Some time ago, I published an article on tyramine intolerance because so little is known about it. And… because I’m intolerant to tyramines. But tyramine isn’t the only “amine” that causes problems for some people.
Histamine intolerance also exists. Not only that, but the average doctor is more likely to know about histamine intolerance than tyramine intolerance, despite the fact that we’ve known for decades that those who take monoamine oxidase inhibitors (MAOIs) need to restrict their consumption of high-tyramine foods.
Many major medical websites have pages on histamine intolerance now. Believe me, they didn’t exist back in 2011, when I was figuring stuff out.
However, these two things have a lot in common, enough to make it difficult to know which one you have.
So, what’s the difference between histamine intolerance and tyramine intolerance? How do you tell the difference between them? In this article, I’ll offer an overview.
First, let’s start with the basics.
What are Histamine and Tyramine?
Histamine and tyramine are the best known of the “biogenic amines.” This means they’re substances that occur naturally in our food and/or bodies, and whose chemical structure contains an amine group.
Tyramine results from the breakdown of tyrosine, an amino acid. It elevates blood pressure and increases constriction of blood vessels, which can cause hypertensive crisis and/or migraines in susceptible people.
People who take monoamine oxidase inhibitors (MAOIs), a type of antidepressant, have to avoid high-tyramine foods. Why is this? These drugs block the enzyme that breaks down tyramine in the body, monoamine oxidase, allowing tyramine to build up and cause unpleasant and even dangerous symptoms.
However, some people (me included) don’t take MAOIs but still have a difficult time breaking down tyramine, due at least in part to slow enzyme activity. Genes play a role in how efficiently our enzymes work, which is one reason why people tolerate foods (and drugs) differently.
Aged and fermented foods such as cheese, deli meats, kimchi, and beer/wine contain high amounts of tyramine. So do slow-cooked foods or old leftovers.
Histamine, on the other hand, results from the breakdown of a different amino acid: histidine.
Aged and fermented foods also contain high amounts of histamine. So do many other foods, such as tomatoes, citrus fruits, eggplant, and spinach, to name a few. Finally, as with tyramine, slow-cooking and leftovers build up histamines.
However, unlike tyramine, which is found in trace amounts in the body, histamine can be found in most of the body’s tissues. It plays an important role in your immune response, and gets released when an allergen or other trigger enters your body, with the goal of fighting off the offender. This is why people with hay fever get symptoms when they breathe in pollen, and why they take antihistamines to help with those symptoms.
When you get swelling, itching, hives, sniffling, sneezing, and watery eyes, that’s histamine doing its job. Histamine even contributes to anaphylactic reactions.
Histamine is stored in mast cells in your skin, lungs, nose, mouth, gut, and blood. When a trigger happens, the mast cells release the histamine, causing inflammation and signaling your immune system to get to work.
Tyramine Intolerance vs. Histamine Intolerance
If you consume foods high in histamine and/or tyramine and react badly, you may have intolerance to one or both compounds. The two share many foods in common.
However, tyramine intolerance is relatively straightforward. Histamine intolerance is not.
If you consume high-tyramine foods and get the common symptoms — high blood pressure, headache/migraine, rapid heart rate, chest pain, or shortness of breath — you probably have tyramine intolerance. The only way to know for sure is to keep a food log.
Once you suspect you have it, avoid those foods as much as possible. If you start to feel better, you have your answer.
Tyramine intolerance results from one of two causes: taking MAOIs, or a reduced ability to break down tyramine efficiently. And breaking down any substance in our bodies requires enzymes—in the case of tyramine, monoamine oxidase.
Genes play a role in how enzymes work. If you have genes that code for a slow-moving enzyme, and you eat more tyramine than your body can break down within a given period, you will get symptoms. However, the genes you inherited are not the only factor here, as many things influence how genes get expressed. Also, most people with tyramine intolerance develop it when they’re well into adulthood; the genes didn’t change, something else did.
There’s clearly more to understand with what causes tyramine intolerance, and what we know is limited. But at least we’re clear on what it is and how to treat it.
Similar to tyramine intolerance, histamine intolerance (HIT) involves your body’s inability to break down histamine efficiently. As such, you get unpleasant symptoms.
Unlike tyramine intolerance, which has a pretty predictable list of symptoms, symptoms of HIT can vary greatly and affect many areas of the body, such as:
- Skin (hives, rashes, itching, flushing)
- Gut (diarrhea, bloating, abdominal pain, nausea)
- Face (runny nose, nasal congestion, itchy/watery eyes)
- Head (headache, dizziness, brain fog)
However, after following this issue for many years and spending time in HIT groups, I’ve found there seems to be two types of histamine intolerance:
- When your body has difficulty breaking down histamine from eating high-histamine foods
- When certain foods or other triggers cause your body to release too much histamine
Number 1 functions much like tyramine intolerance—you eat too much of the wrong foods, your body can’t break down the histamine quickly enough and you develop symptoms. Instead of the MAO enzyme, histamine gets broken down by two enzymes: diamine oxidase (DAO) and histamine N-methyltransferase (HNMT).
Number 2, however, functions less like “intolerance” and more like allergy. A food intolerance differs from food allergy, which involves the immune system. Also, #2 gets triggered not just by food, but other things such as heat, exercise, and or certain chemicals.
Mast Cell Activation Syndrome (MCAS)
MCAS is a condition that causes mast cells to release too much histamine, causing all sorts of symptoms. Mast cells are an important part of your immune system, but in some people they go overboard. The cause of MCAS is unknown.
Many people in group #2 have MCAS, which can prove severe enough to trigger tightened airways and even anaphylaxis.
In my opinion, #1 and #2 are different things. However, for now, they get lumped under the “histamine intolerance” umbrella.
Causes of Histamine Intolerance
I could write a huge volume on this topic alone. Partly because the disorder has many causes, and partly because there’s so much we don’t know about it.
So, rather than turning this article into a book, I will defer to Dr. Becky Campbell’s book, The 4-Phase Histamine Reset Plan. She lists 8 different causes for histamine intolerance:
- Mast Cell Activation Syndrome
- Gluten intolerance
- Leaky gut
- Gut infection (e.g. SIBO, candida, etc)
- Inflammatory digestive diseases (e.g. Crohn’s, ulcerative colitis, etc)
- Nutrient deficiencies
- Certain medications
I don’t agree with everything Dr. Campbell says in her book. For example, gluten isn’t “inflammatory” or a problem for everybody. However, I think the book is good overall, thorough, and offers some sound advice. These 8 potential causes of HIT are a useful place to begin.
How To Tell the Difference Between Tyramine Intolerance and HIT
It’s tricky. Foods high in tyramine are typically high in histamine too, so it can be difficult to tell.
One way is to examine your symptoms. Tyramine intolerance typically results in severe headaches and cardiovascular symptoms such as palpitations and elevated blood pressure. If you have other symptoms (skin, gut, etc), it’s probably not tyramine.
Another way is to test foods high in histamine but not tyramine, such as fresh tomatoes, citrus, eggplant, or spinach. If you react to them, you may have HIT.
That’s all for now.
If you have tyramine or histamine intolerance, let us know your experience. We learn from each other.
Also, my Tyramine Intolerance Handbook is now available on all platforms! In it, I go into detail about TI and offer detailed food lists, recipe ideas, and more.
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The Tyramine Intolerance Handbook by Dr. Christie Hartman
The 4-Phase Histamine Reset Plan by Dr. Becky Campbell
Tyramine Intolerance and Its Role in Migraines, Depression, and Anxiety
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6 thoughts on “Tyramine Intolerance vs. Histamine Intolerance”
Foods high in tyramine seem to give me heart palpitations, tachycardia and sometimes a weak/faint feeling. Fortunately, I don’t get headaches.
A cardiologist tested me and diagnosed my problem as ventricular arrhythmia, about 18 months ago. He prescribed Metoprolol, a beta blocker, in a low dose. I’ve been taking it once a day but don’t notice any effect. I still get the symptoms now and then, and sometimes go weeks without noticing it. The symptoms are not induced by exercise. …. The cardiologist did not discuss causes of my problem, other than to say it might be caused by caffeine or alcohol. He said I had no other symptoms of heart disease (no blockage, etc.) and was not in danger of a heart attack.
I only recently realized my problem is triggered by food. I had bad symptoms last week after eating Smart Food White Cheddar Popcorn, avocado, sauerkraut, beets, ham, pumpkin seeds and some tangerines, all in one day. What they all have in common is high content of tyrosine.
I would like to find a way to have a healthy, low-carb, high-plant food, high-protein diet without having arrhythmias.
Artificial food colorings also give me heart palpitations and tachycardia, plus insomnia. Maybe their chemistry involves tyramine?????
Joyce: those are definitely high-tyramine foods. I’ve noticed that tyramine seems to cause the cardiovascular symptoms OR headaches, based on what people have told me. And yes, many people with amine sensitivity don’t like food additives or preservatives. Kids in particular (some) seem to struggle with them and kids’ food is loaded with them. I should look into their chemistry.
For several years, I’ve been baffled by the cause of a strange skin reaction I’ve been experiencing that seemed to come from nowhere. The skin on my face starts peeling off about 24 hours after I eat aged cheeses, nuts, nut butters, half & half, full-fat milk and ice cream.
I’ve suffered from headaches for many years but attributed them to stress. Lately, I have noticed that I get headaches a few hours after eating foods high in soy.
I eat a pretty healthy diet now. I cut out all the foods that cause the skin problems. I have no problem eating tomatoes, spinach, citrus or tropical fruits.
Based on my symptoms, I’m still not sure which intolerance I have. I’m leaning toward a tyramine intolerance since I’m able to tolerate high histamine foods, but that still doesn’t explain the strange skin reaction.
Yeah, the skin reaction is a mystery. I wonder if there’s some protein common to all those dairy products that you don’t tolerate, or are even allergic too.
Thank you for this article. After going through another list of migraine avoidance foods high in tyramine and/or histamine I had an “Uh Duh” moment and thought to ask the question – How do you tell the difference? Your article popped up and I found it wonderfully clarifying. Not to mention re-affirming.
Three years ago I spent a week in the hospital with hard to control AFib and very low blood pressure which changed without warning to very high blood pressure then back again. The irregular heartbeat was attributed to hyperthyroidism. My newly acquired cardiologists were of the opinion that if the thyroid was controlled, the AFib would stop. They were right and I, blessedly, got to stop taking blood thinners after a few months. I was still on a lot of BP meds which were changed and tweaked several times as the extremely high BP spikes continued. (I had been treated for high BP for over 20 years.) Extensive and repeated testing confirmed that I no longer had an irregular heart beat and that my heart was fine. A couple of trips to an E.R. with worrisome rates (180/103, 167/116, etc, etc) – numbers would come down to a less scary level after a few hours and no cause was found. This went on for 10 months.
I had already figured out that the low BP (80s/low 50s usually) was post prandial hypotension. Then I remembered reading about MAOI’s “cheese headaches” and went from there into the not well understood world of tyramine intolerance. Practicing tyramine food avoidance as much as possible has mostly controlled the problem. I still occasionally goof and then spend a scary few hours and a few uncomfortable weeks until my system settles down again. I’ve discussed what I believe is happening with my primary care doc, my cardiologists and their P.A.s, my endocrinologist and an outpatient dietician. The reactions have ranged from a polite – well let’s do this blood work anyway, to somewhat hostile skepticism, to sympathetic – I really don’t know much, if anything, about this issue. ‘Here’s a copy (1 page) of the Food and Drug Administration tyramine guidelines.’
Your article breaking down the symptoms specific to the different intolerances gives me hope that I might be able to start eating things like oranges, lemons and spinach again. It’s odd how much you start missing things like cinnamon after awhile. I will make this attempt with great caution!
I ran across a study I did not bookmark which I have not been able to find again. It was circa very early 1970’s. The doctor/researcher was trying to prove a link between tyramine intolerance leading to a release of norepinephrine which he believed was responsible for ALL hypertension. He didn’t prove his case but ended by recommending that all patients with high B.P. be first tested for tyramine levels. I found this interesting as everything I’ve read published since then has at least implied that there is no way to test for tyramine levels.
Second. I’ve conducted some fairly wide ranging searches. One led me to FDnow.org. One article discusses how Fordham Univ. starting using olive leaf extract (oleuropein) as a prebiotic in FD patients, whereby “Ingestion of olive leaf extract alters the population of the microorganisms residing in the colon and restricts the growth of tyramine producing bacteria. Daily ingestion reduces the incidence of hypertensive crises in individuals with FD.” I had taken OLE for years – I don’t remember which doctor when had recommended it. I stopped taking it when I was in the hospital and didn’t start back again for about 10 months. My medications and supplements were strictly controlled. I actually had to fight to get to continue to take Vitamin C. During the time I wasn’t taking OLE the BP spikes became more frequent, longer lasting and more extreme.
Thank you for this article. I am unsure whether I have tyramine or histamine intolerance. About 8 years ago I started a diet (primal endurance) that included tyramine laden foods–sourdough bread, avocados, onions, almond butter. All of a sudden, I started to get migraines. I went from one migraine every 3-4 years to 4 -6 times a month. I get them if I eat foods that have tyramine, but I get severe migraines if I eat overripe foods (no more banana bread for me) and have been frozen–one May a few years ago I ate a delicious lasagna that had been cooked and frozen the previous December. Five others ate the lasagna and they had no issues whatsoever whereas I had a severe migraine headache that started around 1 am and ended with dry heaves roughly 10 hours later. Research led me to believe that I have tyramine intolerance. I don’t have other symptoms, like heart palpitations. BUT I also get migraines after I fly in a plane for more then a few hours, if I am dehydrated, the day after a stressful event, and when the pressure drops (just before a storm). I also take an OTC allergy pill. If I forget to take an allergy pill and go to my office, I get a migraine within hours. Every time. Of course I keep extra pills at the office but just a week ago I forgot to take the allergy pill and I was all out at the office and sure enough by 1 pm I had a migraine. My agency tested the air quality and everything checked out as OK. Finally, if I am around a lot of plastic–like literally opening up a kitchen cabinet with a lot of tupperware and plastic containers–my eyes burn and my head begins to hurt. So perhaps I have both intolerances? Is there a test I can take to figure this out? It’s maddening.