Health & Nutrition
HISTAMINE INTOLERANCE – CAUSES, SYMPTOMS AND FOODS CONTAINING HISTAMINE
Sometimes, the intention of improving health conditions and well being may result in adverse consequences. Diets such as ketogenic, low carbohydrate high fat (LCHF), Paleo diet, Gut and psychology syndrome (GAPS) diets mostly include fermented foods such as cheese (aged), cured meat products, kimchi etc. The fermented foods are low in carbohydrates, have intense flavors, convenient and are easy to adhere to. Fermented foods are believed to be high in histamine, which is an important signaling molecule in the body.
If the histamine intolerance in the body is left unrecognized, the symptoms caused by it may mislead people and make them think that, the low carbohydrate diets are unhealthy.
Histamine is a nitrogenous compound found in the body. It is released into the bloodstream by the white blood cells, as a defensive mechanism by body’s immune system against potential allergens. Histamine regulates the physiological functions of the gut. Histamine also acts as a neurotransmitter between brain and other body organs.
Histamine belongs to the family of biogenic amines, which are decarboxylated amino acids. These are generated endogenously (biological purpose) and exogenously (through microbial fermentation). The biogenic amines functions as a receptor mediated signaling molecules and modulates cell growth, release of hormones and also neuronal activities.
Histamine intolerance, also called as enteral histaminosis, is referred to as sensitivity towards the dietary histamine. Histamine intolerance is the inability of the body to metabolize the histamine ingested. The symptoms may be common, sometimes generic, and seems unrelated, making it difficult to recognize.
Symptoms:
- Skin issues
- Migraine headache
- Fatigue
- Insomnia
- Gastrointestinal issues
- Fluctuations in blood pressure
- Asthma
- Angioedema
- Diarrhoea
- Sneezing and nasal congestion
- Sleep related issues
- Palpitations
- Dizziness
Major food sources of histamine:
Foods that are not fresh and containing histidine, and foods that are intentionally fermented, aged, cured, smoked, cultured would accumulate histamine. However, the levels of histamine in foods varies with various factors. The below table gives an approximate values of histamine level in foods (literature sources).
Most foods that are high in histamine are tend be high in protein (cured meat, cheese etc.), and also there are low protein plant foods, that are naturally high in amino acid, histidine. The example for these kind of plant foods is spinach, eggplant, tomatoes. Hence, these foods are more susceptible to accumulation of histamine than the other plant foods.
| Spinach | 20-50 mg/kg |
| Avocado | 20 mg/kg |
| Eggplant | 20-23 mg/kg |
| Sauerkraut | up to 230 mg/kg |
| Sour cream | 5-7 mg/kg |
| Yogurt | up to 10 mg/kg |
| Aged dry sausages | up to 300 mg/kg |
| Red wine | up to 20 mg/L |
| Coffee | 1-2 mg/L |
| Ketchup | up to 20 mg/kg |
| Cider vinegar | 0.02 mg/kg |
| Dark chocolate (conventional) | up to 20mg/kg |
| Dark chocolate (organic) | up to 4 mg/kg |
Histamine intolerance diet:
This is a dietary technique used to identify, eliminate the histamine inducing food causing the problem. It generally involves consuming completely histamine free diet for atleast for 14 days to 30 days, later introducing histamine containing foods, both low histamine and high histamine foods, one after one.
List of foods containing histamine (high & low)
High histamine foods
- Smoked fish
- Alcoholic beverages
- Mushrooms
- Cheese
- Processed meat and fish products
- Nuts
- Kombucha
- Sour cream
- Vegetables like tomato, brinjal, spinach and avocado
Low histamine foods
- Fresh fish
- Eggs
- Non-dairy milk products like coconut milk, almond milk
- Coconut oil
- Olive oil
- Fresh fruits like strawberries and other citrus fruits
- Vegetables like carrots, beetroots, sweet potatoes
- Freshly cooked meat
Diagnosis
Recognizing and diagnosis of histamine intolerance could be challenging. The diagnosis may include non-histamine-food intolerances, medication reactions, mastocytosis. Diagnostic tests that are available tend to have low sensitivity as well as specificity. Intestinal biopsy gives accurate results but is expensive and used in rare conditions. Serum DAO levels tends to be unstable and yields only 50% of accurate results. The most practical and reliable diagnostic test is the fifty-minute skin pricking test which has a specificity of 80% accuracy.
Prevention
- Avoiding consumption of foods and beverages that are cure, smoked, fermented, aged
- Avoid consumption of alcohol as it inhibits the DAO activity
- Avoiding medicines that inhibit DAO activity
- Avoiding foods that are believed to trigger the release of endogenous histamine
- Keeping a record of observation, of the foods and symptoms that are caused after consuming
- Consuming fresh foods
- Cooking and freezing foods properly (may reduce histamine producing microorganisms)
Treatment
Antihistamines, porcine DAO enzyme (supplements), mast cell stabilizers are given to people who are not willing to adapt a low histamine diet.
REFERENCES:
https://www.webmd.com/diet/foods-high-in-histamine#1
https://en.wikipedia.org/wiki/Histamine
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Histamine Intolerance – causes, symptoms and foods containing histamine