Amine intolerance

DRINKING alcohol can result in flushes and headaches, for some people.  

For others, ingesting certain foods can trigger headaches, hives, blood pressure elevation or other more severe symptoms. Many of these reactions are related to allergies or intolerance to amines in foods. 

Amines are naturally present in some plants and animals. They can also be formed in food that is processed commercially or prepared at home. In the body, some amines are neurotransmitters known as “biogenic amines”. Histamine, tyramine, serotonin and phenylethylamine are common biogenic amines that can cause allergic reactions in some people.  

 

Asian food  

In food, tyramine is produced through the breakdown of the amino acid tyrosine by decarboxylation, during fermentation or spoilage of food. Under normal circumstances, when the food is ingested, tyramine is broken down or metabolised into their harmless metabolites by the enzyme monoamine oxidase present in the body. The lack of this enzyme in the body causes intolerance to food containing tyramine.  

Soybean, grapes, milk and fish all contain tyrosine. These are popular ingredients used in manufacturing various food products through fermentation.  

In Asia, soybean is made into drink and tofu, which are good sources of protein. If these foods are not refrigerated, they deteriorate at room temperature. During the spoilage process, tyrosine is converted into tyramine. People who are allergic to amines should avoid soybean drink and tofu that have deteriorated in quality. 

Miso and fermented bean curd (lam yi or fu yi) are soybean products, processed by adding salt and spices to bean curd, then allowed to mature by fermentation. Fish sauce, budu, belacan, and cencaluk are fermented fish or shrimp products. These protein-rich foods contain tyramine.  

The amount of tyramine depends on the temperature and how long the food has been allowed to ferment. Generally, the longer a food ferments and ages, the higher the tyramine content.  

 

 

The 3-Cs 

Cheese, chocolate and citrus fruits are grouped by some nutritionists as the “3-C’s” to alert people who are sensitive to amine residues.  

Cheese is a fermented product made from milk. During the process, enzyme, bacteria and other microbes transform their textures and intensify their flavours. The casein proteins and fat in the milk are converted into amino acids, amines, and fatty acids. The longer a cheese is kept – to produce a stronger flavour and firmer texture – the higher its amine content. People with amines intolerance should avoid aged cheeses, such as blue cheese, emmenthal, parmesan and Romano.  

The cheese used in burgers and sandwiches, available in local fast food outlets, are processed cheese. It is made by mixing regular cheese with milk and other unfermented ingredients, plus emulsifiers, salt, flavouring and colouring. Processed cheeses are usually packed as sliced cheese. Processed cheeses are not kept to age and normally have no notable amount of tyramine. Cheddar, cottage cheese, cream cheese and cheese spread are processed cheeses.  

Roasted fermented cocoa beans is one of the ingredients used in the manufacturing of chocolate. Chocolate may contain tyramine residues from the cocoa beans. Chocolate contains tryptophan, which is an amino acid that may induce sleep. On the other hand, in the body, tryptophan is a precursor of serotonin. People intolerant of tyramine and serotonin may feel uncomfortable after eating chocolate. 

Amines are found in overripe fruits, especially avocado, orange, bananas, pineapple, papaya, plums, grapes, figs, kiwi fruit and strawberries. Mushroom, eggplant and tomato are also known to contain amines. People intolerant of amines should consume mature but not overripe or spoiled fruits.  

However, when fruits are allowed to “spoil” or ferment, wine can be made. Wine and beer are produced by brewing grapes, rice or barley, through fermentation. These alcoholic drinks have amine residues. Comparatively, rice wine has less amine residues as it has a lower amount of protein. 

Peanuts, coconuts, Brazil nuts and broad (fava) beans are other foods that may trigger hypertensive reactions, headaches or other allergic reactions. 

 

Fish and meat 

After a meal of seafood, some people develop an itch or have swollen lips. Their eyes may begin to tear. Others may experience headaches, stomach cramps or diarrhoea, or break out in hives. These undesirable reactions, known as histamine poisoning or Scombroid poisoning, develop in persons with insufficient diamine oxidase activity. It is not due to sensitivity to certain types of fish or shell fish. It is because the seafood has deteriorated in quality and formed histamine residues. 

In our hot climate, if seafood is not refrigerated, it deteriorates rapidly. Some of the amino acids in seafood break down into the biogenic amine, histamine. Ingestion of high concentrations of histamine may lead to symptoms of allergy.  

Dried, salted and fermented seafood such as ikan billis, dried shrimp, salted fish, shrimp paste, budu and cencaluk also contain histamine. People who are intolerant of histamine should consume only very fresh fish or shell fish, and avoid excessive consumption of processed seafood products. 

Meat products that have been allowed to age and cure to improve flavour and tenderness also contain amine residues. Some of these products are sauerkraut and fermented hard sausages. Locally processed fresh sausages, which have not been cured through fermentation, contain no significant amount of amine residues. 

 

Overheated food 

When foods – especially meats – are cooked at high temperatures, another set of amines known as heterocyclic amines are formed. Deep-frying, barbecuing, grilling and prolonged stewing seem to produce more heterocyclic amines. People prone to general sensitivity to amines may be intolerant of heterocyclic amines. 

Sensitivity to these amines can often be misinterpreted as an intolerance of a specific type of food. For example, if eating grilled meat upsets a person, he or she might think it was because of the meat when, in fact, the problem could be the amines. 

The amount of amines present in food varies extensively, not only between different types of foods but also when the same food is differently handled, stored, prepared or manufactured. Tracking one’s allergic reactions through a food diary helps to identify specific foods that trigger the symptoms. 

Furthermore, some medications or drugs, such as antidepressants, can increase one’s sensitivity to biogenic amines. Seek professional guidance as required. Many effective drugs have been developed to hinder amine allergic response.