Heartburn, Skin Rashes, Anxiety. Is It Histamine Intolerance?

Dr. Doni Wilson explains what histamine is, how too much can trigger many unexplained health problems, and how to get back on the road to health – without drugs.

What Is Histamine, Histamine Intolerance, allergies, antibody, leaky gut, probiotics, prebioticsSo many patients come to me because they are suffering from a combination of chronic symptoms, including heartburn, digestive problems, skins rashes, anxiety, and recurring headaches. Typically, their doctors have prescribed medications – often a different one for each symptom. Over time, these patients have found themselves with a medicine cabinet full of prescription meds (and probably a few over-the-counter ones, too), but their conditions haven’t really improved. By the time they come to me, they are frustrated and tired of taking all these medications. Sometimes, they say they feel like “everything is going wrong” in their bodies, and they are starting to lose hope they will ever feel well again.

As a naturopathic doctor, the first question I always want to answer is, “What is causing these symptoms?” Several possible unrelated causes could trigger each of these symptoms. However, one condition could be the cause of ALL of them:

histamine intolerance.

In my practice, I have found that many people are unfamiliar with what histamine is, and how an intolerance to it can trigger a combination of seemingly unrelated symptoms that can make you feel extremely unwell – sometimes for a very long time. But the good news is, once histamine intolerance is determined to be the underlying cause, it is possible to get back to a healthy, drug-free life. In this article, I will show you how and why that is the case. Today, we’ll explore:

  • What Is Histamine?
  • What Is Histamine Intolerance?
  • What Are the Symptoms of Histamine Intolerance?
  • What Foods Can Trigger a Histamine Response?
  • How Leaky Gut Worsens Histamine Intolerance
  • Methylation and Histamine Intolerance
  • Testing for Histamine Levels
  • Healing from Histamine Intolerance
  • Recommended Supplements to Help Histamine Intolerance

What Is Histamine?

Most of us think of the word “histamine” in relation to allergies and sneezing, but it has a much more complex function in our bodies.

Histamine is a substance produced by our immune system as a protection mechanism. Its purpose is to send signals to the rest of the immune system (which, in turn, relays those messages to the rest of the body) that a “foreign invader” has entered the body and it’s time to ward it off. If, for example, we breathe in a tiny bit of pollen, histamine will increase blood flow to the affected area and tell the sinuses to produce mucus, to help flush out the particle. This is called a “histamine reaction.” When your sinuses overreact to histamine, you are likely to sneeze, and get itchy, bloodshot eyes and a runny nose. So, it’s not the pollen that causes your hay fever symptoms, but the histamine. That’s why we use anti-histamine medications and herbs to counteract allergies.

Our immune system doesn’t just produce histamine in the respiratory system, but in many other parts of the body, as well – especially in the digestive system. In all cases, its purpose is to protect those parts of the body from potentially harmful “invaders.” But sometimes, our immune system is overwhelmed by “invaders” and so makes proportionally more histamine than it normally needs, or at a time it doesn’t normally need it. That is when we may develop “histamine intolerance.”

What Is Histamine Intolerance?

Simply put, histamine intolerance is when your body can’t break down and get rid of histamine efficiently. This happens when:

  1. Your immune system frequently overreacts to foreign stimuli (including food) and floods your body with histamine, AND/OR
  2. Your immune system is bombarded by abnormal yeast and/or bacteria in your intestines (e.g. conditions such as SIBO or dysbiosis), AND/OR
  3. Specific enzymes (DAO, HNMT, MAO, and NAT) that your body uses to degrade histamine stop working as well as they should. This can happen as a result of stress, your unique genetic makeup, nutrient deficiencies, and/or decreased methylation (which we’ll look at shortly).

Thus, your overreactive immune system is busy pumping histamine throughout your body, but your body is unable to get rid of it. That is when you become “histamine intolerant,” and may start to experience many negative symptoms.

Histamine Intolerance Symptoms

When it comes to your immune system, the food you eat is no different from a piece of pollen. If it considers that food to be an “invader” it will respond by triggering histamine in the digestive tract – especially in the esophagus and small intestines. When that happens, histamine can trigger one or more from a range of irritating symptoms, such as:

  • Itchy throat
  • Flushing face
  • Runny nose and/or post-nasal drip
  • Cough
  • Heartburn
  • Nausea
  • Stomach ache
  • Bowel urgency and/or cramping
  • Loose stool/diarrhea
  • Dizziness
  • Headache
  • Shortness of breath
  • Heart palpitations or racing heart
  • Swelling or feeling “puffy”

Bear in mind that all the systems in your body are interconnected. This means seemingly unrelated symptoms can be the result of the same trigger. For example:

  • The digestive system and the brain are connected via something we refer to as the gut-brain axis. This means something that starts in the gut can spread to the nervous system, causing symptoms in the brain, such as headaches, anxiety, and
  • Similarly, histamine reactions can also spread to your skin, causing a rash, such as hives.

Which Foods Can Trigger a Histamine Response?

Certain foods are more likely to trigger a histamine response, especially those which actually contain histamine, including:

  • Fermented foods (such as kombucha, sauerkraut, pickles, yogurt, and vinegar)
  • Alcoholic beverages (such as beer and wine)
  • Aged meats (such as salami)
  • Bone broth
  • Canned fish (such as sardines and tuna)
  • Cheese (especially hard cheese)
  • Fruits (such as citrus fruits, strawberries, pineapple, and dried fruits)
  • Certain beans (especially peanuts, soy beans, and chickpeas)
  • Tomato
  • Spinach
  • Wheat
  • Nuts (all types)
  • Cinnamon
  • Chocolate

If you experience any of the aforementioned symptoms after consuming any of these foods, it could be due to histamine intolerance.

Sometimes, it might seem like your body is reacting to just about every food you eat, meaning your immune system is working overtime, responding and reacting to everything that comes into your digestive tract. This could be a sign you have severe leaky gut, which we’ll look at next.

How Leaky Gut Worsens Histamine Intolerance

Intestinal permeability – commonly referred to as leaky gut – is when the cells that line the intestinal walls are unable to prevent undigested food and/or toxins from leaking out of the intestines into the rest of the body. When these particles “leak” outside the intestines, their presence triggers the immune system, which starts to produce antibodies and histamine. These immune system “messengers” then create an inflammatory response to kill the invader and help heal the body.

Leaky gut can develop as the result of:

  • Pesticides (such as glyphosate used on wheat)
  • Gluten (in barley, rye, spelt, and wheat)
  • Certain medications (such as proton pump inhibitors, used to treat heartburn)
  • Excessive alcohol intake
  • Exposure to certain metals (such as lead and mercury from amalgam dental fillings)
  • An imbalance in your gut bacteria (known as “dysbiosis”)
  • STRESS!

In truth, all of these factors are “stress” as far as your body – and immune system – is concerned. While our bodies are built to manage with a certain amount of inevitable stress, when we are exposed to stress and immune triggers left and right, day in and day out, our immune system never gets a break, and our histamine becomes increasingly reactive as it tries to protect us from every little thing that comes through the digestive tract. What’s worse, when we feel stressed, our body tends not to digest our food as well as it should, causing yet more undigested food particles to leak out of the intestines. Thus, unless our exposure to these stressors is minimized, our leaky gut won’t have a chance to heal, and our histamine intolerance will go from bad to worse.

Methylation and Histamine Intolerance

It is an unfortunate paradox that the more stressed your body becomes, the less able it is to cope with the excess stress and inflammation caused by histamine that gets triggered by leaky gut. This puts a major strain on all the processes in your body. When I say “processes”, I mean the biochemistry that makes your body run. For example, within every cell of your body are enzymatic processes that utilize nutrients to create energy, neurotransmitters, and healthy cells. When you have leaky gut due to one or more of the aforementioned triggers, these processes become bogged down and sluggish. It’s like a traffic jam inside your cells, where nothing flows properly.

One of these vital enzymatic processes is methylation, which turns B vitamins into S-adenosyl methionine (SAM) for our cells to use for many purposes. In some people, the methylation process is negatively affected by a genetic MTHFR mutation. But the inflammation caused by leaky gut can also impair methylation. When methylation doesn’t work as it should, it cannot produce enough SAM. This causes your histamine levels to rise because the enzyme that degrades histamine requires SAM to work well. Eventually, it all becomes a vicious cycle:

  1. Environmental/emotional stresses, as well as overgrowth of abnormal bacteria in the intestines, lead to leaky gut.
  2. Leaky gut leads to inflammation and nutrient deficiencies.
  3. Inflammation and nutrient deficiencies slow down methylation.
  4. Slow methylation prevents your body from getting rid of excess histamine.
  5. Excess histamine leads to histamine intolerance.
  6. Your symptoms get worse, putting even more stress on your body.

Thus, the key to breaking this cycle is to:

  • Eliminate or minimize exposure to the specific stresses that are triggering your histamine reactions, AND
  • Address the underlying leaky gut issues that are impairing methylation and preventing your body from being able to recover naturally.

As your body recovers, your methylation cycle will resume normal functions, including the processing and elimination of histamine.

Testing for Histamine Intolerance

It is actually quite difficult to test specifically for histamine intolerance. Many practitioners are not even aware that it can occur. And while there are blood and urine tests for histamine, many of them don’t definitively reveal histamine intolerance. The test could, for example, should you have low levels of histamine and still have histamine intolerance. Because of this, confirming a diagnosis is often determined by looking at the patterns – symptoms that are correlated with results from these and other tests (as shown below), which may indicate the presence of leaky gut, dysbiosis, and/or methylation issues.

I strongly recommend starting by getting tested for food sensitivities. That way, you’ll have a much better idea which foods are the likely culprits causing leaky gut and setting you up for histamine intolerance. You can read about the food sensitivity tests I offer through my practice by clicking HERE.

And I consider it essential to check on your adrenal function, because we need to find out how your body is holding up under stress. Stress affects cortisol and adrenaline levels, both of which can affect histamine metabolism. It is important to work with a practitioner who will check your cortisol levels throughout the day (at least 4 different times) and adrenaline level (a urine test). Find out more about what I recommend here.

I also suggest you do a specialized stool test, which can provide you with information about the balance of bacteria in your large intestines, and identify and measure bacteria based on genes. Although this type of stool test is not yet available from a standard medical doctor, there is one you can order online at uBiome.com (US residents only). When you get your test results, I recommend working closely with a naturopathic doctor who has been trained to interpret the results and make recommendations. If you don’t have a naturopathic doctor, you are most welcome to inquire about setting up an appointment here.

You might also need to do a breath test to find out if you may have an overgrowth of bacteria in your small intestine (referred to as SIBO). As mentioned earlier, SIBO can lead to histamine intolerance, which will resolve only once you successfully address the underlying bacterial issues. In my naturopathic practice, I address SIBO or other bacterial/yeast imbalances with herbal remedies (instead of antibiotics and/or anti-fungal medications), combined with gut-healing approaches, which we’ll explore shortly.

Plus, it is going to be important to know your nutrient levels. The thing is that standard blood tests do not always show what we need to know when it comes to nutrients because we need to know how your body is using nutrients and the nutrient levels INSIDE of your cells. So be sure to work with a naturopathic doctor who can help you get this information.

Lastly, I suggest getting a genetic health profile. You can do this through the site 23andMe (other genetic tests don’t offer health profiling and a file of your genetic data that can be analyzed by software). The results can reveal your genetic tendencies to histamine intolerance. After you get your report, it is then important to work with a naturopathic doctor specifically trained in analyzing these results. Analyzing, expanding upon, and working from genetic health profiles is one of my professional specialisms; you can read more about this idea in a previous article I wrote in 2016.

Healing from Histamine Intolerance

The food sensitivities test will show you which foods are most likely causing damage to your intestinal lining and triggering an immune response. The first step in your healing regimen should be to eliminate those foods from your diet, at least until your body has recovered. In my practice, I have seen patients’ histamine levels decrease exponentially after food sensitivities are addressed.

You should also:

  • Start eating organic “real food”, to eliminate exposure to chemicals and pesticides. While you’re eating, eat more slowly!
  • Address any issues you have with constipation, to ensure your body is eliminating toxins and maintaining a healthy balance of bacteria.
  • Improve the quality of your sleep (read about my upcoming book on this subject), to give your body more “down time”.
  • Replace amalgam fillings in your teeth with non-amalgam materials, to eliminate exposure to toxic metals that may be triggering a histamine reaction.
  • Reduce your daily stress levels. Make more time to laugh, meditate, move, and spend time in nature. And don’t forget to BREATHE!

All these actions can give your body a chance to catch up, stop reacting, and get everything working as it should again.

Supplements to Help Histamine Intolerance

While you are supporting your body’s healing via the above actions, you may also wish to take some supplements* to help speed up the process.

VERY IMPORTANT: If you are experiencing severe histamine reactions, you should NOT take supplements at first. That’s because severe histamine intolerance may cause you to react to the ingredients in the supplements – even those that would otherwise be helpful. Instead, I recommend holding off on supplements until you have been on your elimination diet for at least a month. After that, if all is going well, you can gradually (you may have to start with a tiny sprinkle) add ONE nutrient or herb to your diet at a time, as your body becomes less reactive. When you are ready to begin introducing supplements, I suggest starting with these, in the following order. As the histamine symptoms decrease, you may then be able to increase the doses of these products and add in additional support for healing leaky gut.

  • Plant-based, gluten-free digestive enzymes – taken with meals, these will help you digest food more thoroughly, and help reduce the likelihood of undigested food leaking out of the gut. You can get this in capsule form or in powder form.
  • L-Glutamine powder – to nourish small intestinal cells and start healing leaky gut, OR
  • Glutamine powder with added DGL and aloe both these ingredients help heal leaky gut and soothe histamine reactions.
  • Quercetin – a plant-based anti-histamine. It stops the cells that produce histamine (called mast cells) from releasing histamine. It is also available in combination with other plant-based anti-histamines.
  • B vitamins – B1, B2, B3, B5, B6, folate and B12 all play a role in the enzymatic processes that metabolize histamine. It is important to choose the active form of B vitamins, to be sure your body can use them. And, especially when symptoms are severe, we need to introduce these B vitamins in a step-by-step fashion. This is another time when working with a naturopathic doctor trained in this specialty makes a big difference. A good place to start is with B5 alone as it helps the NAT enzyme reduce histamine.
  • Minerals – specifically calcium, copper, and iron are needed by the enzymes that process histamine. Before taking these minerals, however, it is best to have your nutrient levels checked so that you know exactly which you need.
  • Probiotics – to help rebalance gut bacteria. There are a range of probiotic products to choose from, however, how to know which one is right for you is a complex subject, as I will explain next.

Balancing Gut Bacteria to Help Histamine Intolerance

To prevent histamine intolerance, you also need to maintain a careful balance of over a trillion bacteria in the gut. If one type overgrows and another type under-grows, it makes you more vulnerable to leaky gut, bacterial toxins, and histamine response.

The most common method for rebalancing gut bacteria is to use probiotics – products that contain bacteria that grow in our intestines. People often eat yogurt and other fermented foods that contain probiotics to try to improve their gut bacteria. However, if you have histamine intolerance, eating these foods can cause your histamine issues to become worse.

The other option is to use a probiotic supplement. Most probiotic supplements will contain at least two types of bacteria – lactobacillus and bifidobacteria. However, there are actually many different strains of bacteria in the gut, and these may not be the ones your body actually lacks. Furthermore, certain strains of lactobacillus (casei and bulgaricus) are known to trigger histamine, which we are trying to prevent.

Thus, before you go to the health shop and purchase “any old” probiotic they have on the shelf, the best strategy is to do a specialized stool test and potentially a breath test for SIBO so you can find out which specific bacteria are too abundant and which are depleted. That way, you and your health practitioner can figure out which probiotic product is best for you, so you can feed the bacteria your body needs, and not those it has in overabundant supply. If you haven’t yet been tested, and you are eager to get started right away, I suggest choosing a probiotic that contains only Bifidobacterium or a soil-based probiotic, as neither of these will trigger histamine. Start with a low dose (such as one capsule every other day), and increase your intake slowly.

Another factor in balancing bacteria are prebiotics, which are dietary fibers that feed different strains of bacteria. Once you’ve done a stool test to analyze the bacteria in your intestines, and you know which bacteria you need, you and your naturopathic doctor can fine-tune your fiber intake so you increase the strains of bacteria your body lacks.

If you ever feel worse when taking any product, STOP taking it immediately, and arrange to meet with a naturopathic doctor who can guide you.

Closing Thoughts

There is no “magic pill” for histamine intolerance, and it would be wrong of me to promise that the road back to health will be fast or easy. If your problem is severe or has been going on for many years, it will probably take some time to reverse. However, what I can promise you is that histamine intolerance is not a life sentence; you can feel healthy again if you are patient and committed to your own healing. Working with an experienced natural health professional is often helpful, as they can guide and empower you as you work towards your goal.

I do hope you found this article useful and informative. If you suffer from the symptoms of histamine intolerance, and you’d like more help with dietary changes, choosing the right supplements, or strategies for calming down your histamine reactions, please do not hesitate to contact my office to request an appointment with me or my ND resident.

–Dr. Doni
12th May 2017

*Please keep in mind that any and all supplements—nutrients, herbs, enzymes, or other—should be used with caution. My recommendation is that you seek the care of a naturopathic doctor (with a doctorate degree from a federally-accredited program) and that you have a primary care physician or practitioner whom you can contact to help you with individual dosing and protocols. If you ever experience negative symptoms after taking a product, stop taking it immediately and contact your doctor right away.