Histamine Intolerance and Gluten

What Is A Histamine Intolerance and How Does it Relate to Gluten?

You have probably heard about a number of food intolerances – from gluten and dairy to fructose and FODMAPs. But there is a lesser known intolerance that is the topic of this post – histamine intolerance. It is estimated that 1% of the population has histamine intolerance, and 80% of those people are middle-aged.

This article is going to focus on explaining:

• What histamine is
• The symptoms of histamine intolerance
• The role gluten plays in histamine intolerance
• How to know if you have a histamine problem
• What causes it?
• What can you do to resolve high histamine issues

What is Histamine?

To understand what histamine intolerance is, let’s first discuss what histamine is. Many people have heard of antihistamines.  This class of medicines are available over the counter, and are commonly used to treat the symptoms of outdoor allergies.  They work by blocking histamines.

Derived from the amino acid, histidine, histamine is a bioactive amine  that helps with several key cellular functions. Histamines can be made by your body (endogenous), but they are also naturally present in many foods (exogenous).    As a chemical in the body, histamine  has several key functions. It aids in communicating messages to your brain, triggers the release of stomach acid to help digestion, and assists the immune response after injury or allergic reaction. It is primarily stored in mast cells, which are specialized immune cells found in connective tissues throughout the body.

The body can break down histamines using a specialized enzyme called diamine oxidase (DAO).  However many factors can influence this process, and when histamine levels rise too high, they can trigger numerous symptoms and health issues.

What are the symptoms of histamine intolerance?

Histamine intolerance can be hard to diagnose. The symptoms involved vary widely and can overlap with symptoms of other conditions.

Histamine can affect a number of organ systems which can then manifest through a number of symptoms.  Below is a breakdown of the most common symptoms.

• Respiratory system
  • Rhinitis
  • Nasal congestion
  • Sneezing
  • Rhinorrhea (nasal discharge)
  • Dyspnea (difficult or labored breathing)
• Gastrointestinal system
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Constipation
  • Bloating
  • Feelings of fullness after eating any amount
• Nervous system
  • Headache
  • Dizziness
• Circulatory system
  • Hypotonia (weakened muscle tone)
  • Tachycardia (rapid heart rate)
  • Collapse
• Skin
  • Sudden facial erythema (flushing)
  • Pruritus (itchy dry skin)
  • Rashes
  • Eczema
  • Swelling
• Reproductive system
  • Irregular periods in women

What Causes Histamine Intolerance?

Some histamine is essential for normal body functions, but too much can cause problems. Therefore, the body must balance the production and intake of histamine with the elimination of histamine. If this process is hindered,  histamine builds up, and symptoms of  histamine intolerance occur.

In the human body, the primary pathway for the natural degradation or elimination of histamine is an enzyme called diamine oxidase (DAO or histaminase). When this elimination process is disrupted, an imbalance, or intolerance can occur.

Because histamine symptoms occur when levels are too high,  the causes of histamine intolerance are related to either consuming too many high histamine foods, taking medications that interfere with the breakdown of histamines, or the inability of the body to clear histamine properly.  The following is a list of some of the more common causes:

1. Food: Histamine-rich foods can cause histamine to build up in the body. In addition, other foods can either release histamine in the body or inhibit DAO production.
2. Bacterial imbalance: Bacterial overgrowth can influence digestion and cause histamine overproduction.
3. GI inflammation: Inflammatory gastrointestinal disorders like leaky gut, celiac disease, and other  inflammatory bowel diseases can influence the ability of the body to eliminate histamine.
4. Nutritional deficits: Deficiencies of copper, vitamin C, and pyridoxine (vitamin B6) are associated with decreased activity of DAO.
5. Medications: The development of an intolerance is also facilitated by substances and drugs that affect the metabolism of histamine by reducing DAO activity. Such drugs include verapamil (for high blood pressure), clavulanic acid (typically found combined with common antibiotics like amoxicillin to fight antibiotic resistance), chloroquine derivatives (for immunosuppression and antiparasitic needs), acetylcysteine (to help thin and loosen mucus in the airways due to certain lung diseases), amitriptyline (antidepressant), metamizole (anti-inflammatory and pain killer), and isoniazid (antibiotic).
6. Menstruation: Some research has shown that DAO levels are lower during the female menstrual cycle. This reduction may be linked to headache symptoms in women during their period.
7. Mold: Mold spores, fragments, and mycotoxins can activate the immune cascade, including mast cells.  This can not only lead to increased inflammation, but chronic histamine release by mast cells.  Mast Cell Activation Syndrome (MCAS), is commonly diagnosed in those struggling with chronic mold exposure.

Can Gluten Cause Histamine Intolerance?

In reviewing the list of symptoms of histamine intolerance, you probably see a number of symptoms that are shared with celiac disease and non-celiac gluten sensitivity (NCGS). Research suggests that some symptoms of NCGS may actually be mediated by histamine receptors. Receptors are what control the body’s response to histamine, so this connection means that eating gluten might cause histamine-type symptoms in some people.

Another study found that 9 out of 10 patients with non celiac gluten sensitivity (NCGS) were found to have lower levels of DAO than patients without gluten sensitivity.

In addition, research has shown that celiac disease and histamine intolerance may also be related in the efficacy and responsiveness of their management. One study evaluated celiac disease patients who were not responsive to a gluten-free diet alone. Histamine intolerance was found in more than half of the patients, and the study concluded that unmanaged histamine intolerance played an important role in non-responsive celiac disease.

Which Foods are High in Histamine?

Some foods and beverages that are high in histamine include the following:

• processed, preserved, or smoked meats
• alcohol
• fermented foods and dairy products (yogurt, kefir, kimchi, sauerkraut, etc.)
• dried fruits
• avocado
• eggplant
• spinach
• shellfish
• aged cheese

In addition, there are a number of foods that trigger histamine release from mast cells in the body, and should be limited by those who suspect histamine intolerance. These include the following:

• alcohol
• bananas
• tomatoes
• wheat germ
• beans
• papaya
• chocolate
• citrus fruits
• strawberries
• kiwi
• pineapple
• mushrooms
• nuts (especially walnuts, cashews, and peanuts)
• food dyes and other additives (especially glutamate, benzoate, artificial colorings, sulfites and nitrites)

Finally, certain foods and drinks can block DAO production which in turn can inhibit the body from clearing histamine. These include fermented foods, alcohol, certain caffeinated teas (especially green, black, and mate), and energy drinks.

Which Gluten Free/Grain Free Foods are Low In Histamine?

While no food is guaranteed to be entirely free from histamine, there are a number of healthy gluten-free foods that are low in histamine. These include the following:

• fresh meat and fish
• fresh and non-citrus fruits
• eggs
• dairy substitutes, such as coconut milk and almond milk (choose full fat options with minimal ingredients and no additives)
• fresh vegetables except tomatoes, avocados, spinach, and eggplant
• Coconut and olive oil

It’s important to note, however, that histamine increases as food ages. As a result, precooked and leftover foods have higher histamine levels than their fresh counterparts.

How Do You Test for Histamine Intolerance?

Histamine intolerance can be difficult to diagnose, but if you are experiencing symptoms of histamine intolerance, it is worth exploring the following:

• Histamine levels: High plasma histamine levels can tell you that you have a build up of histamine and may indicate an intolerance.
• DAO levels: If serum DAO activity is low, you may have trouble eliminating histamine and have a resulting intolerance. Research has confirmed this connection.
• Genetic Single Nucleotide Polymorphisms (SNPs): Certain genetic variations are associated with inhibited DAO activity. Research has identified seven SNPs that may influence DAO activity.
• Food allergies: An undetected or unmanaged food allergy can trigger a histamine reaction and build up of histamine in the body. When you eat something that your body cannot tolerate, it can respond by releasing histamine.
• Gluten sensitivity: As discussed previously, gluten consumption in those sensitive to gluten may trigger a histamine response by activating histamine receptors.

What Can I Do to Support Healthy Histamine Levels?

So, what can you do to support healthy histamine levels? In short, you can manage your histamine intake and release, and support DAO production by practicing the following:

• Try a low histamine diet: A low histamine diet will help reduce your overall histamine levels and put less burden on the body to clear histamine. Relief from symptoms following a low histamine diet can indicate a histamine intolerance. Note this can be a short term solution to supporting histamine intolerance, provided that DAO is functioning appropriately.
• Go gluten free: Since gluten may trigger a histamine response, avoiding gluten can help  limit your histamine load.
• Ensure adequate levels of vitamin C, flavonoids, copper, and vitamin B6: Deficiencies of these vitamins and minerals have been associated with inhibited DAO activity and supplementation may provide anti-histamine support. Supplementation with Detox C, Ultra Copper, and Multi Nutrients can help ensure that you are meeting your needs.
• Consume or supplement with ingredients that act as natural antihistamines: Bromelain, quercetin, and stinging nettle are natural agents that support healthy immune response. Bromelain is an enzyme found in pineapple, and can be very supportive for those with histamine intolerance. Quercetin is found in onions and apples and can also be taken as a supplement. Stinging nettle is a plant that can be consumed as a tea, tincture, or supplement. These three natural ingredients can be found together in Hist Assist.
• Avoid alcohol and medicines that interfere with DAO.
• Select probiotics wisely: Lactobacillus probiotics can produce histamine, so seek out other strains, including bifidobacteria, spore-based probiotics, and yeast-based saccharomyces boulardii.
• Eat foods containing fiber and butyrate: Fiber and butyrate support mast cell stabilization which can help manage the release of histamine in the body. Fiber can be found in fresh fruits and vegetables as well as nuts and seeds. Foods that increase butyrate include prebiotic foods like apples, garlic, and kiwi. You can also opt for a high quality fiber supplement and butyrate supplement.

Histamine intolerance is not commonly discussed, but not an uncommon condition. I hope this article brings awareness to its existence so that you feel empowered to explore whether it may be impacting your health.