Is Histamine Intolerance Causing Your GERD?

Imagine this: you’re out with friends, enjoying a delicious meal. You start with a fresh spinach salad topped with strawberries and balsamic vinaigrette. Next comes a hearty chicken sandwich with creamy avocado. For dessert, you savor a piece of dark chocolate alongside a glass of red wine, thinking about the antioxidants you’re getting from your treat.

But soon after, you feel it—uncomfortable acid reflux or even GERD (gastroesophageal reflux disease). While there are many potential causes of acid reflux, one that’s often overlooked is histamine intolerance. That seemingly healthy meal you enjoyed? It was packed with histamine, which could be the root of your digestive issues if your body struggles to handle it.

In this blog, we’ll explore how histamine intolerance may be triggering your acid reflux or GERD and how you can address it naturally. We’ll also touch on silent reflux and its connection to histamine intolerance.

Histamine Intolerance Originates in the Gut

Histamine intolerance often stems from a problem in the gut—specifically, a deficiency in diamine oxidase (DAO). This key enzyme breaks down histamine from the foods you eat. When DAO activity is too low, histamine can build up, leading to symptoms like bloating, diarrhea, abdominal pain, and even food sensitivities.

But histamine isn’t just in food. Your body produces histamine naturally as part of its immune response and as a neurotransmitter. If you’re dealing with an infection or under a lot of stress, your body can release more histamine, filling up what’s often referred to as your “histamine bucket.” Another enzyme called Histamine N-methyltransferase (HNMT) degrades most of the histamine that is released.

For everything to stay balanced, both DAO and HNMT need to work properly. When they do, you can enjoy high-histamine foods—like that glass of red wine—without trouble. But if they’re not functioning well, histamine levels rise, leading to a variety of symptoms.

Want to dive deeper? Check out my blog on histamine intolerance for a full breakdown.

How Does Histamine Intolerance Trigger Acid Reflux or GERD?

Histamine plays a significant role in digestion, including stimulating the production of stomach acid. When you think about food or smell something delicious, your body gets ready to digest. This triggers the release of digestive hormones like gastrin and acetylcholine.

Here’s how it works: gastrin signals specialized cells in your stomach to release histamine. That histamine then activates parietal cells in your stomach lining to produce gastric acid, which helps break down food.

Interestingly, medications for acid reflux, such as H2 blockers, work by targeting this process. They block histamine from triggering the release of gastric acid by blocking Histamine receptor 2 (H2), one of four histamine receptors in the body.

Ever notice how stress can make your acid reflux or digestive discomfort worse? Stress increases histamine release, which could explain why symptoms like acid reflux, bloating, and even constipation tend to show up during stressful times. These are all signs that your body may be struggling to manage histamine levels.

Having high histamine levels topped off with a diet rich in high histamine foods can potentially trigger acid reflux or GERD. Most foods considered acid reflux triggers are high in histamine, like chocolate, red wine, and preserved meats, i.e. bacon, pepperoni.

Whereas histamine intolerance is not recognized as a cause of acid reflux/GERD by conventional medical communities, it has been shown that a low histamine diet can help reduce the symptoms of acid reflux and silent reflux.

You May Not Have GERD but Silent Reflux Caused by Histamine Intolerance

You may have heard of GERD (gastroesophageal reflux disease), but silent reflux, also known as laryngopharyngeal reflux (LPR), is less familiar. Unlike GERD, silent reflux doesn’t always come with telltale symptoms like heartburn or chest pain. Instead, it often presents with less obvious signs like chronic cough, hoarseness, or the sensation of a lump in your throat.

The primary issue with silent reflux is that stomach contents flow backward into the throat, causing discomfort and potentially leading to damage over time. It's often overlooked or misdiagnosed because it lacks the burning sensation typical of GERD.

Histamine’s Role in Silent Reflux

Emerging research suggests a strong connection between histamine sensitivity and silent reflux. A case study published by Alnouri et al. documented a patient with persistent symptoms of silent reflux, even after undergoing surgical treatment for GERD. Upon consultation with a nutritionist, the patient was found to have histamine intolerance. Switching to a low-histamine diet significantly reduced symptoms like coughing and throat clearing and improved diagnostic scores, highlighting the potential role of histamine in LPR.

Recognizing Silent Reflux Symptoms

If you suspect silent reflux, watch for these symptoms:

• Throat discomfort: Hoarseness, frequent throat clearing, a sore throat, or a burning sensation.
• Swallowing issues: Difficulty swallowing or the sensation of a lump in your throat.
• Persistent cough: A chronic or irritable cough, especially in the morning or after meals.
• Respiratory effects: Postnasal drip, excess mucus in the throat, or breathing difficulties.
• Nighttime episodes: Choking or difficulty swallowing during the night.

These symptoms often overlap with other conditions, making diagnosis challenging. If you’ve tried treatments for GERD without success, it may be worth exploring whether histamine intolerance is a factor in your symptoms.

Common Causes of Acid Reflux or GERD

Many causes of acid and silent reflux are tied to how well your body manages histamine. For example, certain medications can block the production of diamine oxidase (DAO), the enzyme responsible for breaking down histamine from food. Similarly, estrogen dominance, a common hormonal imbalance in women even postmenopausal women, has been linked to both acid reflux and histamine intolerance.

Here are Some Other Causes of GERD, Acid Reflux:

• Diet: The Standard American Diet (SAD) is high in sugar, unhealthy fats, processed foods, and commercially raised meats while being low in vegetables and fruits. This imbalance can promote inflammation and digestive issues, increasing the likelihood of reflux.
• Medications: Drugs for asthma, blood pressure (like calcium channel blockers), birth control, sleep aids, and some antidepressants can worsen acid or silent reflux by interfering with stomach acid regulation or blocking DAO activity.
• Antibiotic Use: Long-term antibiotics such as ciprofloxacin, tetracycline, or amoxicillin can lead to heartburn and GERD. These medications may also disrupt gut microbiota, leading to conditions like dysbiosis, SIBO (small intestinal bacterial overgrowth), IBS, and leaky gut, all of which can exacerbate digestive issues.
• Chronic Stress: Persistent stress raises histamine levels and disrupts digestive hormone balance, affecting how your body regulates stomach acid. Over time, this can worsen reflux symptoms.

Addressing these factors through lifestyle changes, dietary adjustments, and stress management can go a long way in relieving acid reflux and improving overall digestive health.

Should You Rely on Antacids for Relief?

Over-the-counter antacids like Tums, Zantac, and Prilosec can provide quick relief by neutralizing stomach acid or reducing its production. However, are they the right solution for long-term use?

Antacids fall into two main categories: H2 blockers and proton pump inhibitors (PPIs). Both work on the stomach’s parietal cells to decrease gastric acid production, offering relief from acid reflux and related discomfort. While H2 blockers temporarily block histamine from triggering acid production, PPIs more permanently suppress gastric acid.

Although effective, these medications come with downsides. Reduced stomach acid lowers the activity of enzymes needed to break down food, especially protein. This can prevent proper nutrient absorption in the small intestine, leading to:

• Gut microbiota imbalances may contribute to conditions like SIBO, IBS, or leaky gut (intestinal permeability).
• Due to disrupted gut health, there is an increased risk of infections such as Clostridium difficile, a serious infection that causes chronic diarrhea.

Antacids may be helpful for short-term relief, but relying on them long-term could lead to digestive imbalances and other health concerns.

Can Antihistamines Help with Acid Reflux?

Since histamine plays a key role in digestion, it’s reasonable to wonder if antihistamines like Claritin or Zyrtec might help with acid or silent reflux. While these medications target H1 histamine receptors, which regulate immune responses, they don’t affect the H2 receptors in the stomach responsible for gastric acid production.

In short, antihistamines designed for allergies won’t relieve digestive symptoms like acid reflux. Instead, addressing the root cause of your reflux—whether it’s diet, stress, or histamine intolerance—will lead to more effective and lasting results.

 Natural Solutions to Help Resolve Acid and Silent Reflux

If you’re looking for ways to manage acid reflux or silent reflux naturally, start with your diet. Following an anti-inflammatory diet rich in vegetables, fruits, and healthy grains can help alkalize your stomach and reduce acidity. Additionally, a low-histamine diet can improve digestion, especially if histamine intolerance is a factor. Not sure where to start? Enroll in my Cooking Low-Histamine Course for just $79.97 to learn how you can easily stick to a low-histamine diet and help to begin your journey on resolving histamine intolerance.

Alongside common GERD recommendations—like eating smaller meals, finishing dinner at least three hours before bed, eating slowly, and prioritizing good sleep—here are more tips to support your digestive health:

• Limit Rich Foods: Even low-histamine options high in sugar, fat, or protein can be hard to digest if you’re dealing with reflux. Keep these foods in moderation.
• Balance Your Plate: Aim for at least one-third of your plate to be filled with vegetables. Not only do they provide essential nutrients and fiber, but they also help neutralize stomach acid, especially when paired with protein-heavy meals.
• Try Natural Antacids: Ginger and fennel are excellent natural remedies for reflux. Fennel, in particular, can be eaten as a vegetable or taken as a supplement—start with the fresh vegetable to enjoy its full benefits!
• Watch Your Water Intake at Meals: Drinking too much water during meals can dilute digestive hormones and affect stomach pH, potentially increasing acid production. Sip water lightly instead.
• Use Digestive Enzymes: Targeted digestive enzymes can ease symptoms of acid and silent reflux. Check out my Fullscript Comprehensive Digestive Guide for recommendations and how to choose the right digestive enzyme supplement for you.
• Consider DAO Enzyme Supplements: The DAO enzyme, which breaks down histamine, may help reduce symptoms related to histamine-induced reflux.

By incorporating these strategies into your routine, you can address the root causes of reflux and improve your overall digestive health naturally.

How to Tell if Histamine Intolerance Is Behind Your Acid Reflux or GERD

While histamine intolerance isn’t widely recognized as a cause of acid reflux or GERD in conventional medicine, the evidence tells a different story. Many foods commonly associated with triggering GERD—like tomatoes, chocolate, and citrus fruits—are also high in histamine. Additionally, chronic stress, a known contributor to reflux, raises histamine levels and may be a key factor in histamine intolerance for some individuals.

To determine whether histamine intolerance is causing your reflux, start by keeping a Food and Symptom Journal. Tracking what you eat and how you feel afterward can help identify patterns and reveal whether high-histamine foods or other triggers contribute to your symptoms.

Ready to take the first step? Use my Histamine Intolerance Food Symptom Journal to uncover your triggers and begin your journey toward better gut health and digestion!

References:

1. Histamine Intolerance Originates in the Gut
2. Histamine Sensitivity: An Uncommon Recognized Cause of Living Laryngopharyngeal Reflux Symptoms and Signs
3. The Impact of Proton Pump Inhibitors on the Human Gastrointestinal Microbiome, Freedberg, et al, 2014
4. The Role of HCL in Gastric Function And Health, Michael Ash