Estimated time: 90 mins.
Firstly let me start by stating that if you suspect that you have histamine intolerance, it’s important to talk to a healthcare provider for an accurate diagnosis and treatment plan. In some cases, dietary modifications, such as avoiding high-histamine foods, may be recommended to manage symptoms.
One of the things that I often get asked about is histamine intolerance as it relates to sourdough bread.
Let’s start by looking at what histamine intolerance is: a buildup of histamine in the body. This stockpile of histamine comes from a reduced ability to break down histamine from foods by a digestive enzyme – diamine oxidase (DAO) – in the gut. In some ways it’s not dissimilar to having lactose intolerance, both linked to an enzyme deficiency. There are many reasons why the buildup can happen:
- In most instances, it’s gut dysbiosis and distress to the gut lining;
- It could be due to medications that are blocking the effects of DAO; or
- There could be a genetic factor to it.
Established research shows that it’s the balance of the microbiome that impacts the levels of histamine your body produces. When we see an imbalance, there is an increase in the abundance of microbes that secrete histamine. These levels are also impacted by stress as during tense times it’s not uncommon to find some bacteria diminished by stress hormones whilst others flourish. There’s a synergistic relationship between bacteria and hormones, and this certainly seems to be the case when it comes to this balance of bacteria.
Histamine is a chemical found in the tissues of the body, often recognised in the form of an allergic reaction. We often see people who believe they have food allergies but are in fact experiencing the symptoms of a histamine response. They describe themselves as being sensitive or supersensitive. This is an area leading to a great deal of frustration and distress in not being able to identify why symptoms exist that resemble food allergies and intolerances.
Spotting the signs
The symptoms of histamine intolerance may be inconsistent, worse on some days and not on others. They don’t necessarily show up in conventional medical tests either. When histamine levels in the body are high, digestive symptoms can show up like bloating accompanied by abdominal pain and diarrhoea. It can also impact your cardiovascular system – lightheadedness, low blood pressure and even irregular heartbeat. Headaches and hives are some other common reactions. Respiratory symptoms like asthma can even be exacerbated.
Interestingly for me one of the main indicators was the fluctuation in my weight. I believe my body was trying to hold onto more fluid almost as a “dilution strategy” for my body. My weight would massively increase overnight if I had it an overload of histamine, sometimes up to eight or nine pounds of water.
In my case, with high histamine levels due to extremely low gut microbial diversity, I thought I had cystitis. I was in immense discomfort for almost a year until I tested for a wide range of conditions. My GP would regularly find blood in my urine and the signs of cystitis yet found no bacteria. After doing some scans, I was diagnosed with interstitial cystitis. It was only when I identified that histamine intolerance was causing my symptoms that I figured out the triggers. That was in 2008.
At that time, one of the fastest ways to relieve the agony of my symptoms was to take an antihistamine tablet which provided instant symptom relief but didn’t resolve the underlying cause of my interstitial cystitis.
Trigger foods
I was lucky enough to have recognised my histamine intolerance, but there are no reliable tests to diagnose it. There are some tests now in the market that measure DAO serum levels (anything less than 10 units per millilitre is considered low), but this doesn’t necessarily look at what’s going on in the gut. When it came down to identifying my trigger foods and looking generally at the foods that activate histamine release in the body, it’s important to try and understand first how histamine is produced.
Histamine is created by bacteria that are related to the decomposition of food – bacteria that can live in fermented foods, cheese, fish, spinach and certain foods in the nightshade family (aubergine and tomatoes). Whilst all the advice out in the world right now is to significantly increase probiotics, if you have histamine buildup in the body, an increase can really set off your symptoms. It’s the same with trying to get your omega-3s by eating more tuna or mackerel but these are generally canned. These types of foods or any kind of preserved meat or fermented food are going to exacerbate histamine symptoms.
For me personally, one of the foods that contained biogenic amine (decarboxylation products of amino acids) was citrus fruit. What I thought at the time was a healthy habit, putting lemon juice in my water turned out to be a disaster and triggered high histamine levels.
Histamine Intolerance Awareness has the following information on foods which are high and low in histamine. [Vanessa I added this, do you want it? – Lucy]
When I hear the description of someone suffering from histamine intolerance, the very first thing I advise is that they go and see their GP and discuss their symptoms. Taking along a food diary empowers you to communicate some history to your GP. It is important to write down your symptoms within the diary and score them.
Most nutritionists now understand histamine intolerance. I would suggest speaking to one who specialises in nutritional advice for food allergies. Venetia Mitchell is our in-house Nutritionist and Research Assistant here at The Sourdough School and works online with individuals across the UK.
The sourdough dilemma
One of the things we encourage at The Sourdough School is eating live bacteria. This form of bacteria combined with the fermentation process is where people who are suffering with histamine intolerance may find certain aspects of our program challenging.
Sourdough – a fermented food in itself – along with all other fermented foods can contribute higher levels of histamine. At the same time, the grains and fibre in bread are what is so desperately needed by your bacteria to rebalance your biome. The very fermentation process that breaks down the fibre making it more bioavailable attracts the very same bacteria that are causing the buildup of the histamine. This presents a dilemma.
The way we recommend eating our sourdough is symbiotically alongside cultured foods.
Symbiotic eating is being in symbiosis with the rhythm of the seasons and farming practices like crop rotation which support regenerative agriculture throughout the year.
Symbiotic eating on the other hand is the sequence and the foods you eat with your bread. Symbiotic eating is probiotic supplementation with prebiotic food to optimise the postbiotic impact of food. If that sounds terribly complex, think of it as eating a slice of sourdough bread made from a botanical blend flour – loaded with herbs and a variety of grains for diversity – with live cultured butter alongside a quinoa salad or lentils.
This is a foundational approach to eating that’s multidimensional, nourishing the gut whilst being in touch with the season and the planet.
A fresh break
DAO supplements to treat symptoms of histamine intolerance are now available but they can be quite expensive. My own personal way around it was eating fresh foods and consuming everything at maximum freshness. That was hard because I had to cook almost everything from scratch. I spent about three months just quietly and determinately rebuilding my biome through an abundance of fresh fruit and vegetables. That also meant strategically purchasing fish that had been caught and frozen instantly on the boat so there was no time for histamine bacteria to form. There are specific websites where you can buy fish that haven’t been sitting around. [Vanessa – did you have some sites in mind you wanted to link to here?]
Cooking doesn’t get rid of histamine either, so you cannot buy histamine-containing foods and hope to cook it off. Instead, the answer is to give your body a break by consuming low-histamine foods and predominantly fresh.
I think there is a huge amount of research still needed to understand histamine intolerance. In some ways, it’s an indication of high levels of dysbiosis and imbalance within the immune system. When you end up with this kind of debilitating food hypersensitivity, it can be frustrating to not know which foods are triggers for you.
I’m not a fan of a restricted diet but from personal experience having to rebuild a significantly damaged gut, the first step may be taking a break from your sourdough. As heartbreaking as that might sound, most people who put themselves onto a program to rebuild their gut by following a diet which prioritises fresh food can return to eating sourdough after six to eight weeks. That was certainly the case with me.
Walk before you run
What I suggest is that you speak to a nutritionist and look at how you can incorporate fibre into your diet that rebuilds the balance of your gut. When you start to find that your symptoms are under control, then you can start to look at eating bread again – not just sourdough bread. I would suggest starting with a light fermentation, like an ambient loaf which has been warm proved. Perhaps one of the 10-minute loaves.
Keep the dough in a warm prover (28°C) for five or six hours and then bake immediately. A fast straight dough will keep the bacterial activity to a minimum whilst prioritising the yeast so you will get a nice rise and it will not be too sour. It is the opposite advice that I would give to someone who has blood sugar issues or potentially non-celiac gluten sensitivity (NCGS).
Not being a terribly broken-down bread fermentation-wise, I would suggest beginning with 30 to 50 percent whole grain. As tempting as it might be to scoff down the entire loaf after abstinence from your bread, you will want to slice it up and freeze immediately after it’s cool to avoid any further spoilage. This allows you to enjoy one slice at a time, toasting the slices lightly and then sense how you feel. Jot down a score in your food diary.
Go at it slowly. Re-introduce your food and your fermentation as though you are beginning a new training program. You wouldn’t attempt to run a marathon after recovering from a foot injury, and neither should you attempt to digest a whole loaf after having taken a break from it for a while. If your symptoms are returning, pause and continue with the rebuilding of your biome stage in your histamine diet.
It’s complex
One of the most difficult problems that you can encounter when you have gastric issues such as histamine intolerance is that it’s never one thing. Often there are many complex aspects to it. Again, speaking from personal experience, I had symptoms of non-celiac gluten sensitivity, IBS and histamine intolerance all at the same time.
Introducing bread that was high in fructose (because it wasn’t well broken down through fermentation), triggered IBS symptoms. If I was eating a lightly-fermented, whole-grain bread, I suffered from bloating and gas. Recovery for me involved reintroducing bran in staged amounts – increasing from 20 percent whole meal to 40 percent whole meal slowly over a period of 12 weeks. It’s a recovery program that we teach here at The Sourdough School, and I think it will make a huge difference.
Histamine intolerance is an area that is not well understood and needs more concrete information and study. One of the books I find most useful when making recommendations is gastroenterologist Dr Will Bulsiewicz’s The Fibre Fuelled Cookbook. He has some fantastic information and resources in there. Will’s website is The Plant Fed Gut
If you’re reading a feature like this one, you are obviously beginning to understand the symbiotic relationship with your gut. Like all relationships, sometimes you go through tough times. Relationships require work and building. You are going to have to rebuild your relationship with your gut, which requires time and being kind to yourself.
In navigating through my diagnosis, I discovered more about myself than I knew was possible. I wish you courage in your journey. If there is anything we can do to support you, please get in contact with us. We’d be delighted to help and look forward to when you can begin eating fermented foods and sourdough again according to the Baking as Lifestyle Medicine Protocols.