Histamine Intolerance: Personalizing Nutrition for Better Outcomes

There’s no doubt that the symptoms associated with histamine intolerance can make a person’s life miserable. It’s completely understandable that they would be willing to do anything to alleviate their symptoms, including shifting to a (highly restrictive) low histamine diet, but is a life free of coffee and chocolate their only choice? Read this article to learn how to:

  • Differentiate histamine intolerance from severe allergies or chronic disorders
  • Help clients avoid a low histamine diet as a solution for their health issues
  • Apply personalized nutrition to build a roadmap for better patient retention

From chronic hives, fatigue and headaches to bloating, abdominal pain and nausea, histamine overload can seriously inhibit our clients’ daily lives, and in their quest to find a quick cure, they often turn to the Internet. However self-diagnosing and then self-prescribing a low histamine diet and avoiding all sorts of food can often do more harm than good.

What causes histamine intolerance?

It is estimated that histamine intolerance affects ~1% of the population, most often middle-aged women, and is often difficult to properly diagnose as the symptoms of histamine intolerance are so similar to other allergens, disorders, or infections. Because histamines are released naturally by our systems as part of the immune response, are also found in food, and require nutrients to be effectively broken down and eliminated, there are several instances that can contribute to a histamine overload. 

How would I know to start thinking about histamines?

A lot of times, we might suspect that there’s some kind of histamine issue if the client is taking antihistamines and not getting better results. Some high histamine symptoms include:

  • Headaches or migraines 
  • Hives
  • Fatigue 
  • Tissue swelling
  • High blood pressure

Reviewing the client’s annual blood work may be useful as well. On a CBC panel, the EOS is a type of white cell and if it’s elevated, it may be a sign that there’s a histamine issue going on. Additionally, if they have elevated total IgE (especially when known allergens are being avoided), this may also be an indication that histamine could be of concern. 

How do I determine a histamine intolerance?

Just because someone suffers from allergies, or experiences skin conditions like chronic hives or eczema, aren’t histamine intolerance symptoms exclusively. There are multiple other reasons why they could be experiencing those symptoms, but if they have ~4 or more of the following, histamine overload is likely: 

  1. Use of antihistamines daily (using one or more daily) typically to address sneezing, congestion, and itching
  2. Experience hives (urticaria) or even dermatographia (where raised welts can form just from a scrape or running something over the skin)
  3. Intense itchiness (after ruling out a skin infection)
  4. Asthma
  5. Confirmed IgE allergies (not sensitivities or intolerances)
  6. Have certain lab markers high such as Total IgE + Eosinophils
  7. Reactive to high histamine foods
  8. Cramps – menstrual and/or abdominal
  9. Difficulty falling asleep 

If your client is already dealing with environmental allergies or finds that they’re becoming increasingly allergic to food and other things in your environment, it’s possible that their histamine breakdown systems have become overwhelmed which can contribute to histamine intolerance. 

Get to the root of your client’s issues, faster, using The BNP Histamine Guide, available now in The BNP Toolkit™, a set of over 100 powerful, done-for-you tools designed to help you run a busier, more profitable practice.

Which foods can trigger histamine reactions?

There are a number of foods that naturally contain histamine, and other foods that trigger histamine release in the body. Your patients may be asking (or googling) are potatoes high in histamine? Are almonds high in histamine?

This is a list of naturally high histamine foods: fermented foods, alcohol, cured meats, hot dogs, processed meats, cured cheeses, collagen products, coffee, avocado, spinach, and chocolate. 

Foods that trigger release of histamine in the body include: alcohol, bananas, tomatoes, beans, papaya, citrus, walnuts, cashews, and peanuts. 

Low Histamine Diets: a Band-Aid or Long-Term Solution?

In an effort to reduce histamine symptoms, clients may have read or been told to reduce or avoid all or many of the foods previously listed. This is often referred to as a “Low Histamine Diet”. They are looking for a way to stop a histamine reaction. But what you both really want is how to fix histamine intolerance.

Because histamine intolerance isn’t caused solely by excess histamine intake in the diet, maintaining a low histamine diet may be ineffective, or a short term band-aid, but likely not a long-term solution. You can help them get to the root cause of their histamine intolerance.

Better nutrition is personalized nutrition. 

When clients avoid foods and entire food groups, it can cause problems for their overall health and even their healing from histamine overload. Instead it is important, as the practitioner, to identify the “root” cause of our client’s symptoms. According to our experts, the percentage of people that would theoretically need to be on a low histamine diet long-term would be very small.

How can we work with clients to identify the root cause of their histamine intolerance?

Using better nutrition assessment tools – with or without labs – you can develop a multi-phased roadmap. You will show them a roadmap from root cause of histamine intolerance through symptom relief and to fixing it. Here are histamine intolerance tests to consider. This list includes ways to help them get immediate relief by clearing histamines naturally as well.

  1. Homeopathic support: may help to keep things calm or provide relief. 
  2. Nutrient sufficiency: a total nutrition evaluation will help you personalized food and the best supplements for histamine intolerance as well as for their overall health.
  3. Medications: assess these to determine which could be helpful versus contributing to their high histamine symptoms. You may determine the best antihistamine for histamine intolerance or that removing an antihistamine is better for them.
  4. Testing: from genomics including Diamine Oxidase (DAO) and HMT (Histamine N-methyltransferase), to allergens to labs that give information about the body’s responses as well as stool tests that can reveal the presence of challengers. 
    1. NOTE: allergy testing is different from food sensitivity testing – food and environmental allergy testing is valuable at this phase.
    2. The client needs to find out if their body has allergies. At this stage, food sensitivities may only confirm that their digestion is irritated. This will not help you identify the true root cause of the histamine issues.
  5. Digestive assessment & Tune up: the link between digestion and inflammation means you need to identify and address digestive symptoms.

Incorporating tools like the new Histamine Guide and the popular Digestive Evaluation, another valuable patient education tool included in The BNP Toolkit™, can provide you with even more information about every client’s current health and habits, making it easier than ever to get to the root of their histamine-related issues. Ready to learn more? Sign up for a free live demo to see how The BNP Toolkit™ system will make practicing personalized nutrition easier!

Contributing experts:

Ashley Koff RD 

Jennifer Fugo MS CNS

  1. The Healthy Skin Show by Jennifer Fugo MS CNS; several episodes
  1. https://www.webmd.com/allergies/what-are-histamines
  1. https://www.healthline.com/health/histamine-intolerance#causes
  1. https://jandonline.org/article/S2212-2672(14)01454-3/fulltext
  1. “Histamine and Histamine intolerance” https://academic.oup.com/ajcn/article/85/5/1185/4633007
  1. https://www.medicalnewstoday.com/articles/low-histamine-diet