Histamine Intolerance

Mast cells are critical players in the inflammatory response. Histamine is a compound found in nearly all tissues in the body, where it is stored in the granules of tissue mast cells. It is also found in blood cells and is called basophils.

Histamine promotes the rapid removal of toxic substances after injury or allergic reaction as part of your immune response.

It is an integral part of intestinal homeostasis, which triggers the release of stomach acid to ease digestion and is essential for the survival of gut bacteria. It also serves as a neurotransmitter, carrying chemical messages to your brain.

Our circadian rhythms, wound healing, blood pressure, contraction of smooth muscle cells, and regulation of cell proliferation are all affected by histamine.

Histamine is naturally produced alongside another enzyme called Diamine Oxidase (DAO) and occurs naturally in food too!

Diamine Oxidase (DAO) breaks down histamine from food intake, preventing it from being absorbed in the gut and entering the bloodstream. (This can trigger an immune response if it happens).

Histamine N-methyltransferase (HNMT) is an enzyme metabolizing histamine (to a lesser extent than DAO).

Histamine generally has a short life in the body, and most people can tolerate the amount found in foods. Still, some people lack the necessary enzyme, Diamine Oxidase, to process it due to many reasons, such as poor gut health, genetics, and medication. See the list below.

Histamine intolerance is a condition where the body cannot metabolize histamine, originating in the gut. Schnedi & Enko (2021).

Some factors can interfere with how DAO and HNMT work and how much of these enzymes reside in the gut.

Histamine intolerance is widespread alongside gastrointestinal issues, and patients with histamine intolerance frequently have DAO deficiency.

High amounts of histamine secreted by gut bacteria were linked to a pro-inflammatory response and signs of deteriorating health in studies on mice. This enhances the toxicity of intestinal histamine. Additionally, an excess of histamine could negatively affect the inflammatory state of the intestinal mucosa. Krell et al. (2021), Sudo et al. (2019), Ferstl et al. (2014).

If you are deficient in diamine oxidase (DAO), you may be unable to break down histamine. Low levels of DAO can cause histamine levels to rise, leading to histamine sensitivity, idiopathic mast cell activation syndrome (Giannetti et al. 2021), and chronic inflammation.

You can develop histamine intolerance when histamine levels get too low or high.

Histamine intolerance is associated with common allergic responses and symptoms. While they may vary, common reactions include:

• Headaches or migraines
• Nasal congestion or sinus issues
• Itchy, watery eyes
• Fatigue
• Hives
• Digestive issues – bloating, stomach pain, diarrhea
• Pain around the chest and shoulders
• Nausea
• Vomiting
• Irregular menstrual cycle
• Dizziness

In more severe cases of histamine intolerance, the following may be experienced:

• Abdominal cramping
• Tissue swelling
• High blood pressure
• Irregular heart rate
• Anxiety
• Difficulty regulating body temperature
• Dizziness

The Expert Advice below provides practical guidance for managing histamine intolerance through nutrition and lifestyle. You’ll find detailed information on foods to focus on and foods to avoid, as well as those that may trigger histamine release in the body. It also includes lifestyle strategies to reduce overall histamine load, as well as supplement recommendations that support natural histamine breakdown and balance. Whether you’re newly exploring histamine intolerance or looking to refine your approach, this guide offers clear, science-backed advice to help you feel your best.

Common factors that change DAO and HNMT enzyme levels are:

• Gut dysbiosis – Studies show that people with histamine intolerance have lower gut bacterial diversity.Schink et al. 2018, Sanchez-Perez et al. (2022).
• Medications that block DAO (or prevent its production) and cause gut dysbioses, such as painkillers, gastrointestinal medicines, muscle relaxants, antiarrhythmic, local anesthetics, antidepressants, narcotics, NSAIDS, etc.
• Alcohol – High alcohol use can cause damage to the gut lining and lead to histamine overload.
• Bacteria, which include food contaminants, can cause intestinal barrier dysfunction.
• Gastrointestinal disorders that will compromise the gut lining and affect digestion, such as IBD, IBS, Celiac Disease, or leaky gut. Schnedl & Enko (2020).
• SIBO – small intestinal bacterial overgrowth.
• Eating and drinking too many foods and drinks rich in histamine, like alcohol and shellfish (see below).
• Eating and drinking foods or drinks that block the DAO enzyme.
• Eating foods that stimulate histamine releases, like pumpkin and nuts (see below).
• Mast cell activation syndrome.
• Genetics.
• Liver conditions. Gittlen et al. (1990).
• Allergy responses.
• B6 deficiency aids DAO in breaking down histamine.
• B12 deficiency often occurs with long-term use of medicine for gastrointestinal conditions. Ruscin et al. (2002), Lett (2004).
• Vitamin C deficiency. Vitamin C boosts the immune system and acts as a natural antihistamine. It lowers histamine blood levels and helps DAO break down histamine. It is a potent anti-inflammatory and antioxidant and may treat allergies.
• Copper deficiency. Copper raises DAO blood levels slightly and helps DAO break down histamine.
• Vitamin D deficiency – Vitamin D is good for the immune system and may help with allergic responses. Liu et al. (2016).
• Zinc deficiency – Zinc helps DAO break down histamines.
• Manganese deficiency – Manganese can enhance DAO activity.
• Magnesium deficiency – Magnesium can raise the allergic response threshold.
• Injury or trauma.
• Chronic stress.

It is worth remembering that most of the above can cause chronic inflammation. Chronic inflammation is a dysregulation of the immune system.

Lowering inflammation and improving gut and immune health with Eat Burn Sleep is a beautiful foundation for you.

The majority of the common factors that change DAO levels are addressed with this lifestyle.

We always advise starting here on the Six-Week Reset.

Take into consideration having less histamine-rich foods listed below.

Anti-inflammatory, nutrient-dense foods will balance your gut microbiota and support your immunity, which may aid histamine tolerance and mast cell activation.

Many foods and drinks contain histamine, but some have higher levels and can trigger inflammatory reactions and other negative symptoms.

Even if a food is not high in histamine, it may trigger our mast cells to release histamine.

So, if you have sensitivities to histamine, paying attention to known foods is a good guide.

Also, note the natural antihistamines below.

Food to Avoid: 

In extensive studies, foods susceptible to accumulating high histamine contents are microbiologically spoiled (frozen fish and meat) or fermented/cured (cheese, meat, sausage, wine).

High histamine content in food and beverages results from microbial contamination. Histamine formation occurs during food production processes. Bodmer et al. (1999).

Also, some known histamine-rich foods can vary significantly in their content, depending on the manufacturer, storage, and variety.

Aged, fermented, cured, salted, and processed foods contain more histamine than fresh foods. These were noted consistently.

Histamine-producing bacteria can grow and produce histamine over a wide range of temperatures, and once histamine has been produced in a food, it cannot be eliminated.

Most histamine-rich foods will be found in the Orange and Red Lists. Because we are all unique, individual tolerance levels will be different, but limiting the intake of these foods has been shown to reduce symptoms. Comas-Basté et al. (2020).

This can help you manage histamine levels and keep triggers at bay as much as possible! These changes need to be maintained, and the lifestyle is not a one-time fix but something that needs to be kept up for you to continue to see more significant results over time.

Note: Histamine-rich Foods Include: 

• Additives – Tartrazine, food colors, benzoates, sulfites, sodium benzoate, butylated hydroxytoluene, butylated hydroxyanisole
• Aged cheese. The longer it is aged, the higher the levels of histamine. (Parmesan, Gouda, Stilton)
• Alcohol, other fermented beverages, and ‘alcohol-free’ beer, wine, ale, etc.
• Avocados
• Baked foods with grains
• Barley malt products
• Buttermilk
• Cereals with grains
• Chocolate and cocoa powder
• Citrus juices
• Cows’ milk and milk products (mainly A1)
• Dried fruit
• Eggplants
• Fermented and pickled foods, like sauerkraut, kimchi and seitan
• Fish that haven’t been gutted within 30 minutes of eating – tuna, mackerel, sardines, anchovies, seafood and shellfish, smoked fish, and canned fish
• Fish sauce
• Kefir
• Ketchup
• Kelp
• Kombu
• Legumes – lentils, chickpeas, beans, peanuts, soya products
• Miso
• Mushrooms
• Nut oils
• Olives
• Pickles
• Processed ready meals
• Processed/smoked meats – salami, sausages, ham, bacon, and pre-packed minced meat
• Quorn products
• Salty snacks with preservatives
• Seeds and nuts
• Seasonings/spices – cinnamon, cloves, chili powder, hot paprika, anise, curry powder, and nutmeg
• Sour cream
• Sourdough bread
• Soy sauce
• Spinach
• Tamari
• Tinned vegetables
• Tofu
• Tomato juice
• Wild meat and game
• Yeast and malt extract

These Trigger Histamine Release from Mast Cells: 

• Alcohol
• Avocado
• Bananas
• Beans
• Chocolate
• Citrus fruit – lemon, lime, and orange
• Eggplants
• Egg white
• Food additives
• Kiwi
• Mango
• Nuts – cashews, peanuts, walnuts
• Papaya
• Peas
• Pineapple
• Pork
• Pumpkin
• Raspberries
• Red prunes
• Shellfish
• Strawberries
• Tomatoes
• Kinds of vinegar
• Wheatgerm

Drinks/Foods That Block Production (or affect levels) of DAO and HMNT include: 

• Alcohol
• Black tea
• Green tea
• Maté tea
• Raw egg whites
• Some yogurts, depending on the bacteria type
• Energy drinks

Which Foods to Favor:

Although there’s no such thing as a histamine-free diet, incorporating low-histamine, anti-inflammatory, nutritious, and fresh foods can help reduce load and symptoms.

Follow the guidelines for buying, storing, and prepping food to keep histamine levels low. Histamine levels change depending on how food is prepared. Dermatol (2017).

Low Histamine, Anti-inflammatory Foods:

• Coconut: oil, flesh, milk and yogurt
• Cooked egg yolk
• Fish. Wild-caught. Sustainably fished. Freshly caught, gutted, and cooked within 30 minutes.
• Fresh meat. Grass-fed beef, lamb, and venison.
• Chicken and turkey. Pastured and organic.
• Fresh vegetables not listed in the Foods to Avoid (tomatoes, eggplant, spinach).
• Fruits (excluding bananas, grapefruit, kiwi, lemon/lime, mango, oranges, papaya, pineapple, strawberries, tangerines, and dried fruit).
• Most leafy herbs
• Non-citrus fruits
• Nut milk – coconut/almond
• Olive oil
• Quinoa

The Importance of Sleep

Circadian rhythms are essential for health. Indeed, good sleep also promotes a healthy immune system. Several studies have demonstrated sleep disruption-induced elevations in circulating immune cells, including T and B cells, which indicate an inflammatory state. Born et al. (1997), Faraut et al. (2011) and Besedovsky et al. (2016).

Getting good sleep, which will occur through good nutrition and eating patterns on Eat Burn Sleep, may aid in reducing histamine intolerance.

Stay Hydrated

Ensure you drink enough water, as dehydration can often worsen symptoms. Reduce alcohol intake, as it is histamine-rich as well as dehydrating. Follow the hydration guide.

• Vitamin C – See above.
• Vitamin D. Studies show that mast cell stabilization occurs with the supplementation of vitamin D. Ziu-Qiang et al. (2016).
• Quercetin – The polyphenol found in many foods (not listed in the high-histamine foods): onions, scallions, peppers, grapes, apples, berries, and herbs. Quercetin’s antioxidant activity in radical scavenging and anti-allergic properties is characterized by immune system stimulation, antiviral activity, inhibition of histamine release, and a decrease in pro-inflammatory cytokines, leukotrienes creation, and suppression of interleukin IL-4 production. Micek et al. (2016).
• Prebiotics – Aiding in good gut bacteria to boost the immune system and reduce inflammation.
• Probiotics – Probiotics promote healthy gut bacteria. Lac B has been shown to reduce allergy-related histamine signaling. Dev et al. (2008).
• Bromelain – Bromelain can help with swelling and inflammation. Bromelain is derived from pineapples, and this is often a trigger for many people with histamine intolerance. However, when taken as a supplement, it is particularly effective for swelling incurred due to surgery and sinus inflammation and can reduce allergic airway disease and allergic sensitization. Secor et al. (2013). Check the supplement does not contain additives.
• Diamine Oxidase. To replace this enzyme in the intestine. Schnedl et al. (2019), Izquierdo-Casas et al. (2019).

By following the Eat Burn Sleep lifestyle, you will know your body better and be more aware of what you eat and how you move, breathe, and think. Being conscious of additives and chemicals, which are everywhere, and reducing exposure will aid in lowering histamine load.

Calming the body and reducing histamine and inflammation aids in reducing stress and improving sleep.