• What is Histamine Intolerance?

    Histamine Intolerance | stupideasypaleo.com

    Dealing with histamine intolerance is a way of life in our household. In this post, I’m going to share a bit about what it is and how we work around histamine intolerance on a daily basis.

    If you’ve been struggling with food intolerances that you can’t seem to pin down, you may be dealing with histamine intolerance, particularly if you’ve removed the usual suspects and done a 30-day elimination diet like Whole30.

    I’ve been waiting to write this post for quite a while, but it’s now been well over a year since my husband stumbled upon histamine intolerance as the cause of his incessant eczema. He’s only had one major flare in over a year, so I decided it was time to share what we’re doing. More on that later.

    What is histamine?

    Before I venture into what can go wrong, let’s quickly consider what’s supposed to happen with histamine in the body:

    Histamine is a chemical compound which occurs naturally in the body and triggers the inflammatory response in certain body tissues. If you’ve ever taken an over-the-counter antihistamine to combat hay fever or seasonal allergies, you’re well aware of histamine’s role in making your respiratory tract feel wheezy and sneezy. (Those medications work by blocking histamine receptors which stops the reaction.) But histamine doesn’t just work on your nose and throat.

    The main body tissues that release histamine (via mast cells) are the nose, mouth, gastrointenstinal tract and blood vessels and the brain (non-mast cell release). Histamine levels are also affected by hormones such as estrogen and cortisol.

    Not only is histamine produced by the body, it’s also present in varying degrees in the foods we eat.

    For a much more extensive look into this process, read these articles by Jamie Scott here and here.

    What is histamine intolerance?

    Let’s consider the word metabolism for a moment.

    Metabolism, in simple terms, is the balance between the building of compounds (anabolism) and breaking down (catabolism) of compounds.

    Normally, the body has an enzyme that deals with the breakdown of histamine and counteracts histamine build-up. It’s name is diamine oxidase or DAO. (Another enzyme, histamine-N-methyl transferase, deals with histamine breakdown inside cells.) The primary place DAO is doing its catabolic duties is in the gut and bloodstream.

    If histamine metabolism is faulty, usually due to reduced levels of DAO, problems can arise.

    Need a picture in your mind to help this all come together? Think of a gallon-sized jar with a spout at the bottom.

    If you continuously fill the jar with water and keep the spout open, it won’t overflow from the top so long as you don’t fill faster than it drains out. That’s what is supposed to happen normally with histamine. DAO (the spout) allows histamine to be cleared so that the jar doesn’t overflow (histamine reaction).

    If you continuously fill the jar with water and keep the spout closed (or you fill the jar faster than the water can drain out) eventually, it’s going to overflow from the top. That overflow is synonymous with a histamine reaction.

    [By the way, there is still a LOT that’s not understood about histamine intolerance from a scientific point of view.]

    Since histamine works on a variety of body tissues, the symptoms of histamine intolerance can range from issues of the gastrointestinal tract (cramping, diarrhea, etc.) to the skin (eczema, hives, etc.) to headaches, dizziness, cardiovascular symptoms like arrhythmia and even dysmenorrhea in women.

    This diversity of symptoms is one of the reasons why histamine intolerance is hard to pin down.

    How is food connected to histamine intolerance?

    For better or worse, food plays a huge role in histamine intolerance because certain foods are naturally high in histamine. Annoyingly, some food, while low in histamine themselves, cause the body to release histamine already stored in cells.

    In folks with low DAO activity, consuming histamine-rich or histamine-liberating foods cause the jar of water to spill over, and a symptoms occur.

    Even more annoyingly, many of the foods promoted as part of a paleo-type diet are high in histamine and some people, despite “doing everything right” find that paleo “doesn’t work for” them or makes their issues worse.

    Which foods are high in histamine?

    Generally speaking, as food sits around and gets older, histamine levels increase due to accumulating bacteria and yeast. These microorganisms produce an enzyme that converts histadine to histamine, thereby raising the histamine content.

    Even foods that are “fresh”—especially meats and fish—can rapidly ramp up in histamine. (More on how we deal with that in our household later in the post.)

    Unfortunately, foods that are aged or fermented are the biggest culprits. And several of these foods are touted in paleo / real food circles because of their probiotic content.

    These include but are not limited to:

    • Wine and beer
    • Sauerkraut and other fermented veg like kimchi
    • Kombucha
    • Smoked, aged or canned meats (yes, including bacon)
    • Smoked, aged or canned fish
    • Cheese and fermented dairy such as yogurt
    • Soy sauce
    • Vinegars
    • Yeast-based breads and baked goods

    And it continues with other foods such as:

    • Citrus fruits
    • Non-citrus fruits such as strawberries, raspberries, pineapple, mango, kiwi and papaya
    • Veggies such as spinach, tomato, and eggplant
    • Avocado
    • Some nuts
    • Coffee and black teas
    • Some spices such as cinnamon and cloves
    • Chocolate / cocoa
    • Egg white

    Now, before you get depressed and think life is over because you can’t eat bacon or drink coffee again, there’s a solution so keep reading.

    Beyond food, some medications or drugs can skew histamine levels, particularly those that block the action of DAO. Notable here are alcohol and nicotine.

    Other notable potential causes of histamine intolerance:

    • SIBO (small intestinal bacterial overgrowth)
    • Gut parasites
    • Leaky gut
    • IBS
    • Celiac disease
    • Vitamin deficiencies such as B6 and C (cofactors needed for DAO to function)
    • Single nucleotide polymorphisms (SNPs) that cause a mutation in the DAO gene

    Z’s Story

    Before you think this post is just me talking into the wind, let me fill you in on my husband’s struggle with histamine intolerance and how we’ve learned to manage it. (There is hope!)

    Z, my husband, has suffered from asthma and eczema since childhood to varying degrees which would come and go in severity.

    A doctor once told him, “That just happens to some people,” when he went in to the NHS (Scotland’s medical system) seeking answers.

    Back in 2008, he found paleo when he read The Paleo Diet for Athletes and immediately adopted this way of eating. Though his overall health improved, it unfortunately did little to resolve his eczema.

    For a long while, he thought the problem was an allergy to beef or eggs, so he avoided them religiously, but his skin problems persisted. Adding insult to injury, particularly bad flares left him with embarrassing, intensely puffy and red rings around his eyes as well as itchy patches on his neck and arms. Not fun when you have a customer-facing job.

    Ever since I’ve known Z, he’s struggled with eczema on and off and never got an closer to solving it, until the summer of 2014. He’d just moved here—and we got married—in the spring. (Yay for no more long distances!) He was still avoiding beef and eggs, though he was now “enjoying” lots of probiotic-rich kraut and kombucha, snacking on jerky and dried meat, and tucking into the weekly food prep that I was doing.

    In hindsight, his histamine levels were sky-high with all the fermented food and leftover meat he was eating. Frustrated that again his skin was flaring, he spent hours and hours poring over the Internet, trying to make sense of it. He circled back to histamine intolerance, something that had popped up on his radar almost a year prior.

    He printed out a list of high-histamine foods to avoid, and we set out to try to nip this thing in the bud.

    The good news: We’re managing it well, and he’s suffered very few flare ups since adopting a low-histamine + paleo dietary strategy plus other key factors.

    How We Manage Histamine Intolerance

    If you’re dealing with histamine intolerance, one of the most important things to consider is what the root cause could be. You’ll want to address any potential gut infections, parasites, or SIBO first, then consider gut permeability issues.

    If you’ve already cleaned up your diet and you’re eating paleo, you may be part of the way toward healing because you’ve removed grains, gluten, dairy and other gut irritants.

    Once you’ve done that, stick to a low-histamine food list to see if you notice any improvement. Keeping a food log of intake can help you correlate flares with what you’ve eaten.

    You may think, “I’ll just get allergy tests,” but it’s not that simple. Immunoglobin E (IgE) antibody skin and blood allergy tests don’t work for sussing out histamine intolerance. Why? Histamine release from mast cells isn’t mediated by IgE. Frustrating. For that reason, histamine intolerance is often dubbed a “pseudo-allergy.”

    First, it’s important to note that Z doesn’t eat a zero-histamine diet. That’d be nearly impossible. However, he’s still able to enjoy many of the foods he likes because the key is balancing the histamine load and keeping it from accumulating too fast. (Remember my analogy of opening the spout to let water drain out of the jar at the same time you’re filling it! You don’t want histamine intake or release to overtake the action of your DAO enzyme.)

    Our strategy involves balancing / managing food intake with supplementation and other lifestyle factors. I say “we” because I cook a majority of the time. Z eats paleo but avoids certain foods that heavily feature in a typical paleo diet.

    There are low-histamine recipe sites such as this one, that focus on healing, anti-inflammatory foods, because what good does it do to avoid histamine, but then eat other foods that inflame the gut?

    Food & Drink

    • He avoids eating large amounts of high-histamine foods. For a pretty good list to print out and put on your fridge, click here. Note: This is not a be-all, end-all list. Some foods may affect your histamine intolerance more than others. You have to be willing to experiment, but choose a starting point.
    • If he does eat some high-histamine foods (example: he still drinks coffee and eats bacon), he eats them in small quantities and is careful to eat only lower-histamine foods the rest of the day.
    • We try to cook meat for him on the same day we buy it. The longer meat sits around in the fridge, cooked or raw, the higher the histamine levels. Through experimentation, we have found that eating leftover, cooked refrigerated meat is a huge trigger for him. He avoids fish completely because it spoils so fast.
    • When we cook meat for him, the leftovers get frozen immediately.
    • I avoid making him slow-cooked meats.
    • When we eat out, he tends to choose a steak or chicken breast over a burger, for example. Why? Ground meats have more surface area and as they sit, more bacteria accumulates.
    • I try to keep high-histamine condiments and spices out of his food. Sometimes that means if I prepare something for the both of us, like meat or veggies, I’ll season my portion separately.
    • He avoids drinking kombucha and alcohol. Kombucha is fermented and alcohol blocks DAO.
    • He avoids other known gut-irritants such as gluten and other grains.
    • We have slowly started introducing bone broth to aid in gut health.

    Supplements

    Note: Evaluate these for yourself first before you decide to take them. This is not medical advice, simply a summary of what works for Z.

    If he suspects he’s eaten meat that wasn’t super fresh or a lot of high-histamine foods in one meal, he’ll often take a cocktail of supplements as a preventative measure. This gets expensive really quickly, so it’s best used as emergency protection, not as a means of gorging on high-histamine foods constantly.

    • Histamine Block which is actually NOT a histamine blocker. It’s DAO plus Vitamin C. (Remember, DAO helps break down histamine and Vitamin C helps DAO work properly. It’s not got a very accurate name.) Think of this product like taking lactase pills if you’re lactose intolerance and want to drink some milk or eat some ice cream. It’s not a fix, just a temporary band-aid. At $1 per capsule, it adds up fast.

    He takes these daily:

    • Vitamin B6, another DAO co-factor.
    • Grapeseed extract, which has anti-histamine properties by reducing the release of histamine from mast-cells.
    • Quercertin, functions in a similar way to grapeseed extract.
    • Bifidobacterium strains found in certain probiotic supplements. Many Lactobacillus strains such as those prevalent in fermented foods make histamine intolerance worse so you need to read carefully.

    Other Factors

    Stress management and sleep are huge.

    Consider stress. When you’re under stress, your body releases adrenalin, and cortisol is released to mop the whole thing up. This stress response causes immunoglobins to cause mast cells to release histamine. Eeek.

    I can’t tell you which stress management skills will work best for you, but some suggestions to try are:

    Sleep is also paramount, and high levels of histamine can interrupt sleep. See my article here on how to improve your shut-eye. Dietary intervention is probably the best ways to get your histamine levels under control so you can sleep better.

    Information in this article was compiled from the above hyperlinked sources listed and our personal experience. Primary research sources for more information can be found listed at the end of this article.

    Do you have questions about histamine intolerance? Put them in the comments below.

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    Histamine Intolerance | stupideasypaleo.com

    Steph Gaudreau is a certified holistic nutrition practitioner, weightlifting and mindset coach, and the author of the best-selling Performance Paleo Cookbook. Her recipes and expert advice have been featured in SELF, Outside Magazine, Elle, and Greatist. Steph loves barbells, cats, and anything Lord of the Rings. She lives in San Diego, CA.

    48 thoughts on “What is Histamine Intolerance?

    1. Great bit here!! I have been through this personally and am so happy to see it addressed so nicely.
      One of my favorite resources for information from a grounded sensible mind based in tons of research is the work of the Low Histamine Chef. Yasmina’s blog was a life-saver in a sea of conflicting and/or confusing claims. She is paleo friendly (many of her books are either paleo or paleo friendly) and has a wonderful take on the whole business of histamine intolerance. Having been a CNN journalist, she knows how to document allllll the science, which I love, and weaves that all in with her amazing personal journey in her healing with real food. Highly recommend her as a resource, even though I no longer follow all of her protocols (in great part because I have healed).

    2. Thanks Steph for posting this! I think I am dealing with this also and am so glad to hear it’s manageable. My symptoms are very different, extreme itchy/burning scalp, hormonal imbalance, extreme brain fog, and through scouring the web, have found out this condition can be brought on by pre-menapause as well! Fun stuff! From the blogs I’ve read, it’s called Sudden High Histamine Intollerance. I’ve eliminated these foods for about a month, but so far, no relief. Have been dealing with this for 10 months now. I’m going to try the supplements to see if they can provide any help!

      1. Hi Tina,

        The frustrating thing is how different the symptoms can manifest in different people, including what sounds like the symptoms you’re dealing with. That’s quite an unfortunate (or maybe appropriate name for it) considering the acronym is basically SHHIT :/

        Sometimes it takes longer than a month so stick at it. With Z it there was some relief in the short term but he’s continued to get better over time!

    3. There’s a connection between histamines and Multiple sclerosis..many many yrs ago I watched a documentary on a woman w MS….she found d a cure for hers thru much research and came up with Procarin, histamine cream….very good doc..should be able to Google it. Good luck..Good work.

      1. Wow that’s pretty interesting. Wondering if it’s the general, persistent inflammatory response that’s playing a role in that. Thanks Sooz…I’ll look into that for sure.

      1. Anything fermented should be approached with caution. I’m not sure how kefir ranks on the histamine list so you’d have to do some investigation.

    4. I’ve never heard of this and have been following health related ideas since I was in my 20s (now in my 60s…wow, have I ever seen a lot of change!). Since a child I have had off and on skin issues, although had perfect skin through adolescence. The last year I’ve had a few itchy patches in various places including inside my ears that just never seem to clear. I know most of the things I should be doing for better health but am not always compliant (less compliant over the last 6 mos). So almost a month ago I had a reaction that seemingly stemmed from an area on my hip where I had gotten an infection from scratching chigger bites. I finally began treating it with diluted Melrose essential oil from Young Living. Infection cleared but major rash began around this site, spread across my abd, up trunk, down thighs, to arms and eventually my neck and face. Unbearable itching prevents more than 3-4 hours sleep a night. The mainstream dermatologist says it is an allergic reaction to something…not too helpful. Out of desperation I agreed to prednisone shot, 12 days of prednisone pills, a daytime and a night time antihistamine, 2 kinds of cortisone cream, special soap and moisturizing cream. After all this, while the rash LOOKS some better (I look as if I’m recovering from measles as well as still have some large angry red patches in various places) I still have extreme itching and can’t get consistent sleep. Over the last year I have been working hard to get products out of my house that contain toxic chemicals so using the dr. treatment plan above has broken my heart. My question is in your experience with your husband did he ever take an antihistamine and receive NO benefit from it? If I haven’t had relief from the itching despite all the meds would this point towards a histamine intolerance or is there really no relationship here? I will research the links in your article as it intrigues me plus I am searching for answers. I can’t go on with the itching and sleep deprivation. Thanks for any input from you or your readers.

      1. Hi Cheryl,

        The issue with antihistamines is that they do not work on all types of histamine receptors, of which there are 4 kinds–H1 through H4.

        H1 is the receptor associated with nasal histamine reactions, so taking an anti-histamine that targets that receptor (such as Benadryl, Zyrtec, Allegra, etc) won’t provide relief if you’re dealing with a gut histamine release issue.

        I recommend checking out the Low Histamine Chef’s website…tons of great info there.

        I also wanted to mention the essential oil thing. I use them and like them a lot, but even I had a very very bad reaction to tea tree oil recently. More specifically I blended tea tree and lavender (two known for calming and soothing) yet I had an extreme reaction that resulted in an insanely itchy patch that correlated to exactly the place I applied it. EO, even when diluted, can still make you react so you may have been dealing with that on top of whatever histamine induced rash you had.

        I hope you find some relief because not being able to sleep is miserable!

        1. Hi Cheryl,

          If this helps, I’m not sure, but for my high histamine condition, an Allergy Specialist put me on two high doses of anti-histamines and had me take two of the stronger variety of Allegra everyday. It did not help at all, I tried it for about 6 weeks. The only thing that currently works to help alleviate the itching is Gabapentin. And believe me, I don’t like to take prescriptions either!

        2. I appreciate so much your answer. I did NOT know that about antihistamines. So interesting. I will check into the site you mentioned for sure. I totally get what you are saying about the essential oils. I have had a gut feeling that three of the patches I’ve had that won’t resolve before all this other started were an EO issue since they are located right where I was constantly using oils. Of course, the oil folks will say it isn’t possible to have an allergic reaction to the oils but that a rash is just a sign that toxins are being drawn out. From my experience, and sounds like from yours as well, I’m going to need more proof. I still diffuse and inhale some oils but I’m not putting them on my skin. I’m also leary of taking them in capsules although I know a lot of people who do. Again, I appreciate your response and the information you provided in this article.

          1. You’re very welcome.

            Contact / chemical dermatitis from EO is well-known, and I’m not buying that reply of “toxins being drawn out.” I also suffer from terrible reactions from poison ivy / oak / sumac so I know I do tend to have sensitive skin.

            Wishing you all the best with your search!!

    5. I have some pretty severe food allergies that send me to the ER several times a year. Seems like I can’t identify the cause anymore or the addition of one ingredient will set me off. Being treated for Asthma presently and informed there is nothing they can do for food allergies. Ate Paleo for about a year and still had reactions-and new ones to familiar foods. Pretty much eating the low histamine foods you linked to but not all organic or grass fed. Really don’t know where to go from here! What would be your suggestions if you can give them?

      1. Hi Joyce…I don’t know if you’ve had any IgE testing but if you’ve not had an allergy testing that could be a good place to start. Also, if you’re dealing with some gut integrity issues, you may want to look into a GAPs protocol. Working with a functional medicine practitioner or naturopathic doctor could help you start putting some of these clues together.

    6. I am just wondering about the NO to sausage. Is it the spices? I usually make my own w lean ground pork and the sausage mix in Well Fed series.

    7. Interesting article, Steph. After reading this I suspect this maybe an issue for me. I’ve noticed that when I eat certain things, like pizza it will exacerbate symptoms of stuffy nose and sinus problems. I have also in the last three years developed some areas of eczema around both elbows and it is worse at times. I have never associated the eczema with foods I’ve eaten but I am going to begin to take notice. Does these symptoms sound like possible histamine intolerance? Thanks so much for your website!

    8. Hi Steph,
      This is my poor 25 year old son in a nut shell! I can’t wait to share with him. He has had terrible breath from the time he was little. I was wondering if Z had this symptom too?
      Kay

    9. What about unfiltered Apple Cider Vinegar? I keep finding websites that says it actually blocks histamine, whereas all other vinegars are high in histamine. Thanks for your input!

      1. Sarah, there is LOTS of conflicting info out there about what is high histamine. We have read where ACV can be okay but he still avoids most vinegar or uses it in very small amounts. Ultimately, you need to test foods for yourself and see how you react.

          1. It’s all about dose, Sarah, so if he eats basically any high histamine foods in relatively small amounts, he’s usually fine. Hope that makes sense.

    10. I was just read an article and wasn’t sure if you had ever heard of this. Here’s a quote……….Turmeric prevents the release of histamine in the stomach, quelling nervous stomach and counteracting food allergies and it fights gum inflammation by halting the action of a gene that creates irritant chemicals. Interesting. Just wanted to share. Thanks for your great cookbook. We love it!

    11. I never expected that Wine and beer contains histamine. Thanks for the info. I really suffer from my allergies because of histamine, now I know what other food I should avoid.

      1. Hi Jane,

        Beer and wine are fermented, and anything fermented is usually high in histamine. Happy to pass on some knowledge to you 🙂

    12. Out of curiosity, does your husband eat just the yolks sometimes since only the egg whites are listed as having a high histamine level?

      1. Hi Tina…extremely rarely. He avoids eggs for the most part. We have talked about reintroducing yolks but he’s not ready yet.

    13. This is a great article! I have suffered from ichiness for my whole life and I also did not experience any relief when I did the whole30. That being said, I would like to better understand the symptoms. I have itchy skin, not dry skin but itchy. It almost always starts at the base of my hair line and then varies all over my body. From what I gathered in the article, docs cannot really diagnose this, is that accurate? Further, my only opportunity for diagnosis would be to begin to eliminate foods based on the histomine list, is that accurate?
      thank you so much for this information!

      1. Hi Nicole,

        Like with my husband’s experience, some doctors say they don’t know what the cause is but having itchy skin like that is not normal, so you have to assume there is an issue going on.

        It’s really up to you what you choose to do (I can’t tell you since I’m not a medical doctor), but I can tell you that we have used dietary intervention with great success.

    14. Thanks so much for this! Histamine intolerance is new to me. I think j have sibo too so it makes sense. As far as the food list I have been noticing some food bother me a lot (strange headaches, reflux, heartburn, nausea, small rash…) but others not at all. For example kefir bothers me but not kombucha, sausage yes but not bacon, milk does but not cheese, black tea bothers me but not coffee, lemon does but not oranges. Is this normal? I started eliminating but if they don’t bother me should I still. As you know with sibo or IBS then something like broccoli and bell peppers will feel like murder! lol.

      1. Hi Denise,

        It honestly depends on what the histamine load in those foods is and your own personal sensitivity which can make some foods seem okay while others aren’t. Z doesn’t react poorly to all the foods on the high histamine list but again, a lot of it depends on the histamine load and how fast the body can clear it. Hope that makes sense. Have you ever had food allergy tests done?

    15. Thank you so much for this post. This makes a ton of sense. I have had eczema since I was a kid too and after doing a Whole 30 where it got worse, I’ve been playing around with certain foods to figure out the trigger- thinking it was hopefully just one specific food. I’ve been eating/drinking some of the things you’ve listed more frequently (and have had more allergy and rash symptoms), so now I have a better idea on things to cut out and see if things improve.

      Thanks again!

    16. Someone asked me about histamine intolerance and my first thought was your podcast episode with Z! Thanks for this post, it’ll be a great start. 🙂

    17. So helpful! Thank You! You are very talented at explaining this complex issue.
      These are very confusing waters that I am only beginning to wade into with trepidation!

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