My food history # 7 (part 3) – food sensitivities – high blood pressure – biogenic amines

Cheese. by Leonie Elizabeth. January 2018.

 

Continuing my story on food sensitivities

I underwent The Royal Prince Alfred Hospital (RPAH) exclusion diet protocol in 1985 (1) which involved a few-foods diet until symptoms settled, followed by food challenges, then a modified diet excluding only problem foods. Lastly, there was moderation of the diet up to my level of food tolerance.

Some of the food challenges raised my blood pressure.

High blood pressure (hypertension) is a medical condition in which blood pressure pumping through the arteries is elevated compared to what is considered normal. It is a major risk for coronary heart disease and can lead to long-term complications such as vision problems, or kidney disease. My own father had uncontrollable high blood pressure and died of stroke in 1974 age 49 years. His mother and aunt also had strokes.

At the age of 29 I presented with hypertension after a stressful period. After six months I managed to bring it down to low levels following a Pritikin-style diet, with particular attention to avoidance of salt. I never considered hypertension could be due to a food sensitivity and so it was a bit of a shock when it came back during the RPAH food challenges. It returned with foods high in amines, nitrates and MSG.

Disclaimer: Please note – any exclusion diet protocol including challenges should only be done under the supervision of a medical practitioner. Other reasons for symptoms need excluding before diet is tried. Medications may require adjustment during the protocol. Some people may experience severe symptoms to challenges. In some instances these need supervision by a medical practitioner or in hospital. 

Biogenic Amines are bioactive nitrogen-containing compounds resulting from breakdown of protein in foods or fermentation. High levels are found in aged foods such as cheese; fermented foods such as beer and wine; and in some fruits and vegetables as tomatoes, bananas and avocados. Biogenic amines vary in concentration even in the same foods at different times, and estimates of average levels vary greatly. Amine levels depend on the starting level of the specific amino acid, the presence of bacteria with the ability to convert the amino acid to an amine and the age of the food. Amine levels increase in time. Amines commonly found in foods include tyramine, histamine, serotonin, tryptamine, and phenylethylamine.

Reactions to Amines

I first learned about amines when studying to become a pharmacist. People who take Mono-amine oxidase inhibitor anti-depressants need to avoid foods high in amines as the drug blocks the enzyme that breaks down the amines. The amines will then build up which can lead to a hypertensive crisis. However, I had never heard of amines being a trigger for hypertension from normal levels in foods when not taking the drugs. Through information subsequently provided by the dietitian at RPAH (2) and later through my own research, I was to learn that amines are vaso-active compounds (they put pressure on blood vessels) and in sensitive people can precipitate symptoms such as hypertension, headaches and migraines. They can also provoke mood changes; and trigger ‘allergic’ symptoms such as rash, itching, respiratory symptoms, gut symptoms, breathing difficulties, and fever (3). Scomboid poisoning is a type of food poisoning due to the build-up of very high levels of histamine in fish resulting in flushing, headache, cramps, diarrhoea and sometimes breathing difficulties. (4)

My Dilemma

After my amine food challenges I had a dilemma. As the challenges were with food (not purified chemicals) I was not able to say with certainty it was “amines” that had provoked the reaction. For two years prior I had excluded salt from my diet. Many amine-foods were high in salt (cheese) as were foods high in nitrates (ham, corned beef) and MSG (soy sauce). It could have been salt that triggered hypertension. However, as my blood pressure had risen alarmingly (to 160/100), I could not re-do the challenges. It was too dangerous. So I was left with the problem of not really knowing whether I should avoid amine foods or salt or both.

Follow-up

The original challenges in 1985 plus various dietary indiscretions over the years have convinced me the biologically active amine in foods are the chief provokers of hypertension in me. Stress, hormonal factors and sodium (I think) are confounding variables. Although wine and champagne are definite problems (they contain amines) alcohol per se (eg: vodka) is not involved, at least at the levels I consume which is only ever one or two serves at a time. I have also experienced a hypertensive reaction to pseudephedrine (a drug chemically related to food-amines) on two occasions, and to adrenaline in local anaesthetic. This has convinced me I have an acute amine sensitivity.

When I was a bit younger I did brave a few dietary tries. Single dietary indiscretions produced short-lived rises to about (140/90) for about 3 hours beginning 6- 24 hours after consumption of high amine foods/ beverages. With more frequent diet relapses (three days in a row), rises up to 170/110 and sustained readings of 160/100 for up to 5 days occurred. The rise in blood pressure was accompanied by symptoms of fluid retention, insomnia, headaches, nausea, dizziness, agitation and lethargy. I only ever did this once. After that once though, I became afraid of eating out for fear of triggering a hypertensive crisis. It was like playing Russian Roulette.

I again saw a doctor at the RPAH after that, on a further two occasions. I wanted to know whether I could block the hypertensive effect (as I could with asthma, by pre-medicating before social events). He told me that was not possible. I was left with the choice of strict avoidance, or medication if I wanted to incorporate more foods in my diet.

Over the past 30 years I have tried medications on two more occasions. However, this did not prove suitable. The medications are designed for people with chronic hypertension. That is not how I was presenting. In the mid-1990s I had periodic hypertension, presenting only with symptoms after eating high-amine foods after social occasions. When I tried medication, I ended up with orthostatic hypotension where my blood pressure was dropping too low. In the mid-2010s, in the midst of a personal crisis, I was presenting with labile hypertension (ie: symptoms came and went). When I tried medication that time I became very weepy on the medication that I tried. Both these times, while I accepted the doctors advice and took medication for  a while, I also brought my diet back to very low amines. The hypertension disappeared.

Thus, my decision as it stands today, I avoid amines at all times, even socially.

Foods I have had a rise in blood pressure after eating are cheese, wine, fish, yoghurt, cauliflower, cream cheese, gravy, aged beef, processed meat. Foods with amines that have triggered other symptoms in me are chocolate, banana, pineapple, spinach and broccoli.

Salt is still a question mark. I tolerate low levels. Sometimes I think my blood pressure has risen after a salty meal but, unlike amines (where both systolic and diastolic readings go up) the salty meal seems to trigger a rise in systolic readings and is not accompanied by mood changes (unhappiness) that I get with amines. To be honest, I do not like overly salty foods, I do not use salt in my own cooking and while I eat salted foods other people cook (to be polite), I am not prepared to “challenge” myself with salt in the name of science. I enjoy living with low to normal blood pressure and without having to medicate myself to achieve that.

And back in 1985 when I first stumbled upon this issue there were more important dietary priorities to consider … that of my children.

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This is a series of posts on my food history from my childhood up until 2013.

This is a series of posts on my food history from my childhood up until 2013.
My food history # 1 – My childhood diet – Late 1950s, early 1960s
My food history # 2 – Mid 1960s – First nutrition lessons
My food history # 3 – Late 1960s – Times are a-changing
My food history # 4 – Critical moments – my father
My food history # 5 – Fit 1970s – fibre – fruit – free of sugar
My food history # 6 – 1980s – Critical moments – a health scare – hypertension
My food history # 7 (part 1) – 1980s – Food Sensitivities – shattered ideals of healthy food
My food history # 7 (part 2) – 1980s – Food sensitivities – proving the culprit foods
My food history # 7 (part 3) – 1980s – Food sensitivities – hypertension & biogenic amines
My food history # 8 – The 1980s Healthy Eating Pyramid
My food history # 9 – The 1990s Nutrition studies – low GI – lipoproteins
My food history # 10 – 1990s combining ‘friendly’ with ‘healthy’ – a bland yet healthy diet
My food history # 11 – The 2000s – slow ticking time bombs
My food history # 12 – Critical events and life catastrophes

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Disclaimer: Nothing in this article or on this website should be taken as medical or dietary advice. Anyone reading any information provided within should seek advice from their own medical practitioner for any issue, disease, illness or health-related problem they may have. Always seek your own advice from a medical practitioner or dietitian before changing your own diet.

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References and notes:

(1) Royal Prince Alfred Hospital (Sydney) Exclusion Diet protocol.

(2) D H Allen, S Van Nunen, R Loblay, L Clarke, A Swain. Adverse Reactions To Foods. Medical Journal of Australia. September 1 1984. Special Supplement.

(3) Control of Biogenic Amines in Food – existing and Emerging Approaches. Aishath Naila, Steve Flint et al, J Food Sci. 2010. Sep; 75 (7): R139-R150

(4) Scromboid poisoning. Piero Stratta, and Guido Badino;CMAJ. 2012 Apr 3; 184(6): 674.

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