Dr. Paul Deglmann
Meghan Feir Walker
It’s not uncommon for people with SIBO to have issues with excessive histamine production, and vice versa. Patients with SIBO and histamine intolerance know it can be hard to tell which symptoms can be attributed to which ailment, but one thing is clear: It’s all miserable and hard to live life to the fullest when you're feeling so unwell.
Gut health plays a major role in overall health and wellness, and when it’s off, this can impact more than digestion. It can impact mental health, energy levels, pain levels, and so much more.
In this article, we’ll show you how SIBO and histamine intolerance are connected, why and how they occur, and much more.
| Key takeaways SIBO and histamine intolerance are interconnected: Excess bacteria in the small intestine can increase histamine production, contributing to symptoms. Gut bacteria play a key role: Some bacteria produce histamine, while others help break it down. An imbalance can worsen symptoms. Diet and lifestyle matter: A low-histamine diet and functional health strategies, like stress management and sleep, can support gut and histamine balance as you discover and address the root cause of the problems. Probiotics need careful selection: Some strains can help, while others may worsen histamine intolerance. |
What is SIBO?
Small intestinal bacterial overgrowth (SIBO) is a condition that occurs when bacteria that are supposed to stay in the large intestine/colon begin to travel up into the small intestine. This bacterium then begins to feed on the food in our small intestine, creating a fermentation process that can lead to significant symptoms.
Some common SIBO symptoms include the following:
- Gas/bloating
- Constipation or diarrhea
- Acid reflux/heartburn/GERD
- Nausea
- Abdominal pain and/or cramping
- Food sensitivities
- Irritable bowel syndrome (IBS)
- And more
SIBO can also contribute to poor absorption in the gut, which can lead to nutritional deficiencies. All the effects of SIBO can greatly diminish overall health and wellness, so it’s imperative to address SIBO to improve your health and quality of life.
What is histamine intolerance?
Histamine is a chemical messenger, signaling molecule, and an excitatory neurotransmitter that impacts several systems in the body, like the immune system, digestive system, and nervous system. Histamine is made by certain immune cells, like mast cells and basophils.
The effects of histamine on how your immune system and body function are vast. Histamine modulates the immune response, influences digestion as well as the microbiome, and impacts wakefulness/alertness, mood, and appetite.
While histamine is a good thing that the body needs, what happens when we produce too much histamine or can’t remove it properly?
When histamine builds up in the body faster than the body can break it down, this leads to histamine intolerance or mast cell activation and the unpleasant and sometimes dangerous symptoms these problems can produce.
There are several reasons why histamine can build up in the body, including:
- Dysbiosis in the gut, which is due to a lack of beneficial bacteria and/or an overgrowth of yeast/candida, bacteria, parasites, etc.
- Nutritional deficiencies such as B6, magnesium, vitamin C, copper, etc.
- Deficiency in our DAO (diamine oxidase) enzymes of the gut that help break down histamine
- An overload of environmental toxins, such as mold, heavy metals, insecticides, pesticides, herbicides, etc.
- Dietary triggers, especially GMO grains in the diet
Histamine can impact several different systems of the body, so the variety of symptoms can vary significantly from person to person.
Some common symptoms of histamine intolerance include:
- Neurological symptoms, including headaches, migraines, dizziness, anxiety, brain fog, poor sleep, etc.
- Digestive symptoms, including bloating, abdominal pain, cramping, diarrhea, nausea, heartburn, reacting to fermented foods/fiber/probiotics, several food sensitivities, etc.
- Immune symptoms, including sneezing, runny nose, congestion, skin flushing, hives, itchiness, eczema, swelling of the lips/eyelids/face, etc.
- Cardiovascular symptoms, including rapid heart rate or heart palpitations that often happen after eating, low BP, hot flashes/feeling hot, etc.
- Other symptoms, including sensitivity to temperature changes, fatigue, increased hormonal symptoms prior to or during your cycle, etc.
How are SIBO and histamine intolerance connected?
Can an imbalance of gut bacteria cause histamine intolerance?
With SIBO, some of the bacteria that can migrate north into the small intestine are histamine-producing bacteria. Bacteria such as Pseudomonas, Klebsiella, Citrobacter, Morganella, Proteus, Enterobacter, Fusobacterium, and even certain strains of Lactobacillus can produce histamine. This is why some people don’t do well with certain strains of Lactobacillus probiotics until the dysbiosis has been addressed.
If the bacterial overgrowth involves any of the species just listed, this can lead to an excess of histamine and, therefore, histamine intolerance or MCAS symptoms.
Symptoms common to both SIBO and histamine intolerance
There is often an overlap of symptoms when someone has both SIBO and histamine intolerance, which can make it hard to know which symptom can be attributed to which condition.
Symptoms common to both SIBO and histamine intolerance:
- Bloating and abdominal discomfort after eating
- Gas and distension
- Loose stools, diarrhea, or inconsistent bowel habits
- Heartburn, nausea, or early satiety
- Fatigue or brain fog, especially post-meal
- Headaches or migraines
- Anxiety, irritability, or sleep disturbance
- Flushing or warmth after meals
- Food sensitivities (reacting to a wide range of foods)
Does SIBO cause mast cell activation?
SIBO doesn’t directly cause MCAS, but it can contribute to an increase in MCAS symptoms downstream. MCAS is a chronic condition where mast cells become overactive and release excessive amounts of inflammatory chemicals, including histamine.
SIBO can certainly increase histamine levels due to certain bacteria producing excess histamine. This excess histamine can make the mast cells more sensitive to degranulate and release even more histamine. If someone’s body is sensitized to histamine, this can definitely increase MCAS symptoms.
People with a history of mold exposure, genetic predispositions that impact their DAO (Diamine Oxidase) enzyme production in their gut, poor methylators/unhealthy detox pathways, and chronic infections can make someone more prone to a flare in MCAS symptoms if SIBO is also present.
The root cause(s) of why someone is dealing with MCAS should be properly addressed because this condition can lead to dangerous histamine-related symptoms.
Understanding DAO (diamine oxidase) and histamine breakdown
DAO stands for diamine oxidase, an enzyme present in the gut that helps break down and degrade histamine.
Can SIBO cause a DAO deficiency? Several things can contribute to or cause a DAO deficiency, and SIBO is one of them.
Here are some factors that can contribute to a DAO deficiency:
- Dysbiosis (SIBO and dysbiosis can cause an increase in histamine and inflammation. The inflammation can suppress DAO enzyme production as there is an increase of histamine being produced by the bacteria)
- Nutritional deficiencies of cofactors needed for DAO production
- Dietary factors
- Genetic predispositions or SNPs involving DAO
- Certain medications
- Estrogen dominance
- Chronic inflammation
- And other factors
Probiotics and histamine intolerance: What works best?
Can probiotics contribute to histamine intolerance? Are they all harmful, or just certain strains?
A wide variety of probiotics are available online or on store shelves, but it can be hard to navigate which ones are safe if you have histamine intolerance or SIBO.
Common strains of probiotics found in probiotic supplements can definitely increase symptoms, especially certain strains in the Lactobacillus species. While there are many Lactobacillus strains that can increase histamine, some don’t increase histamine, including Lactobacillus plantarum.
Most Bifidobacterium strains do not increase histamine levels, and several of the Bifidobacterium strains actually help degrade histamine, so these are safer choices for those looking for low- or no-histamine probiotic options.
Here are some of the simple strains that don’t produce any histamine or have histamine-degrading properties.
Safe strains of probiotics for histamine intolerance:
- Lactobacillus plantarum
- Bifidobacterium longus
- Bifidobacterium brevis
- Bifidobacterium infantis
Dietary approaches to support gut and histamine balance
If you’re struggling with histamine intolerance or MCAS symptoms, consider trying a low-histamine diet under the supervision of your functional medicine doctor.
Low-histamine diets can help minimize the histamine intolerance or MCAS symptoms while you’re trying to get to the root cause. Many high-histamine foods are actually extremely healthy, overall, but can greatly increase symptoms in someone who already has an excess of histamine in their body.
Avoid the following foods for a time as you address the underlying reasons your histamine production is out of balance.
Some high-histamine foods:
- Fermented foods (e.g., sauerkraut, kimchi, kombucha, etc.)
- Egg whites
- Chocolate and cocoa powder
- Certain fruits (e.g., avocado, banana, tomatoes, citrus, and all dried fruits.
- Certain vegetables (e.g., spinach, mushrooms, etc.)
- Legumes (e.g., lentils, chickpeas, peanuts, beans, etc.
- Smoked meats and fish
- Leftover food
- Herbs and spices (e.g., cumin, mustard, paprika, chili, and pepper)
- And many other foods and beverages
Try focusing on eating foods lower in histamine to minimize symptoms.
Some low-histamine foods:
- Certain fruits (e.g., apples, blueberries, mangoes, peaches, pomegranates, etc.)
- Certain fresh vegetables (e.g., potatoes, asparagus, beets, broccoli, Brussels sprouts, cabbage, carrots)
- Certain oils (e.g., olive oil, coconut oil)
- Non-dairy milk (e.g., almond, coconut, or hemp)
- Flax and chia seeds
- Eggs, fully cooked (especially yolks)
- Fresh meat, chicken, turkey (avoid leftovers)
- Individually quick-frozen fish filets
Please note: One thing to keep in mind is that while certain foods are low-histamine, they may be high in FODMAPS, and vice versa. Some foods are both low-histamine and low-FODMAP, but it’s not usually advised to limit your diet so greatly that you’re following both protocols.
Consult with your medical practitioner about which diet strategy is right for you if you are suffering from both SIBO and histamine intolerance. Both diets should be used as a short-term strategy to help minimize symptoms as you address the underlying causes of SIBO and histamine intolerance.
Functional health strategies beyond diet
Along with trying a low-histamine diet for a time, these lifestyle tips should be ongoing throughout your life and can help support good gut health and histamine balance in your body.
Lifestyle tips that can help support your gut and histamine levels:
- Stay well-hydrated by drinking clean, filtered water
- Get good, restful sleep (7-9 hrs)
- Practice good stress-management strategies
- Make sure you are breathing clean air
- Get outside
- Move your body and find a form of exercise you tolerate well
Summary and practical tips for maintaining gut and histamine wellness
- Small intestinal bacterial overgrowth (SIBO) is a condition that occurs when bacteria that are supposed to stay in the large intestine/colon begin to travel up into the small intestine.
- When the bacteria travel into the small intestine, they begin to feed on the food in our small intestine, creating a fermentation process that can lead to significant symptoms.
- Histamine is a chemical messenger, signaling molecule, and an excitatory neurotransmitter that impacts several systems in the body, including the immune system, digestive system, and nervous system.
- Histamine is made by certain immune cells, like mast cells and basophils.
- Histamine can build up in the body faster than the body breaks it down, which can lead to histamine intolerance or mast cell activation symptoms.
- Both SIBO and histamine intolerance can cause similar symptoms, including gas and distension, loose stools, diarrhea, or inconsistent bowel habits, heartburn, nausea, fatigue, brain fog, headaches, migraines, anxiety, sleep problems, flushing, food sensitivities, and more.
- While SIBO doesn’t directly cause MCAS, it can contribute to an increase in MCAS symptoms downstream.
- DAO stands for diamine oxidase, which is an enzyme present in the gut that helps break down and degrade histamine.
- Certain probiotics can make histamine intolerance symptoms worse. Try incorporating lower-histamine probiotics, such as Lactobacillus plantarum, Bifidobacterium longus, Bifidobacterium brevis, and Bifidobacterium infantis into your daily supplement regimen, if advised to by your practitioner.
- Eating a low-histamine diet, for a time, as you address your histamine problems, can help minimize symptoms.
- By incorporating healthy lifestyle habits, you can help support your gut and immune health while you figure out and address the root cause(s) of your gut and histamine issues.
How Restorative Health Solutions can help your gut health
At RHS, we take into account your history and symptoms, along with following the “Test, don’t guess” approach.
When it comes to your gut and immune health, we test thoroughly by doing comprehensive tests like stool tests and organic acid testing (OAT). Outside of these tests, we also consider food allergy/food sensitivity testing, toxin overload testing, nutritional deficiencies testing, and more.
After the results are in, we combine your history with your test results and put together a personalized protocol for you that includes dietary modifications, lifestyle adjustments, and an individualized supplement protocol based on the test results and your history. This is a very one-size-fits-one protocol, and this is where working with an experienced functional medicine practitioner can make all the difference.
Ready to support your gut and balance histamine? We can help
By learning more about your gut and immune health and the reasons why they became imbalanced, you can take proactive steps toward enhancing your whole-body health and overall quality of life.
Are you ready to improve your gut health? Read more on our blog about gut health, or schedule your free 15-minute consultation with Dr. Paul to explore a personalized, functional approach for a helpful and effective path to recovery.
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