Nutrition and Lifestyle Strategies for Histamine Intolerance

Article

4 Sept

By Tamara Agusta, MSc, DipION, NgC, mBANT - Updated January 8, 2025

Navigating the world of food sensitivities can be overwhelming, especially when the symptoms are as diverse and unpredictable as those caused by histamine intolerance. Whether you're dealing with unexplained headaches, skin issues, or digestive discomfort, understanding the role of histamine in your body could be the key to unlocking better health. This guide will walk you through the basics of histamine intolerance, its impact on your body, and practical strategies to manage it through nutrition and lifestyle changes. By the end, you'll be equipped with the knowledge to take control of your symptoms and improve your quality of life.

AI-generated image of a mast cell releasing histamine.

What is Histamine

Histamine is a nitrogen-containing compound classified as a biogenic amine. It is present in many foods, particularly those that are fermented, aged, or processed. Additionally, histamine is naturally produced in the body and is found in various cells and tissues, where it plays a crucial role in several bodily functions, including: (1, 2)

Blood Flow Regulation: Histamine helps widen blood vessels, allowing more blood to flow to areas of the body that need it, which is especially important during an immune response, after an injury, or during exercise. This increased blood flow enables white blood cells to quickly reach and neutralise harmful invaders like bacteria and viruses. It also helps remove waste products like lactic acid, supporting overall exercise endurance and performance.
Muscle Contraction: Histamine causes certain muscles, such as those in the lungs and digestive tract, to contract. In the lungs, this can lead to symptoms like tightness in the chest. In the digestive tract, it influences bowel movements by regulating the speed at which food and waste move through the intestines.
Airway Function: Histamine increases mucus production in the airways, which helps trap allergens and other particles you breathe in. However, this can also lead to congestion and difficulty breathing during allergic reactions.
Brain Function: In the brain, histamine acts as a neurotransmitter, helping regulate attention, alertness, and other cognitive functions.
Digestion: Histamine is a key component of stomach acid, which is necessary for breaking down food during digestion.

While histamine is essential for these bodily functions, too much can disrupt normal processes, leading to symptoms such as excessive blood flow, heightened attention, frequent bowel movements, and congestion.

What Is Histamine Intolerance?

Unlike typical allergies, histamine intolerance is not primarily an immune response but rather a metabolic issue related to enzyme deficiencies. It occurs when the body struggles to break down and eliminate histamine efficiently, leading to an accumulation of histamine. This buildup can trigger a range of symptoms, as described in the next paragraph. In contrast, conditions like Mast Cell Activation Syndrome (MCAS) involve excessive histamine release from overactive mast cells, which can also result in symptoms similar to histamine intolerance but may stem from different root causes. In such cases, both the overproduction of histamine and difficulties in breaking it down contribute to elevated histamine levels in the body. (3, 4)

Symptoms of Histamine Intolerance

Histamine intolerance can manifest with a wide array of symptoms, which often appear with a delay, making it challenging to identify the root cause.

Common symptoms include: (3, 4)
• Flushing and sweating
• Rapid heartbeat and chest tightness
• Tinnitus, headaches and migraines
• Skin issues like eczema and hives
• Food and seasonal allergies
• Digestive problems
• Nasal congestion, runny nose and nose bleeds
• Motion sickness
• Large, swollen mosquito bites
• Nausea and vomiting
• Breathing difficulties, including asthma
• Fatigue and dizziness or vertigo
• Anxiety, irritability, and insomnia

What Causes Histamine Intolerance?

Histamine degradation relies on two main enzymes: diamine oxidase (DAO), and histamine N-methyltransferase (HNMT). When these enzymes, particularly DAO, are ineffective, histamine accumulates, leading to intolerance. Several factors can contribute to this enzyme inefficiency: (3, 5, 6, 7)

Gastrointestinal Diseases: Conditions such as gluten sensitivity, leaky gut syndrome, inflammatory bowel disease (IBD), Helicobacter pylori infection, and small intestine bacterial overgrowth (SIBO) can reduce DAO activity.
Medications: Many medications, including NSAIDs, antidepressants, and antipsychotics, can inhibit DAO.
Diet: Consuming high-histamine foods, histamine liberators, and leftovers can exacerbate symptoms. DAO blockers will, of course, inhibit DAO.
Genetics: Several genes, in addition to DAO and HNMT, are central to processing histamine. When these genes are burdened or slow down, histamine removal is compromised. For example, HNMT requires SAMe (S-adenosylmethionine) as a cofactor to function properly. SAMe production depends on methylation, a process that involves the MTHFR gene. If the MTHFR gene is impaired, it can lead to reduced methylation efficiency, which in turn affects SAMe levels and subsequently hinders histamine breakdown by HNMT, contributing to the symptoms of histamine intolerance.
Nutrient Deficiencies: Insufficient cofactors such as vitamin B6 and copper (and vitamin C) for DAO, or vitamin B2 and SAMe for HNMT, can reduce enzyme activity.
UV-Light: UV-light can also exacerbate symptoms. UV-light appears to have a dual effect by triggering significant histamine release from resting mast cells, while also suppressing up to 90% of its release when cells are appropriately stimulated.

Nutrition and Lifestyle Strategies For Histamine Intolerance

The most reliable way to determine if you have histamine intolerance is by following a low-histamine diet. If your symptoms improve during this period, it may indicate that histamine intolerance is the underlying issue. (4)

STEP 1 - Food Elimination

Start by removing high-histamine foods, histamine liberators, and diamine oxidase (DAO) blockers for 8-12 weeks. (7) This helps reduce histamine accumulation, allowing you to observe whether your symptoms improve.

High-Histamine Foods:

• All alcohol: Beer, spirits, wine
• Certain fruits: Banana, kiwi, raspberries, dried fruit, watermelon
• Gluten-based grains and long-proofed doughs
• Many nuts and their nut butters: Almonds, peanuts, pine nuts
• Certain seeds and their oils: Sesame
• All fermented or pickled vegetables: Kimchi, sauerkraut, onions
• All fermented drinks: Kefir, kombucha
• All fermented condiments: Fish, soy, tamari sauce
• Aged, fermented, raw, or sour dairy products: Hard and semi-hard cheeses
• Cured, canned, pickled, or marinated meats and oily fish
• Certain spices: Anise, cloves, curry, ginger, pepper, nutmeg, vanilla
• Certain vegetables: Eggplant, garlic, leek, mushrooms, spinach

Histamine Liberators - These foods trigger histamine release, even if they’re not high in histamine themselves:

• All alcohol: Beer, spirits, wine
• All seaweed (except spirulina): Kelk, kombu, nori, wakame
• Certain nuts: Cashews, hazelnuts, walnuts
• Beans and legumes*: Soy beans, lentils
• Certain fruits: Citrus, kiwi, pineapple, papaya, plum, strawberries
• Vegetables: Brussel sprouts, chili peppers, onions, tomatoes
• Shellfish: Crab, lobster, mussels, prawns, shrimp
• Organ meats, pork, egg whites
• Chocolate, cocoa
• Flavour enhancers: Glutamate, MSG, yeast extract
• Preservatives: Benzoates, nitrites, sulfites
• Spices: Cumin, horseradish, mustard
• Food dyes
*Sprouted legumes can actually support DAO activity, as they contain levels of DAO that are 250-fold higher than those found in non-sprouted legumes. (4)

DAO Blockers - These foods inhibit the enzyme responsible for breaking down and eliminating extracellular histamine.

• All alcohol: Beer, spirits, wine
• Energy drinks
• Tea: Black, green, mate

For a comprehensive and easy-to-follow guide on what to eat and what not to eat with histamine intolerance, check out my Printable Low Histamine Food List (available for a small fee). This guide categorises foods based on the Swiss Interest Group Histamine Intolerance (SIGHI) scoring system (release 29.08.2024) into a portable single-page format, providing a reliable and practical resource. "YES" foods (score 0) are usually well-tolerated, while "NO" foods (score 1-3) include medium to high histamine foods, as well as histamine liberators and DAO blockers.

Download the Printable Low Histamine Food List

STEP 2 - Food Reintroduction

After the elimination phase, gradually reintroduce foods in small portions over 4-8 weeks to monitor reactions and identify individual triggers. Keeping a symptom log during this phase is essential for tracking improvements and pinpointing specific food triggers. Remember that tolerance is highly individual, so pay close attention to your body's response and adjust your diet accordingly.

STEP 3 - Consider Supplementation

Certain supplements can help support histamine degradation:

DAO: Helps break down excess histamine. (4)
Vitamin C: An indirect cofactor for DAO by helping to regenerate copper. Boost your intake by consuming low-histamine fruits and vegetables rather than relying on ascorbic acid (the synthetic form of vitamin C), which can inhibit DAO activity. (8)
Vitamin B6 and Copper: Cofactors to enhance DAO activity and histamine metabolism.

Be cautious when taking probiotics for gastrointestinal issues, as some strains have been found to trigger the release of histamine from mast cells and basophils, including L. casei, certain strains of L. reuteri, L. saerimneri 30a, and L. bulgaricus. On the other hand, some strains, such as L. plantarum D-103, have shown the ability to degrade histamine. The capacity of microorganisms to degrade biogenic amines like histamine is strain-specific and requires specialised knowledge in the subject. (9, 10)

STEP 4 - Lifestyle Changes

Adopting a healthy lifestyle can play a significant role in improving histamine tolerance: (6, 11, 12)

Adjust Your Cooking Methods: Raw, boiled and lightly cooked foods may be better than frying or grilling, as the latter can increase histamine levels.
Clean Your Environment: Create a clean living environment by using air purifiers, avoiding air fresheners, and keeping your home free from dust and allergens. Making these changes can help reduce exposure to histamine triggers.
Stay Hydrated: There is some evidence that dehydration may lead to “allergy responses” and histamine release.
Manage Stress: Stress can exacerbate histamine intolerance by increasing the workload on enzymes like MTHFR. Managing stress is crucial for maintaining balanced histamine levels. This includes getting regular and restful sleep, supporting adrenal health, and engaging in physical activities without overexerting yourself, as excessive exercise can elevate histamine levels.

Conclusion

Histamine intolerance can significantly impact your daily life, but it doesn't have to control it. Through careful management of your diet, understanding the genetic factors at play, and incorporating lifestyle adjustments, you can reduce your symptoms and regain your well-being. Remember that identifying your personal triggers and maintaining a balanced approach are crucial steps in this journey.

While the strategies outlined in this guide provide a solid starting point, personalised support from a health practitioner can make all the difference. If you're ready to take the next step, I invite you to schedule a free 30-minute call with me. Together, we can create a customised plan tailored to your unique needs.

For those eager to take immediate action, be sure to check out my Printable Low Histamine Food List. With the right tools and guidance, managing histamine intolerance becomes not just possible, but achievable.

✨ Wishing you continued success on your path to wellness!