Which Probiotic Is Best for Histamine Intolerance?

You Don’t Need a Special Probiotic for Histamine Intolerance

• Histamine Intolerance|
• The Microbiome Key|
• Probiotics|
• 4-Step Plan|
• Tackle Histamine|

Have you ever wondered which probiotic is best for histamine intolerance? There must be a specific probiotic strain or formula that helps with levels of histamine in the gut, and one that makes it worse, right? 

In fact, probiotics in general can help improve histamine intolerance symptoms, likely by repairing the gut, restoring the microbiome, and lowering inflammation [1, 2]. That means you don’t need a specific probiotic to relieve histamine intolerance.

Let’s dive into using probiotics for histamine intolerance and how they can serve as part of a gut-centered healing protocol to alleviate this irritating issue.

What is Histamine Intolerance?

Histamine intolerance occurs when the body can’t break down histamine properly, so it builds up and triggers issues like an upset stomach or headache, or allergy-like symptoms like hives. Over time, excess histamine may contribute to more significant complications, like immune system dysregulation and autoimmune disease [3]. 

Histamine intolerance affects approximately 1% of the population, with women being more likely to develop the condition than men [4, 5, 6]. Not to mention, about 30–55% of people with digestive symptoms have histamine intolerance [2].

We can get a lot of histamine from foods when bacteria and yeasts ferment and age compounds, such as histidine, in the food [7]. The higher its levels of histamine—a biogenic amine with a role in inflammation—the more likely a food is to contribute to an inflammatory response. This becomes an issue especially in a body that can’t break down and get rid of histamine. 

High-histamine foods include:

• Tofu and soy sauce
• Cheese (aged ones in particular)
• Mushrooms
• Chocolate
• Sauerkraut
• Yeast products (like sourdough bread)
• Smoked or canned fish
• Processed meats
• Nuts or seeds
• Vinegar-rich foods
• Sweetened or fermented beverages
• Overly ripe fruit
• Leftovers

Symptoms

The most common symptoms of histamine intolerance tend to include:

• Bloating [8]
• Diarrhea [5]
• Heart rate changes or palpitations [5]
• Low blood pressure [9] 
• Headaches [10]

Causes

It’s not totally clear what causes histamine intolerance, but one contributor may be diamine oxidase (DAO) deficiency. A deficiency in the DAO enzyme, which breaks down food histamines in the digestive tract [5], could be related to genetics, certain diseases, some medications, and being older than 40 [11]. 

A DAO deficiency means there’s nothing to break down incoming histamine, say, from eating a can of tuna and some sauerkraut. As it builds up in the body, excess histamine can cause allergic reaction-like symptoms and immune responses in the gut and elsewhere [5, 12, 13]. 

Another theory of what causes histamine intolerance is that it stems from an unhealthy gut.

The Key to Histamine Intolerance: A Healthy Gut Microbiome? 

To understand how probiotics can improve histamine intolerance, we must first understand why a healthy microbiome is important for reducing histamine production. 

For example:

• One study found that patients with histamine intolerance were more likely than controls to test positive for gut bacteria imbalances and intestinal permeability (leaky gut) [14]. 
• The digestive tract is full of histamine receptors that often don’t function properly in people with gastrointestinal diseases [15].
• Low diamine oxidase levels have been associated with inflammatory bowel diseases (Crohn’s disease and ulcerative colitis) [16, 17].
• A small study showed that patients with histamine intolerance had more dysbiosis and lower levels of DAO than healthy individuals [18]. 

Though we don’t yet know how it might work, gut dysbiosis could cause histamine levels to build up in the digestive tract because:

• Imbalanced bacteria in the gut produce too much histamine.
• A leaky gut, which can arise from imbalanced gut microbes, cannot turn histamine into other compounds.
• Microbial damage to the intestinal lining activates the immune system, which then produces more histamine.

As you can see, poor gut health may lead to histamine overload, which may lead to histamine intolerance, which may lead to an even less happy gut, on and on in a vicious cycle. Although clinical research is still catching up, all signs so far point toward histamine intolerance as a byproduct of a gut in distress. 

So, to heal histamine intolerance, healing the gut is top priority. And a big part of healing the gut is establishing a healthy gut microbiome with an anti-inflammatory diet and probiotics. 

The Net Antihistamine Effect of Probiotics

The key is to focus less on the small amount of histamine some probiotics can make in the gut, and more on how probiotics can reduce histamine throughout the gut ecosystem as a whole. 

Probiotics for Histamine Intolerance: A Closer Look at the Research

Early research suggests that probiotics have the potential to combat histamine-related symptoms. For example:

• A petri-dish study found that probiotics reduced the amount of histamine released by human immune cells called mast cells [21]. Mast cells are specific kinds of white blood cells that release inflammatory molecules when they encounter various triggers.
• A mouse study found that probiotics prevented some of the mice’s mast cells from bursting and releasing histamine [22].

The only human clinical research we have are meta-analyses showing that probiotics can reduce hay fever [20, 23, 24] and a randomized controlled trial in which probiotics improved quality of life in people with seasonal allergies [25]. From those studies, we can deduce that probiotics have demonstrated antihistamine effects. 

Having recommended probiotics to many clients, we have seen plenty of before-and-after examples of reduced symptoms of histamine intolerance and gut dysbiosis. 

In all, given the research, our clinical experience, and their solid safety record, we support trying high-quality probiotics (in addition to an anti-inflammatory diet) to alleviate histamine intolerance. Beyond that, the best probiotics for histamine intolerance are those that work best for you.

Are Low-Histamine Probiotics Necessary for Histamine Intolerance?

In the clinic, we find it’s best to support the healing effects of a varied, anti-inflammatory diet with a wide range of probiotic species. This broad-spectrum approach to repopulating the gut encourages a healthier gut ecosystem overall, healing any dysbiosis, leaky gut, or other inflammatory processes that may be contributing to symptoms. An approach we haven’t found helpful is to use one particular species at a time to correct one specific symptom or test result. 

A wide variety of gut symptoms, including histamine intolerance, may come from the same root causes: gut dysbiosis, leaky gut, and chronic inflammation. So, we aim to correct those imbalances and restore the gut at a foundational level. As a result, downstream symptoms, like histamine intolerance, fade away. In the clinic, this approach is our mainstay because we’ve seen the benefits over and over. 

4 Steps to Relieve Histamine Intolerance

Here, I’ll outline the whole 4-step process we use in the clinic to calm histamine intolerance symptoms. 

1. Diet

An elimination diet is the best approach to dulling symptoms suggestive of histamine intolerance. Eliminating potential trigger foods can reduce the density of mast cells in the digestive tract [26], reducing their chances of reacting and releasing histamine. 

The two elimination diets with the best results for people with histamine intolerance are a low-FODMAP diet [27, 28], which removes certain fermentable carbohydrates, and a low-histamine diet [29, 30, 31], which removes high-histamine foods. 

An “elimination diet” might seem intimidating, but we assure our clients needn’t worry. Once inflammation in the gut is reduced, the gut lining is healed, and supplements like probiotics are in place to support long-term gut health, it’s safe to add in many of the foods that were problems initially. Choosing an elimination diet and adding probiotics is the foundation we start with before adding other supplements or healing protocols. 

2. Probiotics

Our clients with histamine intolerance often have GI conditions, like small intestinal bacterial overgrowth (SIBO) or irritable bowel syndrome (IBS). To address their gut health holistically, we recommend adding a triple-therapy approach to probiotics to their tailored anti-inflammatory diet.

Triple therapy combines three categories of probiotics—1) a Lactobacillus–Bifidobacterium blend, 2) the beneficial yeast Saccharomyces boulardii, and 3) soil-based Bacillus species—for a well-rounded approach to restoring the microbiome.

If needed, we have our more sensitive clients start each probiotic one at a time, get the gut used to it for 3–5 days, and then add in the next one. If they have an issue with any probiotic, they wait until their symptoms subside before adding in the next one. This process tends to work well and provides significant symptom relief.

3. Quercetin

For clients with symptoms of histamine intolerance, quercetin (added to the anti-inflammatory diet and probiotics) often helps to calm histamine release in the body and reduce histamine sensitivity. 

Quercetin is a bioflavonoid found in colorful fruits and vegetables that can act as an antihistamine compound, keep mast cells from releasing chemicals like histamine, and reduce inflammation. 

Human clinical trials have shown that quercetin can reduce symptoms of histamine-related conditions, such as seasonal allergies [32], contact dermatitis [33], and sun sensitivity [33].

We typically recommend starting at 500 mg per day, and increasing to 1,000 mg if needed. 

4. Diamine Oxidase

Diamine oxidase (or DAO) is an enzyme that breaks down histamine. Some people with histamine intolerance are deficient in this enzyme, but taking supplemental DAO can support better histamine breakdown in the gut [5, 12, 13]. 

At the clinic, we recommend adding a DAO supplement if histamine intolerance symptoms do not improve after an anti-inflammatory diet, probiotics, and quercetin.

Optional: Vitamin C

Sometimes clients need an extra push, so we’ll recommend vitamin C, which has known antihistamine properties [34]. For example, a clinical study found that patients with various infectious or allergic diseases who received intravenous ascorbic acid (vitamin C) had reductions in histamine levels [35].

Fortunately, intravenous delivery is not required for vitamin C to be effective. Taking vitamin C orally may not only help reduce histamine, but it also helps prevent free radical damage, encourages a healthy immune response, and heals wounds [36]. The body can’t make its own vitamin C, so we have to get it from food and supplements. 

The Best Way to Tackle Histamine Intolerance

The best medicine for histamine intolerance seems to be a healthy gut that can regulate histamine and help prevent it from building up in the body. When the body can easily get rid of excess histamine, the immune system has no reason to react to histamine-rich foods. 

The most effective approach we’ve found to restoring a healthy gut microbiome and alleviating histamine intolerance is to add a diverse range of probiotics to a varied, anti-inflammatory diet. Often, a natural anti-inflammatory supplement or two rounds out this protocol.

If you have histamine intolerance, you don’t need a special low-histamine probiotic. Any high-quality probiotic should both support a healthy gut microbiome and help calm an overzealous immune system. 

For more guidance on starting probiotics for histamine intolerance and building an antihistamine protocol, reach out to our healthcare providers at the Ruscio Institute for Functional Health.

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