Histamine Intolerance

Have you tried to consume gluten free, anti-inflammatory, organic, probiotic and prebiotic foods and still experience gastrointestinal or inflammatory symptoms? Histamine intolerance (HIT) is a possible reason. There is currently no definitive test for histamine intolerance, other than eliminating high histamine foods while observing for symptom improvement, which may take as long as 2-4 weeks.

We can only do so much and try our best because there is no such thing as perfect. Keep this in mind as you read on because increasing your stress can worsen symptoms of HIT. Finding your individual path to health and nutrition takes time, patience, education, and support. Be gentle with yourself and remember that it’s a process!

What is Histamine Intolerance?

Histamine naturally occurs in all plants and animals and is produced in our body by the amino acid histidine. Histamine is essential to many processes, such as defending our body from toxins, thus it is essential in moderation. Even though essential, overexposure to histamine in our foods (as well as medications and hygiene products) and environment (seasonal allergies or insect bites/stings) can be harmful for some.

Our body loves homeostasis (or balance) and also produces two enzymes that break down histamine: histamine-N-methyltransferase (HNMT) and Diamine Oxidase (DAO). If we are consuming or being exposed to histamine faster than HNMT and DAO can break it down, then we may have an intolerance. Some of us may not produce enough of these two enzymes and that can cause or contribute to histamine intolerance. This is similar to someone with lactose intolerance due to a low production of lactase enzyme.

Symptoms that may be related to Histamine Intolerance:

Skin:
  • Hives, rashes, psoriasis, inflammation, acne, extreme reactions to insect bites/stings, flushing/redness, hyperpigmentation (HIT contributes to melasma, as well as “freckles” from sun exposure), vitiligo
Gastrointestinal:
  • Nausea, vomiting, heartburn, acid reflux, stomach pain, food sensitivity, diarrhea, gas, bloating, chronic constipation
Others:
  • Asthma, post nasal drip or runny nose, watery eyes, migraine, joint pain, difficulty concentrating, sleep issues, fatigue, depression, feeling hyper

These symptoms can also be a result of an abundance of other conditions. If you have been tested for allergies from a medical professional and the results are negative, a low histamine dietary approach may alleviate your symptoms.

Disorders that may be Linked to Histamine Intolerance:
  • Gastroesophageal reflux disease
  • Eczema
  • Diverticulitis
  • Fibromyalgia
  • Hemorrhoids
  • IBS/IBD
  • Diabetes
  • Osteoporosis
  • Psoriasis
Potential Causes of Histamine Excess:
  • Foods that are not fresh
  • Fermented foods
  • Bone broth
  • Aged or cured foods
  • Food additives
  • Gastrointestinal disorders or bacteria overgrowth
  • Bacteria overgrowth in our gastrointestinal system
  • Environmental allergies
  • Seasonal allergies
  • Some medications
  • Hormones
  • Stress
Dietary Management

As with any dietary intervention, most people automatically think about all the foods they cannot have. This outlook is not mentally or emotionally healthy. Our mental and emotional health are just as important as our physical health. I prefer to educate and focus on what you can consume. Diet is a 4 letter word in my vocabulary and often, when done for aesthetic reasons, not sustainable. Additionally, behavior change is very difficult. However, I have seen many clients improve their lab values and quality of life, while decreasing symptoms and pain from allowing their gut to heal when they approach their dietary changes for their overall health. This involves removing any known food allergens and intolerances for a brief period of time and then a methodical reintroduction of foods one at a time.

An elimination diet is the gold standard to allow the gastrointestinal lining to heal and is only meant to be consumed for a short duration (approximately 4-6 weeks). Along with this, a symptom journal is key to determining the foods you can eat while remaining symptom-free. The goal is to get you back to optimal health and discover all the foods you can consume on a regular basis. So even though it may start out as an elimination process, the end goal is to determine your individual dietary needs and reintroduce as many foods as possible, while maintaining health.

Elimination diets are also short-term due to the fact that nutrient deficiencies can develop, especially if supplementation is not considered. Also by trying to consume less histamines you may inadvertently increase your intake of oxalates, salicylates, or FODMAPS foods. Foods have many components and combinations that are complimentary and opposing. It’s not possible to live in a bubble. REMEMBER, there is no such thing as perfect and you can only do your best.

Focus on consuming the following foods:

Vegetables:
  • Asparagus, artichoke, beetroot, broccoli, cauliflower, zucchini, cucumber, green beans, lettuce, radish, scallion, carrot, Brussels sprouts, bok choy, fennel, celery, onion, garlic, and sweet potatoes
Fruits:

Apple, blackberries, blueberries, cherries, grapes, melons (except watermelon), nectarine, peach, and raisins

Dairy:

Butter, cream cheese without additives, goat’s milk, mascarpone, ricotta, and mozzarella cheese

Protein:

Fresh chicken, beef, fish, duck, quail, turkey (or cooked and immediately frozen). Avoid ground beef or chicken and canned fish

Starches/grains:

Amaranth, millet, oats, potato, quinoa, rice, spelt, sweet corn

Nuts/Seeds:

Macadamia, chia, and hemp

Fats/oils:

Canola, olive, rape seed, nigella sativa

Herbs/spices:

Basil, mint, oregano, parsley, rosemary, sage, caraway, cinnamon, fennel, paprika, cumin, distilled white vinegar, turmeric

Sweeteners:

Honey, stevia, beet sugar, cane sugar, maple syrup

Supplements:

Antioxidants/bioflavonoids: vitamin C (from ascorbyl palmitate), E, and quercetin; vitamin B-complex, nigella sativa, garcinia mangosteen, basil, and probiotics.

Remember to supplement where diet may not meet nutrient needs.

Try to eat consistently throughout the day to avoid overeating at meals and keep blood sugar stable. Focus meals around plant-based foods, mostly vegetables, then fruits, lentils/beans, grains, and nuts/seeds. Keep symptom-free foods most visible in your pantry and refrigerator. Keep moderate- or high-symptom foods on shelves that are high or low in your pantry or in drawers or opaque containers in your refrigerator. Create a kitchen that promotes your individualized nutrition needs. Visibility enhances your choices.

To save time and money, prepare food ahead of time and buy in bulk. Keep in mind that foods must be kept frozen to minimize histamine. Freeze in single serve containers. Soups, rice and beans all freeze and reheat beautifully. Cooked vegetables also freeze well and can be used later to make a stir fry.

Histamine Food Lists

If you’ve looked into a low histamine diet you may be more confused after reviewing the information. Many of the lists contradict themselves. Some lists have been derived from different surveys where other factors that affect symptoms, other disorders, and single foods versus food combinations may have not been taken into account. One of the main reasons that lists vary is that histamine levels fluctuate in foods depending on the time it has been stored, the food temperature, and the time from when the animal was butchered versus consumed or when food was harvested versus consumed. The most important take away is to remember everyone is individual and to track what works for you. Just like in GERD the foods that may exacerbate symptoms are different for each individual. A list of resources is available at the end of this article.

Minimize Stress

Stress will cause more issues than any food. Minimizing stress in your life will be the best gift you can ever give yourself. It sounds cliché, but it’s true. If you’re stressed, it disrupts sleep, digestion, mood, heart health and more! And it definitely impacts HIT.

Digestion

Practicing mindful eating is a great first step to aid your digestion and help decrease stress. These days, we do everything on the go and that includes eating—many clients even eat standing at the sink! If I could give one blanket piece of advice when it comes to food and nutrition, it would be to eat more slowly.

Practice mindful eating by:
  1. Setting aside 20-30 minutes to eat a meal, even if you can only start with one meal per week. It takes a minimum of 20 minutes for your stomach to signal to your brain that you’re satisfied. Eating until overfull can decrease proper digestion.
  2. Sitting down at your kitchen table or island without the TV or your phone.
  3. Take 3 to 5 deep belly breathes before you even pick up your fork.
  4. Pick up a bite-size piece of food and smell it.  (Taking large bites decreases proper digestion. Smelling a food helps activate digestive enzymes.)
  5. Place the food in your mouth and roll it around on your tongue to truly taste it.
  6. Chew thoroughly, allowing the enzymes in your saliva to begin to digest your food.
  7. Swallow and repeat. Pause by placing your fork down and taking a deep breathe every few bites.

Other ways to decrease stress are meditation, deep breathing exercises, sleep, and exercise.

Movement/Exercise

Exercise is great for us but also must be practiced in moderation. If you do not currently exercise, I prefer to focus on movement. Just find ways to move in your day. Park further at work and take the stairs. All movement counts; cleaning your house, gardening, playing with your children, etc. If you are very reactive to histamine, weight bearing activities such as moderate walking, strength training, Pilates, and yoga are recommended over cardiovascular intensive exercise. As a bonus, yoga has the added benefit of stress reduction through focus on breath work and poses.

What’s most Important?

Your physical, mental, and emotional health are all connected and equally important. Take care of yourself first. Use support and guidance from a medical professional, preferably one who keeps abreast of current research and evidence-based information that can help guide you to making the best decisions for your health.

Resources

www.lowhistaminechef.com

www.low-histamine.com

http://www.mastcellmaster.com/

References
  1. Healing Histamine Workshop: Beyond the low histamine diet. Yasmina Ykelenstam. www.healinghistamine.com
  2. Histamine intolerance and dietary management: A complete review. Jounral of Allergologia Immunopathology. 2016 Sep-Oct;44(5):475-83. San Mauro Martin; Brachero, S.; Garicano Vilar E.
  3. German guideline for the management of adverse reactions to ingested histamine: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Association of Allergologists (AeDA), and the Swiss Society for Allergology and Immunology (SGAI). Allergo Journal International 2017;26(2);72-79. 2017 Feb 27. Reese I, Ballmer-Weber B, Beyer K, Fuchs T, Kleine-Tevve J, Klimek L, Lepp U, Niggemann B, Saloga J, Schafer C, Werfel T, uberbier T, Worm M.
  4. Is Food Making You Sick? ; The strictly low histamine diet. Gibb, James L. 2015
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695393/http://ajcn.nutrition.org/content/85/5/1185.long

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