The Surprising Connection between Histamine Intolerance and SIBO
Post Author: Victoria Tyler
Have you ever experienced stubborn digestive symptoms like bloating, headaches, skin reactions, or even unusual sinus issues and wondered what could be causing them? You might be dealing with more than just food sensitivities. For many people, two hidden conditions—histamine intolerance and Small Intestinal Bacterial Overgrowth (SIBO)—are behind these persistent symptoms.
This article will explore the link between histamine intolerance and SIBO, helping you understand why they’re so closely connected and how SIBO can actually trigger histamine intolerance.
We will cover symptoms, dietary strategies, supplements, and practical tips to help you manage both conditions effectively.
What is Histamine Intolerance?
Histamine intolerance happens when the body can’t break down histamine properly, leading to a build-up. Histamine is a natural compound found in various foods. In healthy people, enzymes (specifically, amine oxidases) usually break down histamine quickly, preventing any negative effects. However, some people have lower levels of these enzymes, especially one called diamine oxidase (DAO). DAO is crucial for processing histamine from food, and if DAO levels are low, histamine can build up and cause symptoms similar to an allergic reaction.
When DAO is working well, it helps clear histamine from the body, especially in areas outside cells. Another enzyme, histamine N-methyltransferase, also breaks down histamine but only works within cells.
What Symptoms Are Linked to Histamine Intolerance?
Here’s a list of common symptoms people experience with histamine intolerance.
Digestive Symptoms
- Bloating
- Abdominal pain or cramps
- Diarrhea
- Nausea or vomiting
- Acid reflux
Skin Symptoms
- Itching (especially on the skin, scalp, and eyes)
- Flushing or redness of the face and neck
- Hives or skin rashes
- Swelling (particularly around the lips and eyes)
- Eczema-like rashes
Respiratory Symptoms
- Nasal congestion or runny nose
- Sneezing
- Difficulty breathing
- Wheezing or asthma-like symptoms
Cardiovascular Symptoms
- Rapid or irregular heartbeat
- Low blood pressure
- Dizziness or lightheadedness
Neurological Symptoms
- Headaches or migraines
- Anxiety or panic attacks
- Fatigue
- Difficulty concentrating (“brain fog”)
Other Symptoms
- Flushing or heat intolerance
- Menstrual irregularities (in women)
- Sensitivity to temperature changes
- Feeling unusually warm or sweaty
These symptoms often appear after eating foods high in histamine or during times when histamine breakdown is slowed, such as with digestive issues or enzyme deficiencies. Symptoms can vary widely and may come and go, making histamine intolerance tricky to pinpoint without careful tracking.
The Link Between Histamine Intolerance and SIBO
Small Intestinal Bacterial Overgrowth (SIBO) AND Histamine Intolerance
Many people are surprised to learn that SIBO can lead to histamine intolerance, creating a cycle of symptoms that affect gut health, immunity, and overall health. Many patients find that many foods are difficult to eat and cause multiple food sensitivities.
So what exactly is the link?
Bacterial Overgrowth Produces Histamine
Small Intestinal Bacterial Overgrowth (SIBO) is a condition where there’s an abnormal increase in bacteria in the small intestine, an area of the gut that should have relatively few bacteria. In SIBO, the overgrown bacteria in the small intestine can produce histamine as a metabolic byproduct. For example, certain strains of Klebsiella and Escherichia coli (E. coli) are known histamine producers. When these bacteria proliferate, they contribute to higher histamine levels in the gut, which can exacerbate histamine intolerance symptoms.
When these bacteria multiply excessively in the small intestine, they release higher amounts of histamine, which can then enter the bloodstream and raise overall histamine levels, potentially leading to symptoms of histamine intolerance.
Inflammation from SIBO Leads to Increased Histamine Release
SIBO often causes inflammation in the small intestine due to bacterial toxins and byproducts. This inflammation can activate immune cells, especially mast cells, which release histamine as part of the body’s defense mechanism. As a result, the inflammation from SIBO can lead to excess histamine in the gut, worsening histamine intolerance symptoms like bloating, rashes, and headaches.
Impaired Histamine Breakdown Due to Enzyme Inhibition
The DAO enzyme, which breaks down histamine in the gut, may become less effective in the presence of SIBO. Inflammation and bacterial byproducts can impair DAO activity, leading to reduced histamine breakdown. When DAO levels are low or its activity is inhibited, histamine levels increase in the gut and bloodstream, contributing to symptoms of histamine intolerance.
Leaky Gut Allows Histamine to Enter the Bloodstream
The inflammation from SIBO can damage the gut lining, leading to increased intestinal permeability, often referred to as “leaky gut.” When the gut lining is compromised, histamine and other inflammatory molecules can cross into the bloodstream more easily, triggering widespread symptoms throughout the body.
Stress and Motility Disorders as Common Triggers
Both SIBO and histamine intolerance are often associated with stress and impaired motility. Stress increases cortisol, which in turn can lower stomach acid and slow down motility, creating an environment that promotes bacterial overgrowth. Additionally, stress can lead to immune activation and higher histamine levels, further compounding symptoms for those with SIBO and histamine intolerance.
How to Overcome SIBO and Histamine Intolerance
Managing both SIBO and histamine intolerance might feel challenging, but dietary adjustments and targeted approaches can make a big difference. Here’s how a combined low-FODMAP and low-histamine diet, along with some key supplements, can help you take control of your symptoms.
If you have both SIBO (Small Intestinal Bacterial Overgrowth) and histamine intolerance, following a combined low-FODMAP and low-histamine diet is often the most effective approach. This diet reduces fermentable carbohydrates that feed bacteria in SIBO and limits high-histamine foods that could trigger histamine intolerance symptoms.
Best Diet for SIBO and Histamine Intolerance
Finding the right diet can ease symptoms of SIBO and histamine intolerance. By following a low-FODMAP, low-histamine approach, you can minimize foods that trigger these conditions. Here’s how to structure your diet and find foods that fit both requirements.
Here’s a step-by-step guide to structuring the diet:
Low-FODMAP Basics for SIBO
- Goal: The low-FODMAP diet reduces fermentable carbohydrates that bacteria in the small intestine use as fuel. This can help relieve symptoms like bloating, gas, and abdominal discomfort.
- Examples of Low-FODMAP Foods:
- Proteins: Eggs, chicken, turkey, fish, and fresh cuts of meat.
- Vegetables: Courgettes, carrots, cucumbers, bell peppers, spinach, and green beans.
- Fruits: Blueberries, strawberries, cantaloupe, and pineapple (in moderation).
- Grains: White rice, quinoa, oats (in small amounts), and gluten-free products.
Low-Histamine Diet Basics for Histamine Intolerance
- Goal: A low-histamine diet minimizes foods that contain high levels of histamine or that trigger histamine release in the body.
- Examples of Low-Histamine Foods:
- Proteins: Freshly cooked meats and poultry, fresh fish (consume immediately after cooking), eggs.
- Vegetables: Leafy greens (except spinach), carrots, zucchini, cauliflower, and sweet potatoes.
- Fruits: Apples, pears, mangoes, and melons (avoid strawberries and citrus fruits, as they are histamine liberators).
- Grains: Rice, oats, and gluten-free grains like millet and quinoa.
Combining Low-FODMAP and Low-Histamine Diets
It can be tricky to navigate a diet that’s both low in FODMAPs and histamine, but with the right planning, it’s possible. Here are some foods that work well for both diets to help you get started.
Finding foods that are both low-FODMAP and low-histamine may seem restrictive, but it’s manageable with planning. Here’s a list of foods that fit both diets:
- Proteins: Fresh chicken, turkey, eggs, and fresh fish (cooked immediately). Avoid processed meats, smoked fish, and leftovers, as these are often high in histamine.
- Vegetables: Zucchini, carrots, bell peppers, cucumbers, and green beans are both low in FODMAPs and histamine-friendly.
- Fruits: Blueberries, strawberries (in moderation), cantaloupe, and pineapple are lower in histamine and FODMAPs.
- Carbohydrates: White rice, quinoa, and gluten-free oats are generally safe on both diets.
- Herbs and Flavorings: Fresh herbs like parsley, basil, and thyme are usually low in histamine and FODMAPs, providing flavor without triggering symptoms.
Avoiding High-Histamine and High-FODMAP Foods
Knowing which foods to avoid is essential for managing SIBO and histamine intolerance. Here’s a list of common high-histamine and high-FODMAP foods to keep out of your diet, plus tips on what to replace them with.
Certain foods are known to aggravate both SIBO and histamine intolerance, so it’s best to avoid:
- Fermented Foods: Sauerkraut, kimchi, pickles, kombucha, and yogurt, which are high in histamine and can worsen SIBO symptoms.
- Aged or Processed Proteins: Processed meats, aged cheeses, smoked fish, and leftovers, as they are high in histamine and difficult to digest with SIBO.
- High-FODMAP Vegetables: Onions, garlic, cauliflower, broccoli, and mushrooms.
High-Histamine Fruits: Bananas, avocados, tomatoes, strawberries, and citrus, which are histamine liberators and can trigger symptoms in sensitive individuals.
Sample Meal Ideas for SIBO and Histamine Intolerance
Creating meals that work for both SIBO and histamine intolerance can take some creativity. Here are a few ideas:
- Breakfast: Scrambled eggs with sautéed zucchini and bell peppers, served with a side of fresh blueberries.
- Lunch: Freshly cooked chicken breast with a mixed salad (lettuce, cucumber, carrots, and green beans) and a simple olive oil and basil dressing.
- Dinner: Grilled turkey breast with steamed quinoa and cooked carrots and green beans.
- Snacks: Fresh apple slices, cucumber sticks, or a handful of blueberries.
Additional Tips for Diet for Histamine Intolerance and SIBO
- Eat Fresh and Avoid Leftovers: Cook meals fresh whenever possible, as histamine levels rise in foods that are stored, even in the fridge.
- Avoid Processed and Aged Foods: Processed and aged foods tend to be high in histamine, which can exacerbate histamine intolerance.
- Monitor Portion Sizes: Even low-FODMAP foods can cause symptoms if consumed in large quantities. Portion control can help keep symptoms at bay.
- Use Fresh Herbs and Spices: Fresh herbs like parsley, basil, and thyme can add flavor without triggering symptoms.
Reintroducing Foods
After a period of symptom relief, consider reintroducing foods gradually to assess tolerance. With both SIBO and histamine intolerance, it’s important to monitor responses to new foods, as tolerance levels can vary widely.
Working with a Professional
Since a combined low-FODMAP and low-histamine diet can be restrictive, consider working with a nutritionist or dietitian who specializes in gut health. They can help you build a balanced diet, suggest alternatives, and guide you through the reintroduction process. Book a consultation
What is the best Low Histamine alcohol?
When it comes to alcohol and histamine intolerance, finding options that are low in histamine is key, as many types of alcohol are naturally high in histamine and can trigger symptoms. Generally, clear spirits tend to be the best choice for those with histamine sensitivity because they contain fewer histamines compared to aged or fermented alcohols like wine or beer. Here are some of the best low-histamine options:
Vodka
Vodka is usually distilled multiple times, removing many impurities, including histamine. Opt for a plain, unflavored vodka as some flavored varieties may contain additives that could trigger reactions.
Gin
Gin is another clear spirit that is typically low in histamine. However, because gin is made with various botanicals, it’s best to try a small amount to see how you tolerate it, as some sensitive individuals may react to certain herbs.
Tequila (Blanco or Silver)
Blanco or silver tequila, which is not aged, is generally lower in histamine compared to aged varieties like reposado or añejo. Choosing a pure, 100%
Can I have coffee on the Low Histamine diet?
Coffee is generally considered moderate to high in histamine, and it can sometimes trigger symptoms in people with histamine intolerance. While coffee itself doesn’t contain high histamine levels, it can promote the release of histamine in the body and may inhibit the activity of DAO, the enzyme responsible for breaking down histamine in the gut. Additionally, caffeine can stimulate the release of stress hormones, which can indirectly increase histamine levels for some individuals.
Here are some considerations and alternatives if you want to include coffee in a low-histamine diet:
Tips for Coffee with Histamine Intolerance
- Limit Intake: If you tolerate coffee, try to keep it to one small cup per day, and monitor how it affects your symptoms.
- Choose Low-Acid, Organic Coffee: Low-acid coffee can be gentler on the stomach, and organic varieties have fewer additives, which may help reduce reactions.
- Decaf as an Alternative: Decaf coffee can sometimes be better tolerated since it has lower caffeine levels, although it still may stimulate histamine release for some.
Coffee Alternatives for Low-Histamine Diets
- Herbal Teas: Rooibos or chamomile tea are good low-histamine, caffeine-free alternatives.
- Chicory Root Coffee: Chicory is caffeine-free and has a similar, robust flavor to coffee, but it doesn’t typically trigger histamine release.
- Dandelion Coffee: Dandelion root is another coffee substitute that’s caffeine-free and unlikely to stimulate histamine release.
If you have histamine intolerance, it may be worth experimenting with low-caffeine or caffeine-free alternatives to see if you feel better without coffee in your diet.
What are the Best Probiotics for Histamine intolerance and SIBO?
Low-Histamine Probiotics
Not all probiotics are suitable for histamine intolerance, as some strains can produce histamine and worsen symptoms. Low-histamine probiotics help maintain gut health without exacerbating histamine-related issues.
- Spore-Based Probiotics: Spore-based strains like Bacillus coagulans and Bacillus subtilis are less likely to trigger histamine release and can survive stomach acid, making them ideal for those with histamine sensitivity.
- How to Use: Typically taken once daily, starting with a low dose to gauge tolerance.
- Considerations: Some people may need to increase gradually, as spore-based probiotics can initially cause mild digestive symptoms as they alter the gut microbiome.
- Saccharomyces boulardii: This beneficial yeast probiotic does not produce histamine and is helpful in managing gut inflammation. Saccharomyces boulardii is known to combat Candida and other pathogenic bacteria.
- How to Use: Often taken twice daily with meals, but dosage varies depending on individual needs.
- Considerations: S. boulardii is generally safe but should be avoided by those with yeast sensitivities.
- Lactobacillus reuteri (L. reuteri) can be helpful for both SIBO and histamine intolerance due to its unique properties that support gut health, reduce inflammation, and help balance the immune system. Here’s why L. reuteri can be beneficial in these contexts:
Histamine Regulation
- Histamine-Degrading Abilities: Unlike some probiotic strains that produce histamine, L. reuteri is generally considered “histamine-neutral” or even histamine-degrading. This means it doesn’t increase histamine levels and can be safer for those with histamine intolerance.
- Mast Cell Stabilization: L. reuteri has been shown to help stabilize mast cells, which are immune cells that release histamine. By calming these cells, L. reuteri may help reduce excess histamine release, which is beneficial for histamine-sensitive individuals.
- Anti-Inflammatory Effects
- Supports a Balanced Immune Response: L. reuteri promotes the production of anti-inflammatory cytokines, which can help reduce inflammation in the gut. Chronic inflammation is common in both SIBO and histamine intolerance, so reducing inflammation can help manage symptoms.
- Gut Barrier Support: Inflammation often damages the gut lining, leading to increased permeability or “leaky gut,” which allows histamine and other irritants to enter the bloodstream. L. reuteri can help restore the gut barrier by promoting a healthier immune response and strengthening the gut lining.
Supplements for Histamine Intolerance and SIBO
These supplements help reduce histamine levels and manage inflammation, making them ideal for people dealing with both SIBO and histamine intolerance.
- Quercetin for Histamine intolerance: A natural antihistamine and mast cell stabilizer, quercetin helps reduce histamine release and has anti-inflammatory effects. Quercetin can help reduce symptoms like bloating, skin reactions, and headaches.
- How to Use: Quercetin is often taken 500-1000 mg per day, divided into two doses.
- Considerations: Absorption is enhanced when taken with vitamin C.
- DAO Enzyme Supplements: DAO supplements provide the enzyme needed to break down histamine from food, which can reduce histamine load and alleviate symptoms after meals.
- How to Use: Typically taken 10-15 minutes before meals to reduce histamine reactions.
- Considerations: DAO supplements help with dietary histamine but don’t impact histamine produced by bacteria in the gut.
- Vitamin C and Nettle: Both are natural antihistamines that help reduce histamine levels in the body. Vitamin C also supports immune function, while nettle leaf has additional anti-inflammatory properties.
- How to Use: Vitamin C can be taken up to 2000 mg daily, while nettle is often used in capsule or tea form.
- Considerations: High doses of vitamin C may cause digestive upset in sensitive individuals.
Gut-Healing Supplements
These supplements help repair the gut lining, support the gut barrier, and reduce inflammation, which is essential for people with both SIBO and histamine intolerance.
- L-Glutamine: An amino acid that aids in gut lining repair, supporting “leaky gut” healing. However, it may convert to glutamate, so those sensitive to excitatory neurotransmitters should start with a low dose.
- How to Use: Typically taken as a powder or capsule, starting with low doses to assess tolerance.
- Considerations: If reactions occur, alternatives like butyrate or zinc carnosine may be better tolerated.
- Zinc Carnosine: Known for its anti-inflammatory and gut-healing effects, zinc carnosine is effective in reducing gut permeability and supporting gut repair without impacting histamine.
- How to Use: Often taken as 75 mg per day, typically with meals.
- Considerations: Those with zinc sensitivity should monitor for any side effects, though they’re rare at this dosage.
- Butyrate: A short-chain fatty acid that nourishes colon cells, reduces inflammation, and strengthens the gut lining. Butyrate can also support motility and reduce bacterial overgrowth symptoms.
- How to Use: Available in capsule form, butyrate is typically taken once or twice daily with meals.
- Considerations: It may initially cause mild digestive symptoms, especially if the gut is highly inflamed.
- Natural Sources of Butyrate: Foods high in resistant starches (like potatoes that are cooked and cooled, bananas, legumes, and whole grains) can support natural butyrate production by beneficial gut bacteria. Supplementation is also an option, but it’s best to consult with a healthcare provider to determine if it’s appropriate for your case of SIBO.
Summary
The right supplements can significantly ease the symptoms of both SIBO and histamine intolerance, but selecting the right ones and understanding how they work is key. A comprehensive approach that includes antimicrobials, digestive support, low-histamine probiotics, histamine-blocking agents, and gut-healing supplements provides multi-level support to address the root issues. Consulting with a healthcare provider can ensure you choose the correct supplements for your unique needs, monitor interactions, and adjust dosages as needed.
References
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- Ghoshal, U. C., Shukla, R., & Ghoshal, U. (2017). Small intestinal bacterial overgrowth and irritable bowel syndrome: A bridge between functional organic dichotomy. Gut and Liver, 11(2), 196-208.
- Rosell-Camps, A., Zibetti, S., Pérez-Esteban, G., & Vila-Vidal, M. (2013). Histamine intolerance as a cause of chronic digestive complaints in pediatric patients. Journal of Pediatric Gastroenterology and Nutrition, 57(6), 722-723.
- Schink, M., Konturek, P. C., Tietz, E., Dieterich, W., & Pinzer, T. C. (2018). Probiotics and histamine intolerance: The role of probiotics in managing histamine levels. Allergy and Asthma Proceedings, 39(1), 33-39.
- De Martinis, M., Cannella, C., Di Benedetto, M. C., & Di Gioacchino, M. (2005). Probiotics, histamine, and health. Allergy and Clinical Immunology International, 17(1), 16-22.
- Mayer, E. A., & Tillisch, K. (2011). The brain-gut axis in abdominal pain syndromes. Annual Review of Medicine, 62, 381-396.
Author – Victoria Tyler BSc Hons MBANT
Victoria Tyler owns and runs two busy clinics : Nutrition and Vitality and the IBS and Gut Disorder Clinic.
Nutrition and Vitality, along with the IBS and Gut Disorder Clinic, were founded with the goal of helping patients alleviate IBS symptoms by uncovering and addressing the root causes of their digestive issues.
As a Registered Nutritional Therapist, Victoria holds a BSc (Hons) in Nutritional Therapy and has trained with the Institute of Functional Medicine. She is also accredited by BANT and CNHC.
Before transitioning into health, Victoria earned a degree in Economics and an MBA, working with corporations including Canon and Vodafone. However, her own health challenges led her to pursue a career in Nutritional Therapy.
With a passion for learning, Victoria is committed to staying at the forefront of Functional Medicine. She helps patients manage IBS and other digestive disorders, including SIBO, Candida, and IBD, by identifying and addressing their root causes.
Victoria strongly believes that every symptom has an underlying cause, and there is always a solution to every health condition. To learn more, or to see patient reviews, visit Victoria’s profile on Google.
DISCLAIMER: The information provided in this article is intended for general informational purposes only and should not be construed as medical advice, diagnosis, or treatment. The products and methods mentioned are not a substitute for professional medical advice from a trained healthcare specialist. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Use of the information and products discussed is at your own risk.
