Red wine. Aged cheese. Citrus fruits. Sauerkraut. Bacon. These foods are frequently consumed by those on a healthy whole foods diet, and are often found in a variety of Paleo-friendly recipes and meal plans. Even conventional doctors frequently recommend including many of these seemingly unrelated foods daily as part of a healthy diet. After all, even a raw vegan probably wouldn’t argue against eating foods like oranges, spinach, or cinnamon.
It may surprise you to learn that these and other popular foods are capable of causing numerous symptoms in certain people, including migraines, hives, anxiety, heartburn and GERD, and nasal congestion, just to name a few. If you’re experiencing strange reactions to certain foods that most would consider healthy, you may be suffering from a little known but not uncommon cause of food intolerance and disease: histamine intolerance.
Still having strange symptoms on a real food diet? You could be suffering from histamine intolerance.
Never heard of histamine intolerance? You’re not alone. This food intolerance is difficult to diagnose, has a multifaceted symptom profile, and is often confused with a variety of other conditions. Many doctors and nutritionists have never even heard of histamine intolerance, and often treat the symptoms without ever addressing the underlying cause. In my practice, I see it especially with headaches and migraines, skin problems and mental health issues. It’s a fairly common, yet poorly understood, food sensitivity.
Histamine Intolerance: Not Your Typical Food Allergy!
Deficiency in the DAO enzyme system, found in the intestinal mucosa, has been suggested as the most probable cause of histamine intolerance. (2) There are likely genetic variations in individual enzyme function, but when activity of either of these enzymes is insufficient, the resulting excess of histamine may cause numerous symptoms resembling an allergic reaction. Common symptoms of histamine intolerance include: (3)
- Pruritus (itching especially of the skin, eyes, ears, and nose)
- Urticaria (hives) (sometimes diagnosed as “idiopathic urticaria”)
- Tissue swelling (angioedema) especially of facial and oral tissues and sometimes the throat, the latter causing the feeling of “throat tightening”
- Hypotension (drop in blood pressure)
- Tachycardia (increased pulse rate, “heart racing”)
- Symptoms resembling an anxiety or panic attack
- Chest pain
- Nasal congestion, runny nose, seasonal allergies
- Conjunctivitis (irritated, watery, reddened eyes)
- Some types of headaches that differ from those of migraine
- Fatigue, confusion, irritability
- Very occasionally loss of consciousness usually lasting for only one or two seconds
- Digestive upset, especially heartburn, “indigestion”, and reflux
Histamine intolerance is unlike other food allergies or sensitivities in that the response is cumulative, not immediate. Imagine it like a cup of water. When the cup is very full (high amounts of histamine in the diet), even a drop of additional water will cause the cup to overflow (symptoms activated). But when the cup is less full, it would take more water (histamine) to cause a response. This makes histamine intolerance tricky to recognize.
In addition, histamine intolerance is closely related to SIBO and dysbiosis, which suggests that curing the latter may alleviate the former. Many integrative practitioners, including myself, believe that a primary cause of histamine intolerance is an overgrowth of certain types of bacteria that make histamine from undigested food, leading to a buildup of histamine in the gut and overwhelming the body’s ability to catabolize the excess histamine. This causes a heightened sensitivity to histamine-containing foods and an increase in symptoms that are commonly associated with allergies.
For more detailed information on histamine intolerance, including causes, symptoms, and treatment, check out this article by Dr. Janice Joneja, a Ph.D. in medical microbiology and immunology and former head of the Allergy Nutrition Program at the Vancouver Hospital and Health Sciences Centre.
What to Do If You Have Histamine Intolerance
Histamine intolerance can be a challenging diagnosis to manage, since many foods contain histamine and for some patients, their gut bacteria is producing the excess histamine that is causing the symptoms. Fermented foods are some of the biggest culprits, since even beneficial bacteria produce histamine during fermentation. In fact, reacting to fermented foods is a classic sign of histamine intolerance, especially if probiotic supplements are well-tolerated. Other foods that are high in histamine include:
- Seafood: shellfish or fin fish, fresh, frozen, smoked or canned
- Eggs
- Processed, cured, smoked and fermented meats such as lunch meat, bacon, sausage, salami, pepperoni
- Leftover meat (After meat is cooked, the histamine levels increase due to microbial action as the meat sits)
- All fermented milk products, including most cheeses
- Yogurt, buttermilk, kefir
- Citrus fruits – eg. oranges, grapefruit, lemons, lime
- Most berries
- Dried fruit
- Fermented foods: sauerkraut, kombucha, pickles, relishes, fermented soy products, etc.
- Spinach
- Tomatoes- including ketchup, tomato sauces
- Artificial food colors and preservatives
- Spices: cinnamon, chili powder, cloves, anise, nutmeg, curry powder, cayenne
- Beverages: Tea (herbal or regular), alcohol
- Chocolate, cocoa
- Vinegar and foods containing vinegar such as pickles, relishes, ketchup, and prepared mustard
Individual sensitivity varies tremendously. I have one or two patients that cannot tolerate any amount of histamine in food, and others that are only sensitive to the foods highest in histamine.
In order to improve your tolerance to histamine-containing foods, it is crucial to heal the gut and address any dysbiosis or SIBO issues that may exist. I recommend working with a qualified practitioner who can help you address any bacterial imbalance and create a treatment plan that is tailored to your needs.
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What Can You Eat on a Low-Histamine Paleo Diet?
You may be feeling overwhelmed by the list of foods to avoid – I don’t blame you! It can be especially challenging to eat low-histamine foods on a Paleo diet. There aren’t many resources available for this condition, and everyone reacts in their own unique way to excess histamine and certain high histamine foods. For example, a person may do fine eating berries and citrus fruits, but they may have horrible reactions to wine or sauerkraut. If you’re dealing with histamine intolerance, you will need to determine your own trigger foods, and reduce or eliminate them accordingly.
For help figuring out what to eat, those with histamine intolerance may want to check out my Paleo Recipe Generator. It contains over 600 Paleo-approved recipes, and allows you to exclude many high histamine foods from your meal plan, including fermented dairy, eggs, tomatoes, eggplant, fruit, certain spices, vinegar, alcohol, and seafood.
Of course, you’ll have to pay attention to whether or not the recipe contains cured meats like bacon or sausage, other spices like cinnamon or cloves, and certain fruits and vegetables like citrus and spinach. Some of these issues can be addressed by excluding fruit and pork from the meal plan, which isn’t necessary but can help make your low-histamine recipe search a little easier. You’ll still need to double check the ingredients of each individual meal, but this search function makes it much easier!
Once you’ve made your selections for foods to exclude, you can plan meals for a full day, a week, or simply find a recipe for a single meal. Even with a histamine intolerance, you can still enjoy many delicious Paleo recipes: Lamb Roast with Fennel and Root Vegetables, Beef Brisket with Mushrooms, Sourdough Buckwheat Pancakes, and even Chicken Pot Pie, just to name a few.
There are few other online resources for low-histamine meal plans, and most are not Paleo compliant. The Low Histamine Chef has a “Low Histamine Diamine Oxidase Boosting Recipe Book” which some people may find helpful, though many of the recipes contain less-than-desirable ingredients such as grains, legumes, and sugar. It’s important to focus on healing the gut and identifying your specific trigger foods in order to reduce symptoms without indefinitely following a strict low histamine diet. Just remember, individual results will vary!
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I recently (last summer) began having more and more symptoms of digestion upset and broke out in hives all over my body in the fall. I noticed that when I am under tremendous stress for extended periods of time, like this summer and other occasions, my body produces more congestion and illness. I’m wondering if I don’t lack the enzymes to break down histamine but if stress, which produces histamine, could be causing my problems, leading to too much histamine in my body. If I eat a low histamine diet and continue to work on my anxiety/panic issues, do you think that in time my body will function normally? Can the histamine from stress be that strong as to cause these problems, but not because of lack of the histamine breaking enzyme?
Check out mast cell activation disorder as well. Histamine intolerance is just one that sets off the mast cells. Stress seems to be a major contributor. Look for article by Dr. Theoharides and Dr. Cassells as well as Dr. Jonega.
How does one know if they are histamine intolerant? Is the LEAP test for histamine reliable? Is the reaction to histamine rather immediate or is it like other food sensitivities that may not manifest for days or longer?
can I please ask what the bacterial overgrowth protocol is?
Could high histamine be a result of methylation mutations? If yes would change in diet even help until you bypass the mutation? Which mutations!
I have seen several doctor’s since September because of hives/allergic reactions and the symptoms sound exactly like the problems I’m having. Are there any other options other than the food elimination diet?
Anyone else anemic or have a low MMA? What do we do next?
How can I adhere to an anti-histamine diet being vegan? Are there vegetarian DOA supplements that I can take?
I have been eating pretty much only meat and fat since I am trying to get my gut straightened out (see Digestive Health – Real Food). I have avoided fish and other than that have just been really careful to only eat freshly cooked meat. I also have been taking histDAO with each mean and it seems to be working well. In one week, symptoms are way down.
Hi Ward,
Can you tell me what the name of the antibiotic that you took, that is known to block the enzyme diamine oxidase (DAO) which degrades histamine in the gut. Thank you!
Hi Sandy,
Keflex (cephalexin). All I know for sure is that several drugs in the cephlasporin family block DAO. I’m guessing cephalexin does also based on my reaction.
Hmm. Interesting. I remember being put on that in Jr. High. Was “allergic” to many anti-biotics, but they were okay with me on Keflex.
Does anyone know how I can order the histamine intolerance test through Dunwoody labs? I was advised to try a low histamine diet and a DAO suppliment however I am about 10 pounds underweight. I was hospitalized at an eating disorder clinic. I struggled there because I felt I had no appetite or would quickly be full. I don’t have body image issues. I cannot restrict my foods without having a clearer idea that this could be a helpful diet for me. Does anyone know where I could find a meal planner for low histamine?
Google “low histamine chef” for food info. She also has interviews from the top people in the field. Listen to the interviews, they’re invaluable. Dr. Cassells, Dr, Theorides, Dr. Joneja are on her site and offer the best info I’ve found.
Taube, what do u eat that doesn’t give u issues? I’m glad u mentioned oxalate….. I feel it’sthe root ccause ofmany issues. what Probiotics helps with oxalate?
Hi Bee, Sorry I did not respond sooner.
Only certain foods are high in oxalates.
Even Dr Oz had a segment this week on green drinks and he recommends avoiding certain vegetables that are high in oxalates such as spinach, chocolate, strawberries, tea , certain nuts if you have kidney stones.
Another article says to limit vitamin C in excess of the RDA (75 mg/day for female, 90 mg/day for male).
I had a bad pseudogout attack two yrs ago after taking heavy doses of Vitamin C and rosehips. I got tinnitus at the same time and it is just now starting to come down after eliminating all supplements. I am working with a nutritionist for my gallstones. I also have a very painful right shoulder (frozen shoulder) which started after I was drinking the kale shakes.
Here is a list of foods by oxalate content
http://www.ohf.org/docs/Oxalate2008.pdf
There is a new probiotic that helps people who have trouble metabolizing oxalates, I think I posted the name earlier but here it is again, prescription only at this point
Oxalobacter formigenes
Here is another article that details how oxalates are handled in the body and how to minimize damage
http://www.greatplainslaboratory.com/home/eng/oxalates.asp
Please note this sentence: Ascorbate (vitamin C) in the blood can be metabolized to oxalate
Here is another really great article which opens a pdf
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=4&cad=rja&ved=0CDUQFjAD&url=http%3A%2F%2Fhrcak.srce.hr%2Ffile%2F164844&ei=aSPlUtu-O-LNsQS40IL4Cw&usg=AFQjCNEo_a3eXd5Ot57rCBZo0x1M6C8yBg
Re: FROZEN SHOULDER
I had “frozen shoulder” for 4 years. I turned down surgery, had been going to a PT to no avail. I read that citrus could cause this and stopped consuming anything with citrus. My arm began working again within 3 weeks. It has been functional for 10 months now (I will not add citrus back to my diet). I believe it was a nerve not functioning. See if cutting all citrus (plus the kale for you) eliminates the problem.
I have SIBO, IBS, Diverticulitis, Acid Reflux, Lupus, and also suspect that I have Leaky Gut and Histamine Intolerance. I’ve tried for years to heal my leaky gut and nothing seems to be working for me. Today I tried Aloe Vera juice, and had sneezing, tight throat, high heart rate. I’ve tried the Gaps, Paleo, Food Combining. I took Xifaxan for the SIBO which seemed to help, but when I started taking probiotics my symptoms got much worse….sore throat, depression, anxiety, severe nasal congestion, joint pain. I’m getting desperate, and would appreciate any suggestions you could offer. Thank you
The more foods I cut, the better I feel. And I am med-free (after 40 years of seizure meds). Have you read up on fructose intolerance? I have eliminated almost all fruit, only drink water and decaf coffee (it was hard to cut the tea, which I cut because of the benzene). The more I cut out, the closer I get to the ketogenic diet. Can you get off all meds?
Hi Ann,
I’m currently on the FODMAP diet, and eat very little fruit….maybe an occasional banana. I’m on some meds….synthyroid, because my thyroid was removed, anti-inflammatories when the pain gets really bad.
Hmm. I don’t know the meds or how removal of the thryoid factors in. I see some of the foods you listed below wouldn’t work for me: eggs, fish, lemon (any citrus). I wouldn’t try cod liver oil or Aloe Vera juice. My arm had stopped working in 2009 and when I cut out citrus in 2013 it was back to its old shape in about 3 weeks.
Thanks for the feedback, Ann. I have such a difficult time sticking with any set diet because I’ve lost so much weight, and I just get hungry :))) It seems like the diets I have been on, work for a while, but when I try to go back and eat normally my GI tract rebels, and by eating normally I mean eating organic wholesome foods.
I used to always be starving and that stopped when I added green juice (no spinach). It ended my daily 4-7 pm ice cream cravings. I was skinny when I was on meds for seizures. Your weight loss may be caused by the surgery or the meds you take. I think the biggest problem we have is that we believe there is a specific way to eat. Wouldn’t we all get the same illnesses if we were all the same? We’re not and one way of eating may be good for one person and bad for another.
What do you put into your green drink?
I use a ratio of 4:1. 1/2 c. of 4 different green veggies and 1/2 c. of green apple. Veggies to choose from: celery, kale, collard green, broccoli, arugula, fennel. I start with 1 c. of water in the blender, then add each ingredient. If I need more water, I add it, plus ice.
Claudia,
Did you do Paleo or Autoimmune Paleo protocol? How long did you do it?
Stay away from probiotics until your gut is healed. What else are you trying for healing your gut? Have you given up dairy?
Hi Mary,
I’m currently on FODMAP diet and food combining. I was on the Paleo, not the Autoimmune Paleo, and that was over a year ago. I stayed on it for 6 months. I eat bone broth, eggs, sweet potatoes, carrots, green beans, boiled chicken, and fish. I drink almond milk, coconut milk, lemon water. I take cod liver oil…tried glutamine, aloe vera juice…neither agreed. I gave up dairy years ago, except eat some cheese.
Is whey protein low histamine?
NO ! Dairy, wheat and gluten can contribute HUGELY to histamine release which can cause flushing, red face,etc
Many people feed small children bowls of mac and cheese for dinner. People laugh about cheese being a food group but it is not a joke. Cheese should be used SPARINGLY as a garnish .
Here is an exellent article on histamines. Suggests taking quercetin which I have used, which is excellent to inhibit histamine release. Also recommends drinking lots of water and AVOID honey ! I used to drink lots of tea with raw honey and it greatly aggravated by tinnitus. Once I quit the honey, all tea, all coffee, very little dairy and starting drinking lots of water, I found that my sinuses felt much better as well as other problems I had such as general anxiety and sleep issues.
http://www.lamuscle.com/laworld/stop-histamine-release
A good friend of mine went to a famous neurologist for a nerve issues in her neck and arms following a bad accident and he told her that dairy is highly inflammatory.
He told her to avoid all dairy.
The link above to Dr Joneja’s article is broken, but I’ve found it here:
http://www.foodsmatter.com/allergy_intolerance/histamine/articles/histamine_joneja.html
I have a yeast allergy and Tachycardia. I have been getting hives. chest back and arm pain (hearts fine) tired, headaches, the dr said my heart rate was high but all my bloodwork came back norma. My whole body also hurts could this be from the allergy??? i watch what i eat to stay away from the yeast but once in awhile something may slip past me esp when eating out
Do you drink wine when you go out ? I had lots of bad symptoms from drinking wine
Chris,
I love your articles and this one is great! I wonder if you know of the healing modality of NeuroModulation Technique, developed by chiropracter Leslie Feinberg? http://www.nmt.md.
This is a more potent form of allergy treatment that NAET and actually can treat more than just allergies – stress and endocrine disruption, digestive issues, chronic pain and more. It uses the natural healing mechanisms of the body by retraining the body systems to act in a more physiological way.
You may call me or contact me if you’d like to talk about it and my experiences working with it, both as a patient and practitioner. 541-653-0446 or http://www.HeartFullHealing.com/contact-us.html
Hello, my gastroenterologist says I do not have intestinal malabsorption or inflammation – he says my symptoms might be due to food intolerances and as my face gradually puffier over some days, we wondered about histamine intolerance. I also have my eyes that water and are red most of the time, and sometimes itch.
How do you diagnose histamine intolerance? He said to go and see an allergy specialist, is that right?
Thank you for your help!
I am having Urticaria since age 12 now I’m 28. till the age 24 I was not knowing the reason then on skin prick test it was found it’s allergy of citrus fruits. now even after avoiding since 3 and half years i’m getting hives. i was on antihistamine drug till now. whether I m having intolerance to histamine? whether on treated for my immunity i get cured?
I’m so glad to see this article. My allergist just ran a bunch of blood test and says I have a histamine problem but didn’t offer any suggestions none other than medication, of course. I take prednisone to help with the itching due to the hives. I wake up with them sometimes and some days I don’t. I need to do the list you have a log in my food with my outbreaks. I am a cancer survivor and I didn’t have this problem until after my cancer treatments. It started like a few months afterwards. I will be following up with my doctor disregards to this article. But I want to thank you, thank you.
Following
Thanks so much for this well-informative article! I am currently researching healing options for my five-year-old son who has many food allergies that continue to get worse each year. He is also recovering from apraxia of speech, eczema, and asthma. I wanted to get your opinion on something. On his past two allergy skin-prick tests, when they do a test prick for “histamine” to see if his body will respond to testing, he has no reaction to it (it does not swell up like a bug bite). Doctors shrug their shoulders at this, but I think it could be a big clue as to what is happening in his body. Would it be a possibility that his body is high in histamine and therefore, when you inject straight histamine into it, it doesn’t react? Almost like 2 positives creating a neutral reaction? They always continue on with the test even though they say it may not work, only to discover he reacts usually to almost everything we test him for. Fish is his worst allergy. The swelling is always so bad it goes outside the grid and reacts all around. Any thoughts you could provide would be much appreciated. Thanks!