Are Food Amines Causing your Migraines?
Does amines in chocolate and red wine (histamines) cause migraines or headaches?When asked about what foods cause allergy or intolerance reactions, many people will volunteer chocolate as the number one suspect food.
Is there any basis to these claims?
What are Amines?
Amines are a group of chemicals derived from amino acids. Breakdown of protein in foods can produce amines. Foods such as meat do not contain amines when fresh but when aged the proteins break down to release amines. Over browning of the meat can also result in the formation of amines.
Fermentation of foods are also known to produce amines through breakdown of the protein. Any foods undergoing fermentation such as kombucha contains amines.
Foods contain many different types of amines, and experience shows that if you are amine sensitive then you may react to one type of amine but be fine with another type. Many people have heard of histamine (a type of amine) is found in many foods.
Other well known amines are serotonin, dopamine and noradrenaline which along with histamine are best known for their role in causing symptoms. Lesser well known food amines are tyramine, tryptamine, and phenylethylamine.
Amines are found often together, although some amines may be more dominant such as phenylethylamine in chocolate.
What are amines thought to do?
The amines present in foods do not provide a health issue for most people unless in very high concentration (for example 'scombroid' poisoning in fish). However for amine sensitive people, the lower and safe amounts found in foods can cause symptoms.
Amines are sometimes called biogenic amines and their impact on the body is due to the fact that they are biologically active in the body. They can be absorbed across the gut wall and enter the body where they can play active roles in the body's chemical processes.
Biogenic amines may act as neurotransmitters, be involved in local immune responses (such as the inflammation produced by histamine release), or regulate functions of the gut.
The classic neurotransmitters serotonin, dopamine, and noradrenaline are all essential to proper brain function.
Imbalances causes problems such as depression and anxiety.
Local symptoms can also occur in the gut including nausea, diarrhoea, and irritable bowel syndrome (IBS), as well as triggering symptoms elsewhere in the body, such as headaches, migraines, asthma, and hives.
As in all areas of food chemical intolerance, evidence is sparse but there is some limited low level evidence (case series) for amines causing migraines. Personal experience of food chemical sensitive people also suggests that other naturally occurring food chemicals such as salicylates, glutamates and food additives can also trigger headaches and migraines, although this does not constitute evidence.
There is also some (limited) evidence for a low amine diet in resolution of urticaria (hives) and eczema.
How this may occur is not known. Amine are usually broken down by enzymes called amine oxidades (monoamine oxidases (MAO) and diamine oxidases (DAO)). An increased sensitivity to biogenic amines has been proposed to be due to a weakened enzymatic amine breakdown caused by genetic predisposition or maybe gastrointestinal diseases which slows down breakdown of the amines.
Which Foods Contain Amines?
The amount of amines in food can really vary so it can be hard to determine how much is typically in any one food.
Amine variation in foods is due to how much is present initially, how the food is prepared, cooked (for example how long meat is browned), if fermentation takes place, level of acidity in the food/meal and storage pre and post cooking.
The Royal Price Alfred Hospital allergy unit have a handbook (RPAH Elimination Diet Handbook) which lists foods low, moderate, high and very high in amines. This handbook online can be bought if you have guidance from a doctor or dietitian.
The following gives a basic account foods shown to be high in amines.
There are a few fruits containing significant amounts of amines such as ripe bananas, grapes, tomato, many berries, citrus fruit, plums, passion fruit and pineapple.
High amine veggies include avocado, broccoli, rocket, eggplant, mushrooms, olives and spinach.
Chocolate is very high in amines as well as cheese, and some meats such as pork, the skin on chicken and many deli meats and other processed meats such as sausages and tinned fish.
Then there are the nuts and seeds- all are high in amines and salicylates with the exception of cashews (especially when raw) and poppy seeds.
Many of these foods contain many different amines. Up to 20 different amines have been discovered in wine, with greater concentrations in red wine. The amount and type depends on a number of different factors such as the vintage, grape variety, geographical region, and vinification methods such as grape skin maceration.
Amines can develop in meats in a relatively short period of time. Choosing meat that is fresh is a great start, and how meat is stored, browned or cooked and how long it is frozen all contribute to development of amines.
Meat does not need to be avoided, just a review of the meat management is important when reducing amines in the diet. This becomes even more crucial when it comes to fish and seafood.
Amines as a result of fermentation may be significant if you choose sour dough bread, wine, beer, soy sauce, probiotics and fermented foods such as kombucha and kefir.
Many amine rich foods also contain salicylates and glutamates which have been found to cause issues in sensitive people.
Amine Sensitivity Diagnosis
The diagnosis of sensitivity to the food amines is usually made through a thorough history and dietary exclusion of the different amines found in foods. Salicylates as well as glutamates and some food additives may also be excluded, if doing the full RPAH elimination diet.
If symptoms can be improved then this is followed by a challenge process to identify if it is amines or salicylates or glutamates or food additives or a combination triggering the migraines. This is followed by an expansion of the diet to include the foods found to be non triggers, and slow reintroduction of the trigger foods as tolerated.
Low Histamine vs Low Amine/RPAH elimination diet
A number of different amines may cause headache or migraines so it makes sense to reduce all the problematic amines rather than just histamine:
Histamine: gut impacts including chronic diarrhoea or constipation, bloating, abdominal pain, and nausea. May also causes systemic symptoms such as migraines, low blood pressure (hypotension), and palpitations. Can also trigger allergic conditions including hayfever, eczema, asthma, and hives.
Tyramine: a strong association with migraine, high blood pressure (hypertension), depression, and Parkinson's disease.
Phenylethylamine: connected to migraine headaches, depression, attention deficit hyperactivity disorder (ADHD), and schizophrenia.
There are different types of histamine diet lists that tend to circulate on the internet:
- lists of foods that contain histamine so avoided on a low histamine diet
- lists of foods that are naturally low in histamine but are linked with the release of histamine
These are two different types of lists which can cause a lot of confusion, especially where lists are combined.
The RPAH elimination diet eliminates foods high in histamine as well as other food amines foods. Thus is more far reaching than a low histamine food diet. Also, other components of the diet such as salicylates, glutamates and some food additives are also eliminated as part of the RPAH elimination package as this is thought to be more effective.
However foods that are low in amines but are thought to release histamine in the body are not part of the RPAH elimination diet.
If you think your headaches or migraines may be related to what you eat then food amines are worth considering. If there is a connection, elimination should result in an improvement in your symptoms and structured challenges help identify what are your exact triggers.
REFERENCES 1.Wöhrl S, Hemmer W, Focke M, Rappersberger K, Jarisch R. Histamine intolerance-like symptoms in healthy volunteers after oral provocation with liquid histamine. Allergy Asthma Proc. 2004;25:305–311.
2. Wantke F, Götz M, Jarisch R. Histamine-free diet: treatment of choice for histamine-induced food intolerance and supporting treatment for chronic headaches. Clin Exp Allergy. 1993;23:982–985. doi: 10.1111/j.1365-2222.1993.tb00287.x.
3. King W, McCargar L, Joneja JM, Barr SI. Benefits of a histamine-reducing diet for some patients with chronic urticaria and angioedema. Can J Diet Pract Res. 2000;61:24–26.
78. Böhn L, Störsrud S, Törnblom H, Bengtsson U, Simrén M. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol. 2013;108:634–641. doi: 10.1038/ajg.2013.105.
11. Smit AY, Engelbrecht L, du Toit M. Managing your wine fermentation to reduce the risk of biogenic amine formation. Front Microbiol. 2012; 3():76.
12. RPAH elimination diet handbook: with food and shopping guide. Anne Swain, Velencia Soutter, Robert Loblay, 2011 (revised edition).