High histamine symptoms and fermented foods

On many low-histamine food lists you won’t find fermented foods. Fermented foods are usually labelled as causing high histamine symptoms.

Once a histamine intolerance is identified, the natural next step people take is removing offending foods, including fermented foods. But this is not always necessary. In fact, it can be more harmful than helpful as Histamine Chef, Yasmina Ykelenstam, says. 

Instead of fermented foods being a trigger of a histamine reaction, they can actually be part of the treatment -provided they are prepared properly. 

Fermented foods do not necessarily cause high histamine symptoms.

Understanding what histamine is, where it’s found, and what it does will help in you knowing what steps to take to manage your histamine symptoms and get the root of it.

I can assure you – it doesn’t have to involve removing fermented foods from your diet.

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 fermented foods, histamine is likely present. 

The good thing is that foods fermented in an anaerobic fermentation vessel – one that doesn’t let a particle of oxygen in – have histamine-degrading bacteria emerge late in the fermentation process.

That’s right. It is possible to make ferments without any histamine that are safe for histamine intolerant people. Analysis on my sauerkraut, which was fermented in an Airlock Fermenter for 14 weeks shows it is possible. 

This isn’t the case for fermented foods fermented in other vessels that permit oxygen into the vessel, like mason jars and threaded-lid airlock systems.

Before we get too far into solutions for histamine, some background to histamine may be helpful.

What is histamine?

Histamine is one of many bioactive chemical messengers classified as biogenic amines that regulates vital body processes. Brain, cardiovascular, and digestive functions require histamine. Additionally, it defends against foreign substances. 

Without histamine, we would have major functional deficits; in excess, histamine causes allergy-like symptoms.

The total load of histamine in the body at any instant is a product of three things:

  1. External inputs: the amount coming into the body from histamine-rich foods and food additives,
  2. Internal inputs: the amount made and stored in the body, and 
  3. Clearance capacity: an individual’s capacity to degrade excess histamine through enzymes in the body.

When histamine inputs exceed the body’s ability to degrade histamine, symptoms develop. 

What does histamine do?

Think of your daily histamine tolerance as a bucket (1). Your bucket may be larger or smaller than another’s, representing a dose-dependent tolerance unique to each individual. Once your bucket is full, histamine spills overs and symptoms result. 

Larger amounts of histamine above an individual’s histamine threshold produce more severe symptoms than smaller amounts. 

High histamine symptoms

Acute symptoms may resemble an allergic reaction, but should not be mistaken for a clinical allergy. Chronic symptoms are often vague and hard to link with excess histamine, especially because histamine testing is ineffective. 

Still, individuals manifest excess histamine differently with a combination of early and late onset, acute and/or chronic symptoms (1, 2), which only adds to the diagnostic difficulty.

Acute symptoms

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 symptoms

• Chronic inappropriate fatigue
• Dysmenorrhea (painful menstruation)
• Sleep disturbances (insomnia)
• Confusion, irritability, panic disorder, and depression

High histamine foods

In food, histamine is formed by specific microorganisms that can convert histidine, one of 20 amino acids (protein building blocks), to histamine. Not all microorganisms have machinery (enzymes) for this conversion, which makes some foods more prone to histamine build up than other foods. 

Fermented foods

With fermentation dependent on the activity of various microorganisms – many of which have histamine-producing enzymes – fermented foods typically have high histamine levels (3, 4).

Non-fermented foods

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. 

Histamine liberators

What’s more, 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 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

In addition to external histamine inputs, immune cells throughout the body convert histidine to histamine for storage in mast cells. 

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.

Emotions can also trigger release of histamine.

Intestinal microbes

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. In fact, a 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 lower amounts of histamine-degrading microbes.

This is where problems arise: People with microbial imbalances in the gut (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 people happily going for seconds.

Histamine degrading enzymes

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. That is their histamine clearance capacity is impaired. 

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.

Normal vs. abnormal histamine response

The diagram (below) (2) illustrates the difference between a healthy normal response to histamine vs. histamine intoxication/poisoning vs. histamine intolerance. 

Figure A: Healthy individuals have fully functioning and adequate amounts of DAO and HNMT (figure A, left). They can handle day-to-day inputs of histamine, like chocolate, sausage, and sauerkraut. 

Figure B: Cases of histamine intoxication (figure B, middle) result when healthy people have excessive inputs of histamine either from food or internal inputs. 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. 

Figure C: Then there are people whose histamine tolerance is drastically lower than in healthy individuals (figure C, right) due to impaired DAO and/or HNMT.


Treating high histamine symptoms

The treatment for histamine intolerance isn’t exclusively cutting out high histamine foods. 

With histamine spread over such a large number of foods, a complete restriction of histamine-containing foods is near impossible. Moreover, severe nutrient deficiencies may develop through such a restrictive diet.

A better approach is targeting the root of the problem. This involves restoring nutrient deficiencies, removing microbial imbalances in the gut, supplementing histamine-degrading enzymes, reducing stress, and fermenting foods in complete anaerobic conditions.

Here is more information on treating histamine intolerance

Overhaul the gut

This is easier said than done, and may take months to accomplish. I like the 5-R approach to gut health developed by the Institute of Functional Medicine: remove, replace, reinoculate, repair, and rebalance. Remove offending foods that are irritants to your system. Replace enzymes and digestive substances that may be low in a damaged gut. Reinoculate with low-histamine fermented foods or use a histamine-friendly probiotic supplement. 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 for people struggling with histamine intolerance). Rebalance your lifestyle to instill balance, exercise, relaxation, and enjoyment. These are basic principles that will make some improvement to your gut.

Ferment vegetables in anaerobic fermentation vessels

Not all airlock fermentation vessels are truly oxygen free, yet this is what’s needed to populate histamine-degrading bacteria late into the fermentation process.

Fermentation of anti-inflammatory foods actually boosts anti-inflammatory action, such as fermented turmeric.

To find out more about fermentation that uses this system, consider taking my online fermentation course to learn how.

Take a Bifodobacteria-exclusive probiotic

Many lactobacillus strains used in probiotics are histamine producers, which we want to avoid when trying to lower histamine (5).

Avoid toxins in your environment

Air, water, food, clothing, furniture, personal care products are common sources of toxins. Toxins dump into the intestinal tract to further damage good bacteria, the ones that degrade histamine. 

Counter this effect by enhance your detoxification systems to facilitate better elimination of toxins from your body. Consider cruciferous vegetables and sprouts, matcha green tea, dandelion root and leaves, rosemary, onion, and foods that are high in soluble fibre – legumes, flax seed, barley, oats, citrus fruits, apples, and psyllium husk.

Work with a health professional.

Find a registered dietitian or nutritionist specializing in histamine intolerance. A 4-week elimination diet followed by a systematic reintroduction phase (1, 6, 7) will help you identify which of the many histamine-rich or histamine-liberating foods are actually problematic for you

Resolve nutrient deficiencies

Ensure your diet is specifically adequate in vitamin C, vitamin B6, copper, and zinc, which are required for optimal DAO and HNMT function (2, 8). Again, a registered dietitian could assist you resolving these deficiencies. 

Grow green pea sprouts

Peas, lentils, and other dried beans contain high levels of DAO when grown as sprouts in the dark. Removing an element for proper plant growth “stresses” the plant and increase DAO production (9).

Lower stress

According to people who have histamine intolerance, stress makes their sensitivity worse. Changes in the sympathetic and parasympathetic nervous system controlled by the brain may be the cause of this (10). Stress reduction will also help restore a healthy gut. Correct negative thought patterns, exercise, have fun with friends and family, pray, journal, and meditate to reduce stress. Sometime as simple as making time to be outdoors, in nature can lower stress.

Final thoughts

Histamine intolerance doesn’t have to be a sentence to a dull, isolated life with a plethora of food restrictions, including removing fermented foods.

Contrary to popular histamine intolerance treatment approaches, extreme food restrictions are actually counterproductive.

Additionally, fermented foods made in the total absence of oxygen can be part of a treatment plan as analysis show.

Approaching high histamine symptoms with a holistic approach is the only way to tackle the root cause of a histamine intolerance, so you can get your life back. And isn’t living a full and abundant life the goal.

4 replies on “High histamine symptoms and fermented foods”

Hello….I just know I was “allergy free” until I started eating these fermented foods again and I don’t want to give them up! I had colon cancer and want to be healthy as possible, so I believe in the fermentation. However, I’m starting to cough and sneeze….wondering if the foods has caused reflux??

Interesting response Belinda. I’m about a year late responding to this. I’ve been doing my master’s on colon cancer actually. Some chemotherapy medications can alter the intestinal microbiota composition. Using fermented foods to add good microbes back to your intestine is always a good thing. Hope you’re doing better.

This is the most informative article I’ve ever read about histamines. It will probably also help solve my gut/dietary mystery issues! I can’t thank you enough for sharing this. I feel there’s light at the end of the tunnel.

Hi Janice, thanks so much for this comment. I do strive to make my articles as complete as possible. When I had a histamine intolerance, I read as much as I could on the topic to overcome it as quickly as I could. So glad that you appreciate it and receive value from it:)

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