The Low Histamine Diet: What Is It And Does It Work?

The low histamine diet is gaining attention. It is being used to treat problems such as rashes, headaches, bloating or other digestive symptoms that occur after eating foods containing histamine. When this connection is seen, it may be a sign of histamine intolerance (HIT) a condition that many feel is under recognized. For those suffering from HIT, the low histamine diet is the primary treatment. After a quick explanation of histamine and histamine intolerance, let’s discuss the low histamine diet and determine if it works.

Histamine is a chemical found naturally in all cells of our body. It is an important component of the immune and nervous systems. Histamine can trigger the immune system and cause symptoms like swelling, rashes and watery eyes. If it affects the nervous system it may cause problems such as headaches, digestive problems and pain.

In addition to the histamine that our body makes, it is also naturally present (or can develop) in certain foods. Histamine content is especially high in fermented foods. But wait – aren’t fermented foods supposed to be good for you? Keep reading for an answer to that question!

Histamine intolerance (HIT) isn’t a true allergy, like we see with bee stings or peanuts. Histamine intolerance is a mismatch between too much histamine in our body, and the speed at which our body can clear it. If our body is releasing too much histamine, or unable to break it down, we really don’t feel well.

How much is too much? This is entirely dependent on each individual and their total health and wellness. Each person has their own tolerance level to histamine.

A person’s tolerance to histamine can be compared to a bucket filling with water; everyone has a different size bucket depending on a variety of health factors. When the bucket is full and begins to overflow, symptoms occur. Gut health is one emerging factor that affects your personal response to histamine containing foods.

For a more detailed explanation of histamine intolerance read my previous article here.

Having too much histamine can cause a range of unpleasant symptoms (1, 2). Bloating may be the most common sign (3).

Other symptoms include:

• Diarrhea
• Migraines or other headaches
• Stomach pain (IBS)
• Anxiety
• Fast heart rate
• Hives, itching
• Red color/flushing of skin
• Wheezing
• Watery eyes
• Swelling of the tongue/mouth
• Severe menstrual pain

It may be difficult to diagnose HIT because the symptoms are similar to other conditions, including food allergies, IBS, gluten-sensitivity (4, 5). Because of this, it is important to speak with your doctor about other possible causes of your symptoms prior to making a diagnosis of histamine intolerance.

Following  the low histamine diet helps symptoms by:

1. Minimizing the overall amount of histamine that you get from foods
2. Eliminating foods that block the action of the DAO enzyme. This enzyme helps break down histamine so that it can be cleared from your body. If this enzyme is not able to do its job,  because certain foods block it, histamine remains in the body and continues to cause uncomfortable symptoms.

For people with histamine intolerance, symptoms tend to increase as the day goes on or if high histamine foods are consumed on the same day or close together. Remember the bucket analogy I mentioned earlier?. Symptoms happen when the bucket fills up due to the combined effect of your natural histamine and the histamine you consume in food. Your body’s natural source of histamine is difficult to control but the dietary intake can be managed..

Determining what foods are problematic for you is a bit of trial and error. Luckily, there are some general tips to get you started. In addition,the food lists below will help guide you. They contain foods to avoid or include to decrease your risk of developing symptoms.

• Fresh is best. Histamine content of  foods increases as foods age or spoil.  Eating fresh food helps minimize histamine production (15).
• Avoid fermented foods – Fermented foods contain high amounts of histamine. While fermented foods are typically good for gut health, if HIT is present they can be problematic.
• Read labels– avoid products that contain high histamine ingredients
• Freeze it.  Some research shows that freezing foods lessens histamine generation in foods. Consider freezing leftovers, especially meats.
• Avoid artificial coloring and preservatives – food additives, dyes  and preservatives such as benzoates and sulfites can release histamine. Remember to check medications and supplements too.
• Pasteurized dairy may be better. Some people with histamine intolerance cannot tolerate dairy at all. Others are able to tolerate small amounts. It is best tolerated if fresh, pasteurized and not fermented.There is less histamine in cheese made from pasteurized milk than from raw milk (16). 
• Boiling may be better. Histamine levels in foods vary depending on preparation methods – boiled foods have the same or less histamine than raw foods while frying or grilling increases histamine levels (17).

Resources: The SIGHI food list is a comprehensive printable guide.

• Fruit: blueberries, apricots, cranberries, apples, mango, peaches.
• Vegetables: Onion, sweet potatoes, asparagus, broccoli, squash, cucumbers, beets.
• Dairy: Butter, cream cheese, pasteurized milk. Eggs are safe in small amounts. The whites may release histamine. Yoiks are safe
• Meats: Freshly cooked meat and poultry. Fish that is fresh or frozen
• Grains: Potatoes, corn, rice, oats
• Fats and Oils: animal fats.
• Flavor: fresh and dried herbs, salt.
• Drinks: water, herbal tea, fruit juice (avoiding citrus).
  

• Fruit: Citrus fruits, strawberries, bananas, pineapple, pears.
• Vegetables: Eggplant, avocado, tomatoes, olives, beans.
• Dairy: Cheese, yogurt, processed cheese.
• Protein: Canned, smoked, dried meats/fish. Tuna, mackerel, anchovies, shellfish. Sausage, lunchmeat, liver.  Avoid eggs except in small amounts baked in products.
• Grains: avoid bleached wheat flour
• Flavor: vinegar, soy sauce, hot spices.
• Fermented Foods: Beer, Wine, Pickled foods, Kombucha,Sauerkraut, Kimchi
• Drinks: coffee, alcohol, black tea, orange juice, lemon wate

• Breakfast: oatmeal with cooked apples and almond milk
• Snack: peach and almond milk smoothie
• Lunch: chicken and vegetable soup with wild rice
• Dinner: grilled frozen cod with quinoa and asparagus
• Dessert: blueberry chia pudding

It can feel challenging to embark on an elimination diet. Always try to focus on foods that you can have. There are many recipe blogs and low-histamine cookbooks available with delicious menu ideas.

Since there are no accurate tests for histamine intolerance, missing other possible causes of symptoms is the biggest risk to those following a low histamine diet. If you are following the diet, you are assuming that HIT is your underlying problem. I can not emphasize enough the importance of first looking for other causes of symptoms before making the diagnosis of HIT and starting a low histamine diet. Please see the complete article on HIT for “look-alike” conditions.

The diet can be very challenging to follow because it is restrictive. Some people working to relieve their symptoms might also have other dietary restrictions such as FODMAP or gluten intolerance. When multiple dietary restrictions are in place, proper nutritional intake can be difficult to achieve. Working with a registered dietitian can be helpful if one is available to you.

If histamine intolerance has been properly diagnosed, underlying issues addressed and the diet implemented, enormous benefits can be seen. I have had numerous patients eliminate their hives, rashes, headaches etc. with the use of the low histamine diet. In my experience, this diet does not need to be strictly followed long-term if underlying conditions are also addressed.The goal is always more dietary freedom and improved overall well-being. In addition,this diet emphasizes fresh, whole foods. That is a roadmap to better health every time!

THIS ARTICLE IS COPYRIGHTED BY AMY BURKHART, MD, RD.