You’ve heard that fermented foods are good for health. Few would dispute that, including me. From the gut to the brain, to the womb and skin – there is no part of the body that doesn’t benefit when we eat foods wiht good microbes (read more about this in past articles here, here, and here). There is one potential problem of fermented foods, however, that is not widely known or discussed. The issue is histamine.
Bank on it: Fermented foods have histamine!
Histamine is plentiful in all fermented foods whether that be vegetable-, dairy-, meat-, grain-, or legume-based ferments. These include but are not limited to sauerkraut, kvass, kimchi, and fermented pickles; yogurt, kefir, lassi, cheese, sour cream, and buttermilk; salami, pepperoni, bologna, and fermented sausages; wine, beer, and other alcoholic beverages; natto, miso, soy sauce, vinegar, and, to my dismay, chocolate. If food products have used microbes to transform raw materials into something with a tangy, sometimes sour source of nutritional goodness, histamine is likely present. I wish it were different.
Histamine is one of many bioactive chemical messengers classified as biogenic amines that regulates vital body processes; such as brain, cardiovascular, and digestive functions; and defends against foreign substances. Without histamine, we would have major functional deficits; in excess, histamine causes problematic symptoms. The total load of histamine in the body at any instant is a product of three things: 1) the amount coming into the body from histamine-rich foods and food additives (external inputs), 2) the amount made and stored in the body (internal inputs), and 3) an individual’s capacity to degrade excess histamine through functional enzymes. When histamine inputs exceed the body’s ability to degrade histamine, thereby, keeping histamine below its threshold, symptoms develop.
Think of your daily histamine tolerance as a bucket (see image on the right) (1). Your bucket may be larger or smaller than another’s, representing an dose-dependent limit of tolerance unique to each individual. Once your bucket is full, histamine spills overs and symptoms result. Larger amounts of excess histamine often produce more severe symptoms than smaller amounts. Acute symptoms may resemble an allergic reaction, but should not be mistaken for an allergy. Chronic symptoms are often vague and hard to attribute to histamine excess. Still, individuals manifest excess histamine differently with a combination of early and late onset, acute and/or chronic symptoms, which only adds to the diagnostic difficulty.
Acute symptoms (1, 2):
•Skin: urticarial (hives), erythema (flushing and reddening), swelling, pruritus (itching),
•Gastrointestinal tract: heartburn, bloating, diarrhea, cramps, and gastric reflux
•Lower airway: cough, respiratory distress, asthmatic symptoms
•Oral cavity and upper airway: nasal congestions and runny nose, swelling of the lining of the nose, phlegm, cough; conjunctivitis (irritated, watery, reddened eyes)
•Cardiovascular system: hypotension (drop in blood pressure), tachycardia (“heart racing”),
•Nervous system: headaches
• Chronic inappropriate fatigue
• Dysmenorrhea (painful menstruation)
• Sleep disturbances (insomnia)
• Confusion, irritability, panic disorder, and depression
Histamine in foods other than ferments (external histamine)
In food, histamine is formed by specific microorganisms that can convert histidine, one of 20 protein building blocks, to histamine. Not all microorganisms have machinery (enzymes) for this conversion, which makes some foods more prone to histamine than others. With fermentation founded on the activity of various microorganisms – many of which have histamine-producing enzymes – fermented foods typically have high histamine levels (3, 4).
Besides fermented foods, histamine is also a product of microbial action in fish not gutted within 20 minutes of catching, leftover meat and poultry, and overripe or rotting plant foods. Citrus fruits, berries, pineapple, tomatoes, eggplant, and pumpkin are also histamine-rich, yet it is unrelated to microbial histamine activity. Aside from histamine content, certain foods and food additives have histamine-releasing properties possibly related to food intolerance mechanisms. Egg whites, food dyes such as tartrazine, stabilizers, taste enhancers, and preservatives such as benzoates and sulfites are known to increase plasma histamine in people sensitive to these chemicals (1). Histamine-rich foods and foods with histamine-releasing chemicals increase the total histamine load in the body, thereby filling the histamine bucket.
Histamine produced in the body (internal histamine)
In addition to external histamine inputs, immune cells throughout the body convert histidine to histamine for storage in mast cells. Inflammation or invasion of pathogenic bacteria and other foreign invaders, such as allergens, cause mast cell degranulation, releasing excessive amounts of histamine. Histamine is the first “defence chemical” to the scene, and triggers inflammatory and allergic symptoms we all hate. Although allergy symptoms resemble symptoms of histamine excess, the cause and onset of each is different: The onset of all allergies is immediate and is immune-mediated; whereas, histamine intolerance may have delayed onset and results from excess histamine that is not efficiently cleared by enzymes in the body.
Microorganism in the gut account for the second part of internal histamine inputs. Similar to microbes in fermented foods, the gut also has microbes equipped for converting histidine to histamine. Healthy intestinal microbiota has less histamine-producing microbes. Instead healthy microbiota has microbes that actually degrade histamine, thus lowering the total load of histamine in the body. An intestine overgrown by harmful microbes, on the other hand, often has numerous histamine-producing microbes and a lower amount of histamine-degrading microbes.
This is where problems arise. Individuals with an altered composition of intestinal microbes, which is due to dysbiosis or small intestinal bacterial overgrowth, may have lower tolerance to histamine-rich foods, such as ferments. So a much loved breakfast of sauerkraut, beet kvass, eggs benedict, and fermented sausage may push some people over the edge with symptoms galore, while leaving other asking for more.
Why is histamine a problem for some people and not others?
Allergies and poor gut health aside, there is yet another reason why histamine in a problem for some people and not for others. People with increased sensitivity to histamine often have a genetic or acquired impairment of the enzymes that degrade histamine in the gut and peripheral tissues. Two enzymes, diamine oxidase (DAO) and histamine-N methyltransferase (HNMT), are essential for histamine degradation. Without these enzymes functioning properly, food with acceptable amounts of histamine (i.e. fermented foods, fruits, eggs – the normal things people should tolerate and enjoy without inducing symptoms) easily tip the histamine bucket, so to speak, causing histamine to spill over into the bloodstream.
The diagram (below) (2) illustrates the difference between a healthy, normal response to histamine, histamine intoxication/poisoning, and histamine intolerance. Healthy individuals have fully functioning and adequate amounts of DAO and HNMT (see figure A, left). They can handle day-to-day inputs of histamine, not to mention sausage and perogies with sauerkraut (my favourite yet intolerable at the moment). Cases of histamine intoxication (see figure B, middle) result when healthy people have excessive inputs of histamine either from food or allergies. Ingestions of foods with histamine above 500mg/kg body weight is intolerable for anyone (2). Food scientists actually use histamine levels to assess spoilage, which is communicated in best before dates. Then there are people whose histamine tolerance is drastically lower than in healthy individuals (see figure C, right) due to impaired DAO and/or HNMT.
The third scenario is where I am currently; however, the following practices have improved my tolerance, immensely, allowing me one ounce of beet kvass and a tablespoon of sauerkraut, daily, symptom-free. I can also eat meat without asking a billion questions. Whoohoo!!! Life for this fermentation lover is better now than five months ago when my histamine intolerance was discovered.
Solutions for people with histamine intolerance
•Overhaul the gut. This is easier said than done, and may take months to accomplish. I like Tom Malterre’s 5-R Program from his book, Nourishing Meals, for healing the gut: remove, replace, reinocculate, repair, and rebalance (5). Remove offending foods that are irritants to your system. Replace enzymes and digestive substances that may be low in a damaged gut. Reinocculate with probiotic-rich food (if histamine is tolerated) or use a histamine-friendly probiotic supplement (see below). Repair the gut lining especially using homemade bone broth, which supplies glutamine and glycine (note: bone broth must be made in a specific way to minimize histamines). Rebalance your lifestyle to instill balance, exercise, relaxation, and enjoyment. These are basic principles that will make some improvement to your gut.
•Take a Bifodobacteria-exclusive probiotic (6). Many lactobacillus strains used in probiotics are histamine producers, which we want to avoid when trying to lower histamine.
•Avoid toxins in your environment (air, water, food, clothing, furniture, personal care products, etc.). Toxins dump into the intestinal tract to further damage good bacteria, the ones that degrade histamine. Additionally, detox toxins currently stored in the body.
•Work with a health professional, specializing in histamine intolerance. A 4-week elimination diet followed by a systematic reintroduction phase (1) (7) (8) will help you identify which of the many histamine-rich or histamine-liberating foods are actually problematic for you.
•Ensure your diet is specifically adequate in vitamin C, vitamin B6, copper, and zinc, which are required for optimal DAO and HNMT function (2) (9).
•Grow green pea sprouts. Peas, lentils, and other dried beans contain high levels of DAO when grown in the dark. Removing an element for proper plant growth “stresses” the plant and increase DAO (6).
The majority of people can enjoy fermented foods and other histamine-rich foods, without symptoms. For the minority of us who can’t, I hope these tips will steer you towards healing so you can enjoy fermented foods, symptom-free.
1. Joneja J. Health Professionals Guide to Food Allergies and Intolerances. Chicago: Acad of Nutrition & Dietetics; 2012. 477 p.
2. Kovacova-Hanuskova E, Buday T, Gavliakova S, Plevkova J. Histamine, histamine intoxication and intolerance. Allergol Immunopathol (Madr). 2015;43:498–506.
3. Leuschner RG, Heidel M, Hammes WP. Histamine and tyramine degradation by food fermenting microorganisms. Int J Food Microbiol. 1998;39:1–10.
4. Straub BW, Kicherer M, Schilcher SM, Hammes WP. The formation of biogenic amines by fermentation organisms. Z Lebensm Unters Forsch. 1995;201:79–82.
5. Segersten A, Malterre T. Nourishing Meals: 365 Whole Foods, Allergy-Free Recipes for Healing Your Family One Meal at a Time. New York: Harmony; 2016. 528 p.
6. FAQs and Fact Sheets – Vickerstaff Health Services – Vickerstaff Health Services [Internet]. [cited 2017 Jul 26]. Available from: http://www.allergynutrition.com/faqs-fact-sheets/
7. Joneja JMV, Carmona-Silva C. Outcome of a Histamine-restricted Diet Based on Chart Audit. J Nutr Environ Med. 2001;11:249–62.
8. King W, McCargar L, Joneja JM, Barr SI. Benefits of a Histamine-Reducing Diet for Some Patients with Chronic Urticaria and Angioedema. Can J Diet Pract Res Publ Dietit Can Rev Can Prat Rech En Diet Une Publ Diet Can. 2000;61:24–6.
9. San Mauro Martin I, Brachero S, Garicano Vilar E. Histamine intolerance and dietary management: A complete review. Allergol Immunopathol (Madr). 2016;44:475–83.