Histamine Intolerance: Should you avoid fermented foods and collagen powders?

Histamine Intolerance: Should you avoid fermented foods and collagen powders?

Histamine is a biogenic amine found in many foods and, according to the European Food Safety Authority (EFSA), is considered a health risk when consumed in large amounts.  The standard Western diet poses a high risk. 

Histamine is also found naturally in the body - being produced, stored, and released by immune cells, called basophils and mast cells, in response to an antigen, injury, allergy or inflammation.  Once released, histamine produces an immune response which leads to symptoms such as swelling and itching, commonly experienced in allergic reactions. 

The mechanism of allergy

Basophils and mast cells are prominent in tissues that are associated with symptoms of allergies such as the skin, nasal passages, sinuses, mouth, and internal surfaces of the body. They are also found in the gut and brain. 

In gastrointestinal tract, histamine is released in response to trigger molecules that enter the gut, and this is one of the underlying mechanisms responsible for food intolerances. 

In the brain, histamine is a neurotransmitter released by neurons and it is known to influence sleep, appetite, and hormonal regulation.

Given the various organs that produce histamine, people who have allergies or food intolerances may experience a variety of symptoms that range from typical allergic symptoms of rash, runny nose, sneezing and itchiness, to gut symptoms and/or changes in brain function such as insomnia, cravings, and brain fog.

The body has in-built protective mechanisms that help prevent excessive damage caused by histamine.  One such mechanism is an enzyme called diamine oxidase (DAO).  DAO is produced by the cells that line the gastrointestinal tract and it acts by breaking down histamine and neutralises its effects.  When too much histamine is consumed or released, or DAO is inactive or overwhelmed, histamine intolerance can develop.

Histamine intolerance refers to a sensitivity to dietary sources of histamine and it can be genetic or acquired.  Genetic cases are very rare however acquired cases on the rise.   The main causative factor for this increase in numbers is the excessive and prolonged consumption of foods or medications that either increase histamine in the body, overwhelm DOA or reduce the activity of DAO.

 

Intestinal degradation of histamine by the DAO enzyme

Foods that contribute to Histamine Intolerance

  • Foods that are naturally high in histamine:
    • Fermented foods
    • Protein powders and collagen powder
    • Coffee
    • Dried fruits, avocados, tomatoes, eggplant, spinach
    • Processed meats, shellfish
    • Vinegar and tomato sauce.

 

  • Foods that block the action of DAO
    • Black and green tea
    • Alcohol.

 

  • Foods that trigger the release of histamine in the body
    • Alcohol
    • Bananas, citrus fruits, papaya, pineapples, strawberries, tomatoes,
    • Legumes
    • Seafood
    • Chocolate
    • Nuts
    • Egg whites
    • Food additives
  • Medications that block DAO
    • Anti-inflammatory medications
    • Anti-depressants
    • Antibiotics
    • Anti-diabetic
    • Anti-arrhythmic drugs
    • Analgesics
    • Muscle relaxants and sedatives 

In addition, gastrointestinal disorders such as irritable bowel syndrome, leaky gut, small intestinal bacterial overgrowth, or inflammatory bowel disease have been associated with an increased risk of histamine intolerance, possibly due to reduced production of DAO or an increase in permeability of the gut wall, allowing more antigens to cross the gut barrier and activate mast cells.   Anecdotal evidence suggests that managing these disorders may lead to improved tolerance of histamine and a reduction in allergy symptoms.

So, are fermented foods and collagen powders right for you?

Great marketing and some scientific data have fuelled the fad for fermented foods, collagen powders, protein powders, dark chocolate, red wine, and coffee.  This is concerning as these foods can cause problems if consumed regularly for too long.   

If you suffer from any of the symptoms noted above, its best to follow a low-histamine diet.  Reduce your intake of the foods listed above for one month or until symptoms resolve.  Then, reintroduce one food at a time and observe for symptoms.  This will help identify which foods you may need to avoid long term.

Most importantly always see a doctor for an assessment of any symptoms you may be experiencing as these symptoms may also be caused by medical conditions that require a formal treatment plan.

 

REFERENCES:

  1. Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT, Latorre-Moratalla M, Vidal-Carou MDC. Histamine Intolerance: The Current State of the Art. Biomolecules. 2020;10(8):1181. Published 2020 Aug 14. doi:10.3390/biom10081181
  1. Rezac S, Kok CR, Heermann M, Hutkins R. Fermented Foods as a Dietary Source of Live Organisms. Front Microbiol. 2018;9:1785. Published 2018 Aug 24. doi:10.3389/fmicb.2018.01785
  1. Derrien M & van Hylckama Vlieg JE (2015). Fate, activity, and impact of ingested bacteria within the human gut microbiota. Trends in Microbiology 23(6):354-366. PMID 25840765
  2. Marteau P, Minekus M, Havenaar R, & Huis in’t Veld JH (1997). Survival of lactic acid bacteria in a dynamic model of the stomach and small intestine: validation and the effects of bile. Journal of Dairy Science 80(6):1031-1037. PMID 9201571
  3. Uyeno Y, Sekiguchi Y, & Kamagata Y (2008). Impact of consumption of probiotic lactobacilli-containing yogurt on microbial composition in human feces. International Journal of Food Microbiology 122(1-2):16-22. PMID 18077045