Histamine intolerance has many faces and even more potential triggers. It is no wonder that sufferers often have a long and rocky path before they can make the diagnosis of "histamine intolerance". However, even with the knowledge of what it is, many affected individuals find life with intolerance challenging. Find out more about the often undetected phenomenon, symptoms of which can manifest as histamine intolerance and what the right diet looks like with this intolerance.
Histamine is a biogenic amine (= a protein compound) that is produced by our body as well as in many foods. While histamine acts as a very effective messenger in our body, it is primarily produced in food by bacterial degradation of the protein component histidine. In addition, some plant-based foods, such as tomatoes or spinach, naturally contain histamine.
Histamine has a bad reputation. It is primarily known as causing allergy-like symptoms and intolerance symptoms. As with many things in life, black and white thinking is also out of place with this biogenic amine. In fact, histamine actually deals with some vital functions in the human organism as a tissue hormone and neurotransmitter. In defence reactions, for example, it causes our blood vessels to expand and more immune cells to reach the site of the event, but this can also cause swelling and itching. In addition, the messenger substance stimulates the production of gastric juices and regulates the sleeping/waking cycle, appetite control, as well as the ability to learn, memory and emotions.
In the case of histamine intolerance, the ratio between the breakdown of histamine and its formation in the body or its intake with food is not balanced. Due to this disparity, an excess of histamine can develop in the body, which can lead to a number of symptoms ranging from just a few to a whole spectrum. The individual tolerance threshold varies greatly. In fact, even healthy people tolerate only a certain amount of histamine. Among other things, fish poisoning – in addition to other toxins – can also be caused by an excessive histamine content due to poor storage. In this case, it is therefore nothing more than an exceedance of the degradation capacities in an otherwise healthy, non-histamine-intolerant person.
If a person suffers from histamine intolerance, his or her body is not able to completely break down the body’s natural histamine or the histamine absorbed via food or it breaks it down too slowly. If this process does not work smoothly, food histamine can create an effect in the body that results in different individual symptoms. The body's own enzyme, diamine oxidase (DAO), which is mainly produced by the intestinal mucosal cells but is also found in the blood, plays a key role in degradation and consequently in the disorder.
Under normal circumstances, DAO is constantly released into the intestine, ensuring that any food histamine is digested before physical reactions are triggered. In the case of increased histamine exposure, this inactivation system can now become overloaded, which causes the allergy-like symptoms. In addition to the degradation of histamine, the DAO is also responsible for the degradation of other biogenic amines (including serotonin, tyramine, putrescin). If the capacity of the DAO is exhausted for the preferred degradation of other biogenic amines, it is no longer available to a sufficient degree for the degradation of histamine. A diet that contains many biogenic amines and histamine can therefore exceed the capacity of the DAO and lead to an increase in symptoms.
In most cases, the reduced activity or production of the histamine-degrading DAO (colloquially known as DAO breakdown weakness or DAO breakdown disorder) is responsible for histamine intolerance. This can be genetically determined, but can also be due to inflammation of the intestinal mucosa (e.g. Crohn's disease, irritable bowel syndrome) – meaning that none or only a small amount of DAO can be formed in the inflamed intestinal mucosa and thus histamine cannot be sufficiently broken down. Bacterial miscolonisation in the intestine (e.g. SIBO) can further increase histamine intolerance, since certain bacteria have their own characteristic of forming histamine from the protein component histidine. A lack of certain micronutrients that are critical to DAO activity can also be critical. DAO requires vitamin B6 in particular, but also copper, vitamin C and zinc to function properly. A lack of these substances leads to a DAO degradation weakness.
Diamine oxidase (DAO) is a copper-containing enzyme that requires vitamin B6 to break down histamine. A vitamin B6 deficiency may be reflected in decreased DAO activity. A copper deficiency can result in less DAO being produced. Zinc supports DAO in its function while inhibiting histamine release.
In addition to vitamin B6, copper and zinc, vitamin C is also beneficial for histamine intolerance. The water-soluble vitamin acts in the metabolism as an opponent to histamine and supports its degradation.
External factors can also interfere with the activity of histamine-degrading diamine oxidase (DAO). This is because it is a sensitive molecule that is not – as is the case with most enzymes – located in a controlled environment within the cell, but acts outside the cell and is thus exposed to various interferences. Important DAO inhibitors include alcohol and nicotine. Certain active substances such as acetylsalicylic acid (ASA), diclofenac, indomethacin, flurbiprofen, meclofenamic acid or naproxen can also reduce the activity of DAO or even block it almost completely. If medications are taken, it is therefore recommended to find out whether they can potentially block the DAO.
Women are disproportionately affected by histamine intolerance. While pregnancy can have a positive effect on histamine intolerance, a significant increase in cases can be recorded around the menopause. For example, 80% of histamine patients are middle-aged women. Scientists suspect that this is caused by hormone changes in the menopause, because female hormones influence both the sensitivity of the histamine receptors and the histamine release.
Histamine is a potent messenger substance that performs a variety of functions in the human organism. Accordingly, the symptoms that can be triggered by a histamine imbalance are multifaceted and individual. In addition, individual physical factors and the histamine concentration influence the occurrence of the symptoms. Possible symptoms of histamine intolerance include:
In people with histamine intolerance, the constant struggle with physical symptoms can lead to increased stress and anxiety. However, this psychological stress can become another histamine trap. After all, the mind and histamine influence each other. Nowadays it is known that stress triggers the release of histamine into the body. This in turn leads to a wide variety of reactions – also at the level of the brain and the mind. Symptoms that may be associated with histamine intolerance include depressive moods, anxiety, nervousness, confusion and sleep disorders.
In order to improve well-being in the event of histamine intolerance, the holistic treatment of body and mind is important. In addition to a dietary change, mindfulness training, stress management and, if necessary, psychotherapy and self-help groups on important coping strategies of histamine intolerance also play a part.
Mindfulness training can help to better manage the negative thoughts and emotions associated with intolerance. This reduces the psychosomatic component of the disease (see: "How histamine intolerance affects the mind").
The reduction of the psychosomatic component also includes stress management techniques. Possible techniques include yoga, breathing exercises, meditation, forest bathing and sufficient sleep.
Psychotherapy can help you to recognise the psychological effects of histamine intolerance as well as negative thought and behavioural patterns.
Interacting with fellow-sufferers helps many people. It makes you feel understood and less isolated.
“How much histamine is there in ...?” Dr Google invites histamine intolerant people to pore over tables. Individual sufferers can be driven to despair when they come to the conclusion, thanks to the myriad tables, that they are actually no longer allowed to eat anything. But don’t let this drive you crazy.
Of course, there are certain foods that due to their production processes are real histamine bombs – such as aged cheese, bacon, prosciutto, salami, sparkling wine or sauerkraut. However, for many other foods, strictly speaking, no reliable information about the exact histamine content can be provided, as this can change hourly.
While people with fructose or lactose intolerance can move in a relatively well defined field from a nutritional point of view, the distinction in histamine intolerance is not quite as simple. Nevertheless, even in the case of histamine intolerance, there are some “golden rules” that can help you to eat low-histamine foods:
Keyword: freshness. Fresh foods and meals are not automatically unproblematic, but they certainly carry a lower “intolerance risk”. Caution is advised when food has been left standing or pre-cooked, because the longer a food is stored and heated, the more the conversion of histidine to histamine is promoted. Thus, a meal that was still tolerable the day before can cause intolerance reactions the next day.
Key word: maturity. Good things don’t always take time! The longer a food matures – be it cheese, salami or similar – the more critical it is for histamine intolerant people.
Keyword: ready meals. Caution should also be exercised towards ready meals. These are generally problematic, especially if they contain flavour enhancers such as yeast extract, colourings or preservatives.
Keyword: alcohol. Alcohol is also considered problematic with histamine intolerance. Because all alcohol, whether it’s schnapps, beer or wine, blocks the body’s own histamine-degradation enzyme DAO. Some alcohols, especially red wine and sparkling wine, also contain a fair amount of histamine.
Histamine-intolerant people who still want more guidance can orient themselves to the following traffic light system.
|
Food |
Evaluation |
|
|
Meat, fresh |
||
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Minced meat |
✓ |
|
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Beef |
✓ |
|
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Pork |
✓ |
|
|
Lamb's Liver |
✓ |
|
|
Duck |
✖ |
|
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Chicken |
✓ |
|
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Turkey |
✓ |
|
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Sausages |
||
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Bratwurst |
✓ |
|
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Landjäger |
✖ |
|
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Liversausage |
K |
|
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Salami |
✖ |
|
|
Ham, smoked, air-dried |
✖ |
|
|
Fish |
||
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Fishfingers |
✓ |
|
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Trout |
✖ |
|
|
Herring |
✖ |
|
|
Salmon, fresh |
K |
|
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Mackerel, smoked |
✖ |
|
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Sardines |
✖ |
|
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Plaice, fresh |
✓ |
|
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Tuna, canned |
✖ |
|
|
Food |
Evaluation |
|
|
Dairy products |
||
|
Camembert |
K |
|
|
Emmental |
✖ |
|
|
Gorgonzola |
✖ |
|
|
Yoghurt |
✓ |
|
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Cow's milk |
✓ |
|
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Parmesan |
✖ |
|
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Cream/whipped cream |
✓ |
|
|
Quark |
✓ |
|
| Tilsiter |
✖ |
|
|
Food |
Evaluation |
|
|
Vegetables |
||
|
Aubergines |
K |
|
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Beans |
K |
|
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Mushrooms |
✖ |
|
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Carrots |
✓ |
|
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Potatoes |
✓ |
|
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Sauerkraut |
✖ |
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Spinach |
✖ |
|
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Tomatoes |
✖ |
|
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Fruit |
||
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Pineapple |
✖ |
|
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Apples |
✓ |
|
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Bananas |
✖ |
|
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Strawberries |
✖ |
|
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Raspberries |
✖ |
|
|
Cherries |
✓ |
|
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Oranges |
✖ |
|
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Watermelon |
✓ |
|
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Lemons |
✖ |
|
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Other |
||
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Yeast etract |
✖ |
|
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Cacoa powder |
✖ |
|
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Nuts |
✖ |
|
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Chocolate |
✖ |
|
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Red wine vinegar |
✖ |
|
Tables adapted from Dr. Axel Vogelreuter, 2015.
✓ = Generally problem-free
K = To be enjoyed with caution, avoid during the abstinence phase
✖ = Generally unsuitable for histamine-intolerant people
In the case of histamine intolerance, it is not only the content of the histamine (and other biogenic amines) that matters. There’s another problem: There are foods that contain only a small amount of histamine, even though they (at least partially) cause increased histamine release in the body. In technical terms, these dietary traps are known as "histamine liberators". The most well-known are strawberries, which are often blamed for allergic reactions that are not even present. But chocolate, tomatoes, kiwi, pineapple, cereal gluten, casein from dairy products or certain painkillers also belong (among others) to the group of “histamine-releasing agents”.
For people with histamine intolerance, tap and mineral water, herbal teas as well as freshly pressed fruit and vegetable juices (from histamine non-critical varieties -> see table) are a good choice. Alcoholic drinks should only be drunk in moderation, if at all. Alcoholic drinks not only contain potentially biogenic amines, they also burden the organism of people who are intolerant to histamine due to their enzyme-inhibiting and histamine-releasing effect. The most tolerable alcoholic drinks are all the clear schnapps. In the case of beer, lower fermentation beers should be drunk with caution, while wine lovers should opt for dry white wines
The diagnosis of histamine intolerance is primarily based on an in-depth survey by the doctor (medical history) regarding the patient's medical history. In the course of this, the observations and complaints of the affected person are recorded.
Blood analyses may subsequently also be used. Although the activity measurement of the histamine-degrading enzyme DAO and the determination of the DAO and histamine levels are not meaningful as individual methods, they help to confirm the suspected diagnosis of histamine intolerance. As part of the laboratory diagnostics, both the histamine in the urine and serum as well as the activity of the DAO in the serum can be determined.
Based on this, those affected can try eating a low-histamine diet for three to four weeks, i.e. they can maintain a histamine abstinence phase. In the course of this, foods and drinks containing histamine and releasing histamine are avoided as far as possible. A diet diary can also help to assign diet and symptoms to each other. If there is a strong improvement in symptoms in this phase, this actually speaks for histamine intolerance
In the case of histamine intolerance, a change in diet to a more or less low-histamine diet is the key. The change in diet should begin with a period of abstinence, transition to a test phase and end in an individually designed long-term diet.
During the abstinence phase lasting up to three weeks, foods containing histamine and releasing histamine should be avoided as far as possible. A DAO preparation can also help to reduce food histamine to a minimum over time. In order to relieve the digestive tract as much as possible, no bloating or fibre-rich foods should be consumed over this time.
As soon as you are free of symptoms, the test phase can begin. During this time, only food containing a moderate amount of histamine is consumed once daily in small quantities to begin with and then the histamine content of the food is gradually increased in a controlled manner. A nutrition and symptom diary helps to maintain an overview of the tolerability of and intolerance to individual foods over time.
When the individual threshold for the tolerability of the foods containing histamine has been exhausted, the long-term nutrition phase begins. In this, the experience gained is put into daily practice.
Whether it’s a holiday abroad or dinner with friends – even people who have learned to deal well with their intolerance are repeatedly faced with histamine-critical situations. However, there are now ways to prepare for such cases. Innovative nutritional supplements target histamine-degrading DAO (diamine oxidase) to increase the amount of DAO in the small intestine. Taken immediately before a meal, DAO capsules or tablets improve histamine degradation in the digestive tract. This eliminates the food histamine that triggers irritation, more quickly and counteracts the flooding of histamine. A secret tip are preparations that also supply L-glutamine. The amino acid strengthens the cells of the intestinal mucosa attacked by the intolerance and thereby supports the body's own DAO formation.
Conclusion: Life with a histamine intolerance can be challenging. On the one hand, the "histamine problem" is spread across many food groups, on the other hand, the symptoms prove to be multifaceted and impair well-being over the long term. In order to be able to enjoy life despite a histamine intolerance, it is therefore important to know your “enemies”. In addition to certain foods, stress is also considered an innate histamine trap that should not be ignored. This makes it important not only to have a low-histamine diet for histamine intolerance, but also to manage stress effectively. Those affected who want to relieve their organism, eat out or break out of their histamine-reduced diet can also use special preparations that specifically supply the enzyme DAO and thus support the body in its histamine degradation quickly and easily.
