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Everything You Need to Know About Histamine Intolerance
Treatment for histamine intolerance and low histamine diet
A histamine elimination diet consists of temporarily eliminating the main dietary sources of histamine. It should be noted that histamine is present in the majority of foods, it is not possible to eliminate it completely. The idea is to reduce your histamine intake, as the symptoms are caused by too much histamine in the body. Care should be taken not to eliminate too many foods and causing other long-term problems such as nutrition deficiencies. There is no consensus on the list of foods to be excluded.
As mentioned above, the amount of histamine in a single food can vary greatly over time depending on various external factors including the freshness of the food. In addition, an individual’s tolerance to a histamine-rich food may differ from one time to another depending on the level of histamine already present in their body. For example, some people are more sensitive to histamine-rich foods at times of the year when they have seasonal allergies.
How to Follow A Low Histamine Diet
To begin, we eliminate foods that are very high in histamine for four to eight weeks. Those include fermented foods like pickles, sauerkraut, soy sauce, vinegar, tempeh, miso, kefir, Kombucha, alcohol and chocolate. Note that soy sauce can be replaced with coconut aminos. Although vinegar should be avoided, apple cider vinegar is generally well tolerated. Fish and seafood that are not freshly caught should also be avoided, especially canned fish and fish sauce. Aging increases histamine content, especially with regard to proteins. You should avoid anything that is not fresh, for example aged cheeses, processed meats, prepared foods, canned foods and bulk products. It is preferable to freeze leftovers, especially meat and poultry, rather than storing them in the fridge, because freezing slows down histamine production. Canned legumes should be avoided, but dried legumes, ideally cooked in a pressure cooker, can be eaten. The plants highest in histamine are spinach, eggplant, tomato and avocado. Certain fruits have a capacity to release histamine, especially citrus fruits, papaya, pineapple and strawberries, and should also be avoided. The list below outlines the main food sources of histamine based on available research.
It is also important to keep a food diary of foods consumed and symptoms. If there is an improvement in symptoms with a low histamine diet, it is then suggested to reintroduce each food one at a time to more accurately identify those that cause the symptoms, since food triggers vary greatly from one person to another. DAO enzyme supplements have recently been postulated as a complementary treatment to enhance dietary histamine degradation in intolerant individuals who have a deficiency of this enzyme in the intestine.
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Food sources of histamine
1) Foods naturally high in histamine
- Fermented foods (Kombucha, pickles, sauerkraut, soy sauce, tempeh, miso, kefir)
- Canned or fresh fish (except freshly caught fish), seafood and fish sauce
- Spinach
- Eggplant
- Tomato
- Cherry
- Avocado
- Soybeans and all its derivatives
- Nutritional yeast
- Aged Cheeses
- Processed or aged meats (sausages, cured meats, bacon, aged steaks, etc.)
- Yogurt
- Condiments that contain vinegar (vinaigrettes, ketchup, mustard, mayonnaise, BBQ sauce, etc.)
- Leftover meat or poultry and expired food
2) Foods with histamine-releasing capacities
- Citrus fruit
- Strawberry
- Plum
- Papaya
- Pineapple
- Chocolate
- Licorice
- Some spices (cinnamon, cloves, anise, nutmeg, curry powder and chili powder)
- Foods containing certain additives (sulfites, BHA, BHT and dye, especially tartrazine)
- Alcohol, especially wine (especially red) and beer (alcohol blocks the function of the enzyme that breaks down histamine)
It is not recommended to eliminate all of these foods in the long term, as this can lead to unnecessary restrictions, nutritional deficiencies, a negative relationship with food and a diminished quality of life. If you suspect that you have an intolerance to histamine, you should consult with your doctor as well as with a Registered Dietitian who specializes in gastrointestinal health.
*FODMAPs are fermentable carbohydrates that are partly responsible for causing symptoms in people with irritable bowel syndrome (IBS). For more info, read this article.
References
- Maintz et Novak (2007) Histamine and histamine intolerance. Am J Clin Nutr; 85:1185–96.
- Music et coll. (2011) Serum diamine oxidase (DAO) activity as a diagnostic test for histamine intolerance. Clin Transl Allergy; 1(Suppl 1): P115.
- Lackner et coll. (2019) Histamine-reduced Diet and Increase of Serum Diamine Oxidase Correlating to Diet Compliance in Histamine Intolerance. Eur J Clin Nutr; 73(1):102-104.
- San Mauro Martin, Brachero et Garicano Vilar (2016) Histamine intolerance and dietary management: A complete review. Allergol Immunopathol (Madr); 44(5):475-483
- Communauté d’intérêts Suisse de l’intolérance à l’histamine (SIGHI). Informations sur l’histaminose / intolérance à l’histamine, pour les personnes concernées et les professionnels de la santé. Last updated on February 7, 2019. https://www.histaminintoleranz.ch/fr/therapie_regimealimentaire.html
- Kovacova-Hanuskova et coll. (2015) Histamine, histamine intoxication and intolerance. Allergol Immunopathol (Madr); 43(5):498-506.
- Comas-Basté et al. (2020) Histamine Intolerance: The Current State of the Art. Biomolecules;10: 1181.
Author
Kathryn holds a Bachelor Degree in Nutrition as well as a Bachelor and a Master Degree in Kinesiology, all from Laval University. She is a Registered Dietitian and active member of the Ordre professionnel des Diététistes Nutritionnistes du Québec (ODNQ) and of the American Academy of Nutrition and Dietetics. She holds the Monash University's certification for the FODMAP diet and IBS, and has considerable clinical experience in that area. She is also an accomplished athlete, having ran track and cross-country at a national level. Kathryn specializes in sports nutrition, weight loss, diabetes, as well as heart and gastrointestinal health.
I have raw sores in my mouth. I have had them for 4 years now. They are very painful. I have gone to several doctors who can’t figure it out. Im trying to figure out what else i can do.
Curious if you have made any progress. I have had mouth sores for 5 years. Thank you