How Probiotics may help with Histamine Intolerance and Mast Cell Activation related disorders.
This post attempts to answer these questions:
How effective are probiotics in reducing symptoms of histamine intolerance?
Which specific probiotic strains have been shown to be effective in reducing histamine intolerance symptoms?
How does Lactobacillus Plantarum degrade histamine?
What is the role of Lactobacillus Plantarum in reducing histamine levels in food fermentation?
What are the key differences between histamine intolerance (HIT) and mast cell activation syndrome (MCAS) and Mast Cell Activation Disorders-Mastocytosis (MCAD)?
How does Lactobacillus Plantarum's histamine degradation ability benefit food fermentation and histamine reduction? References: (Davani-Davari et al., 2019; Goodoory et al., 20 23; Han et al., 2021; Schnedl & Enko, 2021)
At a conference last summer by Institute of Functional medicine, I was mind blown by learning how certain probiotics like Lactobacillus plantarum can help metabolize histamine. I made a note and then decided one day I would research the validity of this comment. And here I am.
As is typical of me, I like to review foundational concepts before introducing new ones. So here we go.
It’s important to acknowledge that Mast Cell Activation Syndrome and Mast Cell Activation Disease are much more severe than histamine intolerance.
• HIT is an intolerance to histamine, while MCAS is a malfunction of the mast cells.
• HIT is diagnosed based on symptoms and response to a low-histamine diet, while MCAS is diagnosed through various tests.
• HIT and MCAS can coexist and be difficult to distinguish.
The symptoms do overlap and consist of:
Abdominal pain
Bloating
Diarrhea
Nausea
Vomiting
Headache
Fatigue
Skin rashes
Itching
Anxiety
Depression
The key difference between MCAS/MCAD and Histamine Intolerance is the amount of Mediators involved. The former has over 1000 mediators possibly involved with the most common being histamine, tryptase, prostaglandin D2, leukotrienes, heparin, prostaglandin f2, and bradykinin. Hence the symptoms are much broader in MCAS/MCAD.
Mainly a histamine intolerance patient will complain of symptoms associated with certain food. Whereas MCAS and MCAD are much more global environmentally and neuroimmune disorders. We have discussed these conditions at length in other podcasts and posts.
See :
In all of these populations; to help them navigate the following dilemma.:
1. What to supplement with to increase tolerance
2. What food to avoid to decrease reactivity
3. How to test and challenge foods into the diet.
4. What foods to include in the diet to improve histamine tolerance
The issue in histamine intolerance (and also in MCAS/MCAD) is that excessive histamine in the diet that is not properly degraded can cause a flare up of the aforementioned symptoms.
The low histamine diet is generally focused reducing high histamine containing foods and monitoring histamine liberating foods.
Some example of high histamine foods includes (Sánchez-Pérez et al., 2021; Smolinska et al., 2014):
· Aged cheeses (cheddar, Swiss, Parmesan, blue cheese)
· Fermented foods (sauerkraut, kimchi, kombucha, soy sauce)
· Canned fish (tuna, sardines, anchovies)
· Smoked meats (bacon, sausage, ham)
· Alcohol (especially red wine and beer)
· Vinegar
· Overripe foods
· Meat leftovers
Some examples of Histamine Liberators include (Sánchez-Pérez et al., 2021; Smolinska et al., 2014)
· citrus fruits
· seafood
· papaya
· tomato
· nuts,
· Pineapple
· Spinach
· chocolate
· strawberries.
So, the question is what supplement should be taken with food to help reduce symptoms?
What also makes it complicated is higher amounts of bioactive amines like putrescine and cadaverine can potentiate and enhance the toxicity of histamine.
High putrescine foods include(Zaman et al., 2010):
· Zucchini
· Peas
· Green peppers
· Sweet corn
· Citrus fruits
· Bananas
· Soybeans
· Pumpkins
· Nuts
High Cadaverine foods include(Zaman et al., 2010):
· Fish sauce
· Dry-fermented sausages
· Cured cheese
· Sauerkraut
· Soy-fermented products
In addition, histamine content of food can increase during storage due to bacterial activity. This is especially true for foods that are not properly refrigerated or that are stored for long periods of time.
Some examples of foods that can have increased histamine levels due to storage include:
· Fish and fish products
· Meat
· Poultry
· Eggs
· Dairy products
· Fermented foods
The question is how should someone with histamine restrictions navigate the world without being stuck in a restrictive lifestyle.
I think the strategy should be:
1. Using supportive medications that can dampen mast cell activity.
2. A supplement like Diamine Oxidase to degrade histamine
3. A probiotic that is immunoregulatory (promotes T-regulatory function) and helps degrade histamine
4. Address overgrowth of histamine producing bacteria that might be present in the gut.
5. Address gut pathogens that produce histamine
It turns out Lactobacillus plantarum, a bacterium found in fermented foods, such as sauerkraut, kimchi, and pickles and also found in the human gut is one of the better at degrading histamine.
Lactobacillus plantarum is used as a starter culture in the fermentation of vegetables and meat products. It produces lactic acid as a byproduct of fermentation, which gives fermented foods their characteristic sour flavor and also inhibits the growth of harmful bacteria.
This does not mean to run out and eat fermented foods if you have histamine issues…. please no! that might be disaster.
However, a Lactobacillus plantarum containing probiotic taken with 1-2 meals daily might a good option.
Some other strains that have been researched to degrade histamine are:
• Lactobacillus acidophilus DDS-1 (one of the original probiotic strains)
• Bifidobacterium lactis HN019 (great studies done on increasing colonic transit time)
• Saccharomyces cerevisiae CNCM I-3856 (used in a lot of IBS studies)
• Lactobacillus casei Shirota (this is what is in the brand Yakult)
• Lactobacillus plantarum APsulloc 331261 (GTB1TM) (this is isolated from leaves of green tea)
• Lactobacillus Plantarum degrades histamine
Certain probiotics appear to reduce histamine by two mechanisms (Smolinska et al., 2014):
· Oxidation: Probiotics can produce the enzyme diamine oxidase (DAO), which breaks down histamine into ammonia and hydrogen peroxide.
· Methylation: Probiotics can also produce the enzyme histamine-N-methyltransferase (HNMT), which converts histamine to N-methylhistamine, which is less active than histamine.
Some probiotic strains have been shown to be more effective than others at metabolizing histamine. For example, one study found that the probiotic strain Lactobacillus reuteri was able to reduce histamine levels in fermented milk by up to 90%.
This an excellent add-on strategy to help with microbiome approaches to histamine issues.
In future posts we will look at pathogens (i.e., h. pylori, candida, parasites, streptococcus, staphylococcus aureus,etc. ) that stimulate mast cell release of histamine as well as commensals species that when overgrown may produce excess histamine in the gut (i.e. Morganella spp. Pseudomonas aeruginosa. Citrobacter freundii, Klebsiella pneumoniae, Proteus mirabilis Enterobacter spp. Escherichia spp. Fusobacterium sp. Etc.) .(Jiménez et al., 2021)
If you glance on Fullscript I have a portfolio with some histamine supportive supplements.
