High performers who struggle with stress and anxiety, or even depression, are frequently perfectionists. They want things to be a certain way, and they have high expectations. Living up to these expectations can increase their stress and anxiety. They have what is referred to as a ‘high histamine type personality’.

There are some apparent traits or personality types observed in high histamine type personality:

High academic achievers
Highly motivated individuals
Carrying inner anxiety with a calm exterior
Being competitive with themselves and others
Having obsessive-compulsive or ritualistic behaviours
Needing a strong sense of routine, order or control over things

Currently, it is thought that roughly 1% of the population could be histamine intolerant with approximately 80% of those affected being middle-aged, with females being more susceptible than males.[1]

When in balance, high-histamine type people are highly intelligent, super productive and tend to be successful in work and life. It’s when their histamine levels get too high that the trouble starts. It often takes the form of stress and anxiety, depression and a lower tolerance for stress.

When you're all stressed out, your body releases hormones and other chemicals, including histamine, the powerful chemical that leads to allergy symptoms. While stress doesn't cause allergies, it can make an allergic reaction worse by increasing the histamine in your bloodstream. If you’re a high performer and you place yourself under a lot of physical or mental stress, you may increase your susceptibility to having a histamine intolerance.

Histamine intolerance is relatively common, though poorly understood, food sensitivity (IgE). It is different from other types of food allergies in both the resulting symptoms and how those symptoms come about. Rather than having an intolerance to a specific food (as seen with gluten or dairy intolerance), histamine intolerance can occur when eating a variety of different foods. Various reasons can cause this to happen; often, it is due to small intestinal bacterial overgrowth (SIBO) or gut dysbiosis. More on this below.

Histamine intolerance can be hard to manage as it seems unpredictable. This unpredictability can be explained with a cup of water analogy. If the cup of water is full, then even a few small drops of additional water will cause it to overflow. However, if the cup is not full, then it would take much more water to have the overflow response.

What is histamine?

Histamine is an organic nitrogen compound involved in the local immune response. Histamine is formed by immune cells called basophils, eosinophils and mast cells, all of which are involved in allergic responses - among other things.

For histamine to form, the amino acid histidine undergoes decarboxylation. Histidine is one of the nine essential amino acids which is found in many different foods, especially fermented foods and protein supplements. Histamine is also formed by certain species of bacteria found in the gut.

What are the symptoms of histamine intolerance?

Itchy skin, eyes, ears, nose
Hives, rashes, athletes foot
Tissue swelling, especially facial and throat
Hypotension (drop in blood pressure, dizzy when you stand up quickly)
Rapid heartbeat, heart palpitations
Anxiety or panic attack
Chest pain
Nasal congestion
Seasonal allergies
Conjunctivitis (red itchy and watery eyes)
Headaches and migraines
Fatigue, confusion, irritability
Digestive upset
Heartburn and reflux
Blackouts and loss of consciousness

Symptoms can go from merely annoying to life-threatening. If a bad lifestyle already compromises your health, histamine intolerance can undoubtedly make things worse. Following a holistic approach, like the 5-Pillars of Sustainable Health, is the best place to start when dealing with histamine intolerance.

How does histamine work?

If you get an insect bite, you can experience redness, itchiness and swelling, which is part of the normal healing process that histamine is used to mediate. Suffering these symptoms due to allergies is a sign of excess histamine production or failure to breakdown histamine.

We need histamine, it's part of the natural healing response. The issue is when histamine levels are too high, and we have trouble breaking it down. The term “histamine intolerance” is not a true reflection of the issue, and a new name “mast cell activation syndrome” (MCAS) is starting to emerge. Most doctors will have no idea what you're talking about it you say histamine intolerance.

When histamine is produced, it is normally broken down by two enzymes diamine oxidase and histamine-N-methyltransferase. Most of this breakdown occurred in the gut, and this is why MCAS can lead to gut issues.

For most people, histamine is not a problem; it’s a normal part of physiological response to help inflammatory action and is then broken down and cleared from the body. The shift in the gut microbiome that we have seen in recent times is one of the main reason why MCAS is on the rise, just as celiac and gluten intolerance is on the rise.

Histamine Testing

To get to the bottom of the histamine issue, you will need to do further testing. Ask your doctor to test:

Serum diamine oxidase
Serum histamine
Serum tryptase - sensitive marker for mast cell activation

As an example:

If one is normal and two is high, you may have an issue with overproduction of histamine due to gut dysbiosis.
If one is low and two is normal, it suggests you have a genetic deficiency of diamine-oxidase, and you will need to supplement.

There are two main reasons why someone may suffer from MCAS:

1. Making too much histamine - this can be caused by gut dysbiosis. Certain types of gut bacteria produce histamine, and other types degrade it. It's possible to have an overpopulation of the bacteria which produce histamine, and not enough of the degrading bacteria to control it.

Over-activation of mast cells can also increase the production of histamine. At this time, researchers are unsure what causes this to happen, it could be genetics, or it could be something else.

2. Inability to break it down - this can be one or more of three causes:

⁃ Impaired methylation as histamine-N-methyltransferase requires methylation to function

⁃ Not enough histamine degrading gut bacteria (gut dysbiosis)

⁃ A genetic issue with diamine oxidase production

What foods to avoid?

A low histamine diet is recommended to lower the total histamine in the body. You will still want to address the underlying cause of histamine intolerance for long-term healing.

The low histamine diet is a critical part of the treatment and for symptom relief. Fermented foods are the biggest offender and must be removed from the diet. All the things that we are often told are healthy for the gut.

The bacteria in the fermentation process produce histamine. These foods are like kryptonite for people who have histamine intolerance and should be avoided for a period of times. Seafood and shellfish must be eaten super fresh as histamine levels can quickly increase as the product ages. Canned or smoked fish is to be avoided.

Eggs as well as processed, cured, or smoked meats like bacon, sausage, salami, pepperoni, must be avoided. Leftover meats can also be high in histamine, and it’s best to eat only fresh grass-fed meat. The levels of histamine in cook meats start to rise as the meat ages; this is due to the bacteria action which occurs when meat is stored.

Certain foods contain high levels of histamines while others have a histamine liberating effect. When undertaking a low histamine diet both groups of foods need to be avoided, given the result is essentially the same, being that excess histamines in the body causing a histamine reaction.

FOODS THAT ARE HIGH IN HISTAMINE

Additives and preservatives
Alcohol (particularly beer and wine)
Avocado
Coffee and tea
Cured and smoked meats and seafood
Dried fruits
Eggplant

Fermented foods (cheese, kimchi, kombucha, sauerkraut, yoghurt)
Foods high in protein
Vinegars and vinegar containing foods (e.g. pickles and mustard)

Leftovers can also cause an excessive reaction, as histamine content increases with the maturation of food.

FOODS THAT LIBERATE HISTAMINE[1,2]

Bananas
Chocolate / cacao / carob
Citrus fruits
Crustaceans
Egg white
Most nuts and seeds (except macadamias)

Paw paw
Pineapple
Pork
Spinach
Strawberries
Tomatoes and tomato-based products

Certain medications may also block DAO activity or liberate histamine, both of which will cause a histamine reaction. Examples include antidepressants, NSAIDs or radio-contrast agents used for x-rays.[1]

Just about all your favourite foods, right?

The idea is not to remove these foods for the rest of your life. The aim is to remove these foods for a short period to help improve the histamine issue. Once you address the underlying causes like the gut dysbiosis or methylation, then you can start to add these foods back in, hopefully without any ill effects.

There is a huge discrepancy in the levels of histamine intolerance, and some people can eat some of these foods with no issues and others must avoid all of them. Each individual needs to experiment with what foods they can and can not eat. Awareness is critical and taking a food log while recording any symptoms in the 24 hours that follow can be very useful.

It’s best to remove all these foods at the start for 30days, and then one-by-one start adding foods back in. If you're keeping a log, you should be able to figure out what foods are ok and what foods are not.

Behaviour Changes to Manage Stress and Anxiety

There are many different behaviour changes that high histamine type personality can implement to help control their anxiety and stress. One such behaviour change comes from Brene Brown’s work on perfectionism is highly recommended. In her book The Gifts of Imperfection, Brene says perfectionism is what we do to protect ourselves from being hurt and criticised. When we worry over the question ‘What will people think?’. We are not allowing ourselves to be seen, warts and all. A good mantra, to begin with, is “I am enough”. Because you are.

Being able to let go of the small things and set your priorities can be useful. Learning to ask for help and take the pressure off can also make a massive difference to anxiety and stress levels. You do not need to do everything solo; asking for help is a real strength.

Working with a health coach can be useful in term of implementing behaviour changes that can help lower histamine leves including diet, sleep, supplements and more. If your interested to find out more please contact us.

As always, this information is not designed to diagnose, treat, prevent or cure any condition and is for information purposes only – please discuss any information in this blogpost with your health care professional before making any changes to your current lifestyle

What about supplements?

If you fail to breakdown histamine, due to methylation or gut issues, you may consider supplementing with diamine-oxidase. Gut dysbiosis can commonly cause increased amounts of histamine in the body. If this is the case, you should follow a low histamine diet and consider doing both and Organic Acids Test and a Stool Test.

Quercetin, bromaline, pine bark extract, or pycnogenol are supplements that can help lower the production of histamine.
Diamine oxidase (DAO) is a supplent that can lower histamine buikd-up. DAO must be taken very shortly before meals as it has a short “half-life” - the time it takes for the enzyme to become inactive. Its effect is limited to the degree of breakdown of histamine in the dietary components with which it is mixed for a fairly short as the food passes through the digestive canal. As few brands include DAOSin (Sciotec), DAO Histaminase (AllergyResearchGroup), Histame (Seeking Health), HistamAid88 (Swanson), and Dao Histamine Digester Supplement (Nutricology), among others.

In a 2-week study in 14 people with histamine intolerance and symptoms that included abdominal pain, bloacting, or diarrhea, 93% of participants reported a resolution of at least one digestive symptom after taking 4.2 mg of DAO twice daily [3].

It’s important to understand that there are many different reasons for a person to have an excess of histamine in their body and all these should be investigated before reaching the conclusion that DAO deficiency is the cause.
There are also certain species of gut bacteria (probiotics) that can help.

Avoid these: Lactobacillus casei, Lactobacillus reuteri, and Lactobacillus bulgaricus. These strains produce histamines, and they’re found in most yogurts and fermented foods.
Try these and see how you feel: Lactobacillus casa and lactobacillus delbruci are often in fermented dairy and help produce histamine. Lactobacillus Plantarum and bifidobacterium bacteria are two histamine degraders.
Increase these soil-based probiotics: Bifidobacterium infantis, Bifidobacterium longum, Lactobacillus plantarum, and some soil-based organisms. (No, you don’t have to eat dirt to get soil-based organisms in your system. Just go on a nature walk barefoot, and eat fresh, organic, and local meat and vegetables.)

It is challenging to get certain probiotics separately as an individual strain; Lactobacillus Plantarum is often the best bet. Soil-based organisms tend to be histamine degrading and tolerated well by most people.

4. Vitamin C increases diamine oxidase, which metabolizes excess histamine, reduces blood histamine, and protects cells from immune stimulating oxidization, making Vitamin C one of the most effective anti-histamines. Vitamin C is not, however, a mast-cell stabilizer as it does not stop histamine degranulation from mast cells. Vitamin C deficiencies, however, are extremely common with histamine type symptoms. For histamine intolerance between 1 – 3 grams a day, with 2 grams a general recommendation. Vitamin C is generally safe with a few exceptions:

It aggravates oxalate issues and worsens genetic hemochromatosis.
Upset trace minerals such as copper, zinc, and magnesium. A trace mineral supplement should be considered. High levels of vitamin c may also be difficult in cases of unbound copper.
Reduce estrogen, which if low may worsen low estrogen symptoms. Estrogen levels should be monitored.
Lead to osteopenia or osteoporosis, if calcium is low. Calcium levels should be monitored
Vitamin E should also be given, as they work symbiotically.

This is why at higher doses of vitmain C long term should be done under supervision where any interactions can be monitored.

Nutritional therapy designed to improve histamine tolerance and DAO function seeks to ensure adequate intake of nutrients that are involved in breaking down histamine, including copper and vitamins B6 and C [1]. Some research also suggests that an adequate intake of healthy fats and other nutrients — like phosphorus, zinc, magnesium, and vitamin B12 — may play a role in enhancing DAO activity [4].