What is histamine intolerance?

HIT occurs when people develop symptoms as a result of higher levels of histamine
in their bodies. This can occur at any time, but may happen during menopause
directly because of fluctuating and reducing levels of hormones contributing to higher
levels of histamine, and indirectly because of the effect the menopause has on
things like the gut microbiome, stress levels, sleep and so on. Symptoms of HIT
include abdominal pain, diarrhoea or constipation, bloating, irritable bowel syndrome,
nausea, joint pains, anxiety, sleep disturbances, hot flushes or cold chills, runny
eyes/nose, sneezing, rashes, fatigue, headaches, dizzy spells, itchiness, indigestion
or acid reflux.

There is no test for HIT. It is possible to test the levels of DAO, and for things which
may contribute to its function such as vitamins C and B6, and zinc, but a normal level
of DAO does not rule out HIT – remember your bucket may be a normal size (normal
levels of DAO) but you may still have too much water in it (for example by producing
too much histamine and/or consuming food high in histamine).

Implementing a dietary restriction of histamine is a crucial step in both diagnosing and managing this condition. The low histamine diet involves a short-term elimination phase, followed by a systematic reintroduction of foods to identify individual tolerance levels to histamine. Seeking dietetic support is crucial to effectively identify triggers while maintaining optimal nutrition. Here are a few ways in which a dietitian can assist:

1. Identification of trigger foods
2. Customized nutrition plans
3. Symptom tracking
4. Supplement recommendation
5. Behavioural and lifestyle counselling

The objective is to keep the diet as diverse as possible, minimising food restrictions while managing symptoms. Given that each individual’s tolerance to histamine is unique, the approach to reducing dietary sources of histamine needs to be personalised.

As well as the hormonal changes of the menopause sometimes triggering HIT, HIT
can make menopausal symptoms worse. Additionally, some people find that they
can be quite intolerant of HRT when they have HIT, meaning they need to have a
completely individualised approach to their HRT regime. At Menopause Care, HIT
appointments are longer than usual so that we can provide a completely holistic
approach to supporting people with HIT, including tailored advice with HRT.
Appointments with our dietitian are also available to ensure people with HIT have
expert nutritional advice with this complex condition.