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Following a low histamine diet is a foundational step when it comes to reducing your overall load of histamine. If you know or suspect that you may have a histamine intolerance, mast cell activation syndrome (MCAS), or a related imbalance, try a low histamine diet for 3-4 weeks, and evaluate how you feel. 

This article will help to guide you through what should be avoided and what can be enjoyed on a low histamine diet, and how to set yourself up for success. 

What is Histamine? 

Histamine is a type of organic compound known as a biogenic amine that is both naturally occurring in our bodies and found in many of the foods we eat. It serves a variety of purposes, from acting as a neurotransmitter in the brain to regulating gut function and stomach acid. 

Above all else, histamine is probably best know for its involvement in triggering a local immune system response and allergic reaction (1). When an allergen, such as dust, pollen, or pet dander is identified in the body, mast cells release histamine to boost blood flow and cause inflammation. The local inflammation is necessary for other immunity factors to join forces and help rid the body of the allergen.  

Although histamine is not detrimental to our health under normal circumstances, problems arise when the amount released or accumulated exceeds the amount broken down. This can happen for a variety of reasons, including excessive mast cell activation, low levels of enzymes like DAO that break down histamine, and gut microbiome imbalances. 

What Is Histamine Intolerance? 

Histamine intolerance is thought to be relatively rare, affecting only 1% of the population (2). If this value seems low, it’s because it may be an underestimation of actual cases. Oftentimes, it’s mistaken as a food allergy or gastrointestinal issue. Many individuals with histamine intolerance have also been diagnosed with other chronic conditions, generally of an inflammatory nature. While these diagnoses may not be wrong, an underlying histamine intolerance that’s contributed to them might be missed.

Despite the uncertainty, some common symptoms of histamine intolerance include: 

– Nasal congestion; sneezing; itchy nose

– Stomach pain; nausea

Indigestion; heartburn

– Rashes; urticaria (hives); itchiness; eczema

– Racing heart; heart palpitations

– Itchy eyes; tearing

Irregular menstrual cycles; menstrual pain; cramping

– Headaches

– Mood swings; anxiety

Brain fog; fatigue; insomnia

– Difficulty regulating body temperature

If you’re experiencing one or several of these symptoms, it’s possibly caused by having an imbalance between histamine production or accumulation and histamine breakdown. Here’s what may be going on:

1. Your body is producing or releasing too much histamine (excessive mast cell activation and/or an overgrowth of histamine-producing gut bacteria);

2. You’re consuming too much histamine in your diet; or

3. The enzyme responsible for histamine breakdown, diamine oxidase (DAO), is not functioning properly (due to genetics, medication, or possible underlying medical conditions).

Whichever the cause may be, something needs to change to enable you to better manage your symptoms. Adjusting your diet can be a beneficial strategy towards keeping histamine in check and improving your quality of life.

The Low Histamine Diet 

It’s important to be mindful that there’s no such thing as a “histamine-free diet”. Instead, the goal is to identify and limit any histamine-rich foods, foods that trigger histamine release, or foods that block DAO production (3).

Monitoring your symptoms when you make dietary changes is important, first to ascertain whether or not histamine seems to be an issue for you, and to potentially identify other underlying food intolerances that may be contributing to your symptoms.

High Histamine Foods

Eat Less of This…

1. Fermented foods: The fermentation process produces chemical changes to food and drinks by converting carbohydrates into alcohols using microorganisms. Some examples include: 

– Yogurt

– Kimchi 

– Sauerkraut

– Alcohol

– Kefir

– Kombucha

– Soy sauce

– Buttermilk

2. Aged foods: Age naturally increases the histamine content of foods, so aged meats and cheeses should be avoided. 

– Aged, processed (deli), cured, and smoked meats like salami

– Aged cheese

– Canned fish including tuna or mackerel

3. Ripened fruits and vegetables: Histamine is formed as a deterioration byproduct in various food items. It’s best to eat fresh sources.

4. Naturally histamine-rich foods: Some foods contain high levels of naturally occurring histamine. Some examples include: 

– Avocados

– Spinach

– Eggplant

– Dried fruits

– Legumes including chickpeas

– Shellfish

5. Foods that trigger the release of histamine: These food sources are known as histamine liberators, as they are thought to cause mast cells to release histamine into our system, even if the foods themselves don’t contain much histamine. These include the following dietary sources: 

– Citrus fruits: oranges, lemons, grapefruits, etc.

– Bananas

– Tomatoes (including ketchup)

– Beans

– Chocolates

– Nuts

– Dairy products

6. DAO blockers: Without proper enzyme activity, histamine can build up in the body over time. Three sources that block enzyme activity include:

– Alcoholic beverages

– Black tea, green tea

– Energy drinks

Low Histamine Foods

Eat more of this… 

– Fresh meats and fish 

– Fresh vegetables (except for tomatoes, avocados, spinach, and eggplant)

– Potatoes, sweet potatoes

– Non-citrus fresh fruits: grapes, apples, pears, kiwi, papaya

– Eggs

– Natural peanut butter

– Gluten-free grains: quinoa, rice, and whole grains

– Dairy substitutes: coconut milk, oat milk, almond milk

– Cooking oil including olive oil, coconut oil 

– Most leafy herbs and herbal teas

– Certain seeds including chia seeds

If you’re uncertain about the cause of your symptoms, it may be worth adopting a low histamine diet to identify the underlying cause. Research has found that after about 4 weeks of reducing your intake of histamine-rich foods, your symptoms should resolve if it is in fact a true intolerance (4). 

This detailed food list rates foods based on their histamine content, and may be helpful as you get started with your histamine elimination diet.

Tips and Tricks

1. Cook more meals at home –  This allows you to control the ingredients being used. You can also substitute for lower-histamine options when necessary.

2. How you cook matters – Be mindful of your methods for food preparation. Frying and grilling food increase the levels of histamine when compared to boiling (5).  Slow cooking also raises histamine levels in food. An Instant Pot is a great alternative.

3. Eat foods in their freshest and most natural form – This helps you to avoid the high-histamine concentrations that occur in fermented, processed, frozen, and microbial-rich environments. Be careful also with leftovers. When it comes to histamine intolerance, fresh foods are best. It’s also important to avoid additives and preservatives.

4. Limit your alcohol intake – Alcohol is made through a fermentation process which influences the amount of histamine present.

5. Consider supplementing – Some supplements that may help alongside your low histamine diet include the DAO enzyme, DAO cofactors including vitamin B-6, copper, and zinc, natural antihistamines like vitamin C, and natural mast cell stabilizers like quercetin.

6. Speak to your doctor –  It’s best to consult with your healthcare provider about your plan to adhere to a low-histamine diet, to ensure that you’re obtaining necessary nutrients. You may also wish to consult with a registered dietitian or nutritionist to help you come up with meal plans.

7. Start using a food diary – Start recording your daily meals, time of meals, and any symptoms you may be experiencing. This can help you identify what food sources your body is more or less accepting of. Modify as you go.

 

If you have, or suspect you may have, histamine intolerance, or for more personalized guidance on anything mentioned here, request an appointment with Dr. Gannage.

 

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