Low Histamine Diet: Foods to Eat, Avoid, and a 3-Week Plan

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 a Low Histamine Diet?

Histamine is a natural signaling molecule best known for its role in allergic reactions, but it also helps regulate the sleep-wake cycle, stomach acid secretion, and brain function.

Histamine intolerance appears to be relatively uncommon, although its true prevalence remains uncertain. With histamine intolerance, the body does not efficiently break down histamine. Reduced activity of the enzyme diamine oxidase (DAO), which normally breaks down histamine in the gut, is one possible contributor. When histamine accumulates faster than it can be cleared, it may trigger symptoms in susceptible individuals.

Histamine in foods is produced by the process of fermentation and aging by bacteria and yeasts 1. Some foods contain high amounts of histamine, while others may trigger histamine release or interfere with histamine breakdown in susceptible individuals, although evidence for these effects varies by food.

On a low histamine diet, you prioritize eating low histamine foods and avoid high histamine or histamine-triggering foods, which reduces the burden on your DAO enzyme levels. Research continues to emerge around low histamine diets, but several small studies suggest a low histamine diet can help control histamine intolerance symptoms. Following a low histamine diet has been shown to reduce histamine intolerance symptoms 2 3, and may even improve DAO levels 3. In another study, a low histamine diet improved chronic hives in a group of adults 4. You can also support your DAO levels with supplements.

The low FODMAP diet may also benefit some people with histamine intolerance, particularly those who also have irritable bowel syndrome (IBS). By reducing fermentable carbohydrates that feed certain gut bacteria, a low FODMAP diet has been shown to improve IBS symptoms 5. Because IBS and histamine intolerance share many symptoms and may both be linked to gut dysbiosis or bacterial overgrowth in some people 6 7, improving the gut environment may also help reduce histamine-related symptoms.

This suggests a low FODMAP diet adapted to accommodate low histamine may be a valuable approach for histamine intolerance.

Low Histamine Foods

There are plenty of low histamine foods to include on a low histamine diet. Using an anti-inflammatory diet as a guide, like the Paleo diet or the autoimmune protocol (AIP) diet, is a good place to start. These approaches include 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

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 through fermentation, aging, or storage. This means that fermented or aged foods and even leftovers usually have higher levels of histamine than fresh foods. However, certain vegetables, including spinach, certain tomato varieties, and eggplant, also naturally have higher histamine levels 8.

During the elimination phase of the low histamine diet, 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)
• Dried fruits
• Eggplant 
• Tomato (histamine levels vary significantly based on variety and product)
• Fermented or aged meats (salami, sausages, prosciutto, and pepperoni)
• Fermented beverages (kombucha and water kefir)
• Fermented dairy products (yogurt, kefir, sour cream)
• Fermented or pickled vegetables (kimchi, sauerkraut, pickles, miso, natto)
• Fish and seafood, particularly tuna, mackerel, sardines, anchovies, and fish that has been smoked, salted, canned, or improperly stored 9
• Soy sauce, tamari, coconut aminos, and liquid aminos
• Spinach
• Leftovers or food that has not been stored properly
• Vinegars (apple cider, rice wine, and balsamic)
• Nutritional and brewer’s yeast

Some foods, including tomatoes and avocado, may worsen histamine-related symptoms in some people even though they are not consistently high in histamine. Individual tolerance varies, and research on these foods is less consistent.

What About Histamine Liberators?

Some foods may not be high in histamine themselves, but are thought to trigger the body to release histamine. These foods are often referred to as “histamine liberators” because they are thought to promote histamine release or otherwise increase histamine activity. However, the evidence supporting this effect is limited, and reactions vary considerably from person to person. 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 10:

• Alcohol
• Citrus fruits (like lemon, lime, and grapefruit)
• Pineapple
• Kiwi
• Papaya
• Chocolate and cocoa
• Egg white
• Cow’s milk
• Nuts (specifically cashews and walnuts)
• Coffee and caffeine-containing tea
• Some spices (cinnamon, cloves, curry powder, chili, and nutmeg)
• Certain food additives and preservatives

The evidence for these foods is much less consistent than for foods that naturally contain high levels of histamine, so individual tolerance varies. Keeping a food and symptom journal can help identify your personal triggers. 

Alcohol and Other DAO Blockers

Some foods and beverages may inhibit diamine oxidase (DAO), the enzyme that helps break down histamine. When DAO activity is reduced, histamine can accumulate more easily and contribute to symptoms. 

Alcohol deserves special attention because it may worsen histamine intolerance in several ways. In addition to containing histamine (particularly wine and beer), alcohol can reduce the activity of diamine oxidase (DAO), the enzyme responsible for breaking down histamine in the gut, allowing histamine to accumulate more easily 11. Energy drinks and teas (green tea, black tea, and yerba mate) have also been proposed as possible DAO blockers 10.

Some foods may also be DAO blockers, including 10:

• Bananas
• Strawberries
• Pineapple
• Citrus fruits
• Chocolate

How to Start a Low Histamine Diet

If you are experiencing histamine symptoms or allergy-like reactions after consuming certain foods, a low histamine diet may improve your quality of life.

Step 1: Begin With a Whole-Food Diet

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. A simple elimination diet, like the Paleo or low FODMAP diet, is an excellent place to start.

Step 2: Remove High Histamine Foods for Three Weeks

Remove high-histamine foods: If you still have histamine symptoms after eliminating potentially inflammatory foods, you can adopt the low histamine diet.

Using the high histamine food list above, 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 what is causing your symptoms.

Step 3: Reintroduce Foods One at a Time

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 mainly due to the overall load of histamine foods, work to find your ideal threshold. 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: Find Your Personal Histamine Threshold

Maintenance: Now that you know your personal threshold for how much histamine you can have without a reaction, 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.

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 after the trial period if it’s truly 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 and apple juice dressing.
• Snack: Gluten-free crackers with hummus (omit lemon if sensitive) and carrot sticks, or a smoothie with coconut milk, protein powder, blueberry, and pear.
• Dinner: Freshly thawed, grilled turkey burger with a side of oven-roasted, herbed, garlic potatoes, and sautéed kale.

Food Storage Tips That Keep Histamine Lower

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.

Cook or Freeze Meat Promptly

Histamine levels increase in meat and fish the longer they sit before cooking. Freezing arrests this process of histamine production. When you return from the store with meat, either cook it immediately or freeze it so you can thaw and cook later.

Freeze Leftovers Instead of Refrigerating Them

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.

Choose Fresher, Less-Ripe Foods

Histamine can increase with ripening. So, if you are eating higher histamine fruits and vegetables, choosing under-ripe options can help 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 12.
• Vitamin B6 is a cofactor involved in histamine metabolism and may support normal DAO activity, particularly in people who are deficient 13 14.
• Vitamin C has mast cell-stabilizing properties and has been shown to lower circulating histamine levels, making it a promising supportive nutrient for people with histamine intolerance 15 16.

Probiotics for Histamine Intolerance

There are many varying opinions, especially on the internet, on how probiotics impact histamine intolerance and histamine levels. While we don’t have any direct research about probiotics and histamine intolerance, we can make some educated inferences.

There are studies that have recognized a connection between histamine intolerance and gut conditions 17, with patients with histamine intolerance more likely to test positive for gut bacteria imbalances and leaky gut when compared with a control group 7.

Research shows that probiotics are effective against gut infections such as small intestinal bacterial overgrowth (SIBO) 18 19, bacterial and parasitic infections 20 21 22 23, and leaky gut 24 25 26 27. 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 28 29, eczema 30, and asthma 31. 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.

Bottom Line on the Low Histamine Diet

A low histamine diet can be a useful short-term experiment if symptoms like itching, headaches, flushing, digestive upset, or fatigue seem to worsen after certain foods. Start with fresh, minimally processed foods, remove the most likely triggers for about three weeks, and then reintroduce foods gradually to find your personal tolerance.

You don’t need to follow a highly restrictive diet forever. The goal is to determine whether histamine is actually contributing to your symptoms and, if it is, identify the foods and quantities your body can comfortably handle.

If your symptoms continue despite dietary changes, there may be more going on beneath the surface. Gut inflammation, bacterial overgrowth, nutrient deficiencies, and other digestive imbalances can all affect how well your body processes histamine.

At the Ruscio Institute for Functional Health, our clinicians take a stepwise approach to uncovering those underlying factors and building a treatment plan around your symptoms, history, and response to care. Book a consultation with us.

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