Hormones and histamine intolerance – reasons why you are suddenly reacting to wine, tomatoes and chocolate!

Are you a woman who feels that as you get older, you have become ‘allergic’ or reactive to more foods and drinks?  Perhaps your allergy symptoms seem to be much worse at a certain time of the month? Maybe red wine triggers red flushed cheeks and sneezing, or tomatoes bring on reflux, or chocolate causes a pounding migraine?

If this all sounds familiar, these new reactions might boil down to you becoming more histamine intolerant due to shifts in your hormones. This blog will help you to understand why this is happening and offer ways to enjoy some of these foods and drinks again without this discomfort.

As a perimenopausal woman myself with a thyroid condition called Hashimoto’s disease, a sensitivity to histamine in foods and drinks crept up with me in my early fifties and caused all sorts of issues from raging night sweats, itchy eyes, a runny nose, headaches and exhaustion. It was pretty debilitating, but thankfully within a week or so of focusing on a lower histamine approach, my symptoms were almost non-existent, and I regained much of my vitality back. I still need to watch my histamine intake but can enjoy eating histamine-rich foods now without big reactions. I hope this will be the same for you too!

What is histamine intolerance?

Histamine intolerance is a condition where your gut has trouble breaking down histamine, a chemical that’s naturally produced in your body. This happens because you are now producing less of an enzyme called diamine oxidase known as DAO in your gut which helps to break down the histamine which is naturally part of certain foods.

These reactions are likely not to be a classic IgE allergy as such, and you do not necessarily have to avoid these foods entirely. Think of your body like a bucket, and when there is too much histamine created, the bucket overflows with symptoms and there are lots of ways of keeping your bucket from being overfilled. Think of the DAO enzyme as like a drain that helps to remove the excess liquid from the bucket, keeping the water level under control. If the drain is clogged due to lack of DAO, the water level can overflow, causing problems.

When histamine builds up in the gut and the body, it can cause a range of symptoms, including digestive issues like bloating, nausea, gut pain and diarrhoea (constipation in some cases). You might also experience skin problems like itching, hives, rosacea flare ups and eczema, as well as respiratory issues like congestion, sneezing and runny nose, as well as headaches and migraine. Some women even report feeling anxious, depressed or experience mood swings. You might also find you get worsening car sickness or sea sickness or you react more to insect bites if your histamine levels are elevated.

Now, you might be wondering why this is happening to you? Well, histamine intolerance can be triggered by a variety of factors, including hormonal changes and even the foods you eat. Some foods, like red wine, fermented foods (kefir, sauerkraut etc), citrus fruits, aged cheeses, dark chocolate, and tomatoes are naturally high in histamine which can make your symptoms worse when your hormones are also out of kilter.

How do hormones play a role in histamine intolerance?

Did you know that women are more vulnerable to histamine intolerance than men? This heightened susceptibility is largely due to how female hormones influence the gut’s production of DAO, which is the enzyme responsible for clearing histamine from our system.

Our menstrual cycles play a role in histamine fluctuations. Research has shown that histamine levels tend to surge during the luteal phase, the second half of your cycle leading up to your period, potentially leading to more symptoms like headaches, insomnia and anxiety during this window of the month. This is likely because high oestrogen levels during the luteal phase stimulate mast cells to release histamine and also downregulates the effect of the DAO enzyme in the gut both. So, because of this dual effect there is much more histamine whizzing around your body just before your period, and you are more likely to react to high-histamine foods like wine, chocolate and tomatoes during this time.

Thyroid disorders, whether hypothyroidism (underactive) or hyperthyroidism (overactive), can influence histamine levels as well as DAO activity, resulting in histamine intolerance for some women who also have a thyroid condition. It’s important to note that histamine intolerance is particularly significant when managing Hashimoto’s disease, an autoimmune thyroid condition. This likely because a TH2 dominant immune system, which is one of the pathways leaning towards autoimmune activity, tends to lead to more allergy symptoms and reactions to our diet and environment. Studies show that elevated histamine levels in women with Hashimoto’s may not only contribute to the thyroid symptoms experienced as well as increasing inflammation and oxidative stress; but it can also worsen blood markers by raising thyroid-stimulating hormone (TSH) production (which you don’t want!). Histamine intolerance may also hinder gut function, thus affecting your absorption of vital nutrients and even your ability to absorb your thyroid medications efficiently.

As we approach perimenopause and menopause, the natural hormonal shifts can have a noticeable effect on histamine levels and DAO activity and this is when some of the more challenging histamine intolerance symptoms can start to kick in. When oestrogen and progesterone play a merry dance during the perimenopause, histamine can be released more freely while DAO activity decreases. This imbalance may lead to excess histamine in the body and may mimic the symptoms of hormone imbalance. During this time, many women may experience symptoms such as hot flushes, night sweats, insomnia, anxiety, depression and digestive disturbances which may be helped by understanding the histamine link. Low-grade histamine and mast cell issues such as car sickness, sea sickness or swollen insect bites may also be amplified whilst a woman’s hormones are changing during the perimenopause and menopause.

If you live with hypermobile joints syndrome, Ehlers Danlos syndrome or are double-jointed, you may also be even more susceptible to both histamine intolerance and mast cell activation syndrome when your hormones are challenged or changing. Think of collagen as the cling film that keeps the body together and if there is a difficulty or difference making collagen this can affect gut function and your gut’s ability to make enough DAO to break down histamine in certain foods and drinks. This difference in your musculoskeletal matrix can add another layer of vulnerability to histamine challenges when going through hormonal changes.

If you get very bloated, especially if the bloating starts from above your belly button, then bacterial overgrowth of the small intestine known as SIBO may be playing a pivotal role in the reason why you might have developed histamine reactions. SIBO can significantly contribute to histamine intolerance by causing an overproduction of histamine in the gut due to bacterial overgrowth, while also impairing the body’s ability to break down histamine properly. This in turn can lead to symptoms like bloating, diarrhoea and skin flushing or rosacea break outs when consuming histamine-rich foods. So a diet and supplement regime to help reduce the SIBO and working on gut health can be a vital piece in the puzzle.

Histamine-rich foods to cut back on

Here is a list of histamine foods in order from highest to lowest. Aim to consume more of the lower histamine foods and do your best to avoid the very high histamine foods and drinks if you are experiencing histamine intolerance symptoms.

Please note that the histamine content of foods can vary depending on factors like storage conditions, handling and preparation and this is not the full list but a general guide. There is no definitive list of high and low histamine foods.

Keeping food in the freezer or the fridge, shopping for fresh food frequently and avoiding leftovers can help to keep histamine in food to a minimum. In contrast, leftovers left to sit on the counter in a warm kitchen will increase the histamine; also fruit and veg that is looking tired or overripe will also be higher in histamine. It is essential to eat food as fresh as possible and handle and store food properly to minimise histamine formation. 

Foods with extremely high histamine levels (>100 mg/100g)

• Fermented fish (e.g. Scandinavian fermented fish) 
• Aged cheeses (e.g. Parmesan, Gouda, blue cheese) 
• Fermented meats (e.g. salami, chorizo) 
• Sauerkraut 
• Kimchi 

Foods with high histamine levels (50-100 mg/100g)

• Cured meats (e.g. bacon, ham, prosciutto) 
• Smoked and tinned fish (e.g. salmon, mackerel) 
• Fermented soya products (e.g. tamari soya sauce, miso, tempeh) 
• Red wine 
• Beer 

Foods with moderate histamine levels (10-50 mg/100g)

• Citrus fruits (e.g. oranges, lemons, limes) 
• Dark chocolate
• Live yoghurt and kefir
• Tomatoes 
• Aubergine
• Spinach 
• Strawberries 

Foods which help to lower histamine

There are lots of foods which naturally contain the histamine reducing enzyme DAO or can help to lower histamine build up. These include a wide range of fruits, vegetables, herbs and spices and many contain natural antihistaminic quercetin, luteolin and vitamin B6. These are foods to add to your shopping basket when you are setting out on a low histamine diet:

• Apples
• Black cumin
• Capers
• Chamomile
• Galangal
• Garlic
• Ginger, fresh root and dried powder
• Holy Basil known as Tulsi
• Lambs’ Lettuce
• Mung bean sprouts
• Nettle tea and soup
• Okra
• Parsley
• Peaches
• Peas and especially pea shoots
• Peppermint tea, fresh mint
• Pomegranate
• Quince
• Red onions
• Red peppers
• Tarragon
• Thyme
• Turmeric
• Watercress

Foods naturally low in histamine include rice, potatoes, quinoa, buckwheat, millet, fresh chicken or turkey, flash-frozen cod or halibut, coconut, most salads and vegetables, as well as blueberries, pomegranate, mango, pears and apple.

Supplements

It can be hard to follow a low histamine diet closely, especially if you are socialising or travelling and this is where supplements can help to manage things if you end up consuming too many histamine heavy foods and drinks, and you are worried about experiencing some challenging symptoms.

Quercetin is my first port of call and it is naturally found in foods like red onions, apples and red peppers. The supplements containing quercetin often also contain vitamin C, nettle and luteolin which work in harmony to help you manage your histamine surges. Palmitoylethanolamide, known as PEA can also stabilise mast cells and mute histamine challenges.

A lack of thiamine (vitamin B1) may also contribute to the more head and brain-related histamine issues such as headaches, migraine, anxiety and brain fog as well as carsickness and seasickness, so this is something to consider if this is your story. Vitamin B1 is vital for many aspects of histamine elimination.

Deficiencies of zinc, copper and vitamin B6 may also contribute to lower DAO levels, so these are the key nutrients to prioritise when experiencing histamine intolerance. There are specialist DAO supplements in the form or freeze-dried kidney or DAO capsules which can be taken at the time of consuming a high histamine meal to help to prevent a build up of histamine later on that day or evening.

Round up

You can be at a loss when you start reacting to all your favourite foods and tipples. However, things do not need to be this way and there are ways to rebuild your DAO levels so you can enjoy eating out again and cooking a variety of foods at home.

Working on a combination of hormone imbalance and histamine sensitivity can be challenging. To help manage your hormones and histamine intolerance our clinical team at NatureDoc can work together with you to identify the triggers, develop a tailored plan to reduce your histamine levels, and support you in feeling your best again. This may include dietary changes, supplements, and finding ways to manage stress. You deserve to enjoy your meals and social occasions – and we are here to help you get there!

References

• Histamine metabolism and female sex hormones in women
• Diamine oxidase (DAO) and female sex hormones
• Effect of dietary fatty acid and micronutrient intake/energy ratio on serum diamine oxidase activity in healthy women
• Effect of the menstrual cycle on serum diamine oxidase levels in healthy women
• Menopausal hot flashes: Mechanisms, endocrinology, treatment
• EMAS position statement: Non-hormonal management of menopausal vasomotor symptoms
• Influence of the menstrual cycle on skin-prick test reactions to histamine, morphine and allergen
• Alternative Treatments for Severely Affected Patients with Urticaria
• Histamine metabolism disorder in pathogenesis of chronic pelvic pain in patients with external genital endometriosis
• Genetic and Environmental Factors in the Pathophysiology of Hashimoto’s Thyroiditis
• Environmental factors affecting autoimmune thyroid disease
• Nutritional treatments in inflammatory bowel disease
• The treatments of hyperthyroidism
• Histamine Intolerance-The More We Know the Less We Know. A Review
• Low-Histamine Diets: Is the Exclusion of Foods Justified by Their Histamine Content?
• Histamine Intolerance: The Current State of the Art  
• Histamine intolerance
• Histamine Intolerance Originates in the Gut
• Regional Changes in Brain Histamine Levels Following Dietary-Induced Thiamine Deficiency in Rats ]
• The increase of histamine levels in the amygdala caused by histidine administration and the suppression of muricide in thiamine deficient rats
• Quercetin with the potential effect on allergic diseases
• Quercetin and Its Anti-Allergic Immune Response