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.
Finding the cause
Even in case of sensitivity to fermented foods, it does not always mean avoiding all such foods. Homemade sauerkraut, yoghurt, and other foods are generally safer.
This post is written with the intention to assist in identifying if fermented foods are the cause of any adverse effect. When identified, such foods can be excluded. Though numerous factors come into play, common allergy triggers are biogenic amines. What are they? How can they be avoided?
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 knows about biogenic amines. People can test negative for allergies but still have a biogenic amine intolerance. A doctor should know what Diamine Oxidase (DAO) and Monoamine Oxidase (MAO) are. These two enzymes are responsible for degrading histamine and tyramine, the most common culprits.
- Always 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 most toxic. However, Similar symptoms can be caused by salicylates and glutamates.
Fermented foods containing amines
Here’s a list of a few fermented foods that contain amines. Keep in mind that in many foods contain a 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 can occur 15 minutes 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 on alcohol, 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.
Can contain tyramine and phenylethylamine if the malt is infected, or because of a later infection. It seems that the amine contents vary from brewery to brewery. In some studies, bottled/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, producing biogenic amines as a by-product. This process is often called ageing. 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 diarrhoea. 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 fermented to achieve its flavour. Dark chocolate contains the chemical tyramine, which has been found to trigger migraine headaches in the majority of migraine-prone subjects tested in some studies, according to the Clemson University Extension. Phenylalanine, another component of chocolate, has been shown to trigger migraines in about half the migraine-prone subjects in another study. However, chocolate lovers can try raw, unfermented cocoa beans or nibs.
Much of the commercially produced yoghurt contain tyramine and sometimes phenylethylamine. However, you can make your own homemade yoghurt free of tyramine. High-quality starter cultures will prevent the creation of amines. One reason for this is because they are composed of probiotic bacteria strains that do not produce amines and even prevent the development of amines.
Many drugs contain amines, including over the counter cold tablets, decongestants, nasal drops or sprays, some pain relievers, general and local anaesthetics and some antidepressants. Be sure to check labels and ask your doctor before taking new drugs.
Biogenic amines in sauerkraut
A study in 1999 aimed to determine levels of biogenic amines in 121 sauerkraut samples. They tested Austrian manufacturers, household-prepared and sterilized with brine in jars. Even though very wide variations occurred, there were generally low concentrations of amines in sauerkraut.
- Lowest concentrations are found in household-prepared sauerkraut
Another 2011 study 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 jars where probiotic bacteria had been with jars without the added bacteria. This is the result:
- Adding probiotic bacteria created much lower biogenic amine levels 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 higher the levels of amines created.
Conclusion: Starter cultures fermenting vegetables prevents the extensive formation of biogenic amines.
This means that if you’re sensitive to amines, you might still be able to enjoy homemade fermented vegetables, sauerkraut or yoghurt.
Spoiled food packed with biogenic amines = food poisoning
The concentration of biogenic amines in food can also 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 problem. Most meats are vacuum packed, repacked and sold as fresh which means it can be up to ten weeks old by the time it’s eaten.
Studies show that vacuum packing can prevent the growth of harmful microorganisms but cannot prevent the development of biogenic amines.
Experience shows that it’s vital to know about the history and freshness of food you eat to be identify possible amine-containing foods.
Other foods containing biogenic amines
Certain bacteria are often used to process many commercially produced foods and as a result, these foods can contain high amounts of biogenic amines.
- For example, fermented soy and canned tuna are known to be very high in histamine, cadaverine, and putrescine.
- Aspartame (Nutrasweet). It is used as a sweetener in many drinks and 600 different foods. It contains phenylethylamine and can cause many problems even in healthy individuals.
- In one study they analysed 45 commercial fish sauces and 23 soy sauces for their biogenic amine content. They reveal that content of biogenic amines varied from 100 mg/kg to 4000 mg/kg, depending on the method of manufacture. The content of biogenic amines in soy sauces was generally much lower than in fish sauces. Tyramine was the main biogenic 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 at a level equivalent to that found in other matured foods like matured cheese.
- As said before, biogenic amines are formed when amino acids in food are broken down. High concentrations can, therefore, be found in fish and fish products that have not been kept according to hygiene guidelines.
Foods to suspect
This is not rocket science so this table only gives the overall idea of what kind of foods can cause a reaction. The high-very high group contains 10-100 times more amines, salicylates and glutamates than the low-medium group. Much depends on how sensitive the body is.
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
Something that is easy to forget is that consuming different foods containing histamines at the same time will increase the risk of adverse effects. People who have low levels of the enzyme diamine oxidase cannot break down all the histamine that their body absorbs from food. This would be histamine intolerance.
Depending on how the food is produced histamine levels differ greatly.
- Dried fruits such as apricots, dates, prunes, figs and raisins (some might eat these fruits without reaction if thoroughly washed first)
- Vinegar or vinegar-containing foods, such as mayonnaise, salad dressing, ketchup, chilli sauce, pickles, pickled beets, relishes, olives
- Soured bread, such as pumpernickel, coffee cakes, and other foods made with large amounts of yeast
- Fermented foods, such as pickled or smoked meats, commercially produced sauerkraut
- Aged or fermented cheese, such as Parmesan, blue and Roquefort and others
- Sour cream, sour milk, buttermilk, and yogurt; especially if not fresh
- Processed meats—sausage, hot dogs, salami and others
- Smoked fish—herring, sardines, and others
- Yogurt, most commercially produced
- 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. The following foods are examples of this:
Resolving fermented food allergy
- First, you might want to try a low-amine diet to confirm that you are not intolerant to any amines. If not, then your case is much easier to deal with.
- If you suspect amines being the cause, then you want to determine which amines are triggering your symptoms—histamine, tyramine or others.
- When you have a pretty good idea of possible triggers of symptoms, then treating fermented food allergy or intolerance includes avoiding all food triggering an adverse effect.
- After avoiding biogenic amines for a while, then the same foods can slowly be reintroduced to your diet to confirm the intolerance of this particular food. Otherwise, you might end up with a long list of foods to avoid when in reality not all those foods will trigger your allergy symptoms.
As you can see, revealing the real cause of fermented food allergy involves becoming your own detective. Your assignment is to investigate the intriguing case of your own body. This requires patience and determination. But it can be done. And in the end, I hope it will help you feel better.