Do you suffer headache, rashes or itching and/or gastrointestinal symptoms such as nausea and diarrhoea? Then read on. In this blog we look at what is histamine intolerance, the link with our gut and the most common foods that contain histamine and how to identify and avoid problem foods.
What is histamine intolerance?
Histamine is a type of vasoactive amine (also known as biogenic amines) and chemicals which occur naturally in certain foods. Other examples of biogenic amines include tyramine and phenylethylamine. High levels of vasoactive amines in foods can make anyone unwell but most people tolerate amounts found in a normal diet. However, some people experience symptoms even to normal levels which may be due to a reduced ability to break them down in their digestive system. This is thought to be due to a lack of a digestive enzyme called diamine oxidase. When they eat too many vasoactive amine containing foods they may suffer ‘allergy-like’ symptoms.
What are the symptoms?
Headaches, rashes, flushing, itching, swelling, runny or blocked nose, irregular heartbeat,
diarrhoea, nausea, vomiting or abdominal pain. Symptoms may occur 30 minutes or longer after eating and the level of tolerance will vary from person to person.
How is it diagnosed and treated?
There are no reliable tests to diagnose vasoactive amine sensitivity. True food allergies should be ruled out by an experienced clinician before experimenting with the diet. Once this has been done, the best way to find out if these are causing symptoms is to try avoiding them for 2-4 weeks. Symptoms should be monitored by keeping a food and symptom diary and reintroducing foods gradually to see how often and how much is tolerated. It is best to do this with the support of a specialist dietitian, particularly if there are other foods are being avoided, to ensure the diet remains well balanced.
Which foods are high in vasoactive amines?
• Coffee, cocoa, chocolate
• Champagne, wine, beer, cider
• Fermented soya products including miso and tempeh
• Blue cheeses, Parmesan cheese, Camembert, Emmental, old Gouda, Cheddar and other hard cheeses, fresh and hard sheep and goat cheeses
• Cured meat especially pork products e.g. sausages and other processed meats (ham, salami, pepperoni, bacon)
• Fresh or canned tuna, sardines, mackerel, salmon, herring, processed fish products e.g. fish pastes, smoked or dried pickled fish
• Tomatoes, pickled cabbage (sauerkraut), broad beans, aubergine, spinach
• Peanuts, tree nuts
• Oranges, tangerines, bananas, pineapple, grapes, strawberries
What can help?
Histamine occurs naturally in many foods and a low histamine diet can potentially be very restrictive, leading to nutritional deficiencies if not supported correctly by a dietitian.
Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT, Latorre-Moratalla M, Vidal-Carou MDC. Histamine Intolerance: The Current State of the Art. Biomolecules. 2020 Aug 14;10(8):1181. doi: 10.3390/biom10081181. PMID: 32824107; PMCID: PMC7463562.
Schnedl WJ, Enko D. Histamine Intolerance Originates in the Gut. Nutrients. 2021 Apr 12;13(4):1262. doi: 10.3390/nu13041262. PMID: 33921522; PMCID: PMC8069563.
Shulpekova YO, Nechaev VM, Popova IR, Deeva TA, Kopylov AT, Malsagova KA, Kaysheva AL, Ivashkin VT. Food Intolerance: The Role of Histamine. Nutrients. 2021 Sep 15;13(9):3207. doi: 10.3390/nu13093207. PMID: 34579083; PMCID: PMC8469513.