As a nutritional therapist I often get calls from clients feeling a little bewildered and confused over apparently new and strange allergies they have developed. And what makes them strange is that they seem to be from foods that they previously enjoyed without any sort of reaction.
I’m talking about breaking out in a rash after a few glasses of red wine; runny nose after eating a regular healthy meal or headaches that just come and go without cause or reason. My clients have reported a range of odd symptoms that come and go leaving them stumped.
These are often new symptoms that they haven’t previously experienced, or reactions to foods that had never been a problem before.
Although not very common and with symptoms that can overlap with allergies, IBS and various other conditions, one of the possible causes can be a degree of histamine intolerance, particularly in perimenopausal women. This is something I’m seeing in clients more and more often. I don’t think because it’s more prevalent, but fortunately we’re learning to listen to our bodies more closely and recognize when something is not right, instead of ignoring it and just getting on with things (go us)!
One of my recent clients (let’s call her Rebecca) presented to me with a range of symptoms which seemed completely unrelated. She was starting to experience a range of new symptoms which seemed to come and go in waves and ranged from mildly annoying to quite debilitating.
Rebecca was getting headaches and was constantly congested with itchy eyes and ears, classic signs of an allergic reaction. She also developed strange digestive symptoms like acid reflux and feeling sick after certain meals.
Other problems included feelings of nausea after one or two glasses of wine, and her anxiety levels were becoming difficult to manage. She felt like she had developed allergies overnight!
Rebecca was quite in tune with her menstrual cycle and aware of perimenopause and wondered if there might be some sort of connection with her symptoms and her female hormones.
So when she came to me we started to track her symptoms with a food and ‘event’ diary noting when the headaches occurred and any foods that she felt were triggering her symptoms. What we started to notice was that the headaches came around the time of ovulation/mid-cycle. We also discovered eating smoked salmon or yogurt left her feeling unwell. Rebecca had also been drinking kefir in an effort to address her digestive issues but this seemed to be having the opposite effect, making the problem worse, not better!
What is histamine and histamine intolerance?
Histamine is a very important chemical that plays a role in our immune system, our nervous system, the gut and our brain. We all need histamine and ideally we have a balanced process happening where the amount of histamine we have entering our body is equal to how much we eliminate.
If this balance is off and we have too much histamine and/or it doesn’t get cleared from the body efficiently then we can develop histamine intolerance. This is when there is an imbalance between the production and the breakdown of histamine in the body.
Our bodies produce two enzymes that work to clear histamine. These are called DAO and HNMT enzymes. Some of us have genetic polymorphisms that contribute to DAO deficiency, some medications can decrease DAO enzymes or if we have too many histamine producing bacteria in the gut or have a high alcohol intake this can compound the problem.
Unfortunately, there is no reliable test to determine histamine intolerance.
So what are the symptoms?
Symptoms can come and go and not everyone will experience all of these. They are also cumulative - the more excess histamine, the worse the symptoms are.
Skin: hives, rashes, itching, redness/flushing
Digestive: food intolerances, diarrhoea, constipation, acid reflux, bloating, nausea
Hormonal: PMT, painful periods, heavy periods, breast pain, fibrocystic breasts and there’s also an association with endometriosis
Neurological: anxiety (especially around ovulation when histamine is high), brain fog, poor concentration, insomnia, panic attacks
Vascular: headaches and migraines, fluid retention, dizziness, oedema/swelling
Respiratory: sinusitis, sneezing, nasal congestion, itchy, red or watery eyes.
Interestingly, those with histamine intolerance often find that their symptoms are so much better during pregnancy! This is because DAO (the enzyme that clears histamine) production is hugely increased when pregnant in order to protect the baby from excess histamine.
Histamine and Perimenopause
There’s good reason why women tend to suffer more histamine related issues and as you may have guessed, our hormones are the reason for this.
Oestrogen and histamine are closely intertwined. Women produce higher levels of oestrogen around Day 14 of our cycle when ovulation happens. When we are in perimenopause our oestrogen levels can be high or can fluctuate like mad and this can be troublesome for some. Our progesterone levels are reducing fairly steadily and without this counterbalancing progesterone our oestrogen can remain too high.
Oestrogen increases histamine and histamine increases oestrogen so you can be stuck in a vicious cycle of one increasing the other.
Oestrogen also downregulates the enzyme DAO, which helps clear histamine from the body.
If you are intolerant to histamine then it’s often the case that you will not tolerate HRT very well either.
For the majority of women who take body identical HRT they get great improvement in perimenopausal and menopausal symptoms such as flushes, sweats, anxiety, joint pain and energy levels. However, if you’re histamine intolerant and taking HRT your symptoms can be worse as the increased oestrogen from the HRT is causing the body to produce more histamine.
As if we didn’t have enough to cope with in peri and menopause. It’s rarely simple when it comes to our female hormones!
How does histamine build up in the body?
We take in histamine in 2 different ways. The mast cells in our body release histamine in response to certain stimuli - for example, those with hayfever produce histamine in response to pollen. We also get histamine from our diet.
What can be done to manage histamine intolerance?
Follow a lower histamine diet for 4 to 6 weeks
Not the easiest thing to do but limiting high histamine foods can really help. These include:
kefir
yogurt
sauerkraut
cured meats
smoked or tinned fish
wine
vinegar
yeast
aged cheese
tomato
spinach
olives and
aubergine.
To make things more complicated how a food is cooked and stored can contribute to histamine levels also. For example, food made fresh and eaten straightaway has very little histamine but if you cook a dish and store it in the fridge for a couple of days then it contains more histamine.
You might find that you are less sensitive to histamine foods during the low oestrogen times of your cycle such as just after your period.
Consume foods that are anti-inflammatory, and have been shown to increase DAO. Olive oil, for example, has been shown to increase the release of the DAO enzyme into the bloodstream by up to 500%! Increase quercetin rich foods like red onion, capers and apples, natural antihistamine foods like nettle tea/pesto/soup and up your intake of Vit C rich foods like kiwi, broccoli and cauliflower (an added benefit of both these vegetables is that they are from the brassica family and contain a compound called DIM which can help with hormone metabolism).
Sort your gut
Conditions such as gut dysbiosis and SIBO can be a big driver for histamine issues and tackling these helps to address the root of the issue. If there’s inflammation in your gut or if your intestinal barrier is compromised then it’s more likely that histamine will be an issue for you. Some species of bacteria are capable of degrading histamine and supplementing with certain strains of probiotics can help.
Supplementation
Supplements must be carefully considered for each individual and need to be checked for contraindications.
B6 upregulates the DAO enzyme.
Natural antihistamines such as Vitamin C, quercetin or l-glutamine.
Binders such as clinoptilolite can be very helpful to bind and remove histamine from the body.
So what worked for Rebecca?
I must stress that every individual case is different. The triggers and symptoms for each person experiencing histamine intolerance need to be examined holistically in order to isolate the root cause. Which often can be down to a number of factors.
Having studied Rebecca’s food and event diary over time we developed a bespoke nutrition and lifestyle plan to help minimize the histamine build up and support her body to clear histamine efficiently. Over time she saw a significant improvement and a major reduction in symptoms across the board and she felt better able to manage her histamine levels.
If you feel you might be experiencing a sudden onset of food allergies or unexplained symptoms, it would do no harm to eliminate histamine intolerance as a possible cause. Working with a nutritional therapist on a personalised food, supplement and lifestyle approach can bring lasting results.
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Here are a few tasty low histamine recipes for you to try!