This blog is a way of sharing the information and resources that have helped me to recover my son Roo from an Autism Spectrum Disorder. What I have learned is to view our symptoms as the results of underlying biological cause, which can be identified and healed. I say "our symptoms" because I also have a neuro-immune disorder called Myalgic Encephalomyelitis.

And, of course, I am not a doctor (although I have been known to impersonate one while doing imaginative play with my son)- this is just our story and information that has been helpful or interesting to us. I hope it is helpful and interesting to you!

Wednesday, March 17, 2010

The Low Histamine Diet

When I first learned that my kids and I might have Histadelia, our symptoms were making us miserable and we were going to have to wait 6 weeks to have a blood test done to check our histamine levels.  I began researching online to see if there was anything we could do to get some relief in the meantime.  I was surprised to find information about a low-histamine diet and thought it might be worth a try.  Our improvement on the diet was so dramatic after only 10 days that I decided I wouldn't believe the blood test if it didn't show elevated histamine levels!

Many people have asked me about this diet and I will do my best to outline it below.  In general, I haven’t been thrilled with the quality of information online about histamine in food or what constitutes a low histamine diet, so I have done my best to put the pieces together in a way that makes sense. If you follow some of the links below you will notice that some of the information is conflicting. This is an extremely complicated issue and I am learning more about it all the time.  In my opinion, the diet is not a long-term solution, but a very effective stop-gap measure to bring relief while the underlying causes of the condition can be figured out and addressed.  Of course, none of this is meant as medical advice, and if you can enlist the help of a knowledgeable doctor or nutritional biochemist than by all means do.

Treating Histadelia with a low-histamine diet:

There seem to be several categories of foods to consider on a low-histamine diet- foods that contain histamine themselves, foods that mediate the release of histamine (some do this in a general way and some in an immediate way), and foods that a person is allergic to.

These foods contain histamine and should be avoided: spinach, eggplant, lunchmeat and processed meat, and anything fermented, cultured, or aged (includes soy sauce and many soy products, vinegar, cultured and pickled veggies such as sauerkraut and pickles, sourdough bread). Fish, unless it is gutted and cooked immediately, should be avoided. Some people report problems with beef because it is routinely aged (I have also heard that beef is often treated with MSG at the time of butchering, and many amine sensitive people are also sensitive to MSG). Histidine is an amino acid (part of protein) that converts to histamine by microbial action, often pretty quickly, so some people can’t tolerate leftover meat. Here is a quote from this site

Histamine occurs in food as a result of microbial enzymes converting the amino acid histidine (present in all proteins) to histamine. All foods subjected to microbial fermentation in the manufacturing process contain histamine. Included in this category are cheeses, fermented soy products, other fermented foods (e.g. sauerkraut), alcoholic beverages, and vinegars.

Foods exposed to microbial contamination also contain histamine in levels determined by the extent and rate of action of the microbes. Histamine levels reach a reactive level long before any signs of spoilage occur in the food. This characteristic has important implications in fin fish, where bacteria in the gut are particularly active in converting histidine to histamine. The longer the fish remains ungutted, the higher the levels of histamine in the flesh.

Additionally, there are foods that can cause the release of histamine and may be problematic even though they don’t contain histamine themselves. Foods that may cause the body to release histamine include milk, wheat, eggs, chocolate, berries, fish, shellfish, nuts, and tomatoes. Foods that are reported to cause the direct release of histamine from mast cells are uncooked egg white, shellfish, strawberries, tomatoes, fish, chocolate, pineapple, and alcohol. I haven’t seen this mentioned anywhere, but it makes sense that foods to which a person is allergic should also be avoided for obvious reasons.

Much of this list is from the book Dietary Management of Food Allergies & Intolerances: A Comprehensive Guide, by Janice Vickerstoff Joneja. 1998. J. A. Hall Publications, which I came across on the website for the International Chronic Urticaria Society (this site also has information about a low salicylates diet). I personally felt that the suggested diet on this site didn’t make sense based on the information about food that it gave, but that the information itself was worthwhile. It also included info about some food additives and dyes that also cause the release of histamine. Here is a quote:

In addition, a number of food additives such as azo dyes and preservatives mediate the release of histamine.

Some of these chemicals such as benzoates occur naturally in foods, especially fruits, and may have the same effect as the food additive in releasing histamine.

Here is a list of foods containing amines (including histamine and other amines) from Allergy Dietitian:

This list also includes avocado, pumpkin, and banana, as well as quite a few spices, and yeast and yeast extracts. This site lists other amines as well, and some histamine sensitive people seem to react to other amines too so that might be worth thinking about.

To implement this diet, you will need to do an elimination diet followed by challenge tests for each food.  I would suggest cutting out as many of the foods mentioned above as possible.  Follow the diet strictly for several weeks, or until you feel that you have improved and stabilized enough that you would recognize any reaction clearly. Different people will reach this point at different times, but you should feel some improvement within several weeks.  If you see no improvement, and are confident that you are following the diet strictly, you may not have high histamine levels or you may need additional restrictions (that will be covered in a future post).  At this point try each of the foods that you have removed one at a time and notice whether or not you react.  You will probably be able to eat some of the foods with no noticeable reaction, while having various degrees of reactions to others.  You will have to experiment to see what works for you. Also, drinking a lot of water during the elimination period helps to flush out the excess histamine.

When my family began challenge tests with these foods we quickly realized that certain foods caused immediate and sever symptoms and others weren't a problem. Eggs, nuts, avocado and banana didn't seem to be a problem whereas berries, salmon, shrimp, and some others caused very intense reactions.  To complicate things, we also noticed that different foods caused very different reactions, so we had to think holistically to determine whether we tolerated a food.  My reactions range from severe depression from cooked tomatoes, to anger from salmon, to a racing heart and agitation from chocolate, to weepiness, dizziness, and exhaustion from many other foods. Roo's only noticeable symptom at the time was irritability, while his brother gets hyperactive, talks constantly and stutters, has to pee frequently, has nightmares and fears, and is prone to intense mood swings and rages.  Over time we have noticed many more reactions but those are the ones that we saw immediately upon challenging foods.

These sites have more info about implementing a low histamine diet:

This site was put together by someone who uses a low histamine diet to control Meniere’s Disease:

Here is a list of amine content of food (it includes amines other than just histamine)

This is a factsheet from the Food Intolerance Network about Amines:

Here is the homepage for the Food Intolerance Network, which has a lot of relevant information:

General information about Histadelia:

I have noticed that there is a lot of discrepancy between various lists of signs and symptoms, and it seems that different people will have different symptoms, and while some will have only a few others will have nearly all. One of my sons is a “textbook case” while the other has almost no signs at all (he even has counter indicators), yet his blood levels were actually higher. I personally don’t have many of the symptoms and have an extremely high level. I have found these lists to be interesting and to raise a lot of questions, but I’d be cautious in using them to either diagnose or rule out Histadelia. Common symptoms include depression, anxiety, strong fears and phobias, obsessive and compulsive tendencies, crying easily, being highly sensitive both emotionally and physically, problems with balance and dizziness such as vertigo or car sickness, and being very sensitive to pain. It seems to be more common in families in which there is a history of depression, anxiety, schizophrenia or other mental illness, or substance abuse. Histadelia is estimated to occur in about 10% of the population, but about 20-25% of the ASD and schizophrenic population. Studies looking at substance abuse have found that nearly all people addicted to drugs or alcohol are Histadelic.

Major Mental Illness Biochemical Subtypes:

This post on a forum sums up some interesting info:

This page has info about abnormal brain histamine (includes info on both Histapenia, which is low histamine levels, and Histadelia):

This is an article entitled “Comparative Physiology of Histamine”

Resources from the Health Research Institute: