Histamine intolerance

Histaminunverträglichkeit

Foreword / About the author

Hello dear reader, I'm glad you found your way here! I'm Julie and I'd like to tell you my personal story before we delve deeper into the subject of "histamine". The trigger for my histamine intolerance was a combination of different circumstances that, in my opinion, messed up my body.

This combination of circumstances happened in 2012, after which I spent almost two years trying to figure out what was "wrong" with my body, or rather why I was suddenly struggling with these random symptoms. In 2014, I was diagnosed with "histamine intolerance" (but only because I went to my GP at the time and specifically mentioned the histamine intolerance and asked her to do the necessary tests). Until then, it had been a long ordeal with many doctor visits and many tests. Among other things, I was diagnosed with a severe nickel allergy and sorbitol intolerance.

After the diagnosis, I changed my diet overnight to a low-histamine diet and I felt significantly better from one day to the next. So I continued to live with my intolerance, of course not without many, many histamine attacks (yes, because I had consciously eaten the "wrong" foods), social isolation, breakdowns, with the constant thought that I could not cure this intolerance and had to live with it. In 2018, I had had enough of it - I was getting worse and worse, the stress at work was not making it any better, the psychological pressure inside me was increasing from year to year, the feeling of being different and having to (wanting to) isolate myself socially - anyone who has a histamine intolerance will know exactly what I'm talking about. I dared to try again and threw myself into an "anti-histamine and anti-inflammatory diet" (by Yasmina Ykelenstam). It is based on incorporating as many bioflavonoids as possible in the form of herbs (anti-inflammatory and histamine-reducing) into the diet and thus supporting the body in breaking down histamine. It enabled me to bring a lot more variety into my diet and it helped me to finally enjoy my food again.

 

However, as the stress at work and some personal events continued to put strain on my body, things went downhill rather than uphill despite a balanced diet. In 2016, I was diagnosed with estrogen dominance, and in 2018, insulin resistance and adrenal fatigue. There were days when I slept up to 16 hours (only on the weekends, of course - on the rest of the days I dragged myself out of bed for my stressful job). I knew that I couldn't go on like this for much longer and decided to draw a line under it. I started training as a health coach on the side and soon after quit my stressful engineering job. I also decided to overhaul my diet once again and concentrate on detoxifying my body. From then on, I ate almost exclusively raw foods, with a high proportion of fruit. Here I am now, in 2020, I have been concentrating on detoxifying my body for a year now - and the liver, intestines, adrenal glands, kidneys and lymphatic system in particular play a major role in this. On the way deep into the functions of the body, I learned why our elimination pathways are actually so important and why its proper functioning plays such a major role in curing histamine intolerance. I am feeling much better now, I would even say that my histamine intolerance is 90% cured.

I know that I still have a long way to go to improve my insulin resistance, but I now know that it is possible. Of course, I cannot promise a cure here - nor do I want to. I deliberately chose the word "cure" because I believe that the body can regenerate if it is given the best possible support. I would like to encourage you with this, but as I said, I cannot promise you a "cure". Your path to getting histamine intolerance under control or becoming symptom-free may currently seem hopeless - my path looked the same for a long time. I can assure you that you can feel much better if you support certain organs in your body and pay more attention to them. But that's enough of my story - enjoy our guide to histamine intolerance!

What exactly is histamine?

Histamine is one of the tissue hormones and is a messenger substance (mediator) that plays an important role in many processes in the body, especially in inflammatory reactions. The body naturally produces histamine from the amino acid histidine. Chemically speaking, histamine is one of the so-called biogenic amines. What is histamine responsible for and important for in the body? Histamine has numerous effects in the body and functions as a tissue hormone, neurotransmitter and messenger substance. It...

  • can dilate the peripheral blood vessels (vessels in the arms and legs).

  • can narrow the central blood vessels (vessels that lead to the heart and brain).

  • can narrow the airways.

  • can cause contraction of the uterine muscles.

  • can cause contraction of the intestinal muscles.

  • In the brain, it is involved in the regulation of body temperature, sleep-wake rhythms and the release of certain hormones (e.g. estrogen).

Certain cells in the body produce histamine and store it. In response to a specific trigger, they suddenly release the stored histamine. Cells that can store histamine include mast cells, basophil granulocytes (a type of white blood cell), thrombocytes (blood platelets) and some nerve cells (neurons). The histamine stored in the mast cells in particular often plays an important role in allergic reactions such as hay fever, i.e. in so-called IgE-mediated allergic reactions: In response to certain allergens, the mast cells suddenly release histamine and acute allergic symptoms occur, such as a runny nose, sore throat, burning eyes (dry eyes), breathing difficulties or skin reactions.

Since mast cells are found in many areas of the body, such as in tissue, the epidermis (outermost layer of the skin), mucous membranes, the bronchi, the stomach and intestines, and the brain, symptoms can vary greatly. The highest concentration of histamine is said to be in the hypothalamus. Even reactions independent of allergies can lead to the release of histamine from body cells. This can be triggered, for example, by certain foods or medications that act as so-called histamine liberators ("histamine releasers"). Once histamine has been released, it is then activated at the molecular level via histamine receptors. This happens when histamine binds to the target receptors (H1, H2, H3, H4).

What role do histamine receptors (H1, H2, H3, H4) play in the body?

Activation of the H1 receptors is primarily responsible for the allergy symptoms triggered by histamine. These include itching and pain with hives and hot flashes. In the central nervous system, histamine is involved in triggering vomiting and in regulating the sleep-wake cycle via the activation of H1 receptors. H1 receptors also play a role in regulating the release of hormones such as adrenaline. Histamine is a messenger substance that is active in inflammatory processes and burns and also promotes the release of other inflammatory mediators. It also appears to play a role in regulating body temperature, central control of blood pressure and pain sensation.

H2 receptors are involved in the regulation of gastric acid production and bowel movements. An increase in gastric acid production can be interpreted as a component of the histamine-induced immune response. Rapid transport of intestinal contents leads to diarrhea and can also be seen as an immune response. Stimulation of H2 receptors also leads to an accelerated or stronger heartbeat and the dilation of smaller blood vessels.

The H3 receptors are mainly found on cells of the central and peripheral nervous system. Via H2 receptors, histamine has a regulatory influence on noradrenergic, serotoninergic, cholinergic, dopaminergic and glutaminergic neurons by blocking the release of neurotransmitters in the central and peripheral nervous system. As a heteroreceptor, it inhibits the release of the neurotransmitters acetylcholine, noradrenaline and serotonin. In this way, histamine indirectly influences the activity of the neurotransmitters. Through these mechanisms, the H3 receptors play a role in the central regulation of hunger and thirst, the circadian rhythm, body temperature and blood pressure. In addition, these receptors are said to be directly or indirectly involved in the pathophysiology of neurological pain, schizophrenia, Parkinson's disease and ADHD.

H4 receptors are involved in the targeted migration of immune cells to sources of histamine. That is why these receptors are thought to play an important role in the recruitment of leukocytes during the immune response, especially in allergic reactions. As you can see, histamine is involved in various bodily functions, which is why the symptoms can be very confusing. There are hundreds of different symptoms, and so I will now focus on the symptoms that were most notable for me. To make it a little easier for you, I have divided them into categories. Before I go on - remember: everyone is different, and what applies to me may not apply to you.

What is histamine intolerance?

Histamine intolerance, also known as histamine intolerance or histaminosis, is a disorder of the breakdown of histamine in the body. The two enzymes that are primarily responsible for the breakdown of histamine are diamine oxidase (DAO), which is produced in the intestine, and histamine-N-methyl-transferase (HNMT), which is mainly produced in the liver and kidneys. Monoamine oxidase (MAO) is also involved in the breakdown of histamine. However, it is mainly responsible for the brain and is primarily responsible for the breakdown of other biogenic amines (such as serotonin). It only comes into play when histamine levels are high. DAO ensures the breakdown of histamine in the intestine, while HNMT ensures the breakdown of histamine in the rest of the body. So if histamine is administered in the form of food and this then leads to reactions, it can be concluded that the enzyme activity of DAO is reduced. However, the connection between DAO and food containing histamine has not been scientifically proven.

In addition to “simple” histaminosis, the histamine degradation disorder, there are other diseases that can lead to similar symptoms, which are generally referred to as mastocytosis or mast cell disease and are summarized under the abbreviation MCAS (mast cell activation disease).

Probably the most common and therefore most important disorder in histamine metabolism is mast cell activation (MCA). It is not a breakdown disorder, but an excessive release of the body's own histamine.

The most common MCA disorders are mast cell activation syndrome (MCAS) and systematic mastocytosis (SM). Another less common disease is mast cell leukemia (MCL). Why do I sometimes react to certain foods and sometimes not?

I have often wondered why there are days when I react to certain foods and then days when nothing happens. A visual illustration of this phenomenon is the so-called histamine "bucket". The bucket fills up with histamine until it overflows and only then do symptoms appear. Actually simple and logical, but that's why it's so difficult to find out which foods you really react to.

Histamine in food

Histamine occurs naturally in many foods. However, it only forms in large quantities when bacteria come into play, which break down histidine into histamine. Therefore, histamine is often found in foods in which bacteria cause fermentation or ripening processes, such as in (ripened) cheese, wine, beer, or soy sauce, pickled foods such as sauerkraut, and in protein-containing foods (because the amino acid histidine occurs naturally there). In general, histamine can quickly form in excess in protein-containing foods, especially in fresh fish or pickled animal products (for example, canned tuna). A basic rule is therefore to avoid anything that has been ripened or pickled for a long time. However, histamine is not only found in protein-containing foods or those that have been ripened for a long time, but also in seemingly random types of fruit and vegetables, such as tomatoes, spinach, avocados, or bananas. To get an overview of which foods to avoid, this list (https://www.mastzellaktivierung.info/downloads/foodlist/11_FoodList_DE_alphabetisch_mitKat.pdf) from the Swiss Histamine Intolerance Interest Group is, in my opinion, a good, reliable start.

Histamine liberators, DAO blockers & other biogenic amines Histamine liberators

Histamine liberators are foods that stimulate the body to release histamine. (Coffee, tomatoes, pineapple)

DAO blocker

So-called DAO blockers are foods that block the enzyme activity of DAO.

Biogenic amines

In general, biogenic amines are substances that are formed when amino acids are broken down. Histamine, as mentioned above, is formed by the breakdown of histidine.

Histamine and symptoms

Symptoms are not uniform and vary greatly from person to person, which is why a diagnosis is so often so difficult. Precisely because histamine is a messenger substance produced by the body and is needed and responsible for a wide variety of processes in the body, the symptoms are very diverse. They can range from headaches (migraines) to skin rashes, diarrhea or gastrointestinal complaints. To better understand these symptoms and your body, you should first read the section on receptors under Introduction. This explains the basics of why our symptoms can be so different. For my exact symptoms, you can also watch my YouTube video (currently still available in English, but German is in the works): https://www.youtube.com/watch?v=-YzpM8yzCR8

Diagnosis of histamine intolerance

Determining DAO activity (in serum) and determining plasma histamine levels or methylhistamine concentrations in urine have been suggested for diagnosing histamine intolerance. However, according to current data, diagnosing histamine intolerance based on measuring DAO enzyme activity in the blood is not considered to be meaningful [4]. Other ways of detecting histamine intolerance include histamine provocation (e.g. through food or a prick test) and testing the intake of H1 and H2 antihistamines (histamine receptor antagonists) in combination.

In my opinion, the best, simplest and most reliable way to track down histamine intolerance is and remains the elimination diet (also called an elimination diet). The principle of an elimination diet is to strictly avoid foods that cause a reaction for at least 7-14 days in order to observe a possible improvement. If an improvement then occurs, a diagnosis of “histamine intolerance” is highly likely. In the case of a histamine elimination diet, this naturally involves a whole group of foods, namely all those that contain (high amounts of) histamine. It should be noted that histamine is found in almost every food, depending on how long the food in question has been “matured” (more on this under “Histamine in food”). Histamine is particularly formed in protein-containing foods and the longer these have been matured or stored, the more histamine is formed. A canned fish, for example, will most likely have an exponentially higher histamine level than a fish from the freezer. Here is a brief summary of the medical diagnostic tools (some of which have not been mentioned yet):

Blood test

  • Histamine concentration in the blood (=histamine level, blood plasma level, blood serum level)
  • DAO concentration in blood plasma or blood serum (DAO level)
  • Enzyme activity of diamine oxidase (DAO) in blood plasma or blood serum

Molecular diagnostics (genetic test = gene analysis = DNA analysis = DNA test)

  • HNMT genetic test (search for genetic defects = polymorphisms)
  • DAO genetic test (search for genetic defects = polymorphisms)

Analysis of urine and stool samples

  • Methylhistamine in urine
  • Histamine in stool

Skin test

  • Histamine prick test

Alternative medicine

  • Bioresonance procedures

Further indications of histamine intolerance / self-diagnosis:

  • Improvement with a histamine elimination diet
  • Improvement through H1-H2 antihistamines (best used in combination)

Causes of histamine intolerance or mastocytosis

The causes of histamine intolerance or mastocytosis are unclear in conventional medicine. However, my research, my work with clients and discussions with those affected have shown that many people with histamine intolerance have similar symptoms. Below is a list of the causes that can trigger histamine intolerance.

External causes:

  • stress

  • Mold in the house/apartment

Physical / organic causes (all of these have an overarching cause):

  • Liver (since this is where HNMT is formed, and the liver is responsible for breaking down certain hormones - e.g. estrogen)

  • Kidneys (since HNMT is formed here)

  • Adrenal glands (where cortisol and other hormones are produced)

  • Thyroid (responsible for our energy balance)

  • Lymphatic system (the lymphatic system is our waste system)

  • Intestinal dysbiosis (this is where DAO is formed and parasites or Candida can form histamine or stimulate the body to release histamine)

  • Hormone imbalance (thyroid / liver)

  • Adrenal fatigue (mitochondria)

  • Weakened immune system

Possible foreign contamination that can cause an imbalance in the body and thus a histamine intolerance:

  • Small intestinal bacterial overgrowth / SIBO (small intestinal bacterial overgrowth)

  • Parasites in the intestine - Candida (fungal infection) in the intestine / intimate areas - Bacteria (e.g. streptococci, etc.)

  • Viruses (EBV, Lyme, etc.) - Mold (in the house) - Heavy metals (from tap water, beauty products, household products, etc.)

  • Chemicals (from beauty products, household products, air, tap water, etc.)

Clinical pictures that are often associated with histamine intolerance:

  • Leaky gut (which has an underlying cause)
  • HPU (which has an underlying cause) - Adrenal fatigue - Intestinal dysbiosis
  • Clogged lymphatic system (lymphedema)
  • Food allergies / seasonal allergies
  • Other food intolerances (fructose, lactose, sorbitol, or gluten intolerance (a distinction must be made between wheat allergy, gluten allergy and gluten intolerance))
  • Hormonal imbalance (especially estrogen dominance)
  • Heavy metal contamination
  • Inflammation of the stomach lining or gastritis - IBS (irritable bowel syndrome)
  • Frequent illness, “getting every flu”

Author’s note : If parasites and viruses or bacteria are flushed out and killed, but elimination pathways are not open and do not properly eliminate toxins, and our mitochondria do not function optimally, there is a very high probability that they cannot be completely eliminated and will therefore multiply again. It is the same for SIBO (small intestinal bacterial overgrowth) - SIBO always has a deeper cause and cannot be combated with that alone, but must always be looked for another (deeper) cause.

Treatment and drug interactions

Histamine intolerance or mast cell diseases are often treated with medications such as antihistamines. These are chemical substances that "dock" onto the receptors responsible for histamine (H1, H2, H3, H4) and thus block the effect of histamine in the body, so that the symptoms should also be avoided. In theory, this is a good idea, as it can suppress all symptoms, depending on which symptoms are to be suppressed and thus also which receptors are blocked (read more about which symptoms are triggered when binding to which receptors under Introduction). Commercially available antihistamines bind to H1 or H2 receptors and thus only suppress specific symptoms.

Since histamine is a natural messenger substance and is therefore needed in the body, I don't think it's a good idea to simply block the associated receptors permanently. In addition, the body adapts to the blockage over time and produces more receptors and more histamine. This makes these antihistamines counterproductive, especially in the long term. By increasing the number of receptors and increasing the histamine level, these medications can actually make histamine intolerance worse. Of course, this is not to diminish the importance of these important medications. They are indispensable for life-threatening allergy attacks and if you find yourself in a situation where you cannot live without these medications - then taking them is of course understandable and sensible. You can find further suggestions for alleviating symptoms in the "Dietary Supplements" section.

In general, a number of other medications are said to have a negative influence on the histamine-degrading enzymes, primarily on DAO. Medications such as acetylcysteine, metamizole, verapamil, metronidazole and metoclopramide are mentioned here. However, according to current literature research, the data for these reports has not been verified. Further research is required to validate the influence of these and other medications on the histamine-degrading enzymes and to determine potential interactions with externally administered histamine. You can also find good content on this on the Swiss Interest Group website.

Dietary supplements

In general, you should be very cautious when it comes to dietary supplements and histamine intolerance, as they often contain incompatible fillers or the dietary supplements have been produced in an incompatible way (for example through fermentation). However, there are some areas in which it even makes sense to use dietary supplements for HIT. There are also now some dietary supplements that have been specially designed for people with histamine intolerance, such as the probiotic "Bifidoflor HIT" from FürstenMED.

Support of the intestinal flora

Probiotics are intended to have a positive effect on the intestinal flora and actively support its natural performance. However, some of these contain histamine-producing bacteria. In the case of histamine intolerance, histamine-producing probiotic bacteria can worsen symptoms. To prevent this, care must be taken to ensure the optimal selection and composition of the bacterial strains:

  • Lactobacillus rhamnosus
  • Bifidobacterium infantis
  • Bifidobacterium longum
  • Lactobacillus spp.

Studies have shown that these intestinal bacteria are well tolerated by people affected by HIT and also have a histamine-lowering effect, so that symptoms due to histamine intolerance can possibly be reduced.

Mast cell stabilizers (vitamin C, quercetin etc) Vitamin D

By taking high doses of vitamin C, histamine levels can be reduced. It can also be taken with quercetin. This is a bioflavonoid with antioxidant and antihistamine effects, which also supports the absorption of vitamin C.

Chlorella

Chlorella algae is used to detoxify the body. It binds toxic substances and waste products. It also supports the brain and metabolic functions in the body. Due to its chlorophyll content, it has a cleansing effect on our blood and covers our mineral requirements.

Spirulina

Spirulina algae with anti-inflammatory and antihistamine properties is a real superfood. It is said to inhibit the release of histamine from mast cells and also contains vitamin C, B6, zinc and copper, important co-factors of diamine oxidase.

Liver support

Overloading the liver can lead to histaminosis. The liver is used by the body to detoxify toxic substances and if there are too many of these, the liver is overloaded with toxic substances, which causes oxidative stress. This activates the mast cells, which then release histamine. Therefore, liver health should be supported with various possible natural measures. If you would like to read more information on this topic, I recommend the guide "Detoxifying the liver naturally". Learn more 

Fighting parasites

Parasites in the intestines damage the intestinal flora, which can often also be accompanied by histamine intolerance. To combat this problem, a complete intestinal cleansing or intestinal rehabilitation is recommended. You can also find more detailed information on this topic in the separate guide with all the important points about "intestinal rehabilitation". Learn more 

Closing words

Histamine intolerance is a serious condition and should not be taken lightly. My experience and working with many clients have shown that it tends to get worse if you ignore it and do not take your body's cry for help seriously. Because that's exactly what it is - a cry for help from your body. A "hey, you - please don't give me any more fast food, please don't stress me out and finally take more time for yourself!" Histamine intolerance is a sign from your body that you need to change something, and do it NOW, before it's too late (well, it will never be too late, but let's say before it gets worse!).

In general, my 8-year battle with histamine intolerance showed that I was better off without animal products (yes, even the supposedly low-histamine representatives like milk, cream cheese, and quail eggs are included! And yes, even chicken and goat cheese!) - and to be honest - you probably are too. It was only when I finally consistently left out all animal products and on top of that concentrated on fully supporting the body in detoxification that I slowly started to see improvement - I even became a raw vegan for a while (and still 80%).

And when I talk about supporting the body, I mean all areas. This includes all five elimination areas:

  • Intestine (digestion)

  • Urinary tract (especially the kidneys)

  • lymphatic system,

  • lung

  • our skin

  • the liver

I have learned to feel my body again, to listen to what it is telling me and to take breaks when it tells me to. When we get to this point, we have usually forgotten how to listen to our bodies. So if you have made it this far, set yourself a task for the coming week: Listen to your body. Breathe. Listen to yourself. What are you feeling? What is it trying to tell you? Do you perhaps already know before you bite into the burger that you will feel bad afterwards? Is it worth it? Even if it is difficult at first - you can do it. We can all do it. It is completely normal that we sometimes lose access to our bodies in today's stressful world. That is not a bad thing, because we can find our way back. For me, essential tools were meditation, breathing exercises, yoga, touching the earth with your bare feet (in English “grounding”). Pick one and just start! You will see - you will feel much better if you integrate one of these tools into your daily routine for a while.


Learn more about the author

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Julie's Website : www.nutristicalhealing.com


Sources:

PDF:

1. Wüthrich, Brunello: "The histamine intolerance syndrome: headaches, sneezing attacks, etc. caused by biogenic amines". Dermatologie Praxis, 2011/2. Wüthrich2011_DP11-2_Histaminintoleranzsyndrom.pdf (193 kb)

2. Rodlauer, Julia: "Food intolerances. A closer look with special consideration of lactose and histamine intolerance as well as fructose malabsorption". Bachelor's thesis, Medical University of Graz, Health and Nursing Science, reviewed by: Prof. Dr. med. Werner Aberer, University Clinic for Dermatology and Venereology, 8036 Graz, March 2011. https://online.medunigraz.at/mug_online/wbAbs.getDocument?pThesisNr=24403&pAutorNr=&pOrgNr=1

3. https://www.aerzteblatt.de/pdf.asp?id=47323

4. Procedure if intolerance to orally ingested histamine is suspected

http://dgaki.de/wp-content/uploads/2010/05/Leitlinie_Histaminunverträglichkeit2012.pdf

Publications:

5. Prick skin test - Website: https://www.hindawi.com/journals/isrn/2011/353045/

6. Akin, C. (2017); Mast cell activation syndromes. Mast cell activation syndromes. Journal of Allergy and Clinical Immunology, 140(2), 349-355.

7. Weng, Z., Zhang, B., Asadi, S., Sismanopoulos, N., Butcher, A., Fu, X., … & Theoharides, TC (2012). Quercetin is more effective than cromolyn in blocking human mast cell cytokine release and inhibits contact dermatitis and photosensitivity in humans. PloS one, 7(3), e33805 - Website: https://pubmed.ncbi.nlm.nih.gov/22470478/

8. Kalesnikoff, J., Starkl, P., Tsai, M., & Galli, S.J. (2012). Evidence questioning cromolyn's effectiveness and selectivity as a 'mast cell stabilizer' in mice. Laboratory Investigation, 92(10), 1472-1482 - Website: https://www.nature.com/articles/labinvest2012116

9. Theoharides, T. C., Sieghart, W., Greengard, P., & Douglas, W. W. (1980); Antiallergic drug cromolyn may inhibit histamine secretion by regulating phosphorylation of a mast cell protein drug cromolyn may inhibit histamine secretion by regulating phosphorylation of a mast cell protein. Science, 207(4426), 80-82 - Website: https://pubmed.ncbi.nlm.nih.gov/6153130/

10. Töndury, B; Wüthrich, B; Schmid-Grendelmeier, P; Seifert, B; Ballmer-Weber, B: “Histamine intolerance: How useful is the determination of diamine oxidase activity in serum in everyday clinical practice?”, Allergologie, 31(8):350-356. 2008 - Website: https://www.zora.uzh.ch/id/eprint/5336/


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