What is Histamine?
Histamine is a natural substance produced by the body and is also present in many foods. It is released by the body during times of stress and allergy. In an allergic response, an allergen stimulates the release of antibodies. Mast cells release histamine which may cause one or more of the following symptoms:
- Eyes to itch, burn, or become watery
- Nose to itch, sneeze, and produce more mucus
- Skin to itch, developing rashes or hives
- Sinuses to become congested and cause headaches
- Lungs to wheeze or have spasms
- Stomach to experience cramps and diarrhoea
Histamine is a vasoactive amine which causes dilatation of the blood vessels (flushing, rashes, itching) and increased mucus production (runny nose, productive cough), and bronchoconstriction (wheezing, cough). Because histamine is contained in almost all body tissues, especially the lungs, nose, sinuses, skin, intestinal mucosa and certain blood cells (mast cells, basophils), it is able to cause a wide variety of symptoms.
What causes histamine intolerance?
- SIBO (small intestine bacterial overgrowth) —SIBO causes an overgrowth of bacteria, which produce excess histamine from undigested food.
- Dysbiosis – Infections such as bacterial or yeast overgrowths and parasitic infections can cause histamine intolerance.
- Methylation dysfunction — Sometimes those who have impaired methylation, whether from genetics or another cause, can have issues or changes in their tolerance to histamine.
- Genetics — In addition to the genetic component to methylation, some people have mutations on the genes that are necessary for the formation of enzymes that degrade histamine (such as diamine oxide, or DAO). Reduced enzyme activity will result in a lower tolerance to histamine.
- CIRS – Chronic inflammatory response syndrome is a condition many who have been exposed to mould toxicity develop, and can cause histamine intolerance. See this article about Mast Cell Activation Syndrome (MCAS).
- Heavy Metal Toxicity – Those who have high levels of heavy metals can develop histamine intolerance - a Hair Tissue Mineral Analysis (HTMA) may be useful in determining heavy metal toxicity.
- Medications — Some medications inhibit DAO enzyme activity and can cause symptoms of histamine intolerance.
The release of histamine can be caused by almost any allergen. Examples include inhalant allergens (ragweed pollen, dust mite, dander), drugs (penicillin, sulphur, aspirin), stinging insect venoms, and foods (egg, wheat, milk, fish, etc).
Histamine in Foods
There are many foods that contain histamine or cause the body to release histamine when ingested. These types of reactions are food intolerances, and are different from food allergy in that the immune system is not involved in the reaction. The symptoms, however, can be the same as a food allergy. Foods that contain the chemical tyramine can trigger headaches. Foods that may have large amounts of tyramine include: fish, chocolate, alcoholic beverages, cheese, soy sauce, sauerkraut and processed meat. Fermented foods may cause allergy symptoms because they are either rich in histamine or because yeast or mould is involved in the fermentation process.
- Fruits and vegetables that are just ripe
- Fish that has only been caught within 12 hours (it's okay to then freeze it)
- Meat that is freshly culled.
Safest cooking methods;
- Baked, steamed, boiled or poached avoid char-grilling or BBQ'd foods
- Don't cook over 220 degrees celsius
Storing;
- Freeze on the day of purchase and eat within 30 days
High histamine level foods:
- Fermented Alcohol such as; red wine, white wine, beer
- Fermented foods such as; Kefir, Kombucha, home-made sauerkraut
- Pickled or canned foods – supermarket sauerkrauts, pickled onions, gherkins etc, pickles
- Matured/Aged cheeses
- Processed and smoked meat products – salami, ham, sausages….
- Meat that isn't fresh, including meat in cryovac packs in the supermarket
- Shellfish
- Mackerel
- Herrings
- Anchovies
- Chicken Skin
- Eggplant
- Beans and pulses – chickpeas, soy beans, peanuts, lentils, kidney beans,
- Nuts – especially walnuts, and for some cashew nuts (some can tolerate cashews)
- Chocolates and other cocoa based products (carob is okay)
- Vinegar
- Ready meals and processed and packaged foods
- Salty snacks, sweets with preservatives and artificial colourings
- Sour cream and buttermilk
- Bread made with large amounts of yeast
- Dessicated/shredded coconut
- Seaweed
- Spices including; cinnamon, anise, cloves, curry spices, cumin, nutmeg, cayenne, paprika
Histamine liberators: (these release naturally occuring histamine in the body)
- Most citrus fruits – lemons, limes, grapefruits, mandarines and oranges.
- Other fruits include; all dried fruits, strawberries, papaya, ripe banana, pineapple, avocadoes and tomatoes
- Cocoa and chocolate (carob is okay)
- Nuts
- Beans and pulses
- Pork
- Wheat germ and other cereals
- Additives – benzoate, sulphites, nitrites, glutamate, food dyes
Diamine Oxidase (DAO) blockers, DAO removes histamine from the body:
- Fermented Alcohol
- Black tea
- Caffeine
- Energy drinks
- Green tea
- Mate tea
Diamine oxidase (DAO) is the main enzyme that metabolises histamine. Interestingly anti-histamines can block DAO, thereby inadvertently increasing histamine levels in the body. Debatable, these can cause problems in some people, but not in others. It would be worth keeping them out of the diet while you're reducing histamine load and then introduce one at a time during the challenging phase;
- Yoghurt – depends on the bacterial culture used
- Milk and Cream
- Egg white – it is a histamine liberator only when in its raw state
- Pineapple
- Raspberries (if fresh and in season - watch for mould)
- Passionfruit (if fresh and in season)
- Pork
- Peanuts
- Pumpkin
- Liquorice
- Beetroot
- Spinach
- Rocket
- Capsicums
- Bananas; firm
- Plums
- Mushrooms
- Avocado
- Almonds and cashews
- Additives such as preservatives and flavourings
- Some spices such as; cumin, cinnamon and turmeric
- Yeast- even though yeast doesn’t contain histamine as such, it can serve as a catalyst for histamine production during manufacturing.
- Distilled Spirits
Low histamine level foods:
- Fresh meat, it's best to buy meat as fresh as possible and either cook it immediately or freeze as soon as you get it home. The longer meat sits around the more amines it will have.
- Freshly caught fish
- Fresh chicken (skinned and fresh)
- Eggs so long as the white is fully cooked as raw egg white is high in histamines
- Fresh fruits – with the exception of the fruits listed above. Safest fruits include; Apples, Blueberries (if fresh and in season or frozen), Pears, Kiwi (may liberate histamine in some people), Mangoes, Passionfruit (if in season) Bananas (only if they're firm and not everyone can cope with them) and Pomegranates. Raspberries can be okay for some people, but only if they're fresh and in season or frozen.
- Fresh vegetables – a lot of vegetables are safe on the histamine lowering diet, but there are some exceptions such as; tomatoes, avocados and eggplants. Spinach is also considered unsafe but this may be dependent on the individual and also on whether they have been picked while young and are in season.
- Safe vegetables include; Asparagus, Iceberg Lettuce, Bok Choy, Celery, Mung Bean Sprouts, Watercress, Snow Pea sprouts, Cabbage, Carrots, Cucumber, Chokos, Cauliflower, Brussels Sprouts, Green beans, Kale, Watercress, white and sweet Potato, Pumpkin, Zucchini, Garlic, Onions, Leeks, Spring Onions, Chives, Ginger and leafy herbs. Many people can tolerate capsicums, but if you're unsure I would leave them until you're symptom free and introduce them in your second or third week (the challenging phase). You can use roasted capsicum in place of tomatoes for bolognese sauces. You can buy them in jars at the supermarket and just blend them up into a sauce.
- Pumpkin seeds or sunflower seeds
- Nuts; Brazil Nuts, Macadamias or pecans - some people can tolerate almonds, but the issue with all nuts are those that have been stored for long periods of time as they may have developed a form of mould that causes sensitivities - the fresher the better.
- White beans; canellini or lima beans. Cooked from dried beans, rather than canned, are usually better, but some people can tolerate the ones in a can.
- Grains – rice, rice noodles, yeast free flat breads, rice crisp bread, oats, puffed rice crackers, corn chips or tacos, millet flour, pasta (spelt and corn based). Wheat is okay but only in moderation.
- Fresh pasteurised milk and milk products (although some people do better on a lactose free milk such as; Zymil or Liddell's)
- Milk substitutes – coconut milk, rice milk, macadamia or almond milk.
- Cream cheese
- Most cooking oils, particularly rice bran oil, first pressed extra virgin olive oil and coconut oil
- Butter
- Most leafy herbs
- Most non-citric fruit juices
- Herbal teas, especially ginger tea – with the exception of those listed above
- Avoiding alcohol while reducing histamines is essential (to allow detoxification to work optimally), but if you are drinking alcohol, then gin, vodka or white rum are the safest choices
RECIPES
Low Histamine Mayonnaise Pear and Oatmeal Muffins Rice and Cottage Cheese Pie Image courtesy of Stuart Miles at FreeDigitalPhotos.net
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