The low histamine diet is not a typical weight-loss plan. It is a medical treatment designed to reduce symptoms associated with a condition called histamine intolerance. This diet should be undertaken with the guidance of a healthcare team.
What is a Low Histamine Diet?
The low histamine diet is an eating plan with a very specific purpose: to manage symptoms associated with a condition called histamine intolerance. The goal of the diet is to reduce foods that are high in histamine or could trigger the release of histamine.
Understanding Histamine in the Body
Histamine plays an important role in the immune system. You may think of itchy eyes on a spring day or a sudden sneeze while petting a friendly dog. Even if you’re unsure of what histamine is, you likely have some idea of its connection to allergies. Mast cells, which are a type of white blood cell, release histamine in response to various triggers, such as certain foods or environmental triggers (like pollen or pet dander). For example, if you have an allergy to a specific food, your immune cells release histamine to protect your body when you eat that food.
Histamine is a chemical substance in your mast cells, which is a certain type of white blood cell. Histamine helps your immune system respond to allergy triggers. If you have an allergy to a certain food, for example, histamine gets released by these immune cells in order to protect the body from what it perceives as a threat. Histamine sends your body a number of different signals in an effort to fend off an allergen. It opens up your blood vessels, while simultaneously constricting both your airways and your gastrointestinal (GI) tract. You also start generating mucus - hence, the runny nose. Our body naturally produces histamine. There’s also histamine, in some quantity, in most of the foods we eat.
How the Low Histamine Diet Works
The low histamine diet can help with the management of histamine intolerance. The diet attempts to reduce foods that are high in histamine or could trigger the release of histamine.
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Signs and Symptoms of Histamine Intolerance
Histamine intolerance is thought to have two main causes. The first is an overproduction of histamine as a result of certain conditions, such as allergies or Mast Cell Activation Syndrome (MCAS). The second is slowed histamine breakdown, which has been associated with certain medications, gastrointestinal conditions, and high stress levels. The main enzyme responsible for the breakdown of histamine is diamine oxidase (DAO). A low level of DAO can make it difficult for the body to break down histamine. For some people with histamine intolerance, low levels of DAO may play a role in their symptoms. Certain groups of people may be more prone to histamine intolerance and have trouble breaking down histamine, including older adults, individuals with gastrointestinal or gut disorders, and kidney or liver diseases.
Common Symptoms to Look For
Histamine intolerance can share classic symptoms of an allergy such as a runny rose, rash, hives, and swelling of the lips, tongue, and throat. However, histamine intolerance is often referred to as a “whole-body condition”, meaning it can also cause other symptoms such as headaches, dizziness, low blood pressure, irregular heartbeat, and digestive symptoms. This wide range of symptoms often means histamine intolerance can be more difficult to diagnose.
How is Histamine Intolerance Diagnosed?
Diagnosing histamine intolerance can be challenging since there are no specific tests for it. A healthcare provider who is familiar with the condition can make a diagnosis based on a detailed history of symptoms, dietary habits, and any related health conditions. While not definitive, blood tests for DAO enzyme levels or histamine levels in the blood may also be conducted to assess how histamine is metabolized in your body. It’s also important to rule out any other conditions that can cause similar symptoms, such as allergies or gastrointestinal disorders. If histamine intolerance is suspected, your healthcare provider may then recommend trialing a low histamine diet. This involves removing high-histamine foods from your diet for a period of time (usually 2 to 4 weeks).
The Importance of Freshness
Selecting fresh foods and fresh meat is important because histamine levels increase the longer food sits. As food ages or if it is stored improperly, bacteria can break down proteins in the food, which can trigger a histamine release. Frozen foods tend to be lower in dietary histamine because they are frozen quickly after harvest, which prevents bacteria from thriving. Try to buy and eat fresh produce within a few days to ensure you are consuming foods in the freshest form possible. Many find that avoiding leftover foods can also help reduce dietary histamine intake.
Foods to Avoid on a Low Histamine Diet
When following a low histamine diet, the goal is to reduce the intake of foods that either contain high levels of histamine or trigger the release of histamine in the body. Since histamine intolerance affects people differently, there is often confusion around which foods to avoid on a low histamine diet. Additionally, research on low histamine diets concluded that there is a lack of consensus as to what foods should be avoided. As a result of this, there isn’t universal agreement about the diagnosis and management of histamine intolerance. Navigating the confusion around which foods to avoid requires careful monitoring and guidance to develop a customized approach, which is why working with a dietitian can be helpful. While the “yes” and “no” food lists can vary depending on what source you look at, there are many similar themes. Examples of foods to avoid on a generalized low histamine diet include:
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Fermented Foods
Fermented foods are avoided on a low histamine diet because they typically contain high levels of histamine. During the fermentation process, certain bacteria can produce histamine as a byproduct, causing histamine levels in the food to increase. Fermented foods include fermented dairy (kefir, buttermilk, sour cream), fermented vegetables (sauerkraut, kimchi, pickles), and soy products (miso, tempeh, tofu).
Aged Foods
The aging of foods can also increase the amount of histamine. Aged cheeses and processed and cured meats are usually avoided on the low histamine diet. Cheese is typically considered “aged” after 6 months or more and often includes parmesan, gouda, blue cheese, and cheddar. Examples of processed and cured meats include salami, pepperoni, sausage, smoked ham, bacon, and luncheon meats.
Canned and Preserved Foods
Other ways of preserving foods, such as canning, smoking, and pickling can increase histamine levels in the foods. Most low histamine diet lists recommend avoiding foods such as canned fish/meats, smoked meats, pickles, and foods preserved in vinegar.
Alcohol
It is recommended to avoid alcoholic beverages on the low histamine diet, particularly red wine and beer. Wine is high in histamine and beer is fermented, so it can trigger histamine release. In general, alcohol has also been reported to block the DAO enzyme that is needed to break down histamine. Alcohol (wine, beer and champagne) should be avoided.
Certain Fruits and Vegetables
Some fruits and vegetables naturally contain higher levels of histamine or produce it during ripening, adding to the overall histamine load in the body when eaten. These include tomatoes, spinach, eggplant, and avocados. Other fruits and vegetables may not contain significant amounts of histamine, but they can trigger the release of histamine in the body. This group includes citrus fruits, strawberries, bananas, and pineapple. As a result of this, these foods can lead to symptoms similar to those caused by high histamine foods. Vegetables like tomatoes, eggplant and spinach and tropical fruit like pineapple, bananas, papaya and citrus fruits should be avoided. Strawberries should also be avoided.
Read also: Weight Loss with Low-FODMAP
Nuts
While nuts are not high in histamine, they can be problematic for some individuals with histamine intolerance due to their potential to trigger histamine release. Some low histamine diet resources list certain nuts to avoid, such as walnuts, cashews, and peanuts, while another resource lists "nuts and peanuts". Whether nuts need to be avoided on a low histamine diet can vary based on individual tolerance and the type of nut. Working with a registered dietitian can be helpful in this situation to ensure your plan is individualized to you and your health concerns. Nuts and peanuts should be avoided.
Other Foods to Avoid
Legumes (lentils and beans), soy products, licorice and chocolate should be avoided. Additives (like colorants and preservatives) should also be avoided.
Histamine Releasers
Studies show that certain foods, including legumes, chocolate, and vinegar, have been reported to trigger the release of histamine in the body. Although these foods are not inherently high in histamine, they can trigger the body’s mast cells to release histamine.
Best Low Histamine Foods to Eat
When following a low histamine diet, it’s essential to focus on fresh, minimally processed foods that are naturally low in histamine. These foods can help minimize histamine intake and reduce symptoms for those with histamine intolerance. Here are some of the best low histamine food options:
Fresh Meats and Poultry (Unprocessed)
Fresh, non-aged and unprocessed meats are low in histamine. It’s important to consume these meats as fresh as possible, as histamine levels can increase in meats over time. Examples include chicken, turkey, beef, lamb, pork. Fresh meat like beef, veal, chicken and turkey and boil or poach to keep histamine levels low.
Fresh Fish (Non-Aged)
Freshness is key, as fish histamine levels rise rapidly after they are caught. Avoid canned or aged fish such as tuna, sardines, and mackerel. Species of fish that are thought to be lower in histamine include plaice, carp, trout and hake. Select the very freshest you can buy or use frozen, but be aware that histamine levels will start to increase during thawing. Cod, haddock, plaice, and sole are lower in histamine compared to oily fish.
Dairy Substitutes
Non-dairy milks are good alternatives for those sensitive to histamine in cow’s milk. Examples include coconut milk, rice milk, and almond milk (as tolerated).
Grains and Starches
Quinoa, oats, and millet are naturally low histamine options. Rice: white, brown, basmati, and jasmine rice. Potatoes and sweet potatoes are good starchy options that are low in histamine and well tolerated by most. Pseudo “grains” like quinoa make a useful base for a pilaf, tabbouleh or salad. Combine with fresh vegetables and serve with chicken or eggs. Make only as much as you need to avoid the need to store leftovers.
Fresh Fruits & Vegetables (Non-Nightshades)
Freshness is important. Avoid overripe or stored fruits and vegetables, as histamine levels can rise during storage. Low histamine vegetables include zucchini, carrots, cucumbers, bell peppers, lettuce, peas, cabbage, and green beans. Low histamine fruits include apples, pears, mangoes, blueberries, melons, and cherries. Most fresh vegetables, including cauliflower, are low in histamine. This simple cauliflower rice is super speedy and makes a great base for a meal - make sure to eat it immediately. Omit spices, like the optional cumin in this recipe, because it may trigger the release of histamine.
Herbs and Spices
Basil, parsley, cilantro, thyme, rosemary, and oregano are low in histamine and add flavor to meals without causing reactions.
Other Low Histamine Foods
Mozzarella and ricotta are unaged cheeses and, therefore, have a lower histamine content. Tapioca and asparagus are also low in histamine. Artichokes are rich in the flavonoid luteolin that helps stabilise the cells that store histamine. Studies suggest legume sprouts like beansprouts are a good source of diamine oxidase (DAO), the enzyme involved in breaking down histamine. Broccoli is rich in sulforaphane and a source of vitamin C, broccoli may have useful anti-histamine effects. Celery is a versatile, low-histamine ingredient that is as good in a salad like our fennel and celery salad, a soup or as an accompaniment, such as our braised celery hearts with roast chicken. Courgette (zucchini) is low-histamine. Cucumber is low in histamine and a refreshing addition to a salad. Fennel is full of flavour yet low in histamine, fennel can liven up a dish. Onions, regardless of their type, have powerful anti-histamine properties. Parsnips are low-histamine and Sweetcorn is also a good choice. Watercress may help prevent histamine release from mast cells.
Managing Histamine Levels in Food
As well as opting for foods with lower histamine levels you may also want to adopt some of these practical tips:
- Select foods in their whole, unprocessed form
- Buy and eat fresh foods rather than those that have been stored or preserved
- Cook from scratch
- Freeze leftovers rather than refrigerate.
Working with a Registered Dietitian
Managing Mast Cell Activation Syndrome involves being knowledgeable about your unique triggers. While more research needs to be conducted on MCAS, many of those with MCAS find a low histamine diet helpful. A registered dietitian nutritionist can help assess your nutrition and develop a personalized plan to reduce histamine-containing foods while still consuming balanced meals. A dietitian will help ensure you eat specific foods that are safe, effective, and nutritionally adequate.
The low histamine diet is a medical treatment that is only meant to be tried for a short period of time. Therefore, it’s essential to work with an experienced registered dietitian who can help guide you through food eliminations and reintroductions so you can identify your unique triggers.