The Low-Histamine Diet
How to Defeat Your Seasonal Allergies with Food
The world has turned upside down, and any commentary I could make on that feels trivial and inadequate. I haven’t made sense of it yet, so I won’t claim to offer insight or wisdom on where we are at. I’m taking it one day at a time, like many of you.
Stable is the opposite of how the world feels right now, at least how we have come to understand what it means to be stable. That is especially true of the elderly, people of color and those experiencing homelessness. Lest we forget, access to the resources that create stability is one of the many manifestations of privilege.
For myself, I am attempting, each day, to take this time as an invitation to redefine stability, or perhaps better said, to cultivate an awareness and gratitude for the stability I do have, and for the things that are showing up for me and keeping me grounded. A few of mine are:
an elaborate and complex knitting project that fascinates me and helps me lose track of time for hours
my partner, who continues to show up for me, even when the stress of all this makes me harsh and prickly
the indelible, extraordinary, unstoppable unfolding of springtime
Ah, yes. Springtime.
Around and amongst the surreality of COVD19, spring marches on in all its lush, fresh, pollen-rich glory. Life abounds from every corner, and with it come the familiar (if less welcome) itchy eyes, runny nose, sneezing and foggy brain of seasonal allergies. I’m so glad the earth is thawing and spring is here at last. It’s majestic and life-affirming. It’s the only thing that feels normal right now. It’s keeping me sane. But it’s also giving me a headache and making me want to rub my eyeballs out, so, yea, let’s talk about what we can do about that.
Here’s a slightly cliche, PG-13 motto for you:
When there’s a ton of shit you can’t control, focus on what you can control.
Cultivating an awareness of your personal agency is grounding, and I find it’s a good antidote to social media-induced anxiety. One of those things you have some control over is your respiratory health. It might go without saying, but it is all the more important to keep our respiratory systems as happy as we can in this time. Walking around with dry, puffy inflamed sinuses definitely qualifies as a respiratory system under strain, and a system under strain is more susceptible to infection. Also, quit smoking. Now. PLEASE.
Why am I prattling on about stability and not getting overwhelmed in an article about allergies? Because when it comes to histamine and the allergic response, the name of the game is:
mast-cell stability (when mast cells aren’t stable, more histamine is released, and it’s released more willy-nilly)
not piling on (more on that below)
It’s not what it looks like, I swear!
So if you don’t want your watery eyes and cough to be mistaken for infection at the grocery store, and want to know why your food should be your first stop to getting rid of hay fever. We’ll cover the foods you should avoid, which surprising veggie you need to be sprouting on your counter, and the adjustments you can make to your meal prep in order to keep you clear-eyed and fatigue-free this allergy season.
(With that being said, PLEASE be informed about your symptoms and don’t mistake a true infection for hay fever - see this helpful guide to help you determine the cause of your symptoms)
HISTAMINE & THE ALLERGIC RESPONSE
I’ll try to keep this brief - Histamine is a chemical with a lotta jobs: it’s intricately involved in making and secreting stomach acid, ensuring proper digestion, it’s a critical part of the inflammatory response and immunity, it’s a neurotransmitter…the list goes on. In healthy people, the naturally-occurring histamine we consume is quickly “deactivated” by enzymes in the gut. For those with allergies or histamine intolerance, there is either an unusually high production of histamine internally, the activity of the enzymes responsible for getting rid of it is unusually low, or both. When you pile on a bunch of high-histamine foods and beverages, you have a recipe for headaches, nasal congestion, hives, fatigue, etc. Symptoms appear when there is more histamine in your body than it can handle. So: if there’s an overwhelming amount of histamine-inducing schtuff for you to deal with at one time (ahem, April in the South) you get allergy symptoms, a manifestation of what we’ll call “histamine overload” or an overflowing “histamine bucket.”
These symptoms arise because, as part of its role in the immune response, histamine causes your blood vessels to dilate and local tissues to swell, so that your body can rapidly quarantine, locate, and attack the infection or injury. In the case of allergies, this buildup is how you land yourself with a headache, and it’s what leaves you itchy and miserable.
A few factors make it hard to nail down absolutes when it comes to the relationship between food and histamine:
Each human’s histamine response is highly individualized - this is why I can be deathly allergic to shellfish or peanuts and my best friend can sit next to me happily munching on a shrimp-and-peanut-butter sandwich without a care in the world (hopefully not tho).
This is a fairly new area of study, so while “histamine intolerance” is becoming a trendy diagnosis in the alternative medicine world, the research is still catching up.
It’s difficult to pinpoint which foods are problematic in a consistent, measurable, repeatable way. Histamine levels can vary widely from study to study, even for the same foods.
For this and some other really complicated reasons, the histamine response and the pursuit of mast-cell stabilization is fraught with almost as many pitfalls as humanity’s quest for other types of stability. As within, so without.
HISTAMINE IN FOOD
Who knew that the foods you eat affect your histamine levels? Certain foods naturally contain more histamine, others potentially trigger a release of our body’s own histamine, and still others block diamine oxidase (DAO), the enzyme primarily responsible for breaking histamine down in our GI tract. Fortunately, we can leverage this by choosing foods that will lower your overall histamine load and reduce your allergy symptoms.
It bears mention here that just because we may need to avoid certain foods during allergy season (or permanently in some cases), that DOES NOT mean that the food is “bad.” Foods are not “good” or “bad,” and placing judgement on yourself or others around this food or that food leads us down the path to a negative, compulsive or disordered relationship with one of the basic requirements for life that we contend with multiple times a day, every day.
Disclaimer: if you have MCAD or a serious, life-threatening allergy, do not rely on the following to deal with anaphylaxis or a severe reaction. The strategies below work best as part of a multi-pronged approach to managing mild-to-moderate seasonal and environmental allergies like dust, pollen and dander. Use your noggin.
HIGH-HISTAMINE FOODS
Certain foods are more likely to have high levels of histamine by virtue of their processing or preservation. Specifically, these foods contain more of the amino acid histidine, which is broken down in the body to histamine. Many of them also contain histamine as a byproduct of fermentation by bacteria, as in the case of, for example, cheeses and fermented sauerkraut.
This is not a comprehensive list (there is no comprehensive list, not really. Remember: histamine response=highly individualized), but here are some of the major players in this game (i.e. foods that almost always cause issues in just about everyone with histamine problems):
Alcoholic beverages, especially fermented ones like wine and beer
Fermented foods: yogurt, sauerkraut, vinegar, kombucha, soy sauce, tofu, etc.
Vinegar-containing foods: pickles, mayonnaise, olives, etc
Smoked and canned fish: tuna, salmon, anchovies, sardines, etc
Cured or processed meats: bacon, salami, pepperoni, lunch meats and hot dogs
“Soured” foods: sour cream, buttermilk, sourdough bread
All cheeses including goat cheese and especially aged cheese
Dried fruit: apricots, prunes, dates, figs, raisins, etc
Think about it this way: the “older” a food is, the more likely it is to contain a lot of histamine. Unfortunately, this goes for meal prep too - the longer a food is around (especially cooked food), the more the bacteria in and around it will start to break the histidine down into histamine, raising its potential to cause issues. So, in addition to avoiding the foods above, do your best (without contributing to the already massive problem of food waste!) to prepare food “to order,” and avoid leftovers. Keep in mind that histamine levels in food can vary widely, depending on factors like storage time and how it’s processed.
*Nerd alert*: I suspect this is the mechanism (at least part of it) behind people taking apple cider vinegar for symptoms of indigestion, as a sudden influx of histamine causes a transitory bump in stomach acid, which facilitates better breakdown of food in the stomach. But to be clear: ACV is a bandaid on a larger issue of poor digestion, an issue that I work with frequently in clinic and that responds extremely well to herbal remedies and dietary changes (more on improving digestion in a future post).
HISTAMINE-RELEASING FOODS?
There is another hypothesis that some foods, while themselves low in histamine, cause the mast cells to release it internally when you eat them. This is an older idea based on in vitro and animal studies, which have not been verified by randomized controlled trials. What that means is that, currently, there is not enough evidence to support the idea of histamine-releasing foods, ie. the case for avoiding them is weaker. More research is needed here.
However, it may still be worthwhile to avoid them if you experiment on yourself and notice symptoms. Here are the commonly cited histamine-releasing foods:
Alcoholic beverages
Citrus fruits: lemons, limes, oranges
Vegetables: some folks have issues with avocados, bananas, strawberries, eggplant, spinach, and tomatoes, while for many people these don’t cause problems.
DAO: YOUR NEW BFF
Diamine oxidase (DAO) is the enzyme responsible for detoxifying the histamine in our digestive tract. It is produced in large part in the intestines, and stored in the cells that line our organs and blood vessels. When called upon, it is secreted into the bloodstream and GI tract, where it scoops up and breaks down the histamine that’s floating around. There’s another enzyme capable of breaking down histamine found only within the cells- HNMT - but it isn’t as relevant to our conversation on things you can do diet-wise to manage your histamine levels.
Remember: allergy symptoms (or, more broadly, symptoms of histamine overload) appear when there’s more histamine than your body can handle, there’s insufficient DAO activity, or a combination of both.
The first way to optimize your use of DAO is obviously to avoid high histamine foods (kind of a no-brainer - consuming less histamine increases the amount of DAO available to deal with the histamine released from breathing pollen, petting kitties, etc. In other words, it bails water out of the bucket.)
The second way is to also avoid those foods that are suspected to inhibit DAO activity. Since this is a newer idea in the research, and there’s so much individual variability, there’s not a definitive list of foods that suppress DAO. However, three of the most likely culprits are:
Alcohol
Green tea
Egg whites
The third way is to add more DAO. Now, you could supplement with DAO directly, and that is a valid option, but most of the time you can get away with just eating pea sprouts.
Yep, pea sprouts. They are phenomenally high in DAO and a cinch to grow on your countertop in a mason jar . I recommend trying this before direct DAO supplementation, since pea sprouts are delicious and contain lots of nutrients. #morevegetablesforever. Toss a handful on top of your meal, but make sure not to cook them as the DAO goes bye-bye when exposed to heat.
ALCOHOL
Did you pick up on the fact that alcoholic beverages showed up on all three of those suspect lists? I bet you did, you smarty pants. That means that it’s possible that it liberates histamine, contains histamine AND blocks DAO. Literally the worst (potential) combination - it’s like smashing a mast cell piñata and starting a histamine party.
There’s some disagreement about its effect on DAO, and shaky research on whether histamine-releasing foods are in fact a thing, but even if the research eventually clarifies those components, it’s flat-out guilty of being high in histamine.
Alcohol has been associated with a higher risk of developing hay fever, and we know that histamine-related symptoms like hives or nasal symptoms following alcohol consumption are incredibly common. Unfortunately for us ladies, they’re twice as likely to occur in women, with one study showing red and white wine to be the most frequent triggers.
Sorry y’all, but if you’re committed to getting those itchy eyes and sneezing under control, I’d ask that you seriously consider limiting how much alcohol you drink during allergy season.
DIET ALONE MAY NOT BE ENOUGH
I would be very surprised if you followed all the advice above and didn’t see an improvement in your allergies, and the good news is most folks who follow a low-histamine diet experience relief within a few days! However, for most of us allergy sufferers, it takes a multi-pronged approach to truly get a handle on symptoms. The body is an ecosystem and we can’t just expect to pull on one thread and make a systemic issue disappear. Leaky gut will make allergies worse. Intestinal dysbiosis or SIBO will make them worse. Certain gene mutations will impair the functioning of DAO enzymes and make them worse. Not enough Vitamin B6 will mean you don’t make enough DAO and…you get the picture.
Ergo, herbal formulas and supplements are also an important part of the well-rounded allergy protocols I provide for clients, but alas they are beyond the scope of this blog post.
Using a combination of a low-histamine diet, a few key supplements, and “antihistamine” herbs, I have seen clients go from Zyrtec every day of their lives (even in the dead of winter), to not having to take it at all and being able to enjoy the outdoors during this beautiful time of the year. Personally, it took me several years of targeted, multi-faceted protocols, but I was able to get a dog for the first time in over a decade, and we co-habitate without incident (well, except when he shreds the Amazon boxes all over the carpet…).
When it comes to allergies, the question we should be asking ourselves is this: how can we manage our symptoms while improving our overall health and vitality to the point where those symptoms are barely noticeable or not noticeable at all? That won’t be possible for everyone, but it’s well within reach for many allergy sufferers who are able and willing to put in the work.
Are you an allergy sufferer? Leave me a comment below and tell me:
One thing you’ve tried in the past that didn’t work
One thing that you’re going to do differently this go-round based on what you know now, after reading
if you want to work with me on getting your allergies under control, you can book an appointment here. *i’m currently offering $100 off phone and video appointments* (use code staywell when booking).
Sources:
Barocelli, E. (2003). Histamine in the control of gastric acid secretion: a topic review. Pharmacological Research, 47(4), 299–304. doi:10.1016/s1043-6618(03)00009-4
Lackner, S., Malcher, V., Enko, D., Mangge, H., Holasek, S. J., & Schnedl, W. J. (2018). Histamine-reduced diet and increase of serum diamine oxidase correlating to diet compliance in histamine intolerance. European Journal of Clinical Nutrition, 73(1), 102–104. doi: 10.1038/s41430-018-0260-5
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
Reese, I., Ballmer-Weber, B., Beyer, K., Fuchs, T., Kleine-Tebbe, J., Klimek, L., … Worm, M. (2017). German guideline for the management of adverse reactions to ingested histamine. Allergo Journal International, 26(2), 72–79. doi: 10.1007/s40629-017-0011-5
Vlieg-Boerstra BJ, van der Heide S, Oude Elberink JN, Kluin-Nelemans JC, Dubois AE. Mastocytosis and adverse reactions to biogenic amines and histamine-releasing foods: what is the evidence?. Neth J Med. 2005;63(7):244–249. https://www.ncbi.nlm.nih.gov/pubmed/16093574.
Zimatkin, S. M., & Anichtchik, O. V. (1999). Alcohol-histamine interactions. Alcohol and Alcoholism, 34(2), 141–147. doi:10.1093/alcalc/34.2.141
https://www.thepaleomom.com/teaser-excerpt-from-the-paleo-approach-histamine-intolerance/
https://www.sciencedirect.com/science/article/abs/pii/S0956713507000059
https://www.functionalnutritionanswers.com/low-histamine-diet-101-what-to-eat-what-to-avoid-and-why/
