How to personalize nutrition for patients with histamine intolerance

There’s no doubt that the symptoms associated with histamine intolerance can make a person’s life miserable. It’s completely understandable that you – like me – would be willing to do anything to alleviate these irritating 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
Why it a low histamine diet is not a lasting solution for their health issues
The choices that will promote a better histamine response.

From chronic hives, fatigue and headaches to bloating, abdominal pain and nausea, histamine overload can seriously inhibit our daily lives. On a quest to find a cure, the internet and non-practitioners offer up a lot of advice including a low histamine diet and avoiding all sorts of food. Unfortunately, this 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 taking antihistamines and not getting better results. Some high histamine symptoms include:

Headaches or migraines
Hives
Fatigue
Tissue swelling
High blood pressure

We can (or your practitioner) review your blood work. On a CBC panel (basic blood 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, 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:

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

If your are dealing with environmental allergies or find that you are becoming increasingly allergic to food and other things in your environment, it’s possible that your histamine breakdown systems have become overwhelmed which can contribute to histamine intolerance.

Get to the root of your histamine issues, faster, using The BNP Histamine Guide, available to all BNP Health™ members (Plus™ and Platinum™ include support personalizing your plan to identify any and reduce histamine concerns).

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, you 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”. With this diet, the goal is to reduce food sources of histamines to prevent overload. While this can be helpful to stop a histamine reaction, what you really need is a plan to fix histamine intolerance, if present.

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. Together, we can get to the root cause of their histamine intolerance.

Better nutrition is personalized nutrition.

When we avoid foods and entire food groups, it can cause problems for overall health and even prevent healing from histamine overload. Instead it is important, to get help to identify the “root” cause of your 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 do we work with members to identify the root cause of their histamine intolerance?

Using better nutrition assessment tools – with or without labs – we develop a multi-phased roadmap. Together, we review this roadmap from root cause of histamine intolerance through symptom relief and to fixing it. Here are histamine intolerance tests and tools we may choose to use as part of your care. This list includes ways to help them get immediate relief by clearing histamines naturally as well.

Homeopathic support: may help to keep things calm or provide relief.
Nutrient sufficiency: a total nutrition evaluation will help us personalize food and supplements for histamine intolerance as well as for their overall health.
Medications: assess these to determine which could be helpful versus contributing to high histamine symptoms.
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. We need 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.
Digestive assessment & Tune up: the link between digestion and inflammation means you need to identify and address digestive symptoms.

There is no reason to be suffering from histamine intolerance or overwhelm! But it does require a personalized inspection under the hood to know what is driving your specific symptoms. We’d love to help!

Contributing experts:

Ashley Koff RD

Jennifer Fugo MS CNS