Histamine

Intolerance (HIT)

Written by Dr Sarah Ball

& Dr Louise Newson
 What is Histamine Intolerance?

Histamine Intolerance (HIT) is a condition that is generally very poorly understood by the
medical profession and is rarely recognised or acknowledged. It is important to be aware of
this condition in the setting of a menopause clinic as it does have implications for our hormonal
health, and how we respond to our menopause and to HRT.

What is Histamine?

Histamine is an important chemical that is indigestion, breathlessness, palpitations,

crucial to the body’s functioning - especially migraines, dizziness, anxiety/panic, joint
the gut, the brain, the nervous system and the aches and nasal congestion. Most people
immune system. Everybody needs histamine affected by HIT don’t get all of these
to survive but problems can occur if we have symptoms, some only have one or two
too much of it. Ideally, we have a balanced symptoms, others may get far more.
process happening, where the amount of Symptoms can be very variable; you may
histamine we have entering our bodies is be fine for short or long periods of time
roughly equal to how much we get rid of. If and then symptoms reoccur - either
this balance is altered and we have too much intermittently or continually. Symptoms are
histamine and/or don’t get rid of it as cumulative - the more excess histamine, the
efficiently, then we can develop histamine worse the symptoms are.
intolerance.
Current opinion is that HIT affects about 1 in
Excess histamine can cause a variety of every 100 people. However, as this is a
different symptoms which very often mimic condition that is so rarely correctly identified
allergic reactions. The most common in sufferers, it may be far more common than
symptoms are rashes (e.g. hives), itching, this. It is more common in females and more
flushing, irritable bowel syndrome (IBS), often happens in mid-life.

Is HIT an allergy?

When a person is allergic to a specific trigger they have been allergic or intolerant to things
and is exposed to this - for example, eating they are eating, but have rarely been able to
peanuts - histamine is released inside the pin down exactly what it is that upsets them.
body very abruptly, in large amounts, and any There is no ‘one food’ that is the culprit and
(or all) of the above mentioned symptoms symptoms can take hours to become
can occur within minutes of ingestion. In its apparent. In fact, HIT could be termed a
severest form, this is called anaphylaxis and ‘pseudo-allergy’.
can be fatal. HIT differs from this in that there
is no specific allergy; histamine builds up in Some sufferers have had allergy tests for
the body gradually and is not broken down common allergens, but no specific allergy has
quickly enough. The allergy-type symptoms been detected. Other sufferers have had
therefore come on gradually and more investigations and/or treatments for their
insidiously. HIT is unpleasant but never fatal. symptoms that have never particularly
Many sufferers of HIT have often thought helped - for example, anxiety medications for

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panic attacks, nose sprays for a blocked nose, adequately explained and they can, at times,
or bowel investigations for unexplained be inadvertently made to feel like
diarrhoea or constipation. They sometimes hypochondriacs or ‘malingerers’.
feel their problems have never been

How does histamine build up in our body?

Histamine comes from two main sources - make things more complex, it is not always
from within us (our own cells, called ‘mast’ about the type of food we ingest but how the
cells release it in response to certain stimuli) food was prepared or how old it is. For
and from what we ingest in our diet. Many example, a green tomato has very little
different types of food contain histamine and histamine, but a red tomato has a lot. Freshly
other foods cause us to release more of our cooked chicken that is eaten promptly
own histamine from mast cells; some foods contains very little histamine, but chicken
contain it and make us release it. Alcohol, for leftovers (kept in the fridge for a day or two)
example, contains a lot of histamine and contains more histamine. Fermented foods
causes our bodies to release more histamine. e.g. yoghurt, kefir, and sauerkraut are rich in
Alcoholic drinks can therefore be quite a histamine and should be avoided if you are a
problem if you are histamine intolerant. To HIT sufferer.

How does histamine leave our body?

We have two enzymes responsible for some foods reduce the efficiency of this
breaking down the histamine within our enzyme. In addition, many drugs can affect
bodies. The enzyme that predominantly the activity of DAO, for example, some
deals with histamine from the food we eat antidepressants and painkillers make
is called Diamine Oxidase (DAO). We all histamine intolerance worse. Ironically,
have a different amount of DAO depending many patients may be prescribed these
mainly on genetics (we can’t do much medications for symptoms caused by their
about this) but it also depends on the HIT, if the intolerance has gone
health of our gut (which we can do unrecognised.
something about). As already mentioned,

What has HIT got to do with hormones?

Hormones and histamine have a very close cycle. In addition, estrogen stops your DAO
link, especially in relation to estrogen. As a from working well. If you are intolerant to
woman, your own estrogen (made histamine, you will not tolerate your own
predominantly by your ovaries) peaks at estrogen very well. You might notice that
various times in your life, for example, when any symptoms get more noticeable at times
your periods first start, at the time of in your life when your estrogen is highest.
ovulation each month, and in the This is why those that develop HIT tend to
perimenopause when your levels of start having problems either in their teens
estrogen can become erratic and very high. when their periods start, around the
When your estrogen levels rise, you release perimenopause or every month in a
more of your own histamine. Histamine pattern, e.g. diarrhea or migraines each
then stimulates your ovaries to release cycle or when it’s a particularly heavy or
more estrogen - thus setting off a vicious painful period.

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Interestingly, pregnancy is a time when levels are adequate, those symptoms will
women with HIT actually feel great and are reduce. If we are histamine intolerant
usually completely free of their symptoms. however, and our own estrogen is stimulating
This is because - although estrogen levels are even more histamine, we can get symptoms
very high in pregnancy - the body develops of histamine intolerance and as you may have
a way of protecting the fetus from excessive noticed, the symptoms can be almost identical.
histamine.This is by increasing the amount of
DAO by 500 times, hence breaking down For the vast majority of women who take
histamine very efficiently. If a woman feels the HRT (especially body identical HRT), their
best she ever has during pregnancy, this is a menopausal symptoms reduce rapidly,
very helpful clue in a woman’s history. and they feel significantly better, usually
within 3-6 months. But for those women
Around the perimenopause our hormones who take HRT and also have histamine
can become very variable. There will be intolerance, their symptoms may get worse
times when our estrogen levels are low and as the estrogen being put into the body
typical menopausal symptoms are can be fuelling the HIT even further. This is
problematic e.g. hot sweats and flushes, low why it is very important to consider the
mood and anxiety, joint aches and possibility of HIT in women who get
palpitations. And then at times when our additional symptoms or worsening of
estrogen levels are high, if our histamine existing symptoms, after starting HRT.

How to diagnose HIT

There are blood tests which can look at way to diagnose HIT is to try
levels of DAO activity, histamine levels and and exclude histamine as much as
that of a substance called tryptase (related possible from the diet for a period of
to mast cell activity). However, these blood approximately 4 weeks.This is likely to bring
tests are not widely available and not about an obvious reduction or elimination
necessarily diagnostic - as our levels vary so of symptoms in a HIT sufferer, thus
much from day to day. The gold standard essentially confirming the diagnosis.

How to treat HIT

There are a number of ways to try and tackle HIT and the most important by far is dietary
modification.

Diet be invaluable to help you make these

The most important element of treating changes. This will almost certainly involve
HIT is with dietary modification - the aim needing to cut out alcohol, many dairy
being to keep your histamine load products and fermented products at
below excessive levels. This takes time the very least. Some food typically
to achieve as histamine-containing foods considered healthy may actually not be
and histamine-releasing foods are so good for histamine sufferers e.g. avocado
widespread. You will need to do research and spinach.
into the foods in your diet and experiment
with different foods and how you prepare You may find this table useful, to start
them. A dietician or nutritionist looking at histamine levels in your diet:
knowledgeable about HIT can

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Food Groups Low Histamine High Histamine Note
Avocado, Aubergines, Tomatoes, The fresher the vegetables
All fresh vegetables except
Vegetables Spinach, Rocket, Mushrooms. the better. Possibly peas
Pickled & canned vegetables may cause symptoms.
Fermented Including fermented
Sauerkraut and other fermented
Vegetables & No vegetable sauces e.g. soya
vegetables. Pickled vegetables
Pickles sauce, miso
Strawberries & raspberries, plums,
All fresh fruit citrus (oranges, limes, lemons,
Fruit Avoid over ripe fruit.
except grapefruit).Tropical fruit e.g.
papaya, banana, pineapple, kiwi.

Including food made with

Only dried fruit that has NO Dried fruit with sulphur dioxide dried fruit such as fruit
Dried Fruit sulphur dioxide or and preservatives should be mince, unless it definitely
preservatives. avoided. has no preservatives and
sulphur dioxide added

Gluten free grains and flours

e.g. rice, oat, corn, quinoa, All gluten grains e.g. wheat, barley, Avoid sourdough bread
Grains, flour potato, millet, amaranth, teff, rye, spelt. Sourdough & Yeast, even if gluten free. Gluten
kamut, buckwheat. Einkorn usually found in breads. free soda bread is ok.
ancient wheat flour is ok.

chickpeas, beans, soy, lentils, butter This includes avoiding dips

Legumes & beans, navy beans, black beans, red containing legumes/pulses
No
Pulses kidney beans, black eyed beans, e.g. hummus and soy
peas etc. products such as tofu.

No, except macadamias,

Most nuts and peanuts, most Including nut butters &
Nuts and seeds pistachios, chestnuts and
seeds. spreads
pumpkin, hemp & chia seeds.

Fresh dairy only e.g. fresh Including yoghurt, kefir,

All fermented dairy foods from
Dairy milk, cottage cheese, quark, fermented cheeses, sour
cow, goat, sheep.
fresh curd, mozzarella, ricotta cream.

Plant milks are ok, even if they Take care with ‘fake’ vegan
Dairy are made from nuts/seeds. Fermented plant foods e.g. cheese as they may
alternatives Almond milk, fortified with coconut yoghurt contain artificial colourings
calcium, is the most suitable. & preservatives.
Fresh unfermented/
Extra virgin olive oil, ghee, Fermented/cultured butter, soy oil,
Fats uncultured butter may be
rapeseed oil, coconut oil. nut oils.
ok to eat.
Cured or aged meat e.g. bacon, Aged fresh meat is also
Meat, Poultry, Freshly cooked fresh meats &
salami, hot dogs, high histamine, very fresh
Eggs poultry. Fresh eggs may be ok.
mincemeat. meat is ok.

Mackerel, mahi-mahi, tuna, sardines,

herring, anchovies. All shellfish and
Freshly caught fish
Seafood crustaceans or molluscs. All
except
smoked fish. All canned fish e.g.
tuna, anchovies, sardines, salmon.

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Food Groups Low Histamine High Histamine Note
Chocolate, cocoa, cacao, carob and Sweeteners such as honey, cane
Sugar, Sweets & Sugar & Sweets are
sweets that contain sulphur dioxide sugar & maple syrup are ok. Not
Chocolate ok except
dried fruit, nuts and seeds. artificial sweeteners or malt extract.
Fresh and dried Other vinegars, mayonnaise, tomato Including heavily salted food. Take
herbs, spices, distilled ketchup, pickles, olives, capers, soy care with hot spices - cayenne,
Seasonings, white vinegar, salt, sauce, miso, fish sauce, tamari, chillies, curries - keep dishes mild.If
Condiments & pepper. Homemade Marmite, Vegemite, cumin, excess not using the vegetable/ fish stock
Herbs vegetable stock & garlic. Yeast extract, enhancers immediately after making, then
homemade white (glutamate, sodium glutamate), freeze in portions & use from
fish stock. bouillon, broth, animal/poultry stocks. frozen.
Green and black teas, Yerber Mate,
coffee, kombucha, kefirs & other
Teas & Coffee, Herbal tea, including Including any drinks with artificial
fermented drinks. Tomato & tropical
Drinks rooibos tea. colours or preservatives.
juice. Energy drinks.
AVOID ALL ALCOHOL.

Improving gut health is integral to you understand correlations with different

improving symptoms. Eating a low foods and helps you and your health
histamine diet for 4 - 6 weeks (under the professional to work out a healing plan.
guidance of a qualified professional), may Probiotics may be helpful, however some
bring about benefits to gut symptoms. probiotics aggravate, rather than help, the
Keeping a food and symptom diary helps symptoms of HIT.

Top tips

• It is really helpful to keep a Food Dairy & • Freshness of your food is very important;
follow the above list for 4 weeks under the if possible, buy little and often, so your food
guidance of a professional who is qualified is always fresh
& understands Histamine Intolerance.
• Alcohol is high in histamine, so best to
• Download a food diary from here:
avoid.
https://www.histamineintolerance.org.uk/w
p-content/uploads/2012/03/food-diary.pdf

Supplements and medications

There are no supplements or medications H2 Blockers - H2 are the type of histamine

that can effectively treat HIT without receptor in our stomach. Cimetidine is an
addressing your diet. But there are some example of an H2 blocker; it is a
additional treatments which may help: prescription-only medicine. This can reduce
the amount of stomach acid made in
Antihistamines - these can be brought over response to histamine excess.
the counter (e.g. cetirizine and loratadine
are examples of non-sedating ones). For Vitamin C (low dose) - this acts a natural
HIT they need to be used twice daily antihistamine.This should ideally be taken 3-
(despite the leaflet advising once daily). 4 times per day in small doses, such as
These do not help to lower histamine levels 250mg each dose. This is to avoid the
but can ‘mop up’ any excess. occurrence of loose bowels happening
from single larger doses.

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L-glutamine - this also acts as a natural Some HIT sufferers may be able to wean off
antihistamine. some or all of their treatments if and when
their diet is stable, but others may need to
DAO supplements - these can be taken continue in the long term, to stay well.
30-60 minutes before a meal to try and
reduce the amount of histamine that is It is necessary to consider the impact that
ingested and absorbed. However, they are any other prescribed medications might
expensive. (They may have a role if you are have and its important that you don't
eating out or have a social occasion where suddenly stop any prescribed medications
it would be impossible to avoid histamine without discussion with a doctor who is
foods). knowledgeable about HIT.

Lifestyle

Avoiding stress can be helpful at reducing effects on HIT sufferers. It is best to take
histamine release. Meditation and yoga can regular exercise and see what type suits
be valuable. Exercise can have variable you as an individual.

Managing the menopause

The principles of managing the difficult is having an impact on your life, this needs
symptoms of the menopause still apply in to be factored in when discussing starting
HIT sufferers. Hormone replacement HRT with your health professional. Usually,
therapy effectively treats menopausal once HIT symptoms are under control with
symptoms and provides future health an established histamine-restricted diet
benefits such as lowering your risk of heart (with or without supplements), HRT can be
disease and osteoporosis. However, if HIT gradually introduced.

Further information on this topic

Table compiled from the following:

SIGHI (Swiss Interest Group Histamine Intolerance). www.histaminintoleranz.ch
www.histamineintolerance.org.uk
https://www.food-intolerance-network.com/food-intolerances/histamine-intolerance/
www.drtinapeers.com
https://youtu.be/em-BxpImE6A
https://thecommunality.com/hit-mcas-treatment

This booklet has been written by Dr Sarah Ball, GP with a special interest in the
menopause, and Dr Louise Newson, GP, menopause specialist and director of the
balance app. Louise is also director of the not-for-profit company, Newson Health
Research and Education, and is the founder of The Menopause Charity.

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 Dr Louise Newson is a GP and menopause specialist in
Stratford-upon-Avon, UK and the founder and writer
of the balance app and website.

The website and app contain evidence-based,

non-biased information about the perimenopause and
the menopause. She created both platforms to empower
women with information about their perimenopause
and menopause and to inform them about the
treatments available.

Her aim is for people to acquire more knowledge and

confidence to approach their own GP to ask for help and
advice about their hormones. She is passionate about
improving awareness of safe prescribing of HRT in all
stages of the perimenopause and menopause.

Louise is also the director of the not-for-profit company

Newson Health Research and Education.

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