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How To Use a Low Histamine Diet for Histamine Intolerance

Written by Dr. Michael Ruscio, DC on November 20, 2020

Written by Dr. Michael Ruscio, DC on November 20, 2020 — Reviewed by Heidi Turner

What To Eat, What to Avoid, and How to Use the Low Histamine Diet

• Histamine Intolerance|
• Symptoms|
• Low Histamine Diet|
• Histamine Diet How-To|
• Foods To Avoid|
• High Histamine Foods|
• Histamine Liberators|
• Low Histamine Foods|
• Sample Menu|
• Low Histamine Food Tips|
• Supplements|
• Bottom Line|

If you have recurring frequent diarrhea or nausea, dizziness, itching skin, or rashes after eating certain foods, you may have a histamine intolerance. As is often the case, choosing the right diet can be the difference between constant, unexpected symptoms and relief. Let’s explore histamine intolerance, the low histamine diet and how to use it, and which supplements can help your low histamine diet succeed.

What Is Histamine Intolerance?

Histamine is a naturally occurring compound in some foods and drinks. Histamine is also released from immune system cells when they are exposed to allergens, like dust, pollen, or food allergens.

Some research suggests that histamine intolerance originates in the gut [1]. How?

Histamine from food is broken down in the digestive tract by the enzyme diamine oxidase (DAO) [2]. If you become deficient in DAO, excess histamine can cause allergic reaction symptoms and immune responses in your gut and body [2, 3, 4].

Histamine intolerance affects approximately 1% of Americans [5] and more commonly affects women [2, 6]. This may be due to monthly fluctuations in estrogen, which appears to encourage the release of histamine [7, 8, 9].

But one study also showed that 30%-55% of people with digestive symptoms also have histamine intolerance [10]. And in another study, more than 50% of individuals with celiac disease who did not respond to a gluten-free diet also had histamine intolerance [11].

Evidence suggests low levels of DAO enzyme in the gut can be triggered by:

• Gut inflammation from dysbiosis [12]
• Deficiencies of vitamin B6 [13, 14, 15]
• Genetic variations [16]
• Consuming foods or drinks that block the action of DAO, such as alcohol [2].

Low DAO levels have been associated with Crohn’s disease and ulcerative colitis [17, 18], and histamine intolerance is associated with leaky gut [12].

When levels of histamine build up, either due to eating high histamine foods or reduced DAO action in the gut, histamine symptoms occur. An overabundance of histamine can cause a wide range of symptoms.

Here are some typical symptoms of histamine intolerance:

• Itching, redness, hives, rash, and/or swelling of the lips, tongue, or skin
• Red or swollen eyes or eyelids
• Sneezing and nasal congestion
• Low blood pressure
• Heart arrhythmia
• Gut health symptoms, including abdominal pain, bloating, diarrhea, gas, nausea, or vomiting
• Headache, migraines, or dizziness
• Sleep disturbances
• Menstrual irregularity
• Chronic fatigue
• Mood symptoms such as anxiety or depression

Let’s talk about how to improve histamine intolerance with a low histamine diet.

Low Histamine Diet

Histamine in foods is produced by the process of fermentation and aging by bacteria and yeasts [19].

On a low histamine diet, you eat low histamine foods and avoid high histamine foods, which reduces the burden on your DAO enzyme levels. You can also support your DAO levels with a few particular supplements.

There aren’t yet a lot of data about low histamine diets, but several small studies suggest a low histamine diet can help control histamine intolerance symptoms.

Decreasing histamine in your diet has been shown to correlate with increased levels of DAO in your blood and to reduce food allergies and histamine intolerance symptoms [20]. In another study, a low histamine diet improved chronic hives in a group of adults [21].

The low FODMAP diet may also have a role to play on a low histamine diet. The low FODMAP diet has been shown to reduce IBS symptoms by decreasing  available food for symptom-causing gut bacteria [22]. Histamine intolerance and IBS symptoms and causes overlap, indicating that bacterial overgrowth may be a cause for both conditions [12, 23, 24, 25]. This suggests a low FODMAP diet adapted for low histamine may be an important approach for histamine intolerance.

How To Do a Low Histamine Diet

If you are experiencing a lot of histamine symptoms, a low histamine diet can improve your quality of life.

Step 1: Clean up your regular diet first: Don’t start a low histamine diet until you are already eating a whole-foods diet free of common allergens and food additives. A simple elimination diet, like the paleo or low FODMAP diet, are an excellent place to start.

Step 2: Remove high histamine foods: If you still have histamine symptoms once you have adopted a clean diet, you can adapt it to the low histamine diet.

Using a high histamine food list (see below), do a three-week elimination of high histamine foods, histamine liberating foods, and foods that block the action of the DAO enzyme. If you don’t experience symptom relief, histamine is not likely part of your symptom picture.

Step 3: Reintroduce foods to test for a reaction: Once you have completed the elimination, it’s time to begin reintroducing foods, one at a time. Start with the foods you miss most.

As histamine intolerance is due more to the overall load of histamine foods, work to find your ideal threshhold. The key to remaining symptom free is to not eat more histamine than your body can metabolize. Using a food diary can help you track your reactions.

Step 4: Maintenance: Continue to avoid the quantity of histamine foods that trigger symptoms while you work on resolving your root causes.

Remember that an elimination diet is not meant to be forever. Continue to avoid the foods that clearly cause a reaction, but feel free to add foods that don’t cause reactions back into your diet. There’s no need to continue to avoid foods that don’t cause symptoms.

If you need support with a low histamine diet, be sure to consult with a dietitian, nutritionist, or health coach.

Foods To Avoid on a Low Histamine Diet

There are three categories of foods to avoid on a low histamine diet: foods that are high in histamine, foods that may trigger a histamine release in the body (called histamine liberators), and foods that block or inhibit the action of the DAO enzyme. Here are lists of foods in these various categories. For a more complete guide, download our Low Histamine Diet eBook.

High Histamine Foods

Histamine in foods is created by the transformation of the amino acid histidine into histamine, often by the action of bacteria or yeasts. This means that fermented or aged foods usually have higher levels of histamine than fresh foods. However, certain vegetables, including spinach and eggplant, also have high histamine levels [26].

During the elimination phase, remove histamine-rich foods from your diet for a period of three weeks. Here is a list of high histamine foods.

• Aged cheeses
• Alcoholic beverages of any kind (especially red wine)
• Avocado
• Dried fruits
• Eggplant 
• Fermented or aged meats, including salami, sausages, and pepperoni
• Fermented beverages like kombucha and water kefir
• Fermented dairy products (yogurt, kefir, sour cream, buttermilk, cottage, and ricotta cheese)
• Fermented or pickled vegetables (kimchi, sauerkraut, pickles, miso, natto)
• Fish and seafood, particularly tuna or mackerel, especially if left over, smoked, salted, or canned, or not gutted and frozen immediately after harvest [27]
• Ketchup
• Soy sauce, tamari, coconut aminos, and liquid aminos
• Spinach
• Leftovers or unfresh food
• Tea (black, green, white, or yerba mate tea)
• Tomatoes
• Vinegars, including apple cider, rice wine, and balsamic
• Yeast products

Histamine Liberators

Some foods may not be high in histamine themselves, but are thought to trigger the body to release histamine. You may or may not react negatively to these foods, so some careful attention is required to determine if you need to remove them from your diet. Here is a list of foods that may be histamine releasers:

• Additives or preservatives
• Alcohol
• Fruits such as bananas, citrus fruits (like lemon, lime, and grapefruit), papaya, pineapple, and strawberries
• Chocolate and cocoa
• Egg whites
• Fish and shellfish
• Legumes like lentils or chickpeas
• Licorice
• Nuts, especially such as cashews, peanuts, sunflower seed, and walnuts
• Pork
• Some spices

DAO Blockers

Other foods are known to inhibit the action of the DAO enzyme, which can increase the effect of other high histamine foods. The worst culprit is alcohol, because it is both high in histamine and is a DAO blocker [28]. Energy drinks and teas (green tea, black tea, and yerba mate) are also DAO blockers.

Low Histamine Foods

There are plenty of low histamine foods to include on a low histamine diet. An anti-inflammatory diet template like the Paleo diet is a good place to start. This includes whole foods like:

• Fresh meat and lower histamine fish
• Gluten free grains like rice, quinoa, or millet
• Fresh vegetables like lettuce, cucumbers, zucchini, kale, onions, green beans, or sweet potatoes
• Fresh fruits like apples, blueberries, kiwis, or pears
• Healthy fats such as olive oil, butter, ghee, coconut oil, or coconut milk
• Herbal teas

Low Histamine Diet Meal Plan

What can you eat on a low histamine diet? Lots of delicious foods. When reorganizing your diet, it’s a good idea to follow these simple tips:

• Keep it simple to start: choose a few particular recipes and use them to develop some simple, customized food lists. Be willing to repeat your core basic recipes frequently in the beginning, then expand.
• Be prepared: Stock your pantry and kitchen with foods you can eat, and build your meals and snacks around those.
• Be as strict as possible for 2-4 weeks.
• Don’t stay on the diet too long if it’s not working.
• Reintroduce foods slowly, one at a time to check for reactions. Chances are you won’t react to all the high histamine foods. Work with a food journal to help you clarify which foods are your worst triggers.

Here is a sample day on a low histamine diet:

Breakfast: Oatmeal with blueberries, toasted almonds, coconut, and a drizzle of maple syrup.

Lunch: Green salad with rice, cucumbers, grated carrot, radishes, and fresh herbs, and roasted chicken breast, with an olive oil-apple juice dressing.

Snack: Gluten free crackers with hummus and carrot sticks, or coconut milk-protein powder-blueberry-pear smoothie.

Dinner: Freshly thawed, grilled turkey burger with a side of oven-roasted, herbed, garlic potatoes, and sauteed kale.

Low Histamine Food Tips

Because histamine levels increase in protein-rich foods the longer they are stored, a few key tips can help you avoid additional histamine in your diet.

Meat handling: Histamine levels increase in meat and fish the longer it sits before cooking. Freezing arrests this process of histamine production. When you return from the store with meat, either cook it immediately or freeze it to thaw and cook later.

Leftovers: Similarly, histamine builds in leftovers as they are stored in the refrigerator. Freeze leftovers in serving sizes appropriate for you or your family, and thaw later to reheat.

Ripeness: Additionally, consuming slightly under-ripe fruits and vegetables that are generally high in histamine may reduce your intake.

Ripeness: Histamine can increase with ripening. So, if eating higher histamine fruits and vegetables like avocado or tomato, choosing under-ripe options can help to reduce your intake.

Histamine Intolerance Supplements

Some dietary supplements can help your body do a better job of breaking down histamine. Antihistamine medications block the histamine receptors but do nothing to deal with the excess of histamine present in the first place.

• A DAO supplement can directly support your body’s ability to break down and excrete excess histamine. One study found that DAO with meals significantly reduced histamine intolerance symptoms [29].
• Vitamin B6 is a cofactor for DAO enzyme production. Supplementing vitamin B6 has been shown in several studies to improve DAO enzyme levels [13, 14, 15].
• Vitamin C is a known MAST cell stabilizer, and has been shown in several studies to improve histamine symptoms [30, 31, 32].

Probiotics and Histamine Intolerance

Many people on the internet have promulgated the opinion that certain types of probiotics are histamine producers or increase histamine intolerance symptoms. It’s likely that probiotics actually lower histamine. However, some controversy exists. We don’t have any direct research about probiotics and histamine intolerance, but we can make some educated inferences.

Studies make a direct connection between histamine intolerance and gut conditions [10], with patients with histamine intolerance more likely to test positive for gut bacteria imbalances and leaky gut when compared with controls [12].

Research clearly shows that probiotics are effective against gut infections such as SIBO [33, 34, 35], bacterial and parasitic infections [36, 37, 38, 39], and leaky gut [40, 41, 42, 43]. There is limited specific data about whether probiotics help resolve histamine intolerance, but probiotics have certainly been shown to benefit histamine-mediated conditions, such as seasonal allergies [44, 45], non-allergic rhinitis [46], and eczema and asthma [47]. These data suggest that probiotics have a role to play in moderating histamine intolerance.

There’s no need to select specific “low histamine” probiotics. Including a quality probiotic from each of the three main categories — Lactobacillus and Bifidobacteria blends, Saccharomyces boulardii, and a soil-based probiotic — and adapting that protocol to how your body responds is your best approach. For more on how to use probiotics, see our Probiotics Starter Guide.

Improve Your Histamine Intolerance

A low histamine diet can make a huge difference in your histamine intolerance symptoms and help you feel better. By reducing your histamine burden, you give your body and your DAO enzyme a chance to rebound. Give the low histamine diet a try, and consider using probiotics, DAO enzyme, and vitamin B6 to feel better.