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

By Amy Burkhart MD, RD

The low histamine diet is being used to treat problems such as rashes, headaches, bloating, and long-haul COVID-19 symptoms.  Histamine intolerance (HIT), is a condition that many feel is underrecognized. 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.

What Is Histamine?

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!

What Is An Intolerance To Histamine?

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 the body and the speed at which the body clears it. If too much histamine is released, it is not broken down fast enough; a person doesn’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 filled with water; everyone has a different-sized 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 or at the link below.

Too much histamine causes symptoms  Bloating is most common

Other symptoms include:

• Diarrhea(1, 2)(3).
• 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.

How Does It Help?

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 is cleared from your body. If this enzyme cannot do its job because certain foods block it, histamine remains in the body and continues to cause uncomfortable symptoms.

The Basic Idea

Remember, this is a “low histamine diet,” not a “no histamine diet.” The goal is to decrease histamine levels. It is impossible to eliminate histamine completely.

For people with histamine intolerance, symptoms tend to increase as the day goes on. Symptoms also worsen if multiple 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 natural histamine and the histamine consumed in food. The body’s natural source of histamine is difficult to control, but the dietary intake is manageable.

Determining what foods are problematic is a bit of trial and error. For this reason, a histamine intolerance diet looks different for everyone. Luckily, there are some general tips to get you started. Also, the food lists below are a place to start. They contain foods to avoid or include to decrease the risk of developing symptoms.

Quick Tips To Get Started

• 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 are 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 tolerate small amounts. It is best to choose fresh, pasteurized, and not fermented products. 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).

Low Histamine Food Lists Vary Depending On The Source

It should be noted that it is difficult to determine the histamine content of foods.

The SIGHI food list is a comprehensive printable guide that is commonly used.

• 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. Yolks 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).
  

Many of the foods on the SIGHI  list are determined by crowd-sourcing, not scientific evidence. That being said, they are a general place to start, and everyone’s tolerance is different.

What Foods Are High Histamine And Most Problematic?

• 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 water

A Sample Menu

• 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.

Are There Risks To The Low Histamine Diet?

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

The diet can be very challenging 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.

Does It Help?

If histamine intolerance is properly diagnosed, underlying issues addressed, and the diet followed, enormous benefits can be seen. I have had numerous patients eliminate their hives, rashes, headaches, etc., with 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!

• Histamine Intolerance: The Current State Of Art
• Comparing Histamine Intolerance And Mast Cell Disorder
• Considering Histamine In Functional GI Disorders
• Non-responsive Celiac Disease And Histamine Intolerance