The low histamine diet: why you might need it

Finding out that you have a histamine intolerance may come as a surprise. Some people may find it a huge relief. Finally, an explanation for their itchy eyes and runny nose!

Others will bemoan their bad luck, and wonder what the heck to do about it.

In any case, the protocol is the same: switching to a low histamine diet. But what is that exactly? What foods are low in histamine and what foods are not? What even IS histamine?

We’ll explain all that - and more.

What is histamine?

Histamine is a chemical that occurs naturally in some foods and is also produced by your body.

It’s actually known as an autacoid, which means it acts like a local hormone near where it is synthesized in the body. The highest concentrations of histamine are found in your intestinal mucosa, skin, and bronchial tissues.80

Why do we need histamine?

Although an inflammatory reaction can be quite unpleasant, histamine is very important in protecting your body from potential harm. It acts like an armed guard, sounding the alarm to let your body know that something foreign has entered and that it needs to be fought off.

This causes your immune system to respond with inflammatory chemicals that help get rid of the invader - known as an allergen - that’s bothering you.

When produced during a local immune response, histamine’s main role is to cause inflammation. Its release causes your capillaries to become more permeable to white blood cells and other proteins, which allows the white blood cells to target and attack foreign bodies in the affected tissue.

As one of the most versatile molecules in your body, histamine can cause a huge range of effects depending on where it’s released.

Immune Cell Release 

Histamine is produced as part of your immune system’s response in order to trigger inflammation. Basophils and mast cells secrete histamine when your body detects one of these invaders. These cells reside in connective tissue and act as potent effector cells of the innate immune system.

Mast cells are the major producer of histamine and express many receptors on their surface. These receptors are activated through stimulants such as allergens, complement peptides, and neuropeptides, which cause the mast cells to release various inflammatory mediators including histamine. 

When released, histamine causes smooth muscle contraction in the intestines (often causing cramps and diarrhea), expansion of blood vessels (often causing low blood pressure), mucus secretion in the nasal passages and GI tract, and many other physiologic effects that are intended to fight off invaders.

When the ‘threat’ is passed, histamine levels return to normal, and symptoms subside.

Stomach Cell Release

Histamine is also released from enterochromaffin-like cells in the stomach, triggering acid secretion from parietal cells. This increases acidity in the stomach to kill off any dangerous invaders. 

Brain Cell Release  

Histamine is also produced in the hypothalamus. It acts as an excitatory neurotransmitter and is involved in regulating the sleep-wake cycle.

Histamine in food

Histamine is a byproduct of the amino acid histidine. It’s created when certain strains of bacteria or yeasts convert histidine into histamine.

Histidine is present in most protein-rich foods such as meat, fish, eggs, soy, whole grains, beans, and nuts. Although most protein-containing foods can form histamine under the right conditions, the foods containing the highest amounts are aged and fermented foods. Fresh foods contain very little or zero.

The breakdown of histamine

Normally, histamine is broken down by two particular enzymes in your body: N-methyltransferase (HNMT) and diamine oxidase (DAO). 

  • HNMT is only present in the cytoplasm of a cell, where it breaks down any histamine inside cells.The highest concentrations of HNMT are generally in the kidney and liver but it’s also present in many other tissues.
  • DAO is produced and stored by the cells lining your organs and blood vessels (known as your epithelial cells). It’s produced in large amounts within the intestines, but also by the placenta during pregnancy. DAO is released into your bloodstream and gut, where it can begin breaking down any histamine that might be floating around.

But if these enzymes aren’t working properly histamine quickly accumulates. This can lead to histamine intolerance

What is histamine intolerance?

Histamine intolerance occurs when your body can’t cope with the levels of histamine that have accumulated. This build-up can lead to symptoms that are very similar to an allergic reaction.

It’s estimated that around 1% of the population has histamine intolerance; most of whom are middle-aged women. Research suggests that estrogen may be to blame here, because it activates histamine release from mast cells, while progesterone inhibits it.

Because histamine plays so many different parts in how your body functions, symptoms of an intolerance are broad and can easily be confused for other things, such as food allergies.

Some of the most common symptoms of histamine intolerance to be aware of include:

Digestive issues

Abdominal cramping, bloating, diarrhea, and other gastrointestinal discomforts. Histamine plays a part in breaking down food. If your body isn’t able to do this properly, you’ll end up with symptoms like gas, bloating, diarrhea, and stomach pain.

Headaches and dizziness

Histamine can cause the blood vessels in your brain to dilate, which can lead to headaches and lightheadedness.

Respiratory issues

Nasal congestion, sneezing, and other respiratory problems. Again, dilated blood vessels in the nasal passageways tend to cause sneezing and congestion. Histamine can also affect other parts of your respiratory system beyond your nose, including your airways. In extreme cases of histamine intolerance, you may have trouble breathing.

Dermatological problems

Rashes, eczema, and itchy skin are also a result of inflammatory reactions in the skin.

Cardiovascular reactions

A racing heart or palpitations is caused by histamine acting directly on cells in your heart.

Other symptoms of histamine intolerance include: 

  • Abdominal cramps
  • Irregular menstrual cycle
  • Anxiety
  • Arrhythmia or increase heart rate
  • Trouble falling asleep
  • Difficulty maintaining body temperature
  • Fatigue
  • Flushing
  • Headaches and/or migraines
  • Hives
  • Blocked nose, sinus congestion, sneezing, difficulty breathing
  • Nausea, vomiting
  • Swelling of tissues
  • Vertigo or dizziness

What is histamine intolerance caused by?

There are several reasons intolerance can develop. 

  • Your body is producing too much histamine. This can happen during an immune reaction or due to a health condition such as mastocytosis, in which mast cells increase in number and as a result, cause the body to produce higher amounts of histamine.

  • You are consuming high-histamine foods or drinks. 

  • Your body is not breaking down histamine properly. This may be due to genetics, medications, or other medical conditions. In most cases, this is due to impaired DAO activity. Studies have shown that people with histamine intolerance tend to have lower serum DAO activity.
  •  Poor gut health due to stress, infection, dysbiosis or inflammatory bowel diseases (such as Crohn’s disease). Inflammation in intestinal cells may lead to a decrease in DAO production. Those with histamine intolerance tend to have less “good” gut bacteria. 

Histamine intolerance testing

If you have the signs and symptoms of histamine intolerance but no apparent allergies or gastrointestinal disorders, it’s important to seek out a proper medical diagnosis.
The gold standard for a histamine intolerance diagnosis begins with a strict low-histamine diet for four weeks.

You will then ‘introduce’ a few high histamine foods and observe your physiological reaction.
A registered dietician or other healthcare professional can help guide you through a structured elimination diet.

It’s also a good idea to keep a food diary for a few weeks and record everything you eat and drink, along with any symptoms.

When is a low histamine diet recommended?

The first step in managing histamine intolerance and reducing symptoms is to follow a low-histamine diet. Studies have shown that reducing intake of histamine also reduces symptoms of intolerance, and may even help to increase DAO levels in the blood.
It’s generally accepted that if your tolerance level for histamine is naturally low, you are likely to react when you eat or drink something containing histamine.

Histamine levels in foods increase with maturation, which means they have been fermented in some way. This includes aged cheeses, yogurt, kefir, sauerkraut, processed meats, aged meats, and alcoholic drinks such as wine, champagne, and beer. Reactions also appear to correlate with the degree of processing.

  • Alcohol- Red wine can have up to three times more histamine than white wine. Wine ‘on tap’ contains higher amounts of histamine than bottled.  
  • Avocado
  • Dried fruits
  • Eggplant
  • Fermented or aged meats: salami, sausages, pepperoni, lunch meat, hot dogs, canned or smoked meats/fish
  • Fermented beverages: kombucha
  • Fermented dairy products: yogurt, kefir, sour cream, buttermilk, cottage cheese, ricotta
  • Fermented vegetables: miso, kimchi, sauerkraut, pickles, natto
  • Fish and seafood, especially smoked, salted, canned, or leftover
  • Matured cheeses
  • Beans and pulses: chickpeas, soy
  • Nuts prone to mold: peanuts, cashew nuts, almonds
  • Chocolates and other cocoa-based products
  • Seitan
  • Rice vinegar
  • Instant or packaged meals
  • Snacks and sweets with preservatives and artificial additives
  • Soy sauce, tamari, coconut aminos, liquid aminos

Histamine liberators

Symptoms can also be brought on by “liberators”: foods that don’t actually contain histamine but can trigger your cells to release it. These foods include:

  • Most citrus fruits, including lemon, lime, oranges
  • Cocoa and chocolate
  • Walnuts, peanuts
  • Papaya, pineapples, plums, kiwi, bananas
  • Legumes
  • Tomatoes
  • Wheat germ
  • Most vinegars
  • Additives – benzoate, sulfites, nitrites, glutamate, food dyes 

NOTE: Symptoms may be triggered by certain foods, but histamine intolerance is not the same as a food allergy. Symptoms may not be immediate; rather, you may react any time your “threshold” is reached. This makes it very difficult to pinpoint a particular food as the culprit.

DAO blockers

Foods that inhibit the activity of DAO should also be avoided - especially alcohol. Alcohol contains high levels of histamine and also slows DAO’s ability to break it down.  

DAO-blocking foods include: 

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

Foods to eat on a low low-histamine diet

Fortunately, there are plenty of low histamine foods out there! Remember, foods with the lowest amount of histamine are fresh, natural foods. 

  • Fresh fruits: apples, apricots, blackberries, blueberries, cherries, coconut, melons, peaches, plums, pomegranate, and raspberries, among others.
  • Most vegetables: asparagus, bell peppers, beets, bok choy, broccoli, brussels sprouts, cabbage, carrots, cauliflower, garlic, greens, leeks, lettuce, onions, rhubarb, rutabaga, shallot, summer squash, sweet potato, turnip, watercress, winter squash, zucchini.
  • Gluten-free grains (these are less likely to aggravate an irritated gut lining): amaranth, corn, millet, quinoa, rice, teff.
  • Fresh herbs
  • Olive oil
  • Fresh animal proteins: chicken, beef, lamb. Choose meat that has been butchered and frozen quickly, and preferably in whole cuts. Ground meat (such as mince) is more prone to bacteria being spread bacteria throughout the meat, allowing histamine to be created.

Again, note that everyone tolerates different foods differently. Even some low-histamine foods can cause adverse reactions. 

Tips for preparing food on a low histamine diet

The key thing about histamine is that it forms as food ages, so it’s vital to keep all food and drink as fresh as possible. Keep a cooler in your car for groceries. Freeze food where possible: this prevents or slows the development of histamine.

Should you take antihistamines?

Over-the-counter antihistamines are medications designed to block the action of histamine, reducing symptoms. However, this is just a temporary fix: antihistamines will not get to the root of the problem, and will certainly not help boost DAO activity. Antihistamines are also known for causing drowsiness, dry mouth, dizziness, and even nausea.

Histamine intolerance supplements

While limiting histamine-containing foods is the most effective way to manage intolerance, it can be difficult to avoid histamine completely. That’s where supplements that support the degradation of histamine and reduce histamine in the body can be helpful.

DAO supplementation

One study showed that when high-histamine patients took DAO supplements before meals, their symptoms improved significantly. When taken over eight weeks, the patients reported significant improvements in histamine-intolerance symptoms, including GI, cardiovascular, respiratory and skin complaints. 

It should also be noted that patients on a low histamine diet showed marked improvement in symptoms along with elevated serum DAO after approximately 2 months. Avoiding DAO-blocking foods is also advised. 

Vitamins to support the breakdown of histamine  

There is also some evidence that DAO enzyme is dependent on vitamin B6, B12, iron, copper and vitamin C in order to function properly. Copper and Vit C play crucial roles in the function of the DAO enzyme, while B6 is a key cofactor that enables DAO to degrade histamine.
Several studies have shown that vitamin B6 deficiency is associated with reduced serum DAO activity, which may correlate with it may influence serum DAO activity.
One of the best ways to increase your intake of these nutrients is with a high-quality multivitamin such as the Methyl-Life™Chewable Methylated Multivitamin + Cognitive. This comprehensive multivitamin contains all the nutrients required for optimal methylation in the body.

The research-based formulation includes methylfolate and hydroxocobalamin to promote your body’s production of glutathione, your most powerful antioxidant.  

The Methylated Multi supports energy production with a host of B vitamins and their cofactors, TRAACS® minerals, Vitamins A, D3, E and bioactive K2. It also contains a new ATP energy combination, Panmol® NADH + MicroActive® CoQ10.

Methylation support

Histamine is also involved in the methylation process, which can be problematic for anyone with defects of the MTHFR gene. 

MTHFR helps regulate methylation, which is needed to reduce intracellular histamine. However, genetic defects can result in a malfunctioning MTHFR enzyme, which in turn can lead to imbalances in methylation status.
Research suggests that a MTHFR mutation(s) compromises your body’s ability to carry out methylation which can lead to a buildup of excess histamine.
Check out our recent article, High histamine: what it does and why it’s so complicated for more about this.

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This highly-recommended product is formulated specially for people with a heightened need for bioavailable folate due to genetic (MTHFR) defects, dietary deficiencies or drug-induced need (i.e. taking warfarin, coumadin, metformin, etc.). 

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As with taking any supplement, it is strongly advised that you consult with a qualified healthcare practitioner before beginning any treatment.
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