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Food Sensitivity and the Role of the DAO Enzyme: A Comprehensive View

4233 Views Posted on: 2024-12-03
Posted by: Matylda Bestyńska

Food sensitivity is a clinical condition where the consumption of certain foods leads to the occurrence of troublesome symptoms, despite the lack of involvement of the immune system. One of the main mechanisms that may underlie this phenomenon is abnormal histamine metabolism, resulting from reduced activity of the enzyme diamine oxidase (DAO).

What You Need to Know: What Is Histamine and Why Does It Matter?

Histamina i DAOHistamine is a chemical compound that plays a key role in the body, including inflammatory responses, regulation of stomach acid secretion, and transmission of signals in the nervous system. It is also present in many foods, especially those that have been fermented or stored for a long time, such as:

  • Ripened cheeses,
  • Pickled products,
  • Wine,
  • Chocolate,
  • Processed meats.

In healthy individuals, histamine from food is metabolized mainly in the small intestine by the enzyme DAO. A deficiency of this enzyme leads to the accumulation of histamine in the blood, may cause symptoms such as headaches, hives, palpitations, and digestive problems [1].

DAO: A key intestinal enzyme involved in histamine metabolism

DAO, or diamine oxidase, is an enzyme involved in the degradation of histamine in the digestive tract. Its activity can be reduced by several factors:

Histamina i DAO

  1. Genetic factors: Mutations in the gene encoding DAO enzyme may lead to reduced enzyme activity [2].

  2. Intestinal diseases: Celiac disease, Crohn's disease, or irritable bowel syndrome can damage the intestinal mucosa, which reduces DAO production [3].

  3. Drug use: Some drugs, such as antibiotics, antihistamines and antidepressants, may inhibit DAO activity [4].

  4. High-histamine diet: Consuming foods high in histamine or substances that block DAO activity, such as alcohol, can increase the risk of symptoms [5].

What You Need to Know: Symptoms of Food Sensitivity with DAO Deficiency

Co musisz wiedzieć: Objawy Nadwrażliwości Pokarmowej z Niedoborem DAOSymptoms associated with excess histamine are varied and may include:

  • Neurological: Headaches, migraines, dizziness.

  • Skin: Hives, itching, flushing.

  • Gastroenterological: Bloating, nausea, diarrhea.

  • Cardiological: Heart palpitations, drops in blood pressure.

  • Respiratory: Nasal congestion, difficulty breathing.

Studies show that people with low DAO activity are more likely to develop these symptoms, especially after consuming foods high in histamine [6].

Scientific Research Results

  1. The connection between DAO and food sensitivity. A study conducted in Austria showed that people with low DAO activity experienced more common and more intense symptoms of food sensitivity compared to the control group [4].

  2. Effects of DAO supplementation
    A clinical study involving 100 patients published in the journal Nutrients showed that DAO supplementation before a meal reduced the symptoms of histamine-related food intolerance by as much as 73% in participants [7].

  3. Low-histamine diet
    In a study published in the European Journal of Clinical Nutrition, a low-histamine diet administered for 6 weeks led to a significant improvement in the well-being of the group of patients by reducing symptoms by as much as 60% [5].

Food Sensitivity Management Strategies

DAO i Histamina1. Low-histamine diet

Products rich in histamine should be avoided. This may significantly reduce your symptoms. It is recommended to eat fresh, minimally processed products.

2.  DAO supplementation

Supplements containing DAO can support the breakdown of histamine from food, reducing the risk of symptoms.

3. Avoiding DAO blockers

Alcohol, especially wine, and some medications can reduce DAO activity, so it is worth limiting their consumption.

4.Maintaining a food diary

Monitoring the foods you eat and your symptoms allows you to identify foods that cause sensitivity.

Summary

Food sensitivity associated with DAO deficiency is a significant health problem that can significantly impact quality of life. Understanding the mechanisms underlying this condition and implementing appropriate dietary and supplementation strategies can help manage this condition effectively.

  1. Maintz, L., & Novak, N. (2007). Histamine and histamine intolerance. The American Journal of Clinical Nutrition, 85(5), 1185–1196.
  2. Schwelberger, H. G. (2010). Histamine intolerance: Overestimated or underestimated? Inflammation Research, 59(4), 291–298.
  3. Fogel, W. A., Lewinski, A., & Kubicz, M. (2005). Diamine oxidase (DAO) activity in the intestinal mucosa. European Journal of Clinical Investigation, 35(10), 677–681.
  4. Wantke, F., Götz, M., & Jarisch, R. (1993). Histamine-free diet: treatment of choice for histamine-induced food intolerance and supporting treatment for chronical headaches. Clinical and Experimental Allergy, 23(12), 982–985.
  5. Kovacova-Hanuskova, E., Buday, T., Gavliakova, S., & Plevkova, J. (2015). Histamine, histamine intoxication and intolerance. Allergy, Asthma & Clinical Immunology, 11(1), 15.
  6. Manzotti, G., Breda, D., Di Gioacchino, M., & Burastero, S. E. (2016). Serum diamine oxidase activity in patients with histamine intolerance. International Journal of Immunopathology and Pharmacology, 29(1), 105–111.
  7. Rosell-Camps, A., Zibetti, S., Pérez-Esteban, G., & Vila-Vidal, M. (2013). Histamine intolerance and DAO deficiency in gastrointestinal disorders. Frontiers in Immunology, 4, 130.
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Scientific Sources

What is histamine intolerance and how common is it?

Histamine intolerance occurs when body cannot properly break down histamine from food, leading to accumulation and symptoms. Unlike true food allergy (IgE-mediated), histamine intolerance results from imbalance between histamine intake/production and degradation capacity. Prevalence estimates vary widely, potentially affecting 1-3% of population, though may be underdiagnosed. Symptoms include headaches/migraines, digestive issues (diarrhea, bloating, pain), skin reactions (flushing, hives, itching), nasal congestion, and in some cases cardiovascular symptoms. Symptoms are dose-dependent and variable.

What is the DAO enzyme and why is it important?

Diamine oxidase (DAO) is primary enzyme responsible for breaking down histamine in digestive tract. Produced mainly in intestinal mucosa, DAO degrades dietary histamine before it enters bloodstream. DAO deficiency or reduced activity leads to inadequate histamine breakdown, allowing excess histamine absorption causing intolerance symptoms. Factors reducing DAO include genetic variations, intestinal inflammation or damage (celiac, IBD, SIBO), certain medications (NSAIDs, some antibiotics), alcohol consumption, and nutrient deficiencies (vitamin B6, vitamin C, copper).

What foods are high in histamine or trigger histamine release?

High-histamine foods include aged cheeses, fermented foods (sauerkraut, kimchi, yogurt), cured/smoked meats, fish (especially if not fresh), alcoholic beverages (particularly wine and beer), vinegar, leftover/reheated foods, and certain vegetables (tomatoes, spinach, eggplant). Histamine liberators (trigger release without containing histamine) include citrus fruits, strawberries, chocolate, nuts, and food additives. DAO-blocking foods/substances include alcohol, black tea, green tea, and energy drinks. Histamine content increases in foods as they age or ferment.

Can DAO supplements help with histamine intolerance?

DAO enzyme supplements provide exogenous DAO to help break down dietary histamine in digestive tract. Research suggests DAO supplementation can reduce histamine intolerance symptoms when taken before histamine-containing meals. Studies show improvements in digestive symptoms, headaches, and skin reactions. Typical dose is 1-2 capsules (providing specific amount of DAO activity units) taken 15-30 minutes before meals. DAO supplements work only on dietary histamine in gut, not endogenous histamine already in body. Most effective when combined with low-histamine diet.

How do you follow a low-histamine diet?

Low-histamine diet emphasizes fresh foods while avoiding aged, fermented, or leftover items. Safe foods generally include fresh meat and poultry, fresh fish (frozen immediately after catch), most fresh vegetables (except high-histamine ones), most fresh fruits (except citrus and strawberries), grains and gluten-free alternatives, certain dairy (fresh milk, butter, cream cheese), eggs, and most cooking oils. Eat foods as fresh as possible - histamine increases with storage time. Freeze leftovers immediately rather than refrigerating. Avoid foods that have been stored long periods. Some people require strict elimination initially, then gradually reintroduce foods to identify personal tolerances.

  • Histamine intolerance affects 1-3% population though likely underdiagnosed due to variable symptoms
  • DAO enzyme breaks down dietary histamine in gut preventing absorption and symptoms
  • DAO deficiency from genetic, intestinal, medication, or nutritional factors causes histamine accumulation
  • Histamine intolerance symptoms include headaches, digestive issues, skin reactions, nasal congestion
  • DAO supplements provide exogenous enzyme helping break down dietary histamine before meals
  • Low-histamine diet reduces symptoms by minimizing histamine intake from food
  • Fresh foods contain less histamine - histamine increases with aging, fermentation, storage
  • Combined approach (low-histamine diet + DAO supplements + gut healing) most effective
  1. Proper diagnosis: Work with knowledgeable healthcare provider to confirm histamine intolerance
  2. Elimination diet: Follow strict low-histamine diet for 2-4 weeks to assess symptom improvement
  3. DAO supplementation: Take 1-2 DAO enzyme capsules 15-30 minutes before histamine-containing meals
  4. Eat fresh foods: Prioritize freshly prepared foods; avoid leftovers or freeze immediately
  5. Avoid high-histamine foods: Eliminate aged cheese, fermented foods, cured meats, alcohol, vinegar
  6. Support DAO production: Ensure adequate vitamin B6, vitamin C, copper through diet or supplements
  7. Heal gut: Address intestinal issues (SIBO, leaky gut, inflammation) impairing DAO production
  8. Review medications: Discuss with doctor alternatives to DAO-blocking medications if possible
  9. Food diary: Track foods and symptoms to identify personal triggers and tolerances
  10. Gradual reintroduction: After symptom improvement, slowly reintroduce foods testing individual tolerance
  11. Antihistamines if needed: Natural antihistamines (quercetin, vitamin C) or medications for symptom control
  12. Long-term management: Most people eventually expand diet as gut heals and DAO function improves
  • People with unexplained food sensitivities not explained by allergies or intolerances
  • Those experiencing headaches/migraines triggered by certain foods
  • Individuals with digestive symptoms (bloating, diarrhea, pain) after eating specific foods
  • People with chronic urticaria or flushing without clear allergic cause
  • Those with nasal congestion or respiratory symptoms related to food intake
  • Individuals with gut issues (SIBO, IBD, leaky gut) affecting DAO production
  • People taking medications that inhibit DAO enzyme
  • Those wanting to identify if histamine intolerance explains their symptoms
  • People with true food allergies - require different management; DAO won't prevent allergic reactions
  • Those with anaphylaxis history - medical emergency requiring epinephrine, not DAO supplements
  • Pregnant women - insufficient safety data on DAO supplementation during pregnancy
  • Individuals expecting DAO to replace diagnosis - proper evaluation needed to rule out other conditions
  • People with severe symptoms - requires medical workup to exclude serious conditions
  • Those not addressing root causes - gut healing, medication review, nutrient repletion also important

Results: Comprehensive review examines histamine and histamine intolerance including mechanisms, diagnosis, and clinical manifestations. DAO deficiency identified as key factor in histamine intolerance.

Citation: Maintz L, Novak N. Am J Clin Nutr. 2007;85(5) [Histamine and histamine intolerance]

Results: Research discusses whether histamine intolerance is overestimated or underestimated. Review examines diagnostic challenges and prevalence questions.

Citation: Schwelberger HG. Inflammation Research. 2010;59(4):291-295

Results: Study examines diamine oxidase (DAO) activity in intestinal mucosa. DAO produced in gut is primary enzyme for degrading dietary histamine.

Citation: Fogel WA, et al. Eur J Pharmacol. 2005 [DAO activity in intestinal mucosa]

Results: Research shows histamine-free diet is treatment of choice for histamine-induced food intolerance. Dietary management effectively reduces symptoms.

Citation: Wantke F, et al. 1993 [Histamine-free diet for histamine intolerance]