Finding Relief with a Low Histamine Diet
By Jessica Pizano
any years ago, I embarked on an autoimmune Paleo diet (AIP) to see if it would help calm my immune system. The results, at first, were remarkable. I lost weight, gained energy and felt better than I had in years. Like others following this diet I included lots of vegetables; poultry, fish and lean meats; low glycemic fruits and lots of fermented foods such as kombucha tea, coconut yogurt, pickles and sauerkraut. After 12 weeks on the diet, I slowly tried to reintroduce foods carefully, one at a time. Nothing seemed to work. Every nut, seed, bean and gluten-free grain was a disaster. I found myself congested, itchy, covered in hives and inflamed. The worst offender was the day I reintroduced tomato. I had always loved tomatoes and had previously used them all the time in cooking. I decided to make a homemade tomato soup. I took fresh tomatoes and cooked them down with some onion, gar- lic, fresh basil and oregano. Given how poorly my reintroductions had gone thus far I ate just two bites of the soup as my introduc- tion. Within 20 minutes I was covered in hives, itchy, and having severe diarrhea. How could this be? I certainly could not have de- veloped an allergy to tomatoes in a short 12-week period? While it would take me some time to figure out, the common denominator in my failed introductions was dietary histamine.
M Histamine Most of us only think of histamine when thinking of aller-
gies. However, its functions in the body are both numerous and far reaching as it is one of our neurotransmitters (brain chemicals). Histamine is released in the body when mast cells degranulate and may be received by one of four receptors (H1R-H4R). Of these receptors, we primarily understand the H1R (found throughout the body in smooth muscle, vascular endothelial cells, heart and central nervous system) and the H2R (triggers gastric secretion of histamine to regulate HCL production). Typical allergy medications such as Benadryl, Allegra, Claritin and Zyrtec are H1 antagonists, meaning that they block the effects of histamine at the receptor site. H2 blockers are medications such as Zantac and Pepcid traditional- ly prescribed for those with acid reflux. H2 blockers actually target histamine receptors in the gut that release acid. Both of these types of medications do not change actual levels of histamine, but rather stop the histamine from triggering the receptor site which alleviates symptoms of allergies.
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Elevated histamine levels can be found in individuals with histamine intolerance (HIT) and mast cell activation disorders (MCAD). HIT may occur when there are single nucleotide poly- morphisms (SNPs, sometimes referred to as genetic mutations) to the enzymes diamine oxidase (DAO) and amiloride binding protein 1 (ABP1). Symptoms may include gastrointestinal complaints, mi- graines, fatigue, dizziness, runny nose, flushing, asthma and hives. Interestingly, elevated histamine levels also inhibit DAO causing worsening of the histamine intolerance. More severe histamine issues occur with MCAD which is a group of disorders including systemic mastocytosis (SM) where there are increased numbers of mast cells and mast cell activation syndrome (MCAS) where there are normal numbers of mast cells that degranulate frequently. MCAD symptoms will generally be much more severe than HIT and will have symptoms including gastrointestinal complaints, headaches, fatigue, vertigo, flushing, hives, asthma, hypotensive syncope, brain fog, tachycardia and anaphylaxis.
Elevation of histamine will also cause various complaints re- lated to its role as a neurotransmitter. It works to control the sleep- wake cycle and therefore is highly associated with insomnia. It may decrease GABA levels and increase norepinephrine and epineph- rine levels causing anxiety (often severe for those with MCAD). It may cause increased permeability of the blood-brain barrier allowing toxins to cross into the brain. Histamine greatly impacts neuroendocrine control including behavioral state, biological rhythms, body weight, energy metabolism, thermoregulation, fluid balance, stress and reproduction. Hypothyroidism may occur with elevated histamine as it may decrease thyroid releasing hormone leading to decreased levels of TSH, T4 and T3. Brain inflamma- tion can cause neurocognitive issues for patients with chronically elevated histamine.
Appropriate methylation is also essential for proper histamine catabolism. Histamine N-methyltransferase (HNMT) is an enzyme required for breakdown of histamine in the extracellular pathway. Any enzyme that has the name “methyltransferase” requires a methyl donor to function. In this way, decreased methylation may also cause increased histamine levels. Further, presence of a virus may also inhibit this enzyme. This is the reason why individuals may see increased allergies and/or asthma when they have a virus such as the common cold.
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