Histamine Intolerance: Causes, Symptoms, and Natural Treatments
For a small but significant subset of people, normally healthy foods can cause mental, digestive, heart, skin, and sexual dysfunction. My patients with histamine intolerance are always surprised to hear that good foods like bone broth, beans, and spinach can make them feel worse.
I am Dr. Will Cole, your go-to functional medical doctor, and I have to tell you about this condition that many people don’t even know about: histamine intolerance. (1) I have found for many of my patients, it is an underlying cause of inflammation and chronic symptoms.
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What Is Histamine Intolerance?
A histamine intolerance (sometimes called “histamine allergy”) means your body either produces too much histamine or does not produce enough enzymes to break down histamine. Excess histamine in your body results in systemic health problems.
Your body produces white blood cells (specifically, mast cells) that release histamine chemicals in 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.
When there is a dysfunction or deficiency of the enzymes that break down histamine, such as histamine N-methyltransferase (HNMT) and diamine oxidase (DAO), you can’t get rid of excess histamine. You could experience a histamine overflow, which can cause widespread issues.
@drwillcole How To Heal From Histamine Intolerance & Mast Cell Activation Syndrome #WellnessTips #SelfCare #Autoimmune #guthealth #guttok #histamineintolerance #mastcellactivationsyndrome #foodsensitivity #anxietyrelief #anxietytips #brainfog #chronicfatigue ♬ original sound - Dr. Will Cole
Causes
As a functional healthcare practitioner, my goal is to identify and treat the root cause of inflammatory problems like histamine intolerance. But of course, we need to figure out that underlying problem first.
Below, I’ve listed a few common causes:
- Leaky gut syndrome
- Small intestinal bacterial overgrowth (SIBO)
- Irritable bowel syndrome (IBS)
- Inflammatory bowel disease (IBD), which may lead to DAO deficiency
- Gluten intolerance
- Lactose intolerance
- Nutrient deficiency or malabsorption
- Medications, such as NSAIDs and painkillers
- Dysregulated nervous system
- Mold toxins (mycotoxins) (2)
- Methylation impairments
- Abnormal mast cell production, sometimes due to mastocytosis
Not sure if your symptoms are due to inflammation or histamine intolerance? Take our inflammation quiz to learn more.
Symptoms
Histamine intolerance is basically an allergic reaction without the allergen, sometimes called a “pseudoallergy.” The typical symptoms of histamine intolerance are similar to those of allergic reactions but also go beyond that.
Common histamine allergy symptoms include:
- Anxiety
- Arrhythmia
- Brain fog
- Constipation
- Diarrhea
- Dizziness
- Eczema
- Fatigue
- Headache
- Hormone imbalances
- Irritability
- Low blood pressure (hypotension)
- Low sex drive
- Migraines
- Nausea
- Racing heart
- Rash
- Runny nose
- Sneezing
- Trouble breathing
Avoid High-Histamine Foods
There are many aspects of a low-histamine diet. You’ll want to avoid histamine-containing foods, histamine-promoting foods, and foods that block enzyme activity and break down histamine. I’ve separated these into different categories.
Adhering to a low-histamine diet is one of the most fundamental parts of healing. Avoid these most common high-histamine content foods that could cause a histamine reaction: (1)
- Alcohol (including wine)
- Bone broth
- Canned food
- Aged cheese
- Chocolate
- Eggplant
- Fermented food (kefir, kimchi, yogurt, sauerkraut)
- Legumes (soybeans, chickpeas, peanuts)
- Mushrooms
- Nuts
- Processed foods
- Smoked meat products (bacon, salami, salmon, ham)
- Certain fish (tuna, mackerel, herring)
- Shellfish
- Spinach
- Vinegar
Avoid Foods That Release Histamine
Certain types of foods are low in histamines but can trigger the release of histamine in your body. People with histamine intolerance should consider avoiding these pro-histamine foods:
- Avocados
- Bananas
- Citrus fruits (kiwi, lemon, lime, papayas, pineapple, plums)
- Strawberries
- Tomatoes
Avoid DAO Enzyme Blockers
Some foods block DAO activity that regulates histamine. Avoid these pro-histamine beverages:
- Alcohol
- Energy drinks
- Teas (black, green, oolong)
Avoid Medications That Affect Histamine Levels
Certain medications can deactivate the DAO enzymes which break down histamine. Talk to your doctor about the following medications if you’re concerned about histamine intolerance:
- Antidepressants
- Antibiotics
- Antihypertensives
- Gastrointestinal medications
- Narcotics
- Over-the-counter medications that affect metabolization
LISTEN: Brooke Siem & Will Cole Reveal the Shocking Truth About Antidepressant Side Effects and More
Natural Treatments for Histamine Intolerance
So can you fix a histamine intolerance? If you struggle with histamine intolerance or find that these foods give you problems, here’s what I recommend: Get a proper diagnosis, change your diet, and support a healthy gut (and, therefore, your immune system).
Get a Proper Diagnosis
In my functional medicine clinic, I run labs to measure a high amount of histamine to DAO levels. A high ratio suggests that you’re eating too many histamine-rich foods and that you have low levels of enzymes that would break histamines down.
Some practitioners use a histamine skin prick test.
Detecting high levels of histamine is relatively easy, but figuring out why you have a histamine intolerance is a whole other story.
I may run an allergy test, or it could be medication overuse. There are tests for nutrient deficiencies and food intolerances that I recommend running. Also, I’d check for leaky gut or SIBO.
Follow an Elimination Diet
When figuring out what is triggering your histamine intolerance, I recommend a short-term elimination diet.
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 reintroducing foods after an elimination period to determine the cause of your problems.
It shouldn’t take more than 4-6 months to reintroduce most foods to your diet. After this elimination diet, you should know what not to eat and what you don’t have to be afraid of eating.
Eat Fresh Foods
Bacterial growth in foods left unrefrigerated can increase histamine and sometimes lead to a histamine reaction. Eat fresh foods and freeze leftovers immediately in single-serve portions to avoid triggering histamine intolerance.
For a low-histamine diet, focus on these foods: (3)
- Coconut milk
- Egg yolk
- Fresh wild-caught fish
- Fresh organic meat
- Fresh vegetables (except eggplants, tomatoes, and spinach)
- Gluten-free grains (like rice, corn)
- Herbal teas (not true teas like green tea or black tea)
- Non-citrus fresh fruits
- Rice milk
Eat Foods That Support Histamine Breakdown
If you have a histamine intolerance, increase your intake of antihistamine nutrients that support the breakdown of histamine. You can increase the following nutrients through your diet or through supplements:
- Copper: asparagus and liver
- Vitamin B6: chicken, turkey, and potatoes
- Vitamin C: fruits and vegetables (except for those high in histamine)
Consider DAO supplements that support the breakdown of histamine, including black cumin, zinc, and quercetin. (4, 5)
Read More: Black Cumin Benefits for Immune Health
Maintain a Healthy Gut
Gut microbiome imbalance can also release histamine and trigger symptoms. Problems like leaky gut syndrome, SIBO, and candida overgrowth could be fueling your histamine intolerance.
For more details on gut health’s relationship to whole body health, pick up Gut Feelings by yours truly.
Probiotics can help. In one study, two strains of Bifidobacterium suppressed histamine release. (6) In another, Lactobacillus rhamnosus suppressed histamine receptors. (7)
Note: Certain probiotic supplements, especially those containing prebiotics, won’t agree with you if you have certain types of bacterial overgrowth. Talk to your healthcare provider about the best probiotics for you or if they’re a good fit for your current situation.
Seeking Support From a Functional Medicine Expert
It’s vital to get support from a functional medicine expert who 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 unique case of histamine intolerance. Take back your health!
As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.
FAQs
Too much histamine can feel like an allergic reaction, complete with runny nose, itching, and hives (urticaria). But an overload of histamine may also cause cardiovascular problems, mental health issues, digestive upset, headaches, or sexual dysfunction.
Drink water! My recommendations include staying hydrated, avoiding dietary triggers (such as shellfish and legumes), and incorporating foods that support histamine breakdown (such as foods containing vitamin B6 and copper).
I have found that histamine is associated with food allergies, digestive disorders, neuropsychiatric disorders, mental health disorders, headache disorders, and even reproductive disorders.
Histamine overload may lead to anxiety, potentially accompanied by allergic immune responses like rash or itching, changes in heart rate and blood pressure, rising body temperature, dizziness or vertigo, abdominal pain, and shortness of breath.
Certain probiotic strains should help with histamine intolerance for many people. But I don’t recommend probiotics for people with SIBO since it can exacerbate small intestine issues.
Yes, high concentrations of histamine buildup may result in digestive issues, like diarrhea, constipation, bloating, gas, nausea, and vomiting.
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- Maintz, L., & Novak, N. (2007). Histamine and histamine intolerance. The American journal of clinical nutrition, 85(5), 1185-1196.
- Lauritano, D., & Conti, P. (2018). Impact of mold on mast cell-cytokine immune response. J Biol Regul Homeost Agents, 32(4), 763-768.
- Joneja, J. M. V., & Carmona-Silva, C. (2001). Outcome of a histamine-restricted diet based on chart audit. Journal of nutritional & environmental medicine, 11(4), 249-262.
- Tariq, M. (2008). Nigella sativa seeds: folklore treatment in modern day medicine. Saudi journal of gastroenterology, 14(3), 105-106.
- Kröger, S., Pieper, R., Aschenbach, J. R., Martin, L., Liu, P., Rieger, J., ... & Zentek, J. (2015). Effects of high levels of dietary zinc oxide on ex vivo epithelial histamine response and investigations on histamine receptor action in the proximal colon of weaned piglets. Journal of Animal Science, 93(11), 5265-5272.
- Dev, S., Mizuguchi, H., Das, A. K., Matsushita, C., Maeyama, K., Umehara, H., ... & Fukui, H. (2008). Suppression of histamine signaling by probiotic Lac-B: a possible mechanism of its anti-allergic effect. Journal of pharmacological sciences, 107(2), 159-166.
- Oksaharju, A., Kankainen, M., Kekkonen, R. A., Lindstedt, K. A., Kovanen, P. T., Korpela, R., & Miettinen, M. (2011). Probiotic Lactobacillus rhamnosus downregulates FCER1 and HRH4 expression in human mast cells. World Journal of Gastroenterology: WJG, 17(6), 750.
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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 also the host of the popular The Art of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian, Gut Feelings, and The Inflammation Spectrum.
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