Fermented food allergy or sensitivity can be hard to recognize. Think of the following questions:
- Do headaches or migraine occur after drinking red wine?
- Does fermented cheese like Parmesan and blue cheese trigger a reaction?
- Can commercially fermented soy, pickles or sauerkraut cause problems?
Answering yes on any on the questions does not mean that a fermented food allergy is certain, only that it should be investigated. However, this is tricky as similar reactions can occur for other reasons. Finding the root cause requires effort.
In case of sensitivity to fermented foods, it does not always mean one must avoid all such foods. Homemade sauerkraut, yoghurt, and other foods are generally safer. Why is that?
Though numerous factors come into play, common triggers are biogenic amines. What are they? How can they be avoided?
This post is written with the intention to assist in identifying if fermented foods might be the cause of any adverse effect. And when identified, such foods can be excluded.
Biogenic amines and fermented food
Biogenic amines are substances created by certain bacteria that are often used commercially to break down amino acids in food. Amines are present in some (not all!) foods that are overcooked, processed, ripened, fermented, or decomposed. Amines cannot be removed by any cooking method.
In healthy individuals, biogenic amines are broken down by the intestine and liver. Enzymes such as MAO (monoamine oxidase) render amines harmless.
However, the MAO enzyme can be missing or become sluggish causing a build-up of amines in the body. Some drugs like antibiotics and antidepressants can inhibit the MAO enzymes causing…
- blood pressure changes
- body temperature
- stomach problems,
- mental confusion,
- a migraine,
- and more.
There are different degrees of intolerance. A few older studies showed that very sensitive ones can get migraine by drinking water containing as little as 1 mg of tyramine chloride, an amine.
Most problems occur with histamine and tyramine while other amines might not cause any problems at all. And even though identifying the specific amines causing a reaction can be hard, it’s still possible to alleviate symptoms.
What to do when suspecting fermented food sensitivity
- Keep a log of food products to discern a pattern of what fermented foods are linked to headache, migraine, or other reactions. This help identifying which specific amines to blame.
- Find a specialist who understands biogenic amines. People can test negative for allergies but still have problems with biogenic amines. The specialist should know about Diamine Oxidase (DAO) and Monoamine Oxidase (MAO) as these two enzymes are responsible for degrading histamine and tyramine, common culprits.
- Consume fresh produce, avoid commercially fermented foods. Remember: Buy fresh, cook fresh, eat fresh.
- Homemade yoghurt and fermented vegetables are usually safe.
- Some feel it helps to take a high-quality probiotic supplement.
Common biogenic amines
Histamine and tyramine are common culprits. Similar symptoms can be caused by salicylates and glutamates.
Fermented foods containing amines
Keep in mind that some foods can contain different tyramine concentrations in different parts of the same food. Poor quality food tend to contain higher amounts, as does food not properly stored, cleaned, or prepared.
Red wine headaches
Red wine is a fermented drink. Symptoms occur shortly after drinking a single glass and might be followed by nausea and flushing. Some researchers believe this is caused by tyramine and histamine present in some red wine, though other potential causes also exist (like tannins and sulphite). In one study, red wine and Sake (made from fermented rice) were found to have the highest amine levels, while some beer had low levels. Red wine can contain between 20–200% more histamines than white wine.
Beer can contain tyramine and phenylethylamine if the malt is infected, or because of a later infection. However, amine concentrations vary a lot from brewery to brewery. In some studies, bottled and canned beers had the highest levels. Only 12% of tap beers had higher levels while the rest had low levels of tyramine.
The “cheese effect”
There are two main types of cheese—fermented and non-fermented. To ferment cheese, live bacteria cultures are needed. The bacteria feed on the lactose in the milk, a process called ageing. This process can produce more or less biogenic amines as a by-product. In one study they found that 18 of 26 kinds of cheese (26%) had high levels of tyramine.
In the 1960s, a British pharmacist noticed that his wife developed a headache every time she ate cheese high in tyramine and at the same time taking MAOI antidepressants. It was discovered that certain drugs as MAOIs (monoamine oxidase inhibitors) inhibit the breakdown of tyramine causing a build-up in the body leading to high blood pressure, headaches, itchy skin rashes, heart palpitations, and diarrhea. In fact, a number of MAOI patients died from strokes or heart attacks before doctors realized that patients taking MAOIs needed to avoid foods high in tyramine. There is also a rare condition where people are born without the MAOA gene and, therefore, lack the MAO enzyme.
The cocoa bean is often fermented to achieve a better flavor. Dark chocolate contains tyramine, which triggered migraine headaches in the majority of migraine-prone subjects tested in some studies (according to the Clemson University Extension). In another study, phenylalanine which is another component of chocolate triggered migraines in about half the migraine-prone subjects. However, raw, unfermented cocoa beans or cocoa nibs are usually fine to consume.
Much of the commercially produced yoghurt contain tyramine and sometimes phenylethylamine. However, yoghurt prepared at home is usually free of tyramine. Using a good yogurt starter prevents the creation of amines. One reason is because starters are composed of probiotic bacteria strains that do not produce amines, some even prevent the development of amines.
Some drugs, including over the counter cold tablets contain amines. Examples are decongestants, nasal drops or sprays, some pain relievers, general and local anesthetics and some antidepressants. Be sure to check labels and ask your doctor.
Biogenic amines in sauerkraut
A study in 1999 aimed to determine levels of biogenic amines in 121 sauerkraut samples. They tested a few Austrian manufacturers, household-prepared, and also sterilized sauerkraut with brine in jars. Even though there were wide variations, there were generally low concentrations of amines in sauerkraut.
Lowest concentrations of amines were found in household-prepared sauerkraut
Another study in 2011 tested biogenic amines in spontaneously fermented (wild fermentation) sauerkraut during 45 days of storage. They also tried adding three different probiotic bacteria strains to ferment cabbage, Lactobacillus plantarum, Lactobacillus casei and Lactobacillus curvatus.
After fermentation, they compared amine levels in the jars. Below is the result:
- Adding probiotic bacteria created much lower levels of biogenic amines in fermented cabbage. All biogenic amine levels were below the 100 ppm threshold. Histamine and tyramine were essentially absent during 45 days of storage.
- Fermenting cabbage without using a starter produced a higher amount of amines. When Lactobacillus bacteria were not added, the dominant biogenic amines created were putrescine, tyramine, and histamine. The longer the sauerkraut was stored, the more amines were created.
Using a starter culture to ferment vegetables at home prevents the extensive formation of biogenic amines.
If you’re sensitive to amines, you can still enjoy homemade fermented vegetables, sauerkraut, and yoghurt.
Spoiled food = food poisoning
The concentration of biogenic amines in food can sometimes be used as an indication of how much it has rotted or decomposed. High concentrations of biogenic amines can cause food poisoning. In lower concentrations, these same chemicals can trigger migraine attacks in susceptible ones.
Food freshness is key to avoid effects of biogenic amines
The way meat is distributed in supermarkets can cause problems. If the meat is vacuum packed, then repacked, and sold as fresh it can be 6-10 weeks old by the time it’s eaten. During this time, several amines can develop in high levels.
Studies show that vacuum packing can prevent the growth of harmful microorganisms but it cannot prevent the development of biogenic amines.
Experience shows that it’s vital to know about the history and freshness of food you consume to be able to identify possible amine-containing foods.
Other foods containing biogenic amines
Certain bacteria are often used to process commercially produced foods and as a result, these foods can contain high amounts of biogenic amines.
Examples of food containing amines:
- Fermented soy and canned tuna are known to be high in histamine, cadaverine, and putrescine.
- Aspartame (Nutrasweet) is used as a sweetener in many drinks and 600 different foods. It contains phenylethylamine and can cause many problems even in healthy individuals.
- One study analyzed 45 commercial fish sauces and 23 soy sauces for their biogenic amine content. They revealed it varied from 100 mg/kg to 4000 mg/kg, depending on the method of manufacture. Biogenic amines in soy sauces was much lower than in fish sauces. Tyramine was the main amine in soy sauce while fish sauces contained high concentrations of tyramine, histamine, tryptamine, and others. The levels of biogenic amines in fish sauces were similar to matured cheese.
- Biogenic amines are formed when amino acids in food are broken down. High concentrations can therefore be found in fish products that have not been kept according to hygiene guidelines.
Foods to be suspicious about
This is not rocket science so this table only gives the overall idea of what kind of foods can cause a reaction. The high to very high group contains 10-100 times more amines, salicylates and glutamates than the low-medium group. Much depends on the level of sensitivity.
Generally, fresh, organic foods are safer than processed, stored products.
Milk (Goat, Cow)
Fresh Cottage Cheese
Tofu Ice Cream
Chicken (No Skin)
Fish (White Meat)
Turkey (No Skin)
Meat Older Than 2 Days
Spicy Flavoured Snacks
Smoked Meat, Chicken
Meat Pies, etc.
Cola Type Drinks
Brains, Kidney, Tripe
Dried, Smoked Fish
It’s easy to forget that consuming several foods containing histamines at the same time will increase the risk of a reaction. People with low levels of the enzyme diamine oxidase cannot break down all the histamine absorbed from food. This is histamine intolerance.
Depending on how the food is produced histamine levels differ greatly.
- Dried fruits like apricots, dates, prunes, figs, and raisins (they might be okay if thoroughly washed)
- Vinegar or vinegar-containing foods, such as mayonnaise, salad dressing, ketchup, chili sauce, pickles, pickled beets, relishes, olives
- Soured bread such as pumpernickel, coffee cakes, foods made with large amounts of yeast
- Fermented foods as pickled or smoked meats, commercially produced sauerkraut
- Aged or fermented cheese, such as Parmesan, blue and Roquefort
- Sour cream, sour milk, buttermilk, yogurt; avoid if not fresh
- Processed meats—sausages, hot dogs, salami, and others
- Smoked fish—herring, sardines
- Most commercially produced yogurt
- Alcoholic drinks as wine and beer
- Cider and homemade root beer
Some foods might be low in histamine but they tend to stimulate the body to release histamines which can also cause a reaction. The following foods are examples of this:
Resolving fermented food allergy
- First, try a low-amine diet to confirm if amines are to blame. If there is no problems with amines things become much easier.
- In case you suspect amines, then need to determine which specific amines are triggering symptoms—histamine, tyramine, or others.
- When you have a good grasp of possible triggers, controlling fermented food allergy includes avoiding those triggers.
- After avoiding biogenic amines for a while, it’s important to reintroduce those same foods (the triggers) to confirm sensitivity. Otherwise, you might end up with a long list of foods to avoid when in reality not all those foods will trigger a reaction.
Revealing the real cause of fermented food allergy involves becoming a detective. The assignment is to investigate the intriguing case of your own body. This requires patience and determination. But it can be done. The result should that you feel better.