Histamine Intolerance! AIP Troubleshooting
Updated: Sep 19, 2018
Could histamine be the cause of your brain fog, fatigue, anxiety, heart palpitations, adrenal fatigue, migraines, panic attacks, dizziness, diarrhea or other vague confusing transient health symptoms? FULL TRANSCRIPT BELOW!
What exactly IS histamine?
What causes histamine intolerance?
How do I know if I have histamine intolerance?
What do I do about it?:
Most people hear the word histamine and they think of seasonal allergies, sneezing, itchy eyes and hives. It is true, histamine does cause these symptoms but there’s a lot more to histamine than that!
First off, what is histamine? Yes, histamine is a chemical the body produces in response to an allergic reaction and yes, can take an anti-histamine like Benadryl to help with acute symptoms like hives and rash and itchiness. And that’s about all most people know about histamine. So when you say “I have a histamine intolerance” they’re like well yeah, doesn’t histamine always make people itchy and sneezy? Or “Why don’t you just take antihistamines then?” Both of which have always frustrated the heck out of me because I’ve never been sure how to explain this whole histamine topic in layman’s terms so that a normal person would know what the heck I’m talking about!!
So here goes...
There is way way more to histamine than what I just mentioned! Histamine is not just produced by the body in response to an allergen.
Most people don’t know that histamine is actually in many foods and is part of a normal diet. Histamine is also a normal product of our gut bacteria. And most people will have no reaction at all to this histamine from foods or gut bacteria because their bodies produce enough of the the enzymes to break it down and it never builds up to level that would produce symptoms. Like running a bath with the drain unplugged, the tub will never fill and overflow.
Histamine intolerance occurs when there is more histamine in the body that it can handle. The drain is plugged up and the tub fills and overflows.
Many of these histamine overload symptoms are just like responses to an allergen: rashes, face flushing and red ears, hives, runny nose, throat swelling, and itching. Except histamine intolerance is basically that same inflammatory allergic response, without an allergen provoking it.
An overload of histamine can also cause a huge range of symptoms that we would never associate with an allergic response, because histamine travels through the bloodstream and can affect the gut, lungs, brain, skin and entire cardiovascular system.
Other histamine induced symptoms can include: migraines, digestive upset (constipation and/or diarrhea), nausea, heart palpitations, panic attacks, high or low blood pressure, irregular menstrual cycles, difficulty sleeping, dizziness and difficulty regulating body temperature.
According to DR. Michael Lamm Histamine also plays a role in worsening adrenal fatigue because rising histamine levels create inflammation that causes already burdened adrenal glands to work more to release more cortisol.
Histamine can even create chemical imbalances in your brain through it’s ability to impact neurotransmitters. It is directly linked to brain fog, fatigue and anxiety.
Histamine intolerance is not like an allergy where just a little bit of it triggers symptoms. It’s more like a bucket (or a bathtub) and every high histamine food you eat or however much histamine your gut bacteria produce or your mast cells release are like drops of water in that bucket.
So if you haven’t had high histamine or histamine releasing foods all week and you have a glass of wine at dinner you might be fine. But if you had some cured meat at lunch yesterday, some sauerkraut at dinner, some yogurt and kombucha at breakfast and then you have that glass of wine at dinner, bam, your bucket overflows and your nose is all stuffed up and you have hives, or your stomach’s a mess and you’re scratching your head like WTH? I had wine last week and I was fine!!!
This makes it very difficult for many people to recognize they have a histamine intolerance because the foods that are high in histamine are so varied and often unrelated and they cause this wide assortment of often vague and unrelated symptoms when that histamine bucket fills up and overflows.
I’d like to point out that histamine in and of itself is not harmful and if you don’t have symptoms of histamine overload there is absolutely no reason to avoid it! It’s not like a pesticide or a carcinogen or bpa or some other substance we need to be aware of and minimize our exposure to for general health. If you don’t have issues with histamine then eat all the kimchi and cold cuts, canned fish and slow simmered meat leftovers that you want, no worries.
I say this because I was telling a friend about my histamine intolerance and they took it to mean histamine foods needed to be limited in normal people and this person was worried about sending their kids to school with a banana as a snack because they had yogurt at breakfast and that might be too much histamine for them. No no no. There is no need to be concerned with histamine intake in normal healthy people without symptoms of histamine overload.
What causes histamine sensitivity?
#1) Leaky gut, or permeable intestinal lining. Also, gluten sensitivity, IBS
In healthy people, our guts quickly break down histamine so it never builds up to amounts that cause us adverse reactions. The bucket never overflows.
Histamine overload can happen because we are not producing enough of the enzymes that break it down such as DAO or HMT. DAO stands for Deamine Oxidase. DAO is secreted by enterocytes, these are the cells that form our gut barrier.
If the gut barrier is damaged, DAO is not secreted in adequate amounts by these cells. To make matters worse, a permeable intestinal lining (leaky gut) can allow histamine to enter the body without passing through the enterocytes where it would be degraded by HMT. (Histamine N-methytransferase), the other major enzyme that breaks down histamine.
By the way, HMT activity will be reduced if there are micronutrient deficiencies.
For a person to show signs and symptoms of histamine intolerance, the histamine has to be absorbed and enter the bloodstream without being deactivated by DAO or HMT, which is very likely in people with severely leaky guts.
#2) Gut dysbiosis:
Histamine build up can also happen if we are producing unusually high amounts of histamine by our gut bacteria (as in the case of SIBO)
#3) Some prescription and over-the-counter drugs can inhibit DAO activity too. Dr. Amy Meyers has a comprehensive list on her website, I’ll link to that in the description below.
DR. Ballantyne mentions that people taking thyroid replacement drugs commonly have histamine intolerance.
Alcohol is especially bad because not only does it inhibit DAO activity, but some alcoholic beverages such as wine and beer also contain a lot of histamine.
#4) HIstamine intolerance can also be caused by genetic predisposition like a mutation in the enzymes that break down histamine or glitches in our methylation process.
#5) Food & environmental allergies
For the record, basophils and mast cells are cells that are part of the immune system and appear in many kinds of inflammatory reactions, especially those that cause allergic symptoms. So when they’re released you get allergic symptoms. These cells contain contain histamine, among other things.
If basophils and mast cells in your body are activated as a result of an undiagnosed food or environmental allergy, your sensitivity to histamine from foods may increase simply because your basal level of histamine is higher.
How do you know if you have a histamine intolerance? keep a food journal with symptoms (trying to correlate all of those symptoms with how many high histamine or histamine releasing foods you ate may be difficult... or most efficiently do a trial with a low histamine diet.)
Blood testing for DAO may or may not be indicative of gut DAO.
How I knew I was histamine intolerance, my symptoms:
NIght & day mood swings after eating: Depression after cod at birthday
Depression, emotional total mood switch after fermented lentil indian dosas (nourishing traditions)
Bright red rash and hot flashes after eating normal salmon
Hives all over stomach after tilapia
Shrimp heart palpitations
Bananas and yogurt before gym, eye watering and running
Raw milk, bone broth, fermented food, gelatin reactions
Intolerance to many probiotic supplements
(Bifido ok and l. Plantarum)
Eye bags from wine
Aaaaand major digestive issues I would rather not get into much detail about..
My major triggers:
Fish that smells like fish
Nori rolls with raw tuna and coconut aminos
"High Histamine" foods that do not affect me:
Avocados that aren't overripe
Canned sardines and salmon
Boneless meat cooked overnight in crockpot
Dates (dried fruit)
Lemon juice...pink grapefruit, orange, lime
Shellfish- loads of fresh but even canned oysters ok
So I am histamine conscious, not low histamine. I avoid my personal triggers. Trial and error involved!
Treatments for Histamine intolerance:
Heal your gut! Address SIBO if necessary
Stay on AIP. It’s already removing so many gut irritants so you’re well on your way.
According to Dr. Sarah MCT’s, medium chain triglycerides, the healthy fat in coconut oil can increase DAO activity.
As far as taking anti-histamines to treat a histamine intolerance? Nooooo. Antihistamines are not for long-term therapy!! OK to take if a large amount is accidentally consumed though (Oops, I binge ate 3 jars of kimchi or a pound of shrimp and now I have a rash and hives and I itch all over!)
The thing is, antihistamine drugs do not stop the production of histamine, they just occupy the histamine receptor so that that the histamine that is there can't act on it. This is fine as in the case above because the receptor gets blocked for a short time, then you stop taking it and go back to baseline.
It’s a terrible idea to just take antihistamines all the time to treat histamine intolerance, as when you do that, your body never goes back to that baseline. Histamine keeps getting produced, your body recognizes that it’s not functioning as it should be and produces even more. You build a tolerance to the antihistamine meds until they no longer work. And when you stop taking them you’ll get flooded with all that histamine your body has been producing higher levels of.
DAO supplements are available, and although no clinical trials have been run to test their efficiency, the amazon reviews seem pretty positive. I have not tried these personally as I can’t find an AIP compliant brand, they all have rice starch or ascorbic acid in them which is derived from corn.
Probiotics are very popular, but if you have a histamine intolerance you shouldn't be popping just any old probiotic supplement. Some strains will actually aggravate a histamine intolerance! Bifidobacteria are safe and helpful. Lactobacillus plantarum is also good. I take Klaire Labs therbiotic factor 4. Link below. Another good one is seeking health’s probiota histaminx.
Selenium and vitamin C intake are important when dealing with histamine and mast cell issues. You’ll find selenium in grass fed beef, turkey and liver among other foods.
And you don't need histamine releasing citrus fruits or corn derived ascorbic acid supplements to boost vit c- you can eat kale, broccoli, brussel sprouts, and parsley!
Quercetin- we hear a lot about this helping with histamine issues. I prefer to get it from food rather than popping supplements. Capers are loaded with Quercetin! Apples and onions are also a great source.
I have to say, I’m pretty wary of supplements in general.
Nigella aka black seed is touted as being good for histamine issues but taking the oil once a day for a few weeks made me really dizzy.
Then we have the herb thyme being touted as great for histamine issues, yet another source says it’s high in benzoates that will trigger histamine release from mast cells. So I’m gonna stick to small amounts of the fresh herb in cooking and not start popping some concentrated version of it in a pill.
Same with holy basil, peppermint, ginger and turmeric. I’ll cook with them. I’m not gonna start popping isolated and concentrated extracts that could have other effects on me.
Then there’s stinging nettles, this one’s in almost all of the herbal histamine reducing supplements. According to webMD, possible side effects can include alterations in blood sugar, low blood pressure and uterine contractions.
Supplements can be as powerful as drugs, they are not to be taken lightly and assumed to be safe because they are all natural.
And don't forget what a big business marketing supplements is! They are not necessarily looking out for your best interests.
A histamine intolerance is not a supplement deficiency, it’s a reason to heal your gut, eat a nutrient dense diet and support overall health.
The fix isn’t going to come in the form of a pill, as much as supplement manufacturers and pharmaceuticals companies would like us to believe that. Anyway, enough of that tangent.
So, sometimes you can address the root cause of your histamine issues, like leaky gut or SIBO and fix it that way,
but sometimes you can’t like in the case of a genetic glitch that affects your ability to produce DAO…Or if you choose to continue drinking alcohol and depleting your production of DAO. In those cases you’re just going to have to stay on a low-histamine or a “histamine conscious” diet if you want to feel your best.
Or you could keep having babies:
during pregnancy the placenta will actually produce large amounts of DAO and many women will experience a total relief from histamine intolerance as well as improvements in allergies and food sensitivities. Unfortunately this only lasts until the baby is born.
How to do Low Histamine on AIP:
Lucky for us, many foods that are high in histamine are not allowed on AIP anyway. Things like aged cheese, yogurt, sour cream, beer, wine (especially red), tomatoes, eggplant, coffee, chocolate and soy products. No worries, we aren’t eating those anyway.
What about AIP compliant foods that are high in histamine or that will stimulate a histamine release from mast cells in our bodies?
According to Chris Kresser, people with histamine intolerance may need to be careful about consuming gelatin. You won’t find gelatin on all of the internet lists of high histamine foods to avoid, but I found out the hard way that it is definitely a trigger for me!
Bone broth is another AIP superfood that we are encouraged to eat, but if you have a histamine intolerance you don't want to slow cook that broth, you are better off pressure cooking it. For some reason I don’t tolerate it that way either, but it’s worth a shot.
To do a low histamine trial you’ll also have to:
Give up fermented foods like kimchi, sauerkraut, pickled vegetables, and kombucha. These are supposed to be very healthful ways of getting probiotics into your diet through food, but these are also very high in histamine.
No vinegars or wine for cooking.
No dried fruits. No overripe fruits. No citrus fruit.
No banana, strawberry, pineapple, papaya.
No spinach- yup spinach is high in histamine, also avocado, mushrooms, pumpkin and olives.
No green tea or black tea.
Cinnamon, cloves and thyme are claimed to be possible histamine releasers. I personally do react to cloves..
No aged or cured meat, so no salami, cold cuts, prosciutto, bacon or jerky.
Avoid pork as it is high in histamine.
Most seaweed is out and yeast can be problematic as well.
Coconut aminos are fermented. No coconut yogurt either.
No anchovy paste, fish sauce or canned fish like tuna, sardines and anchovies- although these can range from no histamine to loads of histamine content, all depending on how it was processed!
It’s not that fish is inherently high in histamine, it’s just that as soon as a fish dies, bacteria in their guts start turning the amino acid histidine that is present in their flesh into histamine. So if you catch a fish, gut it and eat it, histamine will not be an issue!
I assume this is also the case with shellfish as I eat a ton of oysters and clams but I buy them live, steam them and either eat them right away or freeze them and eat them right after thawing. I’ve had no issues with it this way.
Leftover meat can also be high in histamine as bacteria convert the amino acid histidine into histamine. So minimizing histamine formation during food storage becomes very important.
You want to buy fish that was flash frozen at sea, or super fresh meat from a local butcher. Or meat that was frozen right after butchering.
You want to cook it right away, freeze it in portions and eat it right after you thaw it!
You know that ground meat in the 1 lb pack that is sealed to remove oxygen and has a use by date 3 weeks from now? That can be loaded with histamine!!! Bacteria won't grow that can make you sick in the absence of oxygen but histamine will grow in there!!!
I look at the date and only buy it if it has at least 2 weeks to go. I haven't had issue with it.
You might also want to keep in mind that whole cuts of meat will have less histamine than ground meat.
Some sources advise you to go on a lower protein diet to minimize the amount of histidine intake. I think 8 oz a day is a good guideline for protein intake, I go into more detail on that in my protein video. I wouldn't advise eating less than that though. Meats and seafood are so nutrient dense.
So what the heck DO you eat??
Super fresh meats and fish, veggies, healthy fats and paleo carbs. Basically the same stuff we were already eating on AIP but with a little more restriction.
Beef, lamb, bison, chicken, turkey, frozen at sea fish, live oysters and clams, sweet potatoes, taro, celery, broccoli, carrots, onion, garlic, cabbage, squash, turnips, beets, asparagus, apples, pears, mangoes, coconut oil, coconut milk...so much you can eat. If you can do AIP you should have no problem trialing a low-histamine version.
An important note: I would give AIP at least a full month and up to 3 months before you start troubleshooting and implementing more restrictions though!! You might find that after 2 or 3 months that histamine is no longer an issue for you.
A note on re-intros- if you have excluded some AIP compliant foods because of suspected histamine sensitivity (or FODMAPS or salicylates), these should be the first foods you reintroduce. These are sensitivities that are probably a result of a damaged gut. If your gut has not healed enough to tolerate histamines, FODMAPS and the like, it is probably not ready for things like nuts, seeds and eggs. Unless of course, your histamine intolerance is due to a genetic mutation.