Monday, August 19, 2013

About Amines and Histamine Intolerance

Histamine is a chemical which occurs naturally in certain foods, and in our own bodies. When bacteria begin to break down proteins, they create amines as a natural byproduct of this process including histamines and tyramines. Histamine is also one of the chemicals that is released in the body as part of an allergic reaction, causing the typical itching, sneezing, wheezing and swelling allergy symptoms.
We all have an enzyme in our digestive system called (diamine oxidase or DAO) which breaks down any histamine that we absorb from a histamine-containing food. When the majority of people eat a food which contains histamine it does not affect them. However, some people have a low level of DAO as a result from a multitude of factors including but not limited to Hypothyroidism, Leaky Gut Syndrome, Intestinal Dysbiosis, and other illness that are directly correlated to damage in the intestines. SIBO (small intestinal bacterial overgrowth) can also be a factor in a person with histamine intolerance because this displaced bacteria causes fermentation in the small intestines which also produces extra histamine. When a person with histamine intolerance eats too many histamine-rich foods, or foods high in preservatives such as monosodium glutamate (MSG) they may suffer ‘allergy-like’ symptoms such as headaches, rashes, itching, diarrhoea, and vomiting or abdominal pain. Some other symptoms can be more unconventional and more subtle. Symptoms of histadelia or histamine intolerance include:

  • Pruritus (itching especially of the skin, eyes, ears, and nose)
  • Urticaria (hives) (sometimes diagnosed as “idiopathic urticaria”)
  • Tissue swelling (angioedema) especially of facial and oral tissues and sometimes the throat, the latter causing the feeling of “throat tightening”
  • Hypotension (drop in blood pressure)
  • Tachycardia (increased pulse rate, “heart racing”)
  • Symptoms resembling an anxiety or panic attack
  • Chest pain
  • Nasal congestion and runny nose
  • Conjunctivitis (irritated, watery, reddened eyes)
  • Some types of headaches that differ from those of migraine
  • Fatigue, confusion, irritability
  • Dizziness
  • Very occasionally loss of consciousness usually lasting for only one or two seconds
  • Digestive tract upset, IBS, and especially heartburn, “indigestion”, and reflux
  • Decreased mental concentration and "brain fog"
  • Hyperactivity and manic tendencies
  • Depression
  • Suicidal Thoughts

Histamine intolerance is unlike other food allergies or sensitivities in that the response is cumulative, not immediate. Think of  it like a bucket of water. When the bucket is very full (high amounts of histamine in the diet), even a drop of additional water will cause the cup to overflow (symptoms activated). But when the bucket is less full, it would take more water (histamine) to cause a response. This makes histamine intolerance very difficult to pinpoint. 

Foods that are particularly high in histamine and other vasoactive amines include:
  • Champagne, wine, beer, cider and other fermented drinks and spirits
  • Sauerkraut and other pickled foods
  • Vinegar and foods containing it such as dressings, pickles, mayonnaise, ketchup, mustard
  • Tofu and soya sauce
  • Parmesan cheese and other aged cheeses
  • Yogurt, kombucha, kimchee, and other fermented foods
  • Slow cooked soups and broths
  • Sausages and other processed meats (ham, salami, gammon, bacon)
  • Mushrooms 
  • Canned and smoked fish (tuna, salmon, herring) and crustaceans
  • Seafood that is not gutted and frozen immediately
  • Prepared salads
  • Canned vegetables
  • Dried fruit, seeds, nuts
  • Yeast extract, yeast
  • Chocolate, cocoa, cola
  • Processed foods that contain artificial colors, preservatives, nitrates, sulfites and/or MSG
  • Pre-packaged microwaveable frozen entrees
  • Leftovers that have not been frozen immediately

Certain foods (even food that is low in histamine) can stimulate the release of histamine from mast cells in your body. These foods include:

  • Bananas
  • Tomatoes
  • Strawberries
  • Certain types of nuts
  • Peanuts
  • Shellfish
  • Egg white
  • Teas
  • Pumpkin
  • Spinach
  • Aubergines
  • Avocado
  • Papayas
  • Kiwi
  • Pineapple
  • Mango
  • Raspberry
  • Tangerines
  • Grapefruits
  • Red prunes
  • Peas
  • Spices: Cinnamon, Chili powder, Cloves, Anise, Nutmeg, Curry powder, Cayenne
To make matters even more confusing, typically allergy tests measuring IgE levels, such as skin prick testing and specific IgE blood tests for these foods will be negative. This is because reactions to histamine are not caused by a true immune IgE food allergy response.
Diagnosis of histamine intolerance is usually made by a person trialling a low-histamine diet like the Failsafe diet for about 6 weeks and seeing if their symptoms improve. Blood tests that claim to be helpful in measuring levels of histamine or the level of DAO are usually not reliable. There are a few DAO supplements out there on the market, but I have not had any notable success with them. 
Treatment consists of avoiding histamine-rich foods but only to the level that is required by an individual. The amount of histamine rich foods tolerated will vary from person to person, so its important to keep a food diary and note foods and portion sizes.

It's also important to note that many who are histamine intolerant have other intolerances as well such as salicylates or gluten. This all can be very confusing, which is why a good elimination diet is the best place to start.