Histamine may be a familiar word for seasonal allergy sufferers. Anti-histamine medications may be used during pollen season for those with itchiness and a runny nose. Others may have a year long sensitivity as the problem can also be genetic, due to less of the enzyme that is needed to break down histamine. The diamine oxidase enzyme, (DOE), is available as a supplement that can be taken with meals. (1)
We make our own histamine in response to allergy type sensitivities. Mast cells are part of the immune system that might become overactive and produce more histamine than we want during pollen season - or possibly after having experienced an infection such as COVID19. People experiencing odd symptoms months after seeming to recover from the worst of the respiratory and other symptoms of COVID19 may be experiencing excess histamine and mast cell overactivity. See this video for more information: Nicola Haseler interviewing Dr. Tina Peers regarding histamine and overactive mast cells after COVID19 recovery (LongCovid). (7)
Dr. Bruce Hoffman discusses Mast Cell Activation Syndrome - overactivity of the immune Mast cells in more detail.(8) Lab tests for histamine, or other chemicals involved in the inflammatory response are not necessarily reliable and may require a refrigerated centrifuge, which may not be standard lab equipment. The problem may involve genetic susceptibility but not necessarily, anyone might develop symptoms given a combination of stressors.
Infectious or vaccine immune challenge can lead to overactive mast cells, especially when there is also a genetic tendency towards difficulty breaking down histamine. Lack of methyl folate can be a genetic factor but this theory is controversial in standard medical circles, MTHFR, however taking a methyl folate supplement is a simple and safe thing to try. It can also be a genetic difference with the diamine oxidase enzyme needed to break down histamine. Dr Tina Peers provides an overview of how MCAS may be involved in LongCovid at the ILCC Day 2, (youtube), and provides some treatment ideas. The elimination diet would need additional guidance though - see my handout: Histamine Food Lists, for an overview.
Some phytonutrients and the foods in which they are found, may help calm symptoms by inhibiting mast cells.
Emotional or physical stress, lack of sleep, and the foods we eat may over activate mast cells throughout our body or within the mucosal lining of the Gastrointestinal tract (from the mouth, already the way through). Someone with recent bowel illness, may have a short term reduction in the diamine oxidase enzyme needed to break down histamines in food. The enzyme is produced in the lining of the intestinal tract. (8)
Family history may also be a factor, trauma for the person may have left them with an identity of illness; or trauma earlier in the family's history may have left epigenetic changes. Changing diet and lifestyle, and pursuing health can be a lot of work, and which may even be resisted as the patient improves, (psychoneuroimmunology). Misdiagnosis of the physical problem as a somatization disorder ("it is all in your head") may also be a problem according to Dr. Hoffman. (8)
The itchiness is not in my head - it is all over my body.
How do you even know how to be a healthy person if you have never known health, nor has your family? What do people do all day?
Go for a walk, without sneezing - cook delicious food that doesn't leave you with a mystery headache later on - so many choices, but change can be difficult and learning individual trigger foods and lifestyle habits can be complex.
Citrus may be an avoid food for people with histamine sensitivity. It can vary though what individuals are sensitive to regarding mast cell over activation. The health benefits of citrus are significant and may be worth trying in small amounts in case some citrus can be included in the diet.
Yes, really, it can be a problem for people with overactive mast cell problems. Exactly why is unclear. Strobe lights, the rapid flicker of bright light between winter tree trunks on the road while driving, the flicker of fluorescent lighting or a fan blade in front of a light creating a flickering shadow, action movies and cartoons with fast changing bright light patterns. (27, 28)
Sadly. Peace. Namaste.
"Stress conditions activate mast cells to release prestored and newly synthesized inflammatory mediators and induce increased blood-brain barrier permeability, recruitment of immune and inflammatory cells into the brain and neuroinflammation." (29)
Fresh is best, as the bacteria that slowly grow in food, even refrigerated food, can create histamine - see the next section Fermented Food - likely a problem. Pickles & yogurt, sure - but what about the creamy deli salad that you bought a couple days ago? Or the bean soup you made last weekend? Freeze the extra servings in single meal or family meal batches.
Histamine is created by bacteria as they digest food, making any fermented product a source of histamine. They are popular currently as a good probiotic source for a healthy intestinal microbiome - but some people can have an excess -SIBO - Small Intestine Bacterial Overgrowth, and bloating gassy discomfort.
Fermented foods include: Yogurt, pickles, Kimchee, pickled salads or sauerkraut, olives, pickled capers, vinegar, beer and wine, Kombucha, Kefir or yogurt drinks.
Nutritional Yeast Flakes may be a problem while traditionally baked bread would not.(33)
"We exercise caution with probiotics, which can worsen the symptoms of histamine overload. We recommend only using the following bacterial strains: L. reuteri, L. rhamnosus, L. casei and B. bifidum." (30)
While citrus itself doesn't contain histamine it has other chemicals that may lead to an increase in histamine.(37) Symptoms might be a painful tummy after eating, or a headache or odd mood the next day, or seasonal allergy like.
Tomatoes are also likely a problem food for people sensitive to histamine - and sadly that includes tomato sauce, ketchup, & salsa..
Various lists of foods that may be more of a risk of increasing histamine or less risk are available. Small amounts may be tolerable, but there is an additive effect - a small amount of several histamine risk foods may add up to a symptomatic evening or next day.
Here is an example Histamine Foods List. (31) There are many lists.(37) Individual tolerance needs to be checked personally with amount kept in mind -> additive load = symptoms.
Apples, Peaches, Pomegranate, Onion, Garlic, Capers, Watercress, Mung Bean Sprouts, Pea Sprouts, Black Rice Bran, Nettle, Ginger, Galangal - Thai Ginger, Turmeric, Thyme, Holy Basil, Tarragon, Peppermint, Chamomile, and Nigella Sativa - Black Seed Oil. See: Natural Antihistamine Foods.(32)
Black seed oil is very helpful for me, but strong, I just swallow a spoonful quickly, all done, scratchy early sore throat - also all done..
"The dietary recommendations for individuals with histamine intolerance call for a diet rich in folate, vitamin B12, glycine and flavonoids such as quercetin and rutin. We also recommend juicing homemade pea sprouts (which are rich in the DAO enzyme) as well as eating rice bran (in “forbidden rice” or black or purple rice), which has been shown to reduce the release of histamine from mast cells." (30)
In addition to mast cells releasing histamine, we also get some histamine from foods that contain histamine naturally and other foods may have increased content as the food ages - fresh is best for people with histamine excess problems. (4)
Freezing a larger batch of food in meal size portions might be a sensible way to prepare fresh foods (that don't have food additives or seasonings that you need to avoid). Fermented foods such as yogurt, saurkraut and kombucha are popular currently, for the goal of improving intestinal health and the microbiome, (the balance of beneficial bacteria and other microbes within the GI tract). However they may make someone with overactive mast cells worse instead of better. Vitamin C may help. (8)
Avoiding foods that contain histamine or may increase our tendency to make more can help allergy sufferers or the people with the genetic difficulty breaking down the excess. Symptoms can include headaches as well as itchiness and runny nose. Fatigue may also be a problem as well as other odd symptoms or chronic pain. Anxiety and schizophrenia symptoms may worsen with excess histamine. (1, 3, 4)
There is plenty of information on the topic available online that I will link to for more detailed food lists. Several of the articles make the point that the problem is additive and histamine is not something you can avoid all together. Small amounts or a taste may be okay, but several foods or beverages over the course of the day may lead to an uncomfortable headache that evening. (3)
Genetics may affect the enzyme DAO needed to break down excess histamine.
Genetics may be a factor in who is more at risk for having excess histamine and sensitive to histamine containing foods. Diamine oxidase (DAO) is an enzyme needed to break down the excess histamine from foods, within the intestinal tract, which some people may not be able to make. It can be purchased as a supplement and taken with meals. Other people may have overactive mast cells which are the type of immune cell that produces histamine throughout the body. (10 , 11)
Dr. Hoffman also makes the very important point that an apparent 'drug' sensitivity might really be a reaction to other components of the tablet or capsule, or even contaminants, which is also something to look at on labels for other supplements and over-the-counter medications. (8).
Writing down your daily foods, beverages, and symptoms can be a good way to watch for patterns in what seems to make you feel better or worse. Food sensitivities can also vary with how much stress you are experiencing and whether you slept well, or drank enough water. Once you are more familiar with your patterns and know which foods and habits are helpful then recording your daily foods and symptoms may no longer be necessary.
Bad mood changes are later in the day or the next day or two, so making a connection between a food and a symptom can be difficult. It can be simpler to keep a basic meal pattern and only change one thing at a time, so it is easier to recognize a link between symptoms the next day and a new food.
Having learned of the link between foods and histamine levels while writing this, it has helped me to avoid the foods that are mentioned, or reduce them in my diet. A bad reaction for me can include very odd behavior and anxiety. Histamine excess symptoms of congestion and seasonal pollen allergies have been a long term problem for me and many of the foods recommended to avoid I had already learned to avoid, but for others I wasn't aware of the connection.
Health is worth it. Happy dining, and good sleep to you!
Some foods may be particularly beneficial for helping people who tend to have too much histamine. Personal strategies from a non-medical sufferer are available here:
Fennel is available as a vegetable, celery like bulb, the leaves are fine and used in cooking. Fennel seeds are also eaten raw or toasted and may be served in a small dish at the end of a meal in India, as an after dinner digestive aid or breath freshener.
Psychological stress causes mast cells to release their histamine and other chemicals - uh oh, time to think serenely about that. (10)
Foods and the health of our intestinal microbiome, bacteria and other microbes, can also increase histamine directly or indirectly. Some foods contain histamine and others cause more histamine to be produced.
Glyphosate residue may also cause an increase in histamine. (10). Glyphosate as a stimulator of histamine release (10) would create a different list of foods to avoid. It may also affect the intestinal microbiome negatively which might lead to more histamine inducing species.
Glyphosate is a complex topic that may affect many aspects of health other than being a cancer risk or obvious toxin in the sense of a traditional definition of an obvious poison - take too much cyanide and you die. If we have glyphosate residue in food and also in the air (5) then it may be affecting our health in many unknown ways that add up over time. (16)
Possible aids if excessive glyphosate is a concern:
Glyphosate herbicides are used for crops that are used for animal feed or made into ingredients used in most processed foods. It may accumulate within animal tissue and potentially in us too and affect our health in ways less obvious than a poisonous overdose or cancer. It is chemically similar to the amino acid glycine. Supplementing the diet with powdered dimethyl glycine might help provide the body plenty of the natural amino acid. Glyphosate has a sidechain that would make proteins formed with it in place of a glycine likely to be malfunctional.
Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.
Genetics may be a factor in who is more at risk for having excess histamine. There is an enzyme needed to break down the excess histamine from foods, within the intestinal tract, which some people may not be able to make. It can be purchased as a supplement and taken with meals. Other people may have overactive mast cells which are the type of immune cell that produces histamine throughout the body. (10 , 11)
If the mast cells are overactive, MCAS - Mast Cell Activation Syndrome, symptoms may be more severe than a seasonal allergy type of histamine reaction and may include: "rashes, hives, itching, flushing, fainting, headache, abdominal pain, nausea, vomiting, gastroesophageal reflux disease (GERD), fatigue, chronic pain, trouble breathing and many more." (11) To complicate trying to figure out if this is a problem for oneself or a patient the overactivity of mast cells may also be associated with other complex conditions that have varied symptoms too, including: "allergies, autism, autoimmune disorders, cancer, diabetes, Ehler-Danlos syndrome, postural orthostatic tachycardia syndrome (POTS), fibromyalgia, Lyme disease, mastocytosis, migraines and obesity." (11) Add the various symptoms together and a person might have a confusing mixture of "twenty to thirty symptoms" and feel "extremely ill." (11)
Lab tests frequently are not helpful for diagnosing many of the conditions or MCAS and it may also be unclear whether a person is having histamine symptoms because of intestinal digestion or microbiome problems or due to overactive mast cells throughout the body. Severity of symptoms may be worse if the problem is related to mast cell activation throughout the body. Treatment approach would also be different. Some people might be helped by use of the digestive histamine enzyme while others wouldn't need it. Both types, digestive histamine excess and mast cell over activity, would be helped by decreasing histamine containing foods or ones that increase release of histamine from mast cells.
Eliminating all histamine from the diet would be impractical if not impossible. Reducing the amount might make a significant difference though in reducing the negative symptoms. More details about identifying the type of problem with lab tests or other clinical indicators and an elimination diet description are available here: westonaprice.org. (11)
Overactive mast cells may involve cannabinoid deficiency. Mast cells have both Cannabinoid Receptor Type 1 and Type 2 on the cell surface and when activated they cause an inhibition of the mast cell.
That may suggest that a short time, small amount of THC & CBD used may not help suppress the mast cells, by increasing cAMP sufficiently, while a longer exposure, larger dose might be needed for the inhibition - and that both the CB1 and CB2 receptor types need to be activated for the suppression of mast cell. CBD activates CB2 receptors and THC activates CB1 receptors
Edibles or smoke? "However, when it comes to MCAS patients who are more severe, they tend to not tolerate ingesting the Medical Cannabis oil or edibles but may can inhale the actual Organic Medical Cannabis Flower and find great relief from MCAS symptoms." (12). Vaporizers are available that can be used with good quality medical cannabis.
Mast cells are a type of immune cell that can release all of its stored chemicals or only particular ones. Some triggers might cause release of histamine while others might not. Mast cells tend to be located within specific tissue areas of the body or along epithelial layers (skin and membrane linings of blood vessels or other tissue), rather than be free moving like some other types of immune white blood cells. (10) Some people may have overactivity in some areas of the body rather than throughout the entire body. Mast cell activation may also be involved in autoimmune diseases including Multiple sclerosis, Type 1 Diabetes, and Rheumatoid arthritis. (10) The excessive release of cytokines and inflammatory chemicals can lead to cell damage in surrounding tissue.
Viruses can activate mast cells, which then release histamine and other inflammatory cytokines and chemicals. The immune mast cells are also called granulocytes because when activated they release little packets, granules, full of the inflammatory chemicals.
Flu virus has been found to activate mast cells and mast cell inhibitors helped reduce lung damage and mortality in severe cases of influenza where an over-reaction of the immune response had occurred. Too much inhibition during an active infection might not be helpful though, because the goal is to kill the virus infected cells or other pathogens that can activate mast cells. (10)
Regarding COVID19 illness, the cytokine interleukin 6 (IL-6) tends to be present in excess, (17), and it is a mast cell activator. (10) Vitamin C can help inhibit IL-6. (16)
Mast cell stabilizer medications and a COX2 inhibitor has been found helpful for MCAS.
Medications that may help reduce mast cell activation in Irritable Bowel Syndrome, a condition similar to Inflammatory bowel disease but less severe, include mast cell stabilizers and "a medication to reduce prostaglandin E2 synthesis (e.g. a COX2 inhibitor) stopped the hypersensitivity in the animal model of IBS. [ref]" (10) Pomegranate peel extract and other antioxidants may act in part through COX2 inhibition.(post) Prep tips for pomegranate & the peel, see: G13. Pomegranate.
Histamine promotes wakefulness, so an excess may lead to insomnia problems, and it affects a lot of varied behaviors and balance of functions throughout the body, disparate - a wide range of behaviors, which suggests why there can be such a wide range of symptoms, and homeostatic - balance of body functions - no longer as able to stay at an even center, too tired, or too excited, too cold or too flushed, numbness or pain - roughly.
Histamine may also lead to feeling too itchy too often.
Inflammatory bowel disease (IBD) can involve overactive mast cells and excess histamine activating Trp channels in the intestines, (10), leading to sudden diarrhea and/or pain. "Pruritigens" refers to other chemicals that directly activate Trp channels such as horseradish or Latex that cause itching, (pruritus). Others may cause the bowel symptoms of IBD including cinnamaldehyde from cinnamon, capsaicin from hot pepper, curcumin in turmeric, and other chemicals in spices or herbs like ginger, cloves, and mint. Previous post 1, post 2/ webpage G3.5-3.6.2, G5.
Yes, it is not easy to figure out what you can eat if you have Mast Cell Activation Syndrome, or to safely use as skin care products or medications as some of the ingredients might be Trp channel activators.
Tips to worry less - Think about whether you can do anything about the issue? If no, try to let the worry go. If the only thing you can control about a problem is your own attitude about it, then work on acceptance - attitude adjustment. Reframing problems as a blessing may be a stretch, but it might help to look at things as learning experiences, or a message to work on priorities. Pain and stress may be sending a message that delegating some tasks, or streamlining how you do something might be needed.
Writing worries on notes and putting them in a worry jar is another idea - you did something about it. You can look through your worries later. If yes, plan your time - 1. write down your goals, long term - 5-10 years, mid length, this year, and short term, this day/week/month, and 2. make an action plan, what steps to take today, write a list. 3. Do your plan, cross off your list items. It can feel more organized and good to check off your short term goals, and more peaceful to have a plan. (18)
Regarding the complexity of Mast Cell Activation Syndrome, or histamine from food - writing down your symptoms and daily food, beverages, and other lifestyle issues that standout from your routine can help to start seeing a pattern of which foods or habits might be adding to the problem.
Elimination diets are quite simple to start with only a few of the least allergy prone foods, and gradually more are added back later. It needs to be followed for a couple weeks to get the body cleared out of the potential problem foods and hopefully start feeling better, whether itchy, headaches, fatigue, brain-fog, or pain, numbness, or other symptoms. Then add only one thing back and see if symptoms return. Symptoms may be fairly immediate, or the next day or two so gradual reintroduction will be easiest to track whether it seems to cause symptoms.
Lab tests and other help and medication may be nice too, if available, but an elimination diet can be done fairly easily and safely. Stick to a variety of foods from the different food groups and read bottles on any supplements or medications to check for ingredients that might also be trigger substances 'starch' is usually wheat or corn based unless specifically labeled like tapioca or arrowroot starch. See the resource links earlier on the page for food lists, a food diary and information about elimination diets for histamine issues.
Not all people have exactly the same sensitivities and there can be an additive effect, many problem foods on the same day as stress - may become a flare up. Some of the lists vary and some are more restricted than others, but most have similarities in the worst risk foods. Starting with eliminating some of those and seeing if you start feeling better can also be a way to work towards learning what are problem foods for you personally.
The terminology and diagnostic criteria for mast cell over activity is still new. Some problems may include stimulation of mast cells without complete degranulation - release of histamine and other cytokines (IL-6 is a cytokine - a cell signal chemical) contained within the mast cell. The name ‘Mast Cell Mediator Disorders (MCMD)’ has been established for symptoms involving less severe mast cell activity than full degranulation. (25)
The excess Interleukin-6 that is commonly seen in COVID-19 illness may lead to over active mast cells in people who did not have seasonal allergy or Mast Cell Activation Syndrome symptoms for most of their lives (it can be genetic based). "Constant IL-6 exposure can cause the body to form more reactive mast cells." (23)
How mast cell activation relates to Long Covid survivors may also vary based on personal genetic and other unknown factors in their environment or body burden of toxins (yes, we tend to contain a large mixture of modern toxins and heavy metals, (26)). Histamine containing or promoting foods could be a factor that varies based on a person's diet and food sensitivities, in addition to mast cell activity throughout the body.
Mast cell activation may vary based on what each individual is more sensitive to, as well as including some more typical problem foods or chemicals that everyone with overactive mast cells might find problematic. Symptoms can include a broad range and include mental health and behavior changes so diagnostic approaches might miss an inflammatory chronic immune response as the cause.
In Long Covid there may be residual virus but it is possible, maybe probable, that there is simply an overactivation of the mast cell system continuing to react to any food or toxin or even stress.
Mast cells can be activated by viruses and are involved in defense against a viral infection. (20) People suffering with over activity of mast cells tend to not have very many colds or flu symptoms, even though they may have many other symptoms associated with the excessive inflammation and elevated histamine levels, or they may have lingering cases.
Suppressing a mast cell response while trying to actively fight a viral infection would be limiting the body's natural defense against a virus. Polyphenolic flavonoids are known to reduce mast cell inflammation and some have antiviral benefits such as luteolin.(20)
Luteolin is found in celery, thyme, green peppers, and chamomile tea. (21) Some with over activity of mast cells might do better with the celery and thyme. Green peppers may be a mast cell/histamine problem food (22) and chamomile tea is a flower which some people with seasonal allergies (mast cell activation) may react to. See reference G10.12, Nrf2 Promoting Foods, chamomile tea is discussed and may be beneficial for people who are not sensitized to its pollen.
Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.
Psychiatric medications can deplete the body of essential nutrients and make worse symptoms from the nutrient deficiencies.
From the book; Antidepressants, Antipsychotics and Stimulants by Dr. David W. Tanton, Ph.D. (34)
The sudden loss of the medication can leave the brain with unusual thoughts, uncontrollable and frightening. Akathisia is a word used to describe odd body movement s that can occur as a side effect of many medications, but it may also indicate an inner restlessness of the mind too.
Gradually withdrawing from the medication may help reduce the symptoms. The risk of having an akathisia reaction may involve a genetic difference in ability to clear drugs from the body - fewer enzymes needed to breakdown medications or toxins.(35)
Gradual withdrawal is critical. Some patients shared in forums cutting their pills in very tiny fragments and having those for days or weeks while weaning off a medication. Very little to no official guidance is available to medical professionals or patients regarding the risk of potentially deadly side effects or how to cope with the problem. Symptoms may occur after brief use of only a few trial days, or after months or years of use of varied medications. It can be common for a person with mental health symptoms to be prescribed a range of medications to "Just try it, see if it helps." What if it makes things worse though? The mast cell degranulation system is dysregulated in cocaine withdrawal, (36), maybe it is also in akathisia medication reactions.
Eating pomegranate seeds daily, or twice on bad days, helped me with withdrawal problems from olanzapine, a psychiatric medication. Half a pomegranate is about 1/3-1/2 cup seeds, that or 3-4 ounces of 100% pomegranate juice helped stop the whirling repetitive thoughts that were usually fearful or negative in some way.
When you are avoiding many foods and any ingredients mad from them it can become difficult to find anything to eat - so time to cook and bake.
Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.
Jennifer Depew, R.D.
Copyright © 2020 Jennifer Depew, R - All Rights Reserved.
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