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Histamine Intolerance and Sibo

Updated: Jan 2

Are you experiencing other chronic symptoms like headaches, migraines, allergies, brain fog, dizziness, anxiety, or PMS? You may have histamine intolerance! Let's dive deeper into this topic.

What is Sibo?

Small intestinal bacterial overgrowth (SIBO) is a gut health condition characterized by bacterial overgrowth in your small intestine.

Here are some common symptoms of Sibo:

  • Bloating - This is often one of the first and most common symptoms of SIBO. Bloating may occur right after eating and may be accompanied by abdominal pain or discomfort.

  • Gas and flatulence - Excess gas production from the overgrowth of bacteria in the small intestine can lead to increased burping, belching or flatulence. The gas may have a foul odor.

  • Diarrhea - Some people with SIBO develop chronic loose, watery stools or diarrhea. This is likely due to the excess bacteria interfering with nutrient absorption.

  • Constipation - For others, SIBO may cause constipation due to the overgrowth causing dehydration of the stool. Methane-producing bacteria may also contribute to constipation.

  • Nutrient malabsorption - The overgrowth of bacteria can damage the lining of the small intestine and prevent proper absorption of nutrients like fat, protein, vitamin B12 and iron. This may lead to nutritional deficiencies.

  • Fatigue - Malabsorption of nutrients due to SIBO can contribute to lethargy and fatigue. The immune system response to SIBO may also result in tiredness.

  • Nausea - Some people experience nausea, with or without vomiting, especially after meals when SIBO symptoms flare up.

  • Weight loss - Difficulty absorbing nutrients can cause unintended weight loss in some cases.

As a gastrointestinal specialist and Sibo Naturopath, I see patients all the time with both Sibo and histamine intolerance symptoms. So let’s learn about the connection between Sibo and histamine intolerance.

What Is Histamine Intolerance?

Histamine is an essential chemical in your body. Histamine supports your immune system by helping to remove allergens. Histamine also releases hydrochloric acid to help the breakdown of food and bacteria and support digestion. It also serves as a chemical messenger supporting your brain health.

Though histamine is a helpful chemical, if you have too much of it, it can become a problem. If your body is releasing more histamine than it needs and your body can’t break down the excess, you develop histamine intolerance. Histamine intolerance means that there is too much or a buildup of histamine in your body. Histamine intolerance can impact your entire body causing widespread symptoms (1).

Causes of Histamine Intolerance

- Leaky gut syndrome

- Gut infections, including H. Pylori infection, small intestinal bacterial infection (SIBO), candida overgrowth, and small intestinal fungal infection (SIFO).

- Inflammatory bowel diseases (IBDs), including Crohn's disease and Ulcerative colitis.

- Gluten sensitivities.

- Nutrient deficiencies, including vitamin C, copper, zinc, and vitamin B6

- Genetic mutations, including MTHFR.

- Certain medications, including NSAIDs, antidepressants, antiarrhythmics, antihistamines, and histamine blockers, can lead to low DAO enzymes.

Symptoms of Histamine Intolerance

- Itchy skin, eyes, ears, and nose

- Eczema or other types of dermatitis

- Hives

- Red eyes

- Facial swelling

- Acid reflux

- Diarrhea

- Other digestive issues

- Difficulty regulating body temperature

- A sudden drop in blood pressure when standing up

- Low blood pressure

- Heart palpitations or racing heart

- Congestion or runny nose

- Seasonal allergies

- Asthma

- Sleep issues

- Fatigue

- Dizziness or vertigo

- Brain fog

- Irritability

- Confusion

- Anxiety or panic attacks

- Migraines and headaches

- Abnormal menstrual cycle

- Premenstrual syndrome (PMS)

Histamine in Foods

Certain foods are high in histamine. Others are low in histamine. Some promote histamine production. Some block DAO enzyme production, reducing histamine clean-up. Here is what you need to know about food and histamine:

High-histamine foods may include:

- Aged cheese, such as goat cheese

- Citrus fruits

- Dried fruits, such as raisins, apricots, and dates

- Canned and cured meat, such as pepperoni, lunch meat, hot dogs, bacon, salami, and canned meat

- Fermented food, drinks, and alcohol, such as sauerkraut, kefir, kimchi, vinegar, wine, beer, and champagne

- Soured foods, such as sour cream, sour milk, and buttermilk

- Smokes fish and some other fish, such as mackerel, anchovies, sardines, tuna, and fish sauce

- Certain vegetables, such as eggplant, avocados, tomatoes, and spinach

- Vinegar and vinegar-containing foods, such as olives and pickles

- Certain nuts, such as walnuts and cashew

- Processed foods high in preservatives

Histamine-liberating foods that are low in histamine but increase histamine release include:

- Bananas

- Papaya

- Pineapple

- Strawberries

- Cow’s milk

- Chocolate

- Nuts

- Shellfish

- Alcohol

- Wheat germ

- Artificial preservatives

DAO-enzyme-blocking foods that reduce or prevent proper histamine clean-up may include:

- Alcohol

- Black tea

- Green tea

- Mate tea

- Energy drinks

Low-histamine foods may include but are not limited to:

- Most grass-fed meat, pasture-raised poultry, and wild game (fresh or frozen), including beef, lamb, bison, pork, chicken, turkey, and wild boar.

- Pasture-raised eggs, cooked.

- Most fresh fruits, such as apples, pears, apricot, blueberries, blackberries, cherries, melons, and grapes.

- Most vegetables, including artichokes, beets, carrots, asparagus, cauliflower, cucumber, celery, kale, onion, garlic, Swiss chard, mustard greens, beet greens, zucchini, watercress, sweet potatoes, yam, jicama, bell pepper, cabbage, carrots, collard greens, and green beans.

- Certain fats, including extra virgin olive oil, coconut oil, grass-fed butter, and ghee

- Certain flours, including coconut flour, tapioca flour, cassava flour, and arrowroot flour.

- Certain sweeteners, including local honey, maple syrup, blackstrap molasses, and coconut sugar.

- Certain herbs and seasoning, including leafy herbs, pepper, Himalayan salt, Celtic salt.

- Certain tea, including white tea and herbal tea.

High-quercetin foods that naturally help to reduce histamine levels include but are not limited to:

- Apples

- Cranberries

- Black plums

- Black currents

- Cherries

- Blueberries

- Grapes

- Cruciferous vegetables

- Snap peas

- Peppers

- Red onion

- Kale

- Romaine lettuce

- Red leaf lettuce

- Chicory greens

- Cabbage

- Sprouts

- Asparagus

- Olive oil

Histamine Intolerance and Sibo

How is Sibo connected to histamine intolerance? Let's see:

- Food sensitivities: SIBO, gut dysbiosis, and other gut problems can increase the risk of food sensitivities. Food sensitivities may increase the risk of histamine intolerance, chronic inflammation, and leaky gut syndrome, which can further aggravate your issues.

- Gut dysbiosis: Your gut is home to many histamine receptors. This can turn into a problem if you are dealing with gut health issues. If you have gut inflammation, leaky gut syndrome, or gut bacterial imbalance, it can activate your histamine receptors and increase histamine intolerance (2, 3, 4). Research has shown that SIBO can reduce your tolerance to dietary histamine increasing histamine intolerance. It’s not surprising that many develop both histamine intolerance and SIBO, and symptoms can overlap or mimic each other (5, 6).

- Histamine-producing bacteria: If you have a build-up of histamine-producing bacteria, such as L. casei or L. bulgaricus in your small intestine, it can increase your risk of developing histamine intolerance. If there is a buildup of other bacteria, you may experience SIBO without histamine intolerance (7).

- Low DAO enzyme levels: DAO enzymes help to break down and clean up excess histamine. However, gut infections and gut inflammation can decrease your DAO enzyme levels. If you don’t have enough DAO enzymes, it means that your body won’t be able to clean up excess histamine, causing histamine intolerance (8, 9, 10).

- High-histamine foods: If you are eating a diet high in high-histamine foods, histamine-liberating foods, and DAO-enzyme-blocking foods, it can increase your risk of histamine intolerance. Histamine intolerance can increase chronic inflammation and gut inflammation, increasing your risk of SIBO and other gut health issues (11).

Recommendations for Histamine Intolerance

If you have both Sibo and histamine intolerance, addressing histamine intolerance should be part of your Sibo natural treatment protocol. Here is what I recommend:

- Follow a low-histamine diet. Avoid or reduce high-histamine foods and focus on low-histamine nutrient-dense food instead.

- Improve your gut health. Address gut infections and improve your gut microbiome balance. Take a high-quality soil-based probiotic supplement.

- Improve your sleep and reduce your stress levels.

- Move your body regularly.

- Reduce environmental toxins. Choose organic, natural products instead of chemical-filled conventional ones. Use a high-quality air filtration system and drink purified water.

- Try taking quercetin and eating quercetin-rich foods, as quercetin helps to reduce histamine naturally.

My Recommendation

If you have histamine intolerance, I recommend that you follow my tips for histamine intolerance as part of your Sibo natural treatment protocol. If you are not sure if you have histamine intolerance or are unsure where to start, I recommend that you seek help for a Naturopathic practitioner who specializes in gut health.

Check out these two of my favorite supplements that can help with histamine intolerance:

Histamine intolerance and Sibo


1. Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007 May;85(5):1185-96. doi: 10.1093/ajcn/85.5.1185. PMID: 17490952

2. Sander LE, Lorentz A, Sellge G, Coëffier M, Neipp M, Veres T, Frieling T, Meier PN, Manns MP, Bischoff SC. Selective expression of histamine receptors H1R, H2R, and H4R, but not H3R, in the human intestinal tract. Gut. 2006 Apr;55(4):498-504. doi: 10.1136/gut.2004.061762. Epub 2005 Nov 18. PMID: 16299042

3. Schink M, Konturek PC, Tietz E, Dieterich W, Pinzer TC, Wirtz S, Neurath MF, Zopf Y. Microbial patterns in patients with histamine intolerance. J Physiol Pharmacol. 2018 Aug;69(4). . Epub 2018 Dec 9. PMID: 30552302.

4. Enko D, Meinitzer A, Mangge H, Kriegshäuser G, Halwachs-Baumann G, Reininghaus EZ, Bengesser SA, Schnedl WJ. Concomitant Prevalence of Low Serum Diamine Oxidase Activity and Carbohydrate Malabsorption. Can J Gastroenterol Hepatol. 2016;2016:4893501. doi: 10.1155/2016/4893501. Epub 2016 Nov 30. PMID: 28042564

5. Lappinga PJ, Abraham SC, Murray JA, Vetter EA, Patel R, Wu TT. Small intestinal bacterial overgrowth: histopathologic features and clinical correlates in an underrecognized entity. Arch Pathol Lab Med. 2010 Feb;134(2):264-70.

6. Bures J, Cyrany J, Kohoutova D, Förstl M, Rejchrt S, Kvetina J, Vorisek V, Kopacova M. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 Jun 28;16(24):2978-90. doi: 10.3748/wjg.v16.i24.2978. PMID: 20572300

7. Parker EC, Gossard CM, Dolan KE, Finley HJ, Burns CM, Gasta MG, Pizano JM, Williamson CB, Lipski EA. Probiotics and Disease: A Comprehensive Summary-Part 2, Commercially Produced Cultured and Fermented Foods Commonly Available in the United States. Integr Med (Encinitas). 2016 Dec;15(6):22-30. PMID: 28223894

8. Schmidt WU, Sattler J, Hesterberg R, Röher HD, Zoedler T, Sitter H, Lorenz W. Human intestinal diamine oxidase (DAO) activity in Crohn’s disease: a new marker for disease assessment? Agents Actions. 1990 Apr;30(1-2):267-70. doi: 10.1007/BF01969057. PMID: 2115243

9. Raithel M, Matek M, Baenkler HW, Jorde W, Hahn EG. Mucosal histamine content and histamine secretion in Crohn’s disease, ulcerative colitis and allergic enteropathy. Int Arch Allergy Immunol. 1995 Oct;108(2):127-33. doi: 10.1159/000237129. PMID: 7549499

10. Schink M, Konturek PC, Tietz E, Dieterich W, Pinzer TC, Wirtz S, Neurath MF, Zopf Y. Microbial patterns in patients with histamine intolerance. J Physiol Pharmacol. 2018 Aug;69(4). doi: 10.26402/jpp.2018.4.09. Epub 2018 Dec 9. PMID: 30552302

11. Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007 May;85(5):1185-96. doi: 10.1093/ajcn/85.5.1185. PMID: 17490952


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