • Nasal congestion, sneezing, difficulty breathing
  • Abnormal menstrual cycle
  • Hives
  • Fatigue
  • Tissue swelling

 

What Causes High Histamine Levels?

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

Histamine-Rich 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

Histamine-Releasing Foods

  • Alcohol
  • Bananas
  • Chocolate
  • Cow’s Milk
  • Nuts
  • Papaya
  • Pineapple
  • Shellfish
  • Strawberries
  • Tomatoes
  • Wheat Germ
  • Many artificial preservatives and dyes

DAO-Blocking Foods

  • Alcohol
  • Energy drinks
  • Black tea
  • Mate tea
  • Green tea

 

Foods to Enjoy If You Have A Histamine Intolerance

Whew! That was a long list. You might be wondering now what on earth you CAN eat, so I’ve made a list of low-histamine foods as well. Remember that freshness is key when you have histamine intolerance!

Low-Histamine Foods

  • 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, avocado, 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, remember to avoid all grains, legumes, and nuts until you are able to reintroduce them successfully

 

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. So if you’re deficient in DAO, you likely have symptoms of histamine intolerance.

Causes of Low DAO

  • 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 levels in your body.

How to Test for Histamine Intolerance

Elimination/Reintroduction
Remove the above high histamine foods for 30 days and reintroduce them one at a time by following the guidelines in my comprehensive elimination diet eCourse.

Blood Testing
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 simply 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 the one I carry in my store called Histazyme, for immediate relief.

When I was battling histamine intolerance, this supplement was a true life-saver for me, and I would not have a meal without it! Simply take one or two capsules no more than 15 minutes before you eat to prevent histamine intolerance symptoms. You can learn more about Histazyme, how it works, and how to take it in the video below.

Address the Root Cause of Your Histamine Intolerance
The real key to overcoming histamine intolerance is to identify and treat the root cause of the issue. In my clinic, I find that histamine intolerance is often caused by a gut health issue, particularly SIBO. In fact, SIBO was the cause of my histamine intolerance. Other common causes I see are leaky gut and gluten intolerance. If you think gut problems are causing your histamine intolerance, I recommend completing The Myers Way® Guide to the Gut eCourse. It includes diagnostic quizzes, meal plans, and handy tools to help you diagnose and treat your gut infections at home.

 

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  • Chelsea Hibbard

    Hey Dr. Myers! Thank you for this post, it was hugely helpful! I definitely think I’m dealing with this as I’ve finally figured out that anytime I drink kombucha, I get a horrible headache within an hour or two. And anytime I eat fermented foods, I have all sorts of bad reactions. This past week, I drank a little kombucha and a tablespoon or so of sauerkraut all in the same day and had a very scary vertigo episode. All of this finally led me to something I think I’ve been suspecting for a long time. I plan on taking the steps you recommend, but I have two children with very severe eczema, and while we have made huge strides with diet change, for my youngest, it’s not enough. One thing I’ve noticed that makes me think he may be dealing with the same thing as me is that any time he drinks bone broth, he immediately breaks out all around his mouth and starts scratching pretty heavily all over, and his eczema flares. This happens at other times but I’ve never been able to pinpoint it to certain foods, but now I’m convinced he must have the same issue as me. My question is if there is any DAO supplement you would recommend for him? He’s only just about 2 years old. Thanks in advance!

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