by Dr. Tiffany Caplan, DC, CFMP, IFMCP & Dr. Brent Caplan, DC, CFMP, IFMCP
Histamine intolerance, or the inability to effectively break down histamine, is a condition that affects hundreds of thousands of people worldwide. Histamine plays an important role in our immune system health, but when too much is circulating throughout our bodies, it can cause a slew of unwanted symptoms. It is commonly thought that histamine reactions are only allergy symptoms like hives or sneezing, but histamine intolerance can manifest in many forms. It can have many unwanted effects on autoimmune conditions as well. Learning to manage your histamine intolerance through lifestyle and dietary adjustments can help both quell histamine-induced symptoms and help you look and feel healthier.
What is Histamine?
Histamine is a chemical signal, a molecule that the body uses to ensure that certain important biochemical tasks occur when they are needed by the body. Specifically, histamine assists the body in making sure it has the right amount of stomach acid during digestion by communicating directly with the stomach cells as food is being ingested. Histamine also plays a key role in keeping us awake by communicating directly with our brain cells- a key reason why antihistamine medications, like Benadryl, tend to make us sleepy and foggy-headed. Antihistamine medications are sometimes prescribed for acid reflux symptoms as well.
Appropriate levels of histamine in the body are essential for normal immune system reactions, including those to environmental and chemical allergens. Environmental allergens are things like pollen or pet dander. When pollen is detected by the body of someone with pollen allergy, histamine is there like a soldier on the front lines to ensure that the appropriate response occurs.
Once pollen is detected by the body, the immune system creates B-cells, which are there to help cover the pollen in IgE antibodies. Think of these as “wanted” signs that help other immune cells detect the pollen as it circulates throughout the body. After an allergen like pollen is successfully flagged, the immune system will react by letting histamine loose on the allergen.1 The histamine is then able to break down the allergen, with the help of other immune system cells like white blood cells. Under normal circ*mstances, this immune reaction using histamine will come to an end and histamine symptoms will go away. Unfortunately, those that live with autoimmune disorders tend to have overactive immune systems that are particularly triggered by external histamine exposure or have a hard time “turning off” the response.
What Foods Promote Histamine Reactions?
Histamine can be found in many forms. From food sources to environmental histamines, they are truly unavoidable. Foods that contain histamine typically fall into two distinct categories- those that are histamine-rich and those that are histamine-releasing foods. Histamine-rich foods are those that contain high amounts of naturally occurring histamine molecules. Histamine-releasing foods are those that trigger the body’s own immune system cells to release histamine. Both types can cause complications for people with histamine intolerance and/or autoimmune disorders.
Histamine-Rich Food Sources:
- Fermented foods (sauerkraut, sour cream, kombucha, yogurt, etc.)
- Fish (Anchovies, Mackerel, Tuna, etc.)
- Processed/smoked meats (Ham, Salami, Sausage, etc.)
- Jams and Preserves
- Dried fruits
- Vinegars
- Nutritional Yeast/Yeast Extracts
- Reheated foods/leftovers1,4
Histamine-Releasing Food Sources:
- Alcohol
- Bananas
- Chocolate
- Eggs
- Milk
- Papaya
- Shellfish
- Strawberries
- Tomatoes
- Wheat/gluten
These foods can be extremely problematic for those with histamine intolerance as they provoke the immune system to react to otherwise harmless foods.
Unfortunately, food is not the only source of histamines we need to be aware of, especially if an autoimmune condition is present. Environmental sources of histamines range from tree pollen to pet dander, and can cause the classic allergic reactions to appear like hives, respiratory issues, congestion, or worse- depending on your personal sensitivity and DAO enzyme levels.1,4
Environmental/Chemical Sources of Histamine:
- Pollen
- Pet Dander
- Smoke
- Air Pollution
- Chemical fragrances
- Food additives, colorings, preservatives
DAO to the Rescue!
As stated before, histamine is a signaling chemical and therefore needs a way to also “turn off” when the normal immune reaction is complete. That is where the enzyme, diamine oxidase, or DAO, comes into play. DAO is an essential enzyme the body uses for breaking down histamine molecules in the body.1,2,4 Whether the histamine was from natural, internal sources or from an exposure to environmental histamines, both can have detrimental effects on the body and cause a myriad of symptoms if there is not enough DAO present. It is also important to note that you do not have to have an autoimmune condition to have histamine intolerance, but those that live with autoimmune diseases may be at a higher risk of an imbalance in either the DAO enzyme and/or histamine levels.
What Does a Histamine Reaction Typically Look Like?
Histamine intolerance looks differently for everyone and if you begin to experience any of the symptoms mentioned below, you should seek medical guidance on how to support your immune system health. Common symptoms of histamine intolerance tend to mimic an allergic reaction. Many people with histamine intolerance report uncomfortable skin rashes, redness of the face, swelling of extremities, and a wide variety of both neurological and gastrointestinal symptoms.
Other common symptoms of histamine intolerance include, but are not limited to:
- Shortness of breath
- Lightheadedness
- Heart palpitations
- Headaches
- Stomach pain and/or distension
- Diarrhea
- Flushing
- Dizziness
- General food sensitivities1,4
Histamine intolerance can be triggered by both internal and external sources, and depending on your body’s DAO enzyme availability and overall immune health, your symptoms will vary. Additionally, it is very common for those with autoimmunity to have numerous food sensitivities because our immune system is so intimately involved in every aspect of the digestive process. Understanding the signs of histamine intolerance, especially in those with an autoimmune condition, can help functional medicine practitioners create a unique therapeutic protocol to optimize your immune function.
How does Histamine Affect Autoimmune Diseases?
Those that have compromised immune systems tend to have a hard time breaking down histamine for many reasons. Commonly, they do not produce the needed amounts of DAO enzyme needed to balance the amount of histamine in the body due to immune system dysregulation. Autoimmunity unfortunately can cause the immune system to mistake certain triggers as threatening, even when they are not; therefore, it is very common for those with autoimmune diseases to be highly reactive to foods, environmental allergens, and other sources of histamines causing allergic symptoms to transpire. Understanding the root cause of your autoimmunity can be extremely advantageous in creating a protocol that will support you and your health goals best.1,3
There are numerous ways to support the body while having both autoimmunity and histamine intolerance. Research highlights the importance of gut health for histamine balance, as our gastrointestinal system plays a huge role in regulating the amount of naturally occurring histamine in the body. The health of the gut is tremendously important for overall immune health. When we have microbial imbalances, gut dysbiosis, and/or leaky gut, we are more susceptible to an over concentration of histamine in the body; this causes the immune system to react inappropriately, resulting in new symptoms to arise or it can irritate preexisting autoimmune conditions. Adopting a leaky gut protocol or a diet rich in anti-inflammatory foods and high in antioxidants, can be instrumental in addressing the root-cause of histamine intolerance, as well as being incredibly supportive for any type of autoimmune condition.
What Lifestyle Changes Can Lower Histamine Exposure?
Working with a healthcare provider that understands the intimate relationship between histamine and autoimmunity is key when addressing the root cause of any condition. Lowering your environmental, chemical, and dietary exposure to histamines can be a proactive way to support histamine intolerance, whether an autoimmune condition is present or not.
Decreasing histamine exposures will allow the body time to heal and rejuvenate. However, it is important to work with a functional medicine practitioner when going on a low-histamine diet to make sure that it doesn’t cause nutrient deficiencies or worsen your symptoms. Improving gut health and taking DAO are pillars of histamine intolerance treatment. Also, your practitioner will work with you to discover if you have an underlying infection, parasite, or chronic nutrient deficiency that is holding back your recovery.
Research has found that certain nutrients may support the proper breakdown of histamine in the body; these include vitamins B6, copper, iron, magnesium, phosphorus, zinc, and vitamin C.1,2 Each of these nutrients both support and modulate immune function for the better. Supplementing with these nutrients may be beneficial for histamine intolerance and can help with the metabolism of both histamine-rich or histamine-releasing food sources. Educating yourself on the sources of histamine can be a gamechanger for your overall health and can help you further understand the root cause of your histamine intolerance.
There are many herbs and spices that have also been found to be supportive for DAO enzyme production and the proper breakdown of histamine. For example, research highlights the use of nettles (Urtica dioica) for helping to support a normal allergic response and help combat histamine intolerance symptoms; botanicals should always be used under the guidance of your healthcare provider or your clinical herbalist.4
Put a Stop to Histamine Intolerance and Allergic Reactions
Histamine intolerance can be a complicated condition to dissect, but by working with a practitioner that understands your exposures and immune system health, you can find the dietary and lifestyle modifications that will work best for you. Book a 15-minute complimentary call with the Caplan Health Institute. We will work with you to figure out the root of your histamine intolerance and design a customized plan to help get rid of the aches, pains, and general discomfort of histamine intolerance.
References:
- Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007;85(5):1185-1196. doi:10.1093/ajcn/85.5.1185
- Miyoshi M, Ueno M, Matsuo M, et al. Effect of dietary fatty acid and micronutrient intake/energy ratio on serum diamine oxidase activity in healthy women. Nutrition. 2017;39-40:67-70. doi:10.1016/j.nut.2017.03.004
- Reese, I., Ballmer-Weber, B., Beyer, K. et al. German guideline for the management of adverse reactions to ingested histamine. Allergo J Int 26, 72–79 (2017). https://doi.org/10.1007/s40629-017-0011-5
- David Rakel. Integrative Medicine E-Book. Vol 3rd ed. Saunders; 2012. Accessed January 8, 2023. https://search-ebscohost-com.scnmlib.idm.oclc.org/login.aspx?direct=true&db=nlebk&AN=475747&site=ehost-live (n.d.). Retrieved December 3, 2022, from https://gut.bmj.com/content/gutjnl/45/suppl_2/II60.full.pdf
