A Functional Medicine Guide To Histamine Intolerance: Symptoms, Causes + Diet
For healing your gut, bone broth and fermented foods are good food medicine. Beans and spinach are nutrient dense food sources. Smoked meats and fish are great protein options. These foods are all healthful choices for anyone seeking to feel better….aren’t they?
Actually, for some people, these “healthy” foods are anything but, due to a condition many people don’t even know they have called histamine intolerance. (1) If you have histamine intolerance, bone broth, fermented foods, legumes, spinach, and smoked foods can make you feel a whole lot worse, and I have found that for many of my patients, it is an underlying cause of inflammation and chronic symptoms.
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What is histamine intolerance & inflammation?
First, what is histamine? Histamines are chemicals in your body produced in response to allergens. Specifically, your body produces white blood cells called mast cells to release histamines during the inflammatory-immune response to allergens. This is part of a healthy, balanced immune system. Many foods naturally contain histamine, or trigger the release of histamine in the body.
Problems occur however, when there is a dysfunction or deficiency of the enzymes that break down histamine (those enzymes are called histamine N-methyltransferase (HNMT) and diamine oxidase (DAO). Without the enzymes to effectively get rid of excess histamine, you could experience a histamine overflow, which can cause a lot of problems. This is histamine intolerance.
What are the symptoms of histamine intolerance?
Histamine intolerance is basically an allergic reaction without the allergen, sometimes called a “pseudoallergy.” The typical histamine intolerance symptoms are similar to allergic reactions (like rash, trouble breathing, and a runny nose) but also go beyond your typical sneezing, to include:
- brain fog
- digestive problems
- hormone imbalances
- low blood pressure
- low sex drive
- racing heart
If you typically experience any of these symptoms after eating high histamine foods, you may have a histamine intolerance.
What food to avoid if you are histamine intolerant:
Keeping to a low histamine diet is one of the most fundamental parts of healing. are the most common high histamine foods (2) that could cause a histamine reaction:
- Alcohol (including wine)
- Bone broth
- Canned food
- Fermented food (kefir, kimchi, yogurt, sauerkraut)
- Legumes (soybeans, chickpeas, peanuts)
- Processed foods
- Smoked meat products (bacon, salami, salmon, ham)
Foods that release histamine
These foods are low in histamines but can trigger the release of histamine and create problems for people with histamine intolerance:
- Citrus fruits (kiwi, lemon, lime, papayas, pineapple, plums)
Diamine Oxidase (DAO) enzyme blockers
These foods block the enzyme that controls histamine:
- Energy drinks
- Teas (black, green, yerba)
Other Sources of Histamine Intolerance
Another source of DAO enzymes can come medications, such as:
- Gastrointestina medications
- Some over-the-counter medications that affect metabolization
What to do if you have histamine intolerance:
If you struggle with histamine intolerance or find that these foods give you problems, here’s what I recommend:
1. Find out for sure
In my functional medicine clinic I run labs to look for a high histamine/DAO ratio. This suggests that you’re eating too many histamine-rich foods for your body, and that you don’t have enough enzymes to break them down.
2. Get to the root of the problem
Why might people have histamine intolerance in the first place? As a functional medicine practitioner, my goal is to get to the root cause of inflammatory problems like histamine intolerance. A few common possibilities:
- leaky gut syndrome
- small intestinal bacterial overgrowth (SIBO)
- gluten intolerance
- nutrient deficiencies
- medications (NSAIDS, pain medications, among others)
- methylation impairments
- disorders like mastocytosis, which leads to too many mast cells
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3. Eliminate your problem foods.
An elimination diet is the gold standard for uncovering foods that trigger inflammation and histamine intolerance for you. The elimination diet I cover in my mindbodygreen video course is low-histamine-friendly. I’ll walk you through how to reintroduce foods after a period of elimination time to find out which ones are causing you problems.
4. Focus on eating fresh foods.
Bacterial growth in foods left unrefrigerated can increase histamine. Eat fresh foods and freeze leftovers immediately in single-serve portions to avoid triggering histamine intolerance.
For a low-histamine diet, (3) focus on these foods:
- Coconut milk
- Egg yolk
- Fresh wild-caught fish
- Fresh organic meat
- Fresh vegetables (except eggplants, tomatoes, and spinach)
- Gluten-free grains (rice, corn)
- Herbal teas
- Non-citrus fresh fruits
- Rice milk
5. Heal your gut
Microbiome imbalances can also release histamine and trigger symptoms. Problems like leaky gut syndrome, SIBO, and candida overgrowth could be fueling your histamine intolerance.
Probiotics can help. In one study, (4) two strains of bifidobacterium suppressed histamine release, and in another, (5) Lactobacillus rhamnosus suppressed histamine receptors.
Note: Certain probiotic supplements, especially those containing prebiotics, won’t agree with you if you have bacterial overgrowths.
6. Eat foods that help your body get rid of excess histamines.
Increase your intake of foods with vitamin B6, vitamin C, and copper.
Vitamin B6: chicken, turkey, and potatoes
Copper: asparagus and liver
Vitamin C: fruits and vegetables (except for those high in histamine)
Black cumin (6) and quercetin are also two natural medicines that have antihistamine properties.
Seeking support from a functional medicine expert
It is extremely important to get support from a functional medicine expert that can help pinpoint your body’s specific functions, imbalances, and any other underlying conditions. With this guidance you can confidently follow the most effective treatment path for your histamine intolerance and take back your health ASAP!
Need help identifying whether or not you have a histamine intolerance? As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.
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- Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007 May;85(5):1185-96. doi: 10.1093/ajcn/85.5.1185. PMID: 17490952.
- Laura Maintz, Natalija Novak, Histamine and histamine intolerance, The American Journal of Clinical Nutrition, Volume 85, Issue 5, May 2007, Pages 1185–1196, https://doi.org/10.1093/ajcn/85.5.1185
- (2001) Outcome of a Histamine-restricted Diet Based on Chart Audit, Journal of Nutritional & Environmental Medicine, 11:4, 249-262, DOI: 10.1080/13590840120103094
- Dev S, Mizuguchi H, Das AK, Matsushita C, Maeyama K, Umehara H, Ohtoshi T, Kojima J, Nishida K, Takahashi K, Fukui H. Suppression of histamine signaling by probiotic Lac-B: a possible mechanism of its anti-allergic effect. J Pharmacol Sci. 2008 Jun;107(2):159-66. doi: 10.1254/jphs.08028fp. Epub 2008 Jun 5. PMID: 18544899.
- Oksaharju A, Kankainen M, Kekkonen RA, Lindstedt KA, Kovanen PT, Korpela R, Miettinen M. Probiotic Lactobacillus rhamnosus downregulates FCER1 and HRH4 expression in human mast cells. World J Gastroenterol. 2011 Feb 14;17(6):750-9. doi: 10.3748/wjg.v17.i6.750. PMID: 21390145; PMCID: PMC3042653.
- Tariq, Mohammad. “Nigella sativa seeds: folklore treatment in modern day medicine.” Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association vol. 14,3 (2008): 105-6. doi:10.4103/1319-3767.41725
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BY DR. WILL COLE
Dr. Will Cole, DNM, IFMCP, DC is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is the host of the popular The Art Of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian, The Inflammation Spectrum and the brand new book Gut Feelings: Healing the Shame-Fueled Relationship Between What You Eat and How You Feel.
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