Histamine intolerance and tips for managing the Christmas period

With the party season about to get into full swing, Christmas can prove to be a minefield for those with histamine intolerance (HIT), particularly because alcohol and the classic festive foods such as mince pies, Christmas puddings, cheese and chocolate are either high in histamine or classed as histamine liberators.

Explore the information below on histamine intolerance before moving on to learn how you can help balance your histamine levels over the festive period.

What is histamine?

Histamine is stored in mast cells and basophils and is produced by other cells when there is a trigger to the immune system. It can also be produced in the colon in the case of an imbalance of gut bacteria.

It has a wide range of important functions in the body. First of all, it plays an important role in the immune system, helping to defend the body against infection and being released in an allergic reaction. It also functions as a neurotransmitter in the brain and nervous systems regulating our sleep-wake cycle, it triggers the release of gastric acid in the stomach and is also involved in the vasodilation of blood vessels amongst other processes. 

Histamine intolerance 

Histamine intolerance (HIT) is the term for the clinical condition where there is an inability to break down histamine resulting in a myriad of symptoms caused by its build-up in the blood. It occurs in approximately 1-3% of the population, but it mostly affects women, particularly those in the perimenopause.

Identifying HIT is difficult due to the array of seemingly disconnected symptoms, reflecting the fact that there are histamine receptors all over the body. Normally, when histamine attaches to these receptors, its effects will go unnoticed. It is only when there is an excess that symptoms will occur. These might include:

• anxiety
• asthma
• blocked or runny nose
• digestive symptoms such as bloating, abdominal pain, diarrhoea and constipation
• facial flushing
• headaches and migraines
• irritability
• low or high blood pressure
• PMS
• skin rashes
• tachycardia

Histamine receptors

There are four types of histamine receptors on body cells (H1-H4), which determine the symptoms experienced in HIT.

H1 and H2 receptors can be found throughout the body, with H1 receptors being present in a wide range of cells including neurons in the brain and nervous system, blood vessels and airways. H2 is mostly present in the digestive system, but also in the brain, uterus and heart tissue. The H3 receptors are plentiful in the nervous system affecting the sleep-wake cycle and cognition, whilst H4 receptors are present in certain tissues e.g. skin and tonsils in a smaller amount.

The histamine bucket

It’s when the breakdown of histamine is compromised, that it can build up until levels in the body are in excess of the amount that can be disposed of. Predominantly in HIT, this is assumed to be due to a deficiency of the gut enzyme, diamine oxidase (DAO). Using the bucket analogy, this imbalance leads to histamine spilling over, causing reactions such as those mentioned above. 

Finding relief

Managing the intake of high histamine foods and histamine liberators, together with careful food preparation and storage, can reduce incoming histamine levels, but the low histamine diet is difficult to stick to long term. It’s particularly challenging over the Christmas period when we tend to eat out, visit friends and family and enjoy eating traditional Christmas foods and drinks.

A nutritional therapist may recommend a low histamine diet in a situation where case-taking reveals two or more of the key symptoms mentioned above such as bloating, a stuffy nose, heartburn and headaches. This would be after examining a food diary, looking at the context of an individual’s situation and ruling out other causes such as DAO-inhibiting drugs.

On a low histamine diet, a number of high histamine foods will be restricted including mature cheese, alcohol, chocolate, cured meats and also fresh foods such as strawberries, spinach, citrus fruit, avocado, plus fermented and leftover foods.

Careful consideration must also be given to food preparation with an emphasis on fresh foods and the immediate freezing of fish and leftover food and avoidance of slow-cooked meals and broths. 

The low histamine diet should be used as a short-term measure with professional guidance provided on nutritious alternatives to replace restricted foods. Practitioners can also advise on how to ensure a steady supply of cofactors to support enzyme production for the detoxification of histamine and also foods rich in natural antihistamines such as vitamin C to minimise histamine release and stabilise mast cells.

Carefully chosen supplements in the appropriate form (with special attention to ingredients) can play an important role in a clinical protocol, together with lifestyle measures and a focus on managing stress – a key trigger for endogenous histamine production.

Tips for the Christmas period

To help you manage your histamine levels over the festive period, here’s a list of suggestions to get you started:

• Keep well hydrated to flush histamine out of the body.
• Enjoy low histamine foods rich in natural antihistamines such as vitamin C and quercetin e.g. apples, blueberries, onions and broccoli.
• Minimise your histamine intake in advance of a Christmas meal or party, if you know you’ll be eating high histamine foods and drinks.
• Avoid eating Christmas dinner leftovers on Boxing Day.
• Use a yeast-free gravy mix or stock cube and avoid making your Christmas Dinner gravy from bone broth.
• Coffee and tea can both act as a trigger for symptoms so opt for a chamomile or peppermint tea instead.
• Moderate your alcohol intake or abstain and enjoy a glass of sparkling water.
• Alcohol-free drinks may also contain high levels of histamine so again consider sparkling water as your choice of drink.
• If you do drink wine, experiment with a wine wand to lower histamine levels.
• Avoid the cheese board and charcuterie selections.
• Try to avoid the temptation of chocolate and swap to a low-histamine fruit as a sweet alternative.
• Take an Epsom salt bath once a week or more to aid detoxification of histamine.
• Find time to relax and minimise stress levels.

Take a targeted and personalised approach to histamine intolerance

Histamine intolerance can feel like a minefield, but changes to diet and lifestyle can help to reduce symptoms and even keep them at bay. As a registered nutritional therapist with a special interest in histamine intolerance, my approach focuses on food, gut health, lifestyle and the use of carefully chosen supplements (where appropriate).  

NHS blood tests and functional tests e.g. stool profiles and DNA testing provide invaluable information and can help to identify root causes to allow a more targeted approach. If you would like support with histamine intolerance, please don't hesitate to contact me.

References

1. Comas-Basté O., Sánchez-Pérez S., Veciana-Nogués M.T., Latorre-Moratalla M., Vidal-Carou M.D.C. histamine intolerance: The current state of the art. Biomolecules. 2020;10:1181. 

2. Dr Janice Joneja. histamine intolerance, The Comprehensive Guide for Healthcare Professionals. Berrydale Books. 2017.

3. Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007;85:1185–1196.

4. Schnedl W.J., Lackner S., Enko D., Schenk M., Holasek S.J., Mangge H. Evaluation of symptoms and symptom combinations in histamine intolerance. Intest. Res. 2019;17:427–433.