There are a few articles I found that were really great for learning about low histamine diets. Between the articles and some SWAGing (Scientific Wild Ass Guess) I have come up with some pretty decent connections that have helped me greatly in finding triggers. SWAGing is obviously not ideal, but when you are dealing with a rare disease I find you either learn to do it or flounder.
*Side Note: I was introduced to the term SWAG by this Tiktok video. I fell in love with it*
My mast cell activation syndrome causes me to be on a low histamine diet. Finding decent information on a low histamine diet is extremely hard because most articles absolutely stink. They rarely have reasons why something is on the list and when they bother breaking down the list into categories they often are conflicting. I love the Medical News Today article I found on it because they actually do a nice job covering the scientific reasons for food histamine intolerance issues. It is technically an article on histamine intolerance. Histamine intolerance is another medical disorder like IBS which is now called IBD. A disorder is not a disease. A disorder is caused by a disease. An arrhythmia is a disorder often caused by a cardiovascular disease. Why does this definition matter? Because disorders should not be treated as a disease. Its a way of easily labeling a grouping of symptoms. If you don't treat the disease causing the disorder the disorder often gets worse. Finding the cause of your histamine intolerance will help greatly in narrowing down what foods you may want to watch as triggers. I also have EoE which allows food and drink particles into my blood stream. Sorry no link for that. I got that information straight from my GI doctor and have yet found any information that backs up what he said. That being said my body works that way, so I'm not doubting it. I become triggered by things common in liquids much faster than food items.
Onto the good stuff. Per medical news today:
"Histamine intolerance occurs when there is a buildup of histamine in the body. Drugs, medical conditions, the environment, nutritional deficiencies, and diet can lead to histamine intolerance. Factors that lead to histamine intolerance cause the following:
• An increase in how much histamine a person's digestion releases.
• A decrease in the effectiveness or abundance of diamine oxidase, or DAO, the primary enzyme that breaks down ingested histamine.
• A decrease in the effectiveness or abundance of histamine-N-methyltransferase, or HNMT, an enzyme that helps break down histamine within cells."
Noting those three reasons can be huge to figuring out why you are reacting at any given moment. Sometimes, probably often, its a combination of all of them. Most mast cell people learn quickly that our food often has histamine and histamine is higher in food that has been in contact with air longer. Medications, conditions, vitamin C & B-6, copper, or zinc deficiencies, stress, food and drinks, low oxygen levels, injuries, and even temperature extremes can effect your ability to deal with histamine from your diet.
That article also has a nice list of symptoms of histamine intolerance. They do not go into why you might have these symptoms, but I'm probably making some more SWAGs. The fact that they list diarrhea, chronic constipation, and IBS, however does bother me. IBS includes diarrhea and constipation, especially if they're chronic folks. So here's my SWAG on why certain things are on the list.
Allergic type reactions! An allergic reaction is when the body has an IgE trigger that causes the body to release chemicals (such as histamine) that tell the body to have an inflammatory response so it can destroy the invader! Your mast cells are heavily involved in this. The nice thing about IgE proteins is we can easily see them in the blood. When you don't have an IgE protein for something you are not allergic to it. You can be triggered by it however. A lot of this information is not well known. I would guess its partially because our immune systems are not well understood and a lot of doctors have enough on their plates dealing with stuff we basically know how to deal with that they just don't have time to read scientific journals. I have started searching for nerdy doctors. They must thrive on learning for me to want to spend time with them. There are plenty of doctors out there that you can't be allergic to peanuts unless you have an immediate horrific reaction. That's wrong on so many levels. Having an immediate horrific reaction only means your body is extremely sensitive to something. Back to the point, most of the items listed under the article are all common signs of an allergic reaction. When histamine is a major component of telling your body its having an allergic reaction its not really surprising that you might have a similar reaction if you aren't dealing well with histamine in your diet. That moment you realize the editor didn't know enough general medical information. Less common symptoms of a histamine intolerance is anaphylaxis. Why you don't say?
GI track irritation. Irritating your GI track causes an inflammatory response as your body tries to fix it
Chronic headache can be caused by pure inflammation of the skull or allergic type reactions. I only note this separately because I've been told time and again that vessel inflammation and allergic type reactions are very different things. Ultimately I'm not a doctor. If you can understand the difference please explain with science, because all I'm hearing is inflammatory response.
Dizziness has many causes, so many causes. Its about as easy to track down as unexplained exhaustion. Often unexplained symptoms actually just means the water is too murky to label it distinctly. If you're part of the rare disease community you know the hell of having a doctor saying well it must be x because that's a very common symptom of x. Its also a common symptom of many other conditions because its often a inflammatory response. You may begin beating your head against the table now. Oh but wait under less common symptoms they list sleep problems. Really? Must keep going!
Severe menstrual pain is not one I'd bother taking to a doctor because its going to stretch many doctor's minds. However, you may have less issues with your period if you get a better hold of your histamine response. Remember folks, our whole body is interconnected. There are more common boundaries, but nothing is a lone ship.
Okay so here's the serious SWAG moment. Irregular or increased heart rate, tremors, low blood pressure, and dizziness are all things that can happen with large or chronic adrenaline rushes. Having a lot of adrenaline coursing through your body can actually cause all kinds of autonomic functions to go haywire. If you get an adrenaline rush for no reason you can also have unexplained anxiety. What do we do if a person is going into anaphylaxis? Pump them full of adrenaline. Our body will do this naturally to combat histamine and other allergic type responses. I and many others I have spoken to have noticed close ties between autonomic dysfunction, anxiety (or anxiety presenting as another mood eg depression), and our histamine issues. We cut back our food histamines and we often have the others get better. Any of the three can effect the other two. I find this most notable because it isn't well documented and yet its a logical conclusion. Some doctors will not take to it because they are black and white inside the box thinkers. I avoid those like the plague because rare diseases just don't go well with those mind sets. We don't know enough about rare disease (typically) to know anything for sure.
My favorite symptom listed though is loss of consciousness. I'm assuming they mean without an obvious explanation, but when you're having autonomic functions going haywire are you really surprised someone might pass out? Especially since we still don't actually have autonomic dysfunctioning well described?
On to the meat and potatoes! Where does the diet come in?
https://www.histaminintoleranz.ch/downloads/SIGHI-Leaflet_HistamineEliminationDiet.pdf
The table saying what foods are typically tolerated can be used if you want some examples. The really great part of this resource is at the end of that PDF where they explain the difference between the high histamine foods, biogenic amine foods, histamine liberators, DAO inhibitors, and foods that increase intestinal permeability. The best part however?! They also list what medications help best for each issue. In that PDF they do not mention if there is actually difference between histamine liberators and histamine releasers. I have seen some lists that have them listed separately. I have also seen them given two different definitions of either causing the body's cells to release extra histamine or causing histamine in certain foods to be released at higher amounts. In the PDF histamine liberators is specifically meaning cells are releasing extra histamine. I could see two causes of food histamine being released. It could be the histamine is attached to another chemical compound similar to how water can attach to other compounds. Another possibility is it could be that the food you ate is causing more fermentation of other foods in your stomach and the histamine levels are rising because your stomach is suddenly a still. Below is quoted information from the PDF because it explains almost all the different categories well.
- High histamine foods - histamine is formed as a deterioration product in perishable food, in microbial fermentation and maturation processes and in the ripening of fruit. Even some vegetables are naturally histamine containing, although very fresh.
- Other biogenic amines - besides histamine, there are numerous other biogenic amines. Several amines share the same main degradation pathway with histamine: They are competing substrates, degraded by the same enzyme diamine oxidase (DAO). The DAO prefers other amines before it degrades histamine. While the DAO is busy with the breakdown of other biogenic amines, the breakdown of histamine is temporarily decreased or blocked. Some of these biogenic amines have properties similar to those of histamine and can cause histamine-like symptoms directly.
- Histamine liberators - the foods and additives listed on the right have the property of releasing endogenous histamine from certain cell types (mainly from mast cells). This mechanism is independent from a lack of diamine oxidase (DAO). Histamine release is enhanced in persons with mast cell activation disease (MCAD) and to a lesser extent maybe also when the enzyme activity of histamine-N-methyltransferase (HNMT) is reduced. HNMT is an intracellular histamine degradation pathway. Even healthy people can react to liberators if the dose is strong enough.
- Diamine oxidase inhibitors - the diamine oxidase is a sensitive molecule that can be inhibited in its activity by chemical influences. The foods and additives on the right are or contain DAO inhibitors that can block the breakdown of histamine by the DAO. It is still too little known about which substances can inhibit The activity of histamine N-methyltransferase (HNMT) can also be inhibited by chemicals, but it is little known about which substances are inhibitors.
- Increase in intestinal permeability Certain substances affect the intestinal permeability ("Leaky Gut Syndrome"). They make the intestines to leak, so that macromolecules and other substances from the digestive tract can enter the body, which normally is not the case. This enhances the risk to develop an IgE or IgG food allergy or poisoning.
A note on bacteria and yeast. We know there are good and bad bacteria, but beyond that the information starts getting shaky. Both can be responsible for histamine levels. Ground meat is often highly avoided because it has been so thoroughly exposed to the air causing the bacteria to be able to be much more active. Histamine intolerance can even be caused by a bacteria or yeast getting a foot hold in your gut and over producing histamine. At the same time we need certain strains of bacteria and yeast.
Sources & other reading:
https://www.medicalnewstoday.com/articles/322543
https://www.histaminintoleranz.ch/downloads/SIGHI-Leaflet_HistamineEliminationDiet.pdf
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