Nucleus

nu·cle·us/Noun: The central and most important part of an object, movement, or group, forming the basis for its activity and growth.

Histamine Intolerance & Histaminosis

Brief Introduction to Histamine Intolerance -

You’ve probably heard of histamine. It’s the chemical our bodies produce when we have an allergic reaction. But there’s much more to histamine than itchy eyes and a runny nose. We all need a bit of it for our immune systems to work. But too much will make us ill: If our bodies can’t safely break all our histamine down, we can become very ill indeed. This condition is called Histaminosis, (sometimes known as Histamine Intolerance or HIT.)

Histaminosis is a spectrum disorder: At the mild end are those sufferers who get a headache after drinking a glass of red wine, while at the severe end are those at risk of scrombroid poisoning, anaphylaxis and death. Most are somewhere in-between, but they may not realise it because the symptoms are so common. Impairment and misfunction of histamines leads to joint/muscle pain (rheumatoid arthritis), anxiety & depression, and low defence towards certain viruses and bacteria.

About 2% of the population suffer from severe Histaminosis, experiencing chronic symptoms that limit their capacity to enjoy life. More than 10% of the population have some sensitivity to Histamine, becoming occasionally unwell and missing out on time at work, at leisure, or with their families. Compare those figures to the estimated 4% who suffer from the ‘common’ food allergies (like peanuts or shellfish) and you can see that sensitivity to histamine affects far more people. Histaminosis is clearly a serious public health issue.

Our bodies’ histamine is not only liberated by environmental factors such as pollen, pollution, stings or bites. We can also have histamine reactions to food and drink. Much of the food we regard as safe – healthy even – is actually slightly toxic. We only cope with it thanks to our hardworking immune systems.

To make matters worse, histamine naturally occurs in most foods. In fact, there are very few zero-histamine foods. Normally, this histamine would be made safe by special enzymes in our gut: diamine oxidase (DAO), monoamine oxidase-b (MAO-b) and histamine-N.methyltransferase (HNMT). Histaminosis sufferers often can’t make enough of these enzymes, which is why they get ill. The histamine-rich foods common to our western diet don’t give those poor enzymes much of a chance, either. Human evolution has yet to catch up with the convenience food industry.

Clearly, adopting a lower-histamine diet is a significant step towards easing Histaminosis. This is why I’m so happy that Ella has written this wonderful book. Using only scientifically tested low-histamine ingredients, she’s created a remarkable collection of mouth-watering recipes. Here, Ella has shown that it’s easy to adopt a lower-histamine lifestyle without having to feel ‘deprived’ by dietary restrictions.

(Extract taken from ‘The Red Wine Headache Cookbook’ - Foreword by Dirk Budka)

‘Approximately 2 % of the population suffer from a severe form of histaminosis or reaction to other Biogenic Amines. 10% or more have some reaction to Biogenic Amines. These figures show that HIT and Biogenic Amine reaction is now a vastly more serious health problem than all food allergies put together!

Digestive problems, bloating, stomach pain, heartburn, acid reflux but also tension/cluster headaches, migraines, palpitation, low blood pressure, urticaria, eczema, hay fever and asthma can be signs of a histamine intolerance (HIT) or a problem with other Biogenic Amines (BA) like Tyramines (very much connected with Migraines and Cluster Headaches).’ http://www.histrelief.com/

Who Needs A Low-Histamine Diet? 

Some people imagine a leaky bucket being filled with water faster than it can drain away. Our bodies’ tolerance to histamine is like that bucket: each new challenge – a meal, a drink, a high pollen count – fills the bucket up a little more, until it finally overflows. And that’s when we feel ill.

By easing off our histamine exposure, the water level drops a little, and then we don’t feel so bad. But remember, that bucket is still nearly full. It won’t be so long before it overflows again!

So how much histamine is too much? Well, that’s the trouble: Everybody’s tolerance is different. Some people are extremely susceptible and have to carefully manage their exposure to histamine, while others may go through life without ever realising they’ve been affected.

I lived my first twenty-five years blissfully unaware that histamine was a problem for me, until it suddenly became a problem in a very big way! I didn’t know the warning-signs. 

Take a look at some of the symptoms below:

Stomach pain

Bloating

Heartburn & acid reflux

Joint & muscle pain

Asthma

Hay fever

Frequent common colds

Tension or cluster headaches

Migraine

“Red Wine” (or chocolate) headaches

Panic attacks

Mood changes & depression

Dizziness

Palpitations

Low blood pressure

Racing pulse (tachycardia)

Irregular heartbeat (arrhythmia)

Menstrual pain

Pre-menstrual tension

Premature ejaculation

Dry nose

Eczema

Hives (urticaria)

Prickly Heat

Itchy or red skin

With such a wide range of symptoms, Histaminosis is difficult to diagnose and far too often overlooked. I know people whose lives were blighted by miserable, chronic symptoms for years: symptoms that just wouldn’t go away, no matter what pills or potions they took.

Not appreciating histamine’s significance, their doctors grew impatient and unsympathetic; “You’re sensitive,” they’d be dismissively told, “You need to learn to live with it.” I’ve sometimes wondered if many healthcare professionals would be willing to ‘live with’ feeling awful all of the time? Of course not! They’d do something about it.

Yet with Histamine Intolerance you can do something about it! Empower yourself to manage how histamine makes you feel. Take charge over that aspect of your life: The food and drink that you consume. 

Please note -

Everybody is different. Identify the specific ingredients that trouble you the most, and work out the level of histamine you can safely consume without getting ill. You’re the expert at this. Your body will tell you if you learn to listen.

This book describes an effective dietary way to reduce or prevent symptoms of Histaminosis and HIT, but it is not a manual for self-diagnosis or self-treatment. If you suffer from any chronic symptoms you must see a doctor, even if only to rule out any other conditions. You should always seek consultation and supervision from an appropriate medical professional about any matters regarding your health and diet. 

(Extract taken from ‘The Red Wine Headache Cookbook’)

Getting tested for HIT…

First off the bat, strictly speaking we have to be careful about using the word “diagnosis.” In the UK, only a medically qualified doctor who’s registered with the General Medical Council can “diagnose” a medical condition, and other countries have similar rules. An alternative practitioner may offer interpretations of your symptoms & test results, and suggest guidance on ways to improve your health, but it is ultimately up to the individual to work out their own tolerance level and what works best for them. And of course, the success of any treatment depends on a person’s willingness to stick to it.

We used the term “diagnosis” in our survey simply because we felt it reflects how most people feel once their ailment has been identified, either by a medically qualified doctor or alternative practitioner. So as long as respondents personally felt they had a received one, it was good enough for us when analysing the results.

Does that make it clear? Good, lets move on… 

In the search to understand your symptoms, it’s very important to maintain a good relationship with your doctor. Your doctor can be one of your most helpful allies, so try to keep them informed, and interested in your progress. Often, doctors are experienced at dealing with ‘true’ allergies, but may have less understanding of Histamine Intolerance (HIT) because the condition is not yet well known.

So don’t rely too heavily on your doctor to have all the answers you need right away. This is a process in which you’ll both be learning. A technique I’ve used is to take a copy of this scientific study into both my doctor and dentist’s offices - http://www.ajcn.org/content/85/5/1185.full.pdf+html and I’ve found that quite often my health providers have been rather grateful to receive it.

Extract – “The diagnosis of allergy using using the skin-prick test for food allergens or determination of specific IgE should be carried out to exclude food allergy. The diagnosis of allergy usually proves to be negative because histamine intolerance is a pseudoallergy.

In a patient with clinical suspicion of histamine intolerance (ie, ≥2 typical symptoms), improvement of symptoms by histamine-free diet or antihistamines, DAO may be determined in serum (123) or tissue biopsy (32). Several radioextraction assays (REA) have been developed for the determination of the enzymatic activity of DAOFurthermore, the total histamine degradation capacity can be measured (69). Plasma activity of DAO, which generally is relatively low, may be increased by the liberation of tissue-bound DAO through an injection of heparin (127-132), which was the main method used before the development of more sensitive assays. Serum DAO concentrations showed no significant daily variations and no significant sex differences (97). In patients with a DAO activity Histamine intolerance is presumably highly likely in patients with DAO activity <3 U/mL, likely (but less likely) in patients with DAO activity <10 U/mL, and improbable in patients with DAO activity ≥10 U/mL (18, 131).

Conversely, in some patients with a clear clinical picture of histamine intolerance, normal DAO activities have been observed, so that an additional determination of histamine concentrations and interpretation of laboratory data in view of the clinic seem advisable. Histamine can be measured in plasma or in urine, as can its degradation product N-methylhistamine (53, 132).”

In the UK, your doctor may refer you to a specialist Allergy Consultant at an NHS hospital for skin-prick testing. If you have HIT, these tests will probably come back negative, indicating no ‘true’ allergy, and the hospital might discharge you. Don’t be frustrated by this: You can learn as much from a negative test result as you can from a positive. That negative result suggests that you may be right to suspect HIT. Sometimes a large response to the histamine control can also be a good indicator.

HIT is associated with having low levels of Diaminoxidase (DAO), Monoamineoxidase-b (MAO-b) and N-methyltransferase (HNMT,) special enzymes that make histamine safe in the gut. Sometimes an HIT sufferer may also have Small Intestine Bacterial Overgrowth (SIBO), which can result in an imbalance in the gut flora. SIBO can make matters worse because some of those bacteria produce more histamine than your body can break down by itself.

Your levels of DAO, MAO-b and HNMT can be determined with a blood test. In some countries, such as Germany and Austria, such tests may be available through the local public health service. Unfortunately at this time, they aren’t available on the NHS in the UK, although some British HIT sufferers are campaigning to address this.

Interestingly, 60 % of the respondents to our survey had experienced symptoms for over 5 years before seeking help and almost half of responders waited another 3 years to receive a ‘diagnosis’. And out of the 60 % who’d been ill more than 5 years, a quarter of them are still not ‘diagnosed’. And while we’re in number-crunching mode, over half of all respondents reported spending over £1000, while 35 % have spent over £5000.

Please do not be discouraged however, even over the last couple of years, Histamine Intolerance as a condition is becoming more and more recognised. 

So for now, with your doctor’s agreement, an alternative is to ‘go private,’ and pay to have your blood sample analysed by a commercial laboratory. One option is to search the Internet for “The Doctor’s Laboratory,” or “Purehealth Clinic.” They both offer mail-order DAO tests: You have the blood drawn and then post them the sample to them the same day (usually early on in the week to avoid delay at weekends.)

As always, it’s worth keeping your NHS doctor informed and on your side. You might even be able to get your blood drawn for free by their practice nurse if you ask them in advance (some private hospitals also offer phlebotomy services, which will usually cost between £10 and £30.) And again, once you’ve received your test results, don’t forget to give your doctor a copy to add to your medical records.

SIBO can be identified using a Hydrogen Breath Test, which is available through some private practitioners, and on the NHS. However, in the NHS it is a likely to be a gastroenterologists’ test, rather than allergists’. (Ask your doctor if this is the case for your local health authority, so that you can be referred to the correct department.)

Dirk Budka based at the “Integrated Medical Centre” also tests for SIBO, plus histamine and enzyme levels, amongst others. Unlike postal tests, he can give detailed interpretations of the test results, and suggest methods to begin dealing with your condition. [Edit: Dirk Budka has recently stopped practising, and has ‘moved back to Europe and is concentrating on his research, books and supplements’.] In addition, respondents also told us that Dr Adrian Morris at the “Surrey Allergy Clinic” helped them identify HIT.

Hopefully over time, as the condition becomes better recognised, tests and treatment will become much easier to access. If you know of any other practitioners that you feel have helped you, please use the comments box below to let us know.

Of course, opting for private testing inevitably means having to spend some money, and these tests aren’t usually covered by private medical insurance policies. Expect to spend in the region of fifty to three hundred pounds in the first instance, depending on the route you choose. But once I had the first set of results, I personally found that doors began to open for me – such as a referral to an NHS dietician who checked my low histamine diet and confirmed that it was nutritionally balanced. 

And as one respondent put it “Getting everyone on the same page and speaking to one another has got excellent results for me medically.”

The “No” List - 

Sometimes it feels as though a complete list of foods for Histaminosis sufferers to avoid could fill a book on its own. And here’s the bad news: the foods that our society most likes to eat are often the very same foods that are most likely to make us ill. Some are even promoted for their healthful properties!

Some popular foods that are very high in histamine, or that trigger histamine-release in bodies, include:

Red meats e.g. beef & pork

Game meats like rabbit or grouse

Poultry e.g. chicken, duck & goose

Charcuterie like sausages or ham

Fish, including Shellfish and other seafood

Vegetarian meat alternatives derived from soybeans, such as tofu; or from the mycoprotein, Quorn™

Mushrooms and truffles

Fermented cheeses, e.g. Brie, Camembert, Gruyere, Cheddar, Roquefort & Parmesan

Yogurt, especially the pro-biotic kind

Potatoes & Tomatoes

Spinach

Soft fruits, like strawberries, raspberries & blackcurrants

Citrus fruits, like oranges, limes and grapefruit

Dried fruits, such as raisins and sultanas

Pineapple

Chocolate & Vanilla

All nuts except almonds

Anything made with vinegar, such as ketchup, pickles, vinaigrette and mayonnaise

Fermented products, like soy sauce or sauerkraut

Anything made with bakers’ yeast such as bread, or brewers’ yeast like Marmite, Vegemite or Cenovis

Most alcoholic beverages, especially red wine & beer

Coffee and tea

Cola and other soda drinks

“So What Can I Eat?”

This is the Histaminosis sufferer’s dilemma. Imagine walking into any big supermarket with a different kind of shopping list: A list of foods you mustn’t buy. Frustratingly, the aisles seem full of products made with high-histamine ingredients, or manufactured by histamine-liberating processes. The modern food industry just isn’t geared up to cater for histamine-sensitive diners. Little wonder then, that some extreme sufferers become afraid of food. They cocoon themselves with a meagre handful of bland, ‘safe’ foodstuffs. That breaks my heart. Food should be about love and joy, not fear. Not to mention the inevitable malnutrition that comes with such fanatically limiting regimes.

If you’re particularly histamine intolerant, then your symptoms may be a constant roar rather than an occasional murmur. You might start noticing the benefits of ‘Going Low-Histamine’ very quickly or it may take a little longer. Perhaps you’re one of the fortunate ones; troubled only by the occasional headache after red wine or strong cheese, or maybe you experience bloating and gas after eating a pizza. If so, try eating the lower-histamine meals from this book just two or three times each week.

I refuse to be ruled by the “No” lists, telling us what we can’t eat. The Red Wine Headache Cookbook is my “Yes” list!

Please note -

Everybody is different. Identify the specific ingredients that trouble you the most, and work out the level of histamine you can safely consume without getting ill. You’re the expert at this. Your body will tell you if you learn to listen.

This book describes an effective dietary way to reduce or prevent symptoms of Histaminosis and HIT, but it is not a manual for self-diagnosis or self-treatment. If you suffer from any chronic symptoms you must see a doctor, even if only to rule out any other conditions. You should always seek consultation and supervision from an appropriate medical professional about any matters regarding your health and diet.

(Extract taken from ‘The Red Wine Headache Cookbook’)

Soak, Stock and Freezing Meals -
From time to time I receive queries from visitors asking about how I personally deal with some basic food-related situations. The info below is based on a couple of my email replies - I thought others might also find this information useful!
On soaking pulses:
Re. Using beans, I do use canned and those in cartons - you can buy them organic and quite cheaply and readily from supermarkets and health food shops (in the UK) but be careful to drain and rinse them carefully before you cook with them. 
Since developing Histamine Intolerance I tend to steer away from buying beans dry as they often have to be soaked overnight and occasionally I find that they seem to ferment a little if you leave them for too long. In emergencies though, I find it is possible to cook the beans from dry a little quicker than overnight – firstly, bring them almost to the boil, then cover and remove from the heat for an hour or so (depending on the size of bean I’m using); they’ll have then ‘soaked’. 
For lentils, I actually use them dry as they cook so quickly and don’t need soaking beforehand. I rinse them in a sieve to clean them before adding to the pan though.
On making ‘stock’:
For a root veg ‘stock’ - I often parboil root vegetables in a lidded pan with just enough water to cover (and then go on to roast them as wedges or add them to a pie, make bubble & squeak etc.) Try using a selection of parsnip, carrots, celery, swede, sweet potato etc. with a sprig of robust herbs (vary thyme, rosemary, bay, sage…) and a pinch of ground black pepper, sometimes even a little crushed garlic. 
Once the vegetables are removed, this cooking liquor can then be reduced a little further if needed and frozen for later use. 
Otherwise, I find some of the best ‘stocks’ are the cooking liquors from cooking lentils - you can make tasty gravy from brown or puy lentil liquor, reduced down with caramelised red onion, robust herbs, s&p and a Beurre manié (a flour and butter paste that is whisked into a warm liquid to thicken). The liquor from cooking the lighter red and green lentils can also add an extra layer of flavour and texture to sauces.
Personally, I don’t use commercial stocks.
Edit: Other than the root vegetable stock, the ‘lightness’ of the stocks depends upon the type of lentils used (and therefore, their cooking liquor, which is retained to make the stock.) The exact nature may depend on the brand of lentil used and the length of time they have been cooked before draining, but a guide is -
Red lentils = Light stock,
Green lentils = Medium stock (mild),
Brown lentils = Medium stock,
Puy/Green speckled lentils = Dark stock.
Ps. Try experimenting with adding different herbs to your lentils as they cook, with a twist of ground black pepper.
On freezing meals:
Regarding eating leftovers, personally I don’t eat any leftovers that have been stored at room temperature - however; I can have serious symptoms (including heart arrhythmia) that I prefer not to take that chance. Other people may have less severe symptoms that mean that they are more comfortable to try to eat something the next day and see if it works for them. However, I wouldn’t advise eating such leftovers on a regular basis even if a person felt well.
In the book, following Dirk’s advice, I explain not to freeze and then defrost meat and other animal products as the histamine levels increase dramatically on thawing. As I understand, this isn’t the case when defrosting other foods. I certainly haven’t ever had a problem myself in doing so.
What I do at home is to cook a large meat-free meal, serve the amount needed freshly made and then divide the remainder into individual portions. I then immediately cover the portions and allow them to cool a little before putting on the top shelf of the fridge to cool further – and as I freeze meals so often I have a small area reserved on the top shelf of my freezer for putting the freshly cooled food into. I also tend to label the containers with the name of the meal and the date it was frozen (not that they usually hang around for more than a few days!)
This works particularly well for the vast majority of meals in the book - I even used it for an apple crumble and mince pies over Xmas and they were equally delicious when reheated. It makes life a little easier on those days when you just don’t have the time to cook meals from scratch.
I also advise on some applicable recipes different storage methods, such as on the biscuit creams recipe to - ‘Store in an airtight container, also in the fridge if possible, and eat within a day or two. Remember that these biscuits do not contain preservatives!’ If people are comfortable to, they could also try this themselves for other baked goods. Alternatively, for the cookies perhaps prepare the cookie dough and freeze it in portions raw on the baking sheet and then cook these in a slightly cooler oven for a little longer on the day they’re needed.
As always, remember that your personal tolerance level is very important and you may be able to tolerate differently than others before experiencing symptoms. Introduce any changes to your routine carefully.

To buy and download a copy of ‘The Red Wine Headache Cookbook’ eBook (£15 for over 240 pages of low-histamine goodness) click here –http://sellfy.com/p/Yibb
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