Histamine sensitivity or intolerance

Histamine intolerance (HIT) results from an imbalance between the amount of histamine that is released from your cells in response to certain triggers, or builds up in your body as a result of foods you eat – and your body’s ability to break it down and clear it out, which it does using two
naturally occurring enzymes your body is supposed to produce – Diamine oxidase (DAO) and histamine N-methyltransferase (HNMT).
However, due to either genetics or acquired reasons, your body might not produce enough of one or the other, or both of these. HNMT is produced inside the cells and is usually more genetically influenced. DAO, however, is produced in the intestine, and is also the enzyme
responsible for breakdown of ingested histamine, so if there has been intestinal damage, DAO production might be reduced. This can occur as a result of:
• Leaky gut
• Crohn’s disease or ulcerative colitis
• Coeliac disease and non-coeliac gluten intolerance
• Small intestinal bacterial overgrowth (SIBO)
• Certain medications including: NSAIDS, Antidepressants, Antihistamines, Histamine blockers , Antiarrhythmics/Calcium channel blockers
DAO-blocking foods including alcohol can also lead to decreased availability of DAO to breakdown histamine, resulting in elevated levels.
 
Consuming high histamine foods can also cause a problem, especially if your enzyme system is impaired.
HIT is more common in people with inflammatory and irritable bowel disease, and SIBO, as well as eczema, all conditions that have been associated with intestinal inflammation.
Dysregulation in the stress response system – whether adrenal overdrive with high cortisol, or inhibited adrenal function with low cortisol – can also impair the immune system leading to increased reactivity to foods, and stress seems to worsen HIT in many individuals.
There are currently no tests that are proven to diagnose histamine intolerance, and though blood and urine levels of histamine can be measured, because histamine levels are so naturally variable depending on time of day and also when you’ve eaten, it’s just not a reliable way to test
for this problem. Similarly blood levels of DAO can be measured, but these levels don’t really correlate neatly with symptoms.
 
The best way to ‘test’ for histamine intolerance is through a low histamine diet, which is described below. A reduction in symptoms on the diet, and a return of symptoms when higher histamine foods are re-introduced, suggests that there is histamine intolerance.
 
Can I Treat This? Depending on the root cause of your histamine intolerance it can be reversed (usually if there’s gut damage causing the problem), reduced dramatically (if there’s low DAO production), or reduced to a tolerable extent (genetic).
1. Eat a low histamine diet
2. Heal your root causes
3. Supplement
 
A low histamine diet is the first line of treatment. The best approach is to remove all high histamine containing foods, as well as foods that cause the release of histamine, as well as avoiding all DAO blocking foods and whatever DAO blocking medications you can also avoid for
30 days. During this time keep a food journal to record how you feel both immediately andabout 2-3 hours after each meal. Symptoms don’t always appear immediately, they may appear when your body accumulates histamine over the course of the day. So paying close attention
throughout your day during this 1-month period is very important, but it’s not always 100% possible to identify the individual triggers for you.
If during this 30-day period you notice that your symptoms have disappeared or have been dramatically reduced, I highly recommend sticking with the low-histamine diet for 3 months total before trying to reintroduce foods from the lists below. If and when you do reintroduce foods
you’d removed, do so slowly, adding in foods from one group at a time over 3 days each, so forexample, you might add in higher histamine fruits for 3 days and record any symptoms if they arise. If they do, you are probably sensitive to those fruits, and omit them for now. Wait until the
symptoms have passed before introducing the next group, for example, nuts, and again track, and so on.
Histamine intolerance varies highly amongst different people – some can’t reintroduce some of the higher histamine provoking or containing foods at all, while some can include small amounts in their diets. You have to experiment with it – it can feel quite restrictive and like a long road
when you eliminate all of these triggers, but chances are you won’t mind as much when you’re feeling better, and if gut damage was a component of your histamine intolerance, then once your gut is healed, you may be able to resume a diet that includes a broader variety of foods. Gut healing can take weeks to up to a year so you have to be patient with the process.
 
High Histamine Foods to Eliminate
Aged and fermented foods, leftover meats, poultry and fish, and wine are often the biggest triggers; however, any of the foods on this list may be a problem for you, so remove them all for 30 days.
•Alcohol: Champagne, red wine, beer, white wine, cider
•aged meat eg sunday lunch leftovers. Eat meat as fresh as possible. Freeze if not using the same day. Pork is best avoided altogether as are processed meats
•slow cooked meats, stews and casseroles
•meat stocks, bone broth, gravy
•Aged cheeses: Parmesan, Gouda, Swiss, and cheddar
•Grains: Wheat, sourdough bread
•Legumes: Chickpeas, soybeans
•fish: sardines, mackerel, herring, tuna
•Fermented or smoked Meats/Fish
•Fermented and pickles vegetables: Pickles, sauerkraut, kimchi, relish, soy sauce/tamari
•Fermented milk products: Yogurt, kefir, and buttermilk
•Fruit: Dried fruit, citrus fruits, strawberries
•Vegetables: Tomatoes and tomato products, spinach, avocado, and aubergine, mushrooms
•nuts
•Also: Cinnamon, chocolate
Histamine Liberators to Avoid : Citrus, bananas, dairy products, chocolate, papaya, pineapple,
nuts, strawberries, food additives, shellfish, egg white, artificial dyes and preservatives
DAO Inhibitors to Avoid : Alcohol, black and green tea, mate
 
Other possible histamine releasing occurrences in some people:
High temperatures e.g. hot weather or hot showers/baths
Cold temperatures
High pressures e.g. air travel
High impact/energetic exercise
Insect bites
Cosmetics, particularly nail polish and hairspray
Sodium benzoate, contained in lots of things especially fizzy drinks
Complimentary body therapies e.g. deep tissue massage, Bowen therapy, Reiki etc. It is recommended that you do not eat for at least 3 hours before having such a therapy, thisway histamine levels in the body are already lowered and there is a decreased chance of a reaction.
Emotional stress
The body’s ability to handle high histamine foods is compromised at times of emotional or physiological stress (e.g. a cold or other illness) as natural histamine levels are already high.
Reducing intake of high histamine foods during these times is recommended to avoid a reaction.
 
Low-histamine foods you can enjoy include:
•Freshly cooked meat and poultry (fresh or frozen – no leftovers!)
•Freshly caught or fast frozen fish
•Egg yolks
•Gluten-free grains: rice, quinoa
•Peanut butter
•These fruits: mango, pear, watermelon, apple, kiwi, cantaloupe, grapes
•Most vegetables except those listed earlier
•Dairy alternatives: coconut milk, rice milk, hemp milk, almond milk
•Oils: olive oil, coconut oil
•Many of the non-caffeinated herbal teas
 
Note that methylated B vitamins seem to aggravate some people with histamine intolerance; if you are taking methylfolate or methyl-B12 I recommend stopping these while you are on the 30 Day Low Histamine Diet and re-introducing them as a ‘food group’ to see how you respond. If you are planning to conceive, however, it is still important to be on folate or folic acid in some form for at least 30 days prior to conception and during pregnancy.
 
Gut healing is vital – reduce or remove any foods that irritate or inflame the gut. Take L- glutamine in increasing dose starting with 1⁄4 teaspoon twice a day.
If there is a lot of stress your immune response may also be over-activated. Include simple daily stress reduction practices in your lifestyle.
 
Supplements:
• Quercetin and Stinging Nettles: these are natural antihistamines, that do not block DAO and are very effective in preventing histamine reactions and calming mild to moderate reactions. Dose: 250 mg quercetin or isoquercetin three times daily; quercetin should not be used in pregnancy or if you have kidney disease. Use nettles as a fresh tea or in powder form.
• Vitamin B6: 50 to 100 mg a day (do not exceed 100 mg/day)
•Vit C to tolerance levels
• Probiotics and Prebiotics: A daily combination of both a probiotic and a prebiotic helps to repair the intestinal wall, however, avoid probiotics with Lactobacillus casei, a strain that may increase histamine. Lactobacillus rhamnosus, Bifidobacterium infantis and B. longum are the most useful. Nutri advance ProbotiX daily 5 live contain allergy reducing Lactobacillus rhamnosus and Bifidobacterium infantis, but does not contain allergy provoking L casei or L bulgaris.
• Direct DAO supplementation is often recommended, however, I’ve not found nearly as effective as the above combination, and therefore rarely recommend it anymore.