Fermented food intolerance is a complex subject. There are many different intolerances triggered by things like artificial additives or chemicals like salicylates and flavor enhancers. In this post we focus on fermented food intolerance or sensitivity and I hope it will be a helping hand to find answers.
Look at the following questions:
- Do you get headaches or migraine after consuming red wine?
- Do fermented soy, pickles, or fermented vegetables cause problems?
- Does consuming ripe cheese as Parmesan or blue cheese trigger a reaction?
If you answered yes on any of the questions, don’t make the hasty conclusion that you have fermented food intolerance. Similar reactions can occur for many reasons.
- Looking for clues
- What are biogenic amines?
- If you suspect fermented food intolerance
- Common problematic fermented foods
- Decayed food = higher BA concentrations
- Histamine-rich foods
Looking for clues
Fermented food intolerance require some detective work and the assignment is to investigate the intriguing case of your own body. When looking for clues, it’s essential to take notes along the way. A food diary helps to find what triggers a reaction. In the case of fermented food intolerance, you might include the following:
- Exactly what food items seem to trigger a reaction?
- Exactly what kind of reactions are you experiencing?
- Besides fermented food, are there other triggers as well?
- Is there a stronger reaction when combining several fermented foods like wine and cheese?
Though numerous factors come into play, common triggers in sensitive people are biogenic amines (BAs). Why do they cause problems? How can they be avoided?
What are biogenic amines?
Biogenic amines are produced by certain bacteria when they break down amino acids (protein) in food. Amines are present in most foods that are overcooked, processed, ripened, fermented, and decomposed. In theory, all foods containing proteins or amino acids are a potential source of amines. Spoiled food can contain toxic concentrations. Once BAs are formed, they cannot be removed by any cooking method.Biogenic amines in foods – PubMed (nih.gov)(PDF) A review on biogenic amines in food (researchgate.net)
The paradox is that biogenic amines are vital for many body functions. For example phenylethylamine triggers the release of dopamine and norepinephrine promoting alertness and stimulates the senses.Phenylethylamine Health Benefits (draxe.com)
In healthy individuals, BAs are broken down by the intestine and liver. Enzymes such as MAO (monoamine oxidase) and DAO (diamine oxidase) render amines harmless. However, if the enzymes are missing or have become sluggish it can cause a build-up of amines in the body which will trigger a reaction. In addition, alcohol, smoking, black tea, mate tea, energy drinks, antibiotics, and antidepressants can inhibit the MAO and DAO enzymes.Dietary tyramine and other amines – PubMed (nih.gov)Histamine and histamine intolerance – PubMed (nih.gov)
A few biogenic amines and potential adverse effectsBiogenic amine contents in food products (intechopen.com)
- Histamine. Headaches, sweating, facial flushing, dizziness, itching rashes, hives, diarrhea, constricted airways, increased heard rate, blood pressure changes.Adverse reactions to ingested histamine | SpringerLink
- Tyramine. Headaches, migraine, nausea, vomiting, respiratory disorders, high blood pressure.20 Tyramine Rich Foods To Be Careful With | Food For Net
- Phenylethylamine. Headache, migraine, rapid heartbeat, arrhythmia, high blood pressure, anxiety.Phenylethylamine in migraine – PubMed (nih.gov)Phenethylamine: Uses, Side Effects (emedicinehealth.com)
- Putrescine. Can cause increased heart rate, palpitations, low blood pressure.Putrescine and cadaverine in foods | Scientific Reports (nature.com)
- Spermidine, cadaverine. Increases the effects of other amines like histamine and tyramine.
As seen from the above, BAs can cause a number of symptoms in sensitive individuals. Even healthy people will feel a toxic effect when concentrations are high enough. There are different degrees of intolerance to BAs. Very sensitive individuals can get headaches or migraine by drinking water containing as little as 1 mg of tyramine chloride, an amine.
Summary: Biogenic amines are essential neurotransmitters and involved in many body functions. However, consuming too much has a toxic effect even in healthy people. For sensitive and intolerant ones, BAs can cause many unpleasant reactions even in low concentrations. In many fermented foods, histamine and tyramine are common culprits. However, similar symptoms can be caused by salicylates, sulphites, glutamates, and other chemicals. It requires some detective work to reveal the true culprits and to discover what foods to avoid.
If you suspect fermented food intolerance
Here are a few things people have found helpful.
- Get an overall understanding about food intolerance; this helps a lot. Here is one food intolerance review.
- Keep a food log/diary to keep track of foods you consume and to discern any pattern as to which foods seem to trigger a reaction.
- Fermented food intolerance is very personal and each individual have their own cluster of symptoms.
- It can be difficult to determine your individual threshold tolerance to specific BAs.
- Consult with a specialist who understands biogenic amines.
- Consume fresh produce: buy fresh, cook fresh, eat fresh.
Determine the role amines play in your symptoms:
- Try a low-amine diet to see if amines might be to blame. If you discover no problems with amines, things become much easier to handle.Low Amine Diet (wch.sa.gov.au)
- You can also try the more specific low histamine diet (mentioned further down in this post).
- If you strongly suspect amines, then histamine and tyramine are main suspects. In some cases, there are also additional triggers like salicylates or other chemicals.
- Headaches can have many triggers. Diet and Headache: Part 1 – PubMed (nih.gov)Diet and Headache: Part 2 – PubMed (nih.gov)
- When you know some possible triggers, controlling fermented food intolerance includes avoiding those triggers.
- After avoiding the triggers 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.
Summary: You need a plan to find out what’s triggering your symptoms. It’s helpful to keep a diary and to write down symptoms, possible triggers, suspicious foods etc. Common triggers include BAs, salicylates, sulphites, glutamates, benzoates, and other chemicals. Below I’ve collected foods that are common triggers.
Common problematic fermented foods
One problem is that foods can contain vastly different amine concentrations depending on how they are produced. Even different parts of the same food can have great BA variations. In general, poor quality food tend to contain higher amounts, as does food not properly stored, cleaned, or prepared. BA concentrations often increase the longer it’s stored or ripened.Control of biogenic amines in food – PubMed (nih.gov)
Discovery of 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.[Histamine and tyramine in ripening cheeses] – PubMed (nih.gov)
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, it took some time 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.
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 while most tap beers had low levels of tyramine. High concentration of histamine and tyramine is linked with microbial contamination during brewing. But putrescine, agmatine, spermidine, spermine, and phenylethylamine could be natural constitutes either from malt or hops.Biogenic amines in beer.pdf (page 12; gla.ac.uk)
In 18 samples of Chinese beer, all contained at least three biogenic amines—putrescine, histamine and tyramine. Spermidine was detected in 89% of the beers; spermine in 78%, tryptamine in 61%, and phenylethylamine in 44% of the beers. However, levels in these samples were low.Biogenic amines in beer – PubMed (nih.gov)
A study on 114 Czech beer samples revealed low levels of histamine, phenylethylamine, tryptamine, spermine and spermidine. However, tyramine, putrescine and cadaverine reached high levels in alcoholic beers. An interesting discovery was that at the end of the best-before date, 25% of the beer samples had developed higher BA concentrations. You can draw two conclusions from this study: 1. The lowest BA levels are found in non-alcoholic beer; 2. The longer you store beer the more BAs are formed.Biogenic amines in beers from the Czech Republic – Wiley Online Library
The cocoa bean is often fermented to achieve a better flavor. Chocolate contains tyramine, phenylethylamine, tryptamine, clovamide, and serotonin. It seems that chocolate has the highest level of phenylethylamine among tested foods. Phenylethylamine is produced in the brain and is metabolized to phenylacetic acid. When consumed at high levels, effect such as blushing, headaches and increased blood pressure can occur.Biogenic amines in chocolate.pdf (page 10, lines 20-24)
Tyramine in dark chocolate triggered migraine headaches in the majority of migraine-prone subjects tested in several 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.Biogenic amines in chocolate – PubMed (nih.gov)Biogenic amines in chocolate–a review (fao.org)
Putrescine seems to be dominant, followed by spermidine, spermine, and serotonin. Cadaverine and tyramine are generally present in smaller amounts. But there are great variations in different coffee beans depending on many factors.1Biogenic amines in coffee.pdf (page 11, lines 1-11)
Some commercially produced yoghurt contain tyramine and sometimes phenylethylamine. However, yoghurt prepared at home usually have low levels of tyramine. Using a good yogurt starter prevents the creation of excess amines. One reason is because starters are composed of probiotic bacteria strains that do not produce amines, some even prevent the development of amines.
Fermented vegetables (industrial)
Often contain high BA levels. Interesting that Brussels sprout and broccoli turned out to be the most risky fermented vegetables in one study.Biogenic Amines in Traditional Fermented Vegetables (acs.org)
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. This might be caused by tyramine and histamine present in most red wine, though other potential causes also exist (like tannins and sulphite). Studies show a great variety of amine concentrations independent on which grapes are used and where they grow. It’s likely that the specific microorganisms present during wine production will to a great extent determine BA levels. Some red wine contain between 20–200% more histamines than white wine. The studies indicate that it’s hard to predict which red wines will be low in certain biogenic amines like histamine.Formation of biogenic amines in red wine – PubMed (nih.gov)Levels of biogenic amines in high quality red wines. (archives-ouvertes.fr)
Researchers fermented cabbage without using a starter (wild fermentation) which was stored and sampled for 12 months. The sauerkraut contained high levels of amines and they continue to rise during storage. The dominant amine was tyramine, but they also detected putrescine, tyramine, and histamine.Biogenic amine concentration in sauerkraut during storage (jcu.cz)
Adding a suitable starter prevents the creation of amines.
A study in 2011 shows that levels of biogenic amines in sauerkraut was significantly lower when adding lactobacillus bacteria species commonly used in culture starters (L. plantarum, L. casei, L. curvatus). This way BA levels were much lower and histamine and tyramine were essentially absent. This is a good indication that fermented vegetables prepared with a starter cultures are much safer.Reduced biogenic amine contents in sauerkraut (researchgate.net)
Fermented soybeans have great variations of BAs. High quality products are relatively safe while others can contain high amounts. This variation of biogenic amines levels in commercial fermented soybean products is due to variations in manufacturing processes; the kind of beans used, the specific bacteria involved, and duration of fermentation. Fermented soybeans can contains histamine, tyramine, putrescine, and cadverine. Tyramine is most common in Chinese fermented soy sauces. Japanese natto seems to contains low amounts.Biogenic amines in fermented soya beans – PubMed (nih.gov)1Biogenic amines in soybean products (intechopen.com)Biogenic amines in soybean products (page 12; gla.ac.uk)
More than 15 BAs are found in wine ranging from low to high levels. Red wine generally has higher concentrations than white and rose. There are also great differences between wine-producing countries. Histamine, putrescine and tyramine are present in higher concentrations, other amines in smaller amounts. The presence of putrescine and cadaverine are often associated with poor sanitary conditions of the grapes; high quality wines contain less of those BAs.Biogenic amines in wine.pdf (pages 13, 14; gla.ac.uk)Histamine detection in wine | SpringerLink
- Canned tuna is known to be high in histamine, cadaverine, and putrescine.
- Aspartame (Nutrasweet), a sweetener in many drinks and foods contains phenylethylamine and can cause problems even in healthy individuals.
- Commercial fish sauces can be very high in BAs, up to 4000 mg/kg depending on the method of manufacture. Fish sauces contain high concentrations of tyramine, histamine, tryptamine, and others. The BA concentration in fish sauces are similar to matured or ripened cheese.
- High concentrations are found in fish products that have not been kept according to hygiene guidelines.Formation of biogenic amines in herring and mackerel – PubMed (nih.gov)
- Besides amines, many foods also contain sulphites, benzoates, monosodium glutamate, salicylate.Sensitivity to food additives – Wiley Online Library
Decayed food = higher BA concentrations
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 histamines can cause food poisoning. In lower concentrations, the same chemical 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 be a problem. 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, amines can develop in high concentrations. Studies show that vacuum packing can prevent the growth of harmful microorganisms but it cannot prevent the development of biogenic amines.
Summary: It’s vital to know the history and freshness of food you consume, not only to avoid a reaction but also to identify possible amine-containing foods that trigger a reaction.
Consuming more histamine than 500 ppm can lead to poisoning which causes symptoms like breathing, itching, rash, vomiting, fever, and hypertension. An intake of 5-10 mg of histamine might affect sensitive people, 100 mg can induce a medium toxicity, and 1000 mg is highly toxic. Among the biogenic amines, histamine and tyramine are considered most toxic while putrescine and cadaverine strengthen the toxic effect by inhibiting the body’s production of histamine detoxifying enzymes.Toxicological aspects of biogenic amines.pdf (page 16; gla.ac.uk)
Please remember 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 (DAO) cannot break down all the histamine absorbed from food. This is histamine intolerance.Histamine intoxication and intolerance – ScienceDirectHistamine and histamine intolerance | Oxford Academic (oup.com)Management of adverse reactions to ingested histamine | SpringerLinkAre You Suffering From Histamine Intolerance? – DrJockers.com
This list only gives you a general idea as histamine levels can differ greatly in these products. Read more on this siteHistamine Intolerance.org.ukHigh Histamine Foods List (connersclinic.com)
- Vinegar-containing foods as mayonnaise, dressings, ketchup, chili sauce, pickles, olives
- Soured bread such as pumpernickel, coffee cakes, foods made with much yeast
- 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
- Dried fruits like apricots, dates, prunes, figs, and raisins
- Smoked fish—herring, sardines
- Commercially produced yogurt
- Wine and beer, cider, root beer
- Sea foodHistamine in Fish and Fishery Products | (fsai.ie)
Low histamine foods
- Fresh vegetables (except tomatoes, eggplant, and spinach)
- Fresh milk products, including goat milk, sheep milk
- Some fresh/frozen fish – hake, trout, plaice
- Grains (including bread and pasta)
- Cream cheese, mozzarella, butter
- High quality cooking oils
- Fresh fruits
- Herbal teas
- Fresh meat
Some foods might be low in histamine but they stimulate the body to release histamines which can cause a reaction. Histamine causes dilatation of the blood vessels (flushing, rash, itching) and can increase mucus production (runny nose, productive cough).
The following foods are a few examples:
- Many citrus fruits
Summary: Histamine is a common culprit in fermented food intolerance. If you decide to try a low histamine diet, give it at least four weeks to determine the effect.
Discovering the true cause of fermented food intolerance involves research and some detective work. I truly hope that this post might be a helping hand along the way to find relief.
This is partly because the BAs can trigger the release of adrenaline and noradrenaline, setting in motion a chain reaction: it triggers the production of stomach acid, causes a higher heart rate, increased blood sugar, and changes in blood pressure. All of this often cause headaches and other symptoms. Depending on the severity of the symptoms, the effects of BAs can be described as 1) a reaction, 2) intolerance, or 3) poisoning.
No, that’s not possible. Once BAs are formed, they cannot be removed by any cooking method. Therefore, prevention is a must. For example the bacteria associated with histamine production in fish products can be slowed down by refrigeration or freezing.
Often caused by consuming tuna, herring, or mackerel that are naturally high in histamine and maybe also other biogenic amines. After fish, cheese and fermented sausage are also responsible for histamine poisoning. Symptoms usually show after about one hour. The severity of symptoms depends on how much histamine was consumed and how sensitive the individual is. Common symptoms are flushing, hives, itching, headaches, stomach cramps, nausea and more. It’s similar to an allergic reaction.