Dr Joneja's Guides to Histamine Intolerance
Dr Janice Joneja, a world expert on histamine intolerance, has published two books on histamine intolerance:
A Beginner's Guide to Histamine Intolerance – read more about it here.
Histamine Intolerance: The Comprehensive Guide for Healthcare Professionals – read more about it here.
Buy the ebook from Amazon here.
The development of the microbiome with especial reference to histamine
As part of our Q&A series on histamine, Dr Joneja was asked how someone with histamine intolerance could restore balance in their gut microbiota.
Dr. Joneja, your work online is a great resource as I try to understand my recently developed histamine intolerance. (I think due to change in my microbiota.) I'm interested in restoring my gut microbiota and I'm happily working with diet. Among the broader restore-your-gut crowd, I see lots of suggestions for kimchi, sauerkraut, kombucha, etc. I have a histamine intolerance, however, so (1) I try to avoid fermented foods, and (2) I don't want it to be the bacteria that make amines that take up residence in my gut. Aside from dirt and kissing dogs, where else can I get good bacteria? Incidentally, I am a 35 year old male.
Dr Joneja says:
As I hold a doctoral degree in Medical Microbiology I can speak with some authority on this topic, so am taking the opportunity to put forward some facts and dispel a variety of myths on the subject of the microbial flora of the digestive tract and its impact on health and disease.
Let us take a look at the colonic microflora (the microorganisms that inhabit the large bowel) of the typical human. The large bowel is the site where the largest number of microorganisms that affect our health are located. When a baby is born the first microorganisms that gain access to, and establish themselves, in the digestive tract come from the mother’s vagina and then the outside world. When the baby is delivered by Caesarian section, of course, the vaginal microorganisms are by-passed. Further organisms are encountered from the environment and during feeding - ideally breast-feeding by the mother right from birth. Breast-feeding not only provides the organisms themselves, but also the nutrients to aid in the establishment and multiplication of the “beneficial strains” best suited to the baby’s optimal health. It can be argued that this is the very first “probiotic” we come into contact with – and undeniably the best! In the healthy new-born breast-fed infant, bacteria of the genus Bifidobacterium (bifidobacteria) tend to predominate and along with others, including species of Lactobacillus, help to exclude more harmful strains from invading. At the same time, the established strains aid in promoting a strong immune system.
When the baby is introduced to solid foods the types of microorganisms in the bowel change; it is now that the permanent microflora becomes established. This microbiota in most cases persists for a lifetime. Every person has a unique microbiota. People living in the same household, for example, siblings, will have a markedly different range of microorganisms in their colon, in spite of living under the same conditions and eating an identical diet. Temporary changes can be induced by changes in environment (for example, moving to a different country) and completely altering one’s diet. However, unless these new conditions are maintained, the original microflora will become re-established quite quickly. It is here that one needs to understand that taking a probiotic for a while will not permanently change a person’s microflora; unless the probiotic strains, together with the prebiotic (the nutrients required to nurture and aid in the establishment of the new microorganisms) are consumed uninterruptedly, the original microflora will reappear. In other words, if a person takes a probiotic yogurt as a method of changing their microflora, introducing the desired microorganisms together with the nutrients required for their growth in the form of the milk constituents, will need to be continued indefinitely to maintain the desired effect. When they discontinue the regimen their original microflora will become re-established over time.
Now a word about “good” and “bad” bacteria. As you no doubt are aware, every type of bacterium has its own particular requirements for growth, and a unique metabolism. Within an enclosed ecosystem, such as the human bowel, there is interaction between the different types of organisms; competition for nutrients, and both positive and negative responses to other organisms in the area as well as interactions with the host (the human). The products of metabolism of one species can provide nutrients for promoting the growth of another. In contrast, certain strains produce materials that are noxious to others, thereby impeding their growth. In addition, the microorganisms within our bowels provide us with essential micronutrients, for example, vitamin K, and several B vitamins. They also break down certain types of fibre, which humans cannot digest, releasing additional nutrients to improve health. The fact that many people do not fully appreciate is that without our resident microorganisms we would not survive. Gnotobiotic (germ-free) rats, which are maintained in a completely sterile environment in the laboratory do not live for long. The microorganisms required for their immunological protection and provision of essential nutrients are absent. It is a similar situation for humans. Our native microflora is essential to our survival. In the broadest sense then, our established microorganism are “good”! Furthermore, our resident microorganisms go a long way in defending their territory against invasion by the “bad” disease-causing (pathogenic) strains that could cause infection.
Indisputably some established strains of microorganisms can lead to distress and disease if the human host is not immune to them. An example is Clostridium difficile. In some people this bacterium is established and causes no problems; in others, especially those with weakened immune systems, the elderly and the very young, it can cause overt infection. An important event contributing to such an infection is oral antibiotic usage. The antibiotic kills off many strains of the resident microflora, allowing an overgrowth of the C. difficile that produces a toxin, which may cause severe diarrhea and inflammation of the colon. In extreme cases this can be fatal. So here we have a situation that an intact microflora is actually protective against infection by one of its own residents, but when “attacked’ by an outside agency in the form of an antibiotic, can no longer maintain its control, with catastrophic results. It is estimated that perhaps as much as 10% or more of our resident microorganisms are potential pathogens, which in one way or another protect us from others to which we are not adapted. So now we have a nice philosophical question: what are the “good’ and which are the “bad” bacteria? Obviously it depends on the context of the individual micro-environment.
Since the early 1990s foods containing probiotic cultures have become established as a method of introducing new strains of microorganisms into the body in the management of an ever-increasing number of conditions. The aim is to displace unwanted organisms by introducing beneficial strains together with a source of nutrients to aid in their establishment in the new environment. However, as the above poses the question, how do we safely displace the unwanted strains in order to allow the desirable ones to invade? And how do we ensure the continued survival of those we favour? We still have a long way to go before we can answer these questions with any degree of confidence.
You have specifically queried the possibility of introducing strains that might be beneficial in the management of histamine intolerance. Microorganisms capable of converting histidine from residual proteins in the digestive tract into histamine occur naturally as part of the normal microflora of many people. These strains synthesise (produce) the enzyme histidine decarboxylase (HDC). When these organisms are present in large numbers it is probable that this is a contributory cause of histamine excess or sensitivity.
As you will learn from my various publications, histamine is broken down by enzymes, especially diamine oxidase (DAO) and removed from the body. Some strains of microorganisms can synthesise DAO. Unfortunately, currently we do not have any research that has definitively established the effectiveness and safety of these strains within the body.
Clearly, if we could displace microorganisms producing HDC and histamine with those capable of producing DAO it would be of great benefit to the histamine-sensitive individual. We need to identify precisely which strains of microorganisms synthesise histidine decarboxylase and which produce diamine oxidase. By eliminating the former and promoting the establishment of the latter we might expect to greatly aid histamine reduction in the digestive tract, and possibly within the body as well. I submitted proposals for this research 15 years ago, but unfortunately was unable to obtain funding because governments and universities could not provide the support required and the drug and food companies who would have funds available could not see the profit in the proposal; I had to shelve it for lack of backing and facilities in which to conduct the research.
At the present time we have the situation in which an attempt to introduce DAO-producing strains into the histamine intolerant individual carries the risk of also introducing bacteria capable of producing histidine decarboxylase, and thereby actually increasing the level of histamine entering the patient’s circulation. Until we have much more information on the strains capable of producing DAO at an effective level within the body, and how to introduce them safely, while suppressing those synthesizing HDC, the use of probiotics as a management strategy for histamine intolerance is a hit and miss situation with a rather uncertain outcome.
For readers who have a particular interest, I can provide summary lists of the microorganisms which produce HDC and those that synthesize DAO. It is important to understand that these lists include known strains of HDC- and DAO-producers, but makes absolutely no claim as to their safety in humans, nor their ability to produce sufficient DAO to reduce histamine in vivo, and thus their suitability as probiotics. That research remains to be carried out.
To further answer your question: any food that is produced by fermentation is likely to contain a fairly high level of histamine. A histamine-intolerant person should definitely avoid it. Sauerkraut, kimchi, kombucha are all fermented and if you are histamine-intolerant you must avoid them. I am unsure as to the aims of the “restore-your-gut” crowd, or how they justify their dietary choices, but for you I would suggest that it is something you should assiduously avoid.
To quote an overused cliché, “One man’s meat is another’s poison”. As you should now be aware, having read the above, strains of microorganisms that may be beneficial in certain conditions can be very strongly contraindicated in others. It depends on context and requirements.
If you found this article interesting you can find a number of other articles on histamine intolerance both by Dr Joneja and others here, reports on histamine research here and a Q & A section on histamine with Dr Joneja here.
Dr Janice Joneja Ph.D., RD
Dr. Janice Joneja is a researcher, educator, author, and clinical counsellor with over thirty years of experience in the area of biochemical and immunological reactions involved in food allergy and intolerances. Dr. Joneja holds a Ph.D. in medical microbiology and immunology and is a registered dietitian (RD).
She has been a member of the faculty at several Canadian universities, starting her career as an Assistant Professor in the Department of Microbiology, Faculty of Science, and in the Faculty of Dentistry, at the University of British Columbia, Vancouver. Since 2001 Dr. Joneja has been a faculty member in the School of Biomedical and Molecular Sciences, at the University of Surrey, in England, teaching in the M.Sc. course in Nutritional Medicine. For 12 years she was head of the Allergy Nutrition Program at the Vancouver Hospital and Health Sciences Centre.
Dr. Joneja is the author of six books and a dietetic practice manual on food allergy, a textbook on Irritable Bowel Syndrome, and several distance education courses. Her most recent books include “The Health Professional’s Guide to Food Allergies and Intolerances”, “Dealing with Food Allergies”, and “Dealing with Food Allergies in Babies and Children”. Dr. Joneja’s work has been published in peer-reviewed scientific and medical journals, as well as in popular magazines. She is a respected lecturer at universities, colleges and hospitals internationally, and regularly appears on television and radio call-in shows as an expert in her field.
Dr. Joneja is President of Vickerstaff Health Services, Inc., a practice that provides counselling for people suffering from all aspects of adverse reactions to food, and resources for the professionals and care-givers who support them.