Your Ultimate Guide to the Low-Histamine Diet

Do you know how much histamine you eat? Very few people do, but histamine can have great
bearing on your health.

You’ve most likely heard of hay fever, where the histamine in pollen causes an allergic reaction.
You may even take antihistamines for part of the year. However, you may not have heard about
the histamine found in food and how this has the potential to make you feel sick. If there’s a
build up of histamine in your body it can result in uncomfortable symptoms, seriously affecting
your quality of life.

Do you have:

• Regular migraines or headaches

• A constant runny nose
• Hives or itchy skin
• Regular diarrhea
• Stomach cramps
• Difficulty sleeping
• Brain fog
• A feeling of constant fatigue, even after sleep
• Depression or anxiety
• Dizzy spells
• Heart palpitations

If you have one or more of these symptoms, you may be struggling with undiagnosed histamine
intolerance and the food that you eat may be making your symptoms worse.

The good news is that histamine intolerance is treatable and with careful changes to your diet,
you can feel a lot better. But why does histamine have such a big effect on your body?

What is Histamine?
Histamine is a natural substance and neurotransmitter that’s produced by your body and can be
found naturally in some foods. Your immune system uses histamine as a mediator. When your
mast cells detect an intruder, they release histamine, raising the signal to increase inflammation
in that area. Inflammation is an important response to injury or a foreign invader in your body, as
it increases the response of your immune system to protect, heal, and repair the affected area.

The Link Between Histamine and Inflammation

There are five signs of inflammation:

• Swelling - Fluid and white blood cells flood the afflicted tissues to fight and flush out
bacteria and other foreign matter.
• Redness - Your small blood cells dilute in order to increase blood flow in the area
• Pain - Although it brings discomfort, pain is a crucial message as it alerts you that
something’s wrong.
 • Heat - The increase in blood flow causes increased heat. When the inflammation occurs
throughout your body, you experience the heat as a fever.
• Loss of function in the area - Stiffness or impaired use occurs during the process of
inflammation.

The inflammatory effect of histamine can’t be overstated. When your skin comes into contact
with the stinging nettle plant, the tiny hairs on the leaves press into your dermis and release a
number of chemicals, including histamine. The resulting inflammation causes the itchy rash that
then appears on the skin.

Some bacteria and yeasts can feast on protein, turning an amino acid known as histidine into
histamine. All protein-laden food has the potential to contain histamine and the older or more
fermented the food the more likely it contains high levels of histamine. Histamine in your diet
shouldn’t usually be a concern, but if you have mast cell activation syndrome (MCAS) or
histamine intolerance, it can worsen your symptoms quite dramatically.

What Does Histamine Do to Your Body?

Histamine is important in the body. Not only does it trigger the fight against infection or
allergens, but it helps regulate your gut function and plays an important role in brain cognition
and affects your sleep cycle. Histamine is highly useful in a number of different ways.

However, when there’s too much histamine in your body, its role in triggering inflammation can
result in multiple issues. If you have histamine intolerance, eating foods high in histamine can
cause a number of issues, including:

• IBS symptoms such as abdominal cramps and diarrhea

• Increased nasal mucus
• Increased intestinal mucus
• Low blood pressure
• Headaches and migraines
• Asthma
• Painful menstrual cramps
• Loss of muscle tone
• Palpitations or dizziness
• Hives or itchy skin
• Flushed skin
• Chronic fatigue
• Depression
• Anxiety
• Trouble sleeping

Histamine intolerance is a subsection of MCAS. If you suffer from the syndrome you’re not only
dealing with too much histamine entering your body through food, which your gut or liver is
unable to break down due to an enzyme deficiency, but your mast cells are also releasing too
much histamine.

Normally when mast cells are triggered into releasing histamine, once the threat in the body has
been neutralized the histamine is broken down by a couple of enzymes. N-methyltransferase
(HNMT) can be found in the cytoplasm of your cells and is well placed to break down histamine
inside cells. HNMT occurs in particularly high concentrations in your liver and kidneys.

Your epithelial cells, such as the ones that line your gut, provide the other enzyme, diamine
oxidase (DAO). When it’s needed, your epithelial cells funnel DAO into your bloodstream and
gut to degrade the histamine. However, when you have histamine intolerance, your body’s
unable to cope with an accumulation of histamine and these processes don’t work as well. Low
DAO has been linked to histamine intolerance and related conditions such as migraine. This is
often why your symptoms can resemble those of an allergic reaction, including a runny nose or
itchy skin. Yet in your case, it’s an issue with histamine instead of a specific allergen that’s
triggering the release.

If you have histamine intolerance, it may be caused by:

• A genetic mutation causing DAO deficiency.

• Increased estrogen production and decreased progesterone, if you’re female. Estrogen
activates your mast cells to release histamine. In turn, histamine can stimulate the cells
in your ovaries, creating more estrogen in what amounts to a vicious circle.
• Stress, infection, or gastrointestinal disease such as Crohn’s disease and IBS, causing
poor gut health.
• Poor methylation causing problems with the HNMT degradation pathway, which is
explored in more detail later.

So what’s the difference between MCAS and histamine intolerance?

What is Mast Cell Activation Syndrome?

Histamine intolerance is only a subcategory of MCAS, focusing on when your mast cells release
too much histamine. Yet mast cells can release a number of different mediators and MCAS
occurs when your mast cells activate a number of these signalers and it interferes with your
health.

Other inflammatory mediators released by your mast cells include:

• Leukotrienes - Their effects are even more potent and last longer than the effects of
histamine.
• Prostaglandins - These amplify the effects of cytokines and may cause a feedback loop
of inflammation, contributing to chronic inflammation, pain, and autoimmune disease.
• Pro-inflammatory cytokines - Some of these are responsible for the pain experienced
during inflammation.

These pro-inflammatory mediators combined with histamine can have a poor effect on your
health.

I’ve previously written about the similarities and differences between MCAS and histamine
intolerance. Histamine intolerance often presents itself like an allergy, but MCAS is more like a
multisystem condition, an underlying contributor to conditions as wide-ranging as lupus,
gastroesophageal reflux (GERD), celiac disease, and chronic inflammatory response syndrome
(CIRS).
Like histamine intolerance, triggers of MCAS include stress, certain foods (where histamine can
induce mast cell granulation), and hormone imbalances. Other factors that contribute to MCAS
include:

• Medication and medicine excipients, including additives such as dyes and fillers
• Chemicals, particularly airborne varieties
• Exposure to mold
• Changes in temperature, pressure, or altitude
• Lyme disease

If you suspect that you have MCAS it’s vital that you find a doctor that’s an expert in both MCAS
and histamine intolerance so that you can be tested for the right markers and any coinciding
infections or diseases can also be treated.

What Is Methylation Imbalance and How Does It Relate to

Histamine Intolerance?
Earlier I touched upon the connection between genetics and DAO insufficiency causing an
increase of histamine in the body. While there’s a mutation that can affect your body’s ability to
break down histamine, methylation also plays a part in the HNMT degradation pathway within
your cells.

Your epigenome is a set of additional information laid on top of your DNA. Its purpose is to call
attention to certain genes and say which genes should be left unread. It’s as if you scribbled all
over your textbook to flag which parts were crucial to the syllabus and which parts were
unnecessary to revise. This emphasis changes from one cell to another. It’s important to note
that epigenetics aren’t permanent. They can change due to your environment, diet, level of
physical activity, and medications, which is great news. You’re in charge of your health!

DNA methylation is one aspect of epigenetics as the biochemical process governs the way your
genes are regulated and influenced. Methylation is the process needed to facilitate gene
expression, DNA and RNA synthesis, and cell division, among other things. Our DNA becomes
less methylated as we age. Methylation is essential to the process of HNMT breaking down
histamine within cells and if your levels aren’t sufficient, it can contribute to a histamine
imbalance.

What causes poor methylation?

• Genetic mutations, which are often overstated

• Nutrient deficiencies, especially related to vitamin B 12 and folic acid
• Stress
• Toxins, such as heavy metals like mercury and lead
• Mold exposure

Note how this list resembles the list of MCAS triggers, which I don’t think is a coincidence. Your
body’s systems aren’t separate and everything’s connected. When your body’s imbalanced,
many aspects can go wrong at the same time, including your gut health, your immune system,
and your methylation.
Why Do Women Get Mast Cell Activation Syndrome?
Patients with MCAS are predominantly female and above I touched upon how increased levels
of estrogen triggers your mast cells to release histamine, often resulting in a vicious circle of:

• Increased estrogen
• Mast cells releasing histamine
• Histamine triggering estrogen release in the ovaries
• Mast cell activation

However, a rise in estrogen can also induce a rise of copper in your blood. Your body needs
copper to create red blood cells and to make DAO in order to break down histamine but too
much copper in your bloodstream can be a problem.

Excess copper from food is intercepted by the protein metallothionein (MT) in your gut, binding
to it and preventing it from entering your bloodstream and liver. This is the primary way your
body deals with copper so it can be removed as part of your normal waste. When your MT
function is affected, it increases your copper load but can also affect your immune system, gut
health, ability to digest gluten, and ability to reduce inflammation. This represents further proof
that everything in your body’s connected and one simple imbalance can be a tipping point.

The copper that reaches your bloodstream should normally bind to a protein called
ceruloplasmin, so that it can be carried to where it’s needed in the body, or to the liver, which
can get rid of the excess. When there’s too much copper, ceruloplasmin is unable to take it all to
the liver and you may struggle with increased oxidative stress.

Ceruloplasmin has a number of other functions, including the ability to break down histamines
alongside histaminase. However, if your ceruloplasmin is tied up with dealing with increased
copper due to increased estrogen, it can’t help to break down the increased levels of histamine,
also brought on by estrogen.

Women experience an estrogen rise every month during their menstruation cycle, but it can be
elevated in a major way thanks to the following events, medications, or procedures:

• Puberty
• Birth control, such as the combined contraceptive pill
• IUDs that may contain copper
• Pregnancy
• Menopause
• HRT (both synthetic and natural)

Obviously, it’s impossible to avoid an increase in estrogen in some of these cases and it may
not always lead to issues with histamine intolerance or MCAS. For example, your DAO levels
increase significantly in concentration during pregnancy. However, it’s worth being aware of if
you suspect you have a histamine sensitivity.

Is There a Link Between Histamine and Tyramine?

Histamine and tyramine are both neurotransmitters that can be found in foods. Like histamine,
tyramine can be made by bacteria and yeasts from proteins in food as it ages. It’s also released
by mast cells in the event of an immune system threat and triggers the release of catecholamine
hormones from your adrenal glands.

These hormones include dopamine, norepinephrine, and epinephrine or adrenaline. You need
these hormones when you experience a sudden allergic reaction, such as an insect bite, or an
injury, because they goad you into action. Your blood pressure increases, your heart beats
faster and moves blood to your major organs, and you start to breath heavily. In the event of
danger, you can move away from the wasp nest or get help for your injury. Monoamine oxidase
is an enzyme that breaks down tyramine once the danger passes. It’s a fantastic system.

But when you’re not in harm’s way, and your immune system doesn’t need to leap into action,
excess tyramine caused by the foods you eat or MCAS can be a problem. And if you have a
monoamine oxidase deficiency, even what are considered to be normal levels of tyramine can
cause trouble.

Tyramine sensitivity or tyramine intolerance can cause:

• Nausea
• Vomiting
• Heart palpitations
• Migraines and headaches

It’s worthwhile keeping tyramine in mind if you suspect that you have MCAS. Although our focus
is on histamine, tyramine is one of a number of neurotransmitters that can cause health issues.

Do I Have Histamine Intolerance?

You can’t test for histamine intolerance or MCAS with a single blood test. Your integrative or
functional medicine doctor needs to work with you in order to come up with the right diagnosis.

Testing and diagnosing histamine intolerance may include:

• Taking a full medical history, including past infections and poor gut health, any history of
stress, and reproductive history.
• Blood tests for lowered DAO levels.
• Genetic testing to check if there’s a genetic factor causing a DAO or HNMT deficiency.
• Blood tests for MCA, including for histamine, prostaglandin D2, Chromogranin A, serum
tryptase. More information is available here.
• Urine tests for MCAS, including for N-Methylhistamine, prostaglandin D2, leukotriene E4.
More information can be found here.
• Blood tests to check copper and zinc levels in the bloodstream or a possible blood test
to check estrogen levels, depending on your medical history.
• An elimination diet under the care of your doctor or a registered nutritionist, lasting for six
to twelve weeks maximum. This is an excellent way to see if certain foods worsen your
symptoms, although it’s not a long-term solution.

Once you’ve been diagnosed with histamine intolerance, what comes next?

There are a number of actions you can take to reduce your symptoms, including finding ways to
rebalance your hormones or heal your gut. I’m going to concentrate on making changes to your
diet and supplementing where needed. There are an overwhelming number of lists out there,
but I’m providing you with the following ones.

What Foods Are High in Histamines?

Remember how histamine builds up in aged food because bacteria eat any amino acids that are
available? Well, you may not be surprised to learn that fermented foods contain the highest
levels of histamines but it may be time to put down that slice of leftover pizza. Yes, the longer
leftover food is left out, or in the refrigerator, the longer the bacteria have to make histamine.

Of course, I remind patients that histamine levels aren’t set in stone. The levels in food may vary
depending on the way it’s processed, how long it’s been stored, and its general maturity. In the
case of plants, the leaves and stems may also contain different levels of histamine when
compared to the fruit, vegetable, or nut. Consequently, there’s no definitive list of the quantities
of histamine in different foods.

If you’re looking to avoid histamine in your diet, I recommend removing the following foods from
your diet:

Foods high in histamine:

• Leftovers or spoiled food

• Over-ripe fruit or vegetables
• Alcohol
• Raw milk
• Cheese, especially aged varieties
• Prepackaged meat
• Eggplant (see other nightshades on this list)
• Avocado
• Potato
• Green beans and peas
• Dried fruit
• Fermented or aged meat, including processed meats and cold cuts
o Salami
o Lunchmeat
o Sausages
o Canned meat
o Hot dogs
• Fermented or pickled vegetables
o Kimchi
o Pickles
o Miso or natto
o Sauerkraut
• Kombucha or other fermented beverages
• Fish and seafood, particularly if leftover, smoked, or salted
• Fermented dairy
o Sour cream
o Buttermilk
o Cottage cheese
 o Ricotta cheese
o Yogurt
o Kefir
• Tomatoes
• Grapes
• Dates
• Stone fruits
o Apricots
o Nectarines
o Peaches
o Prunes
o Plums
• Ketchup and other condiments such as tabasco sauce or mustard
• Canned foods
• Spinach
• Pineapple
• Yeast products
o Bread
o Most baked products
o Vinegar
o Cereal
o Stock, stock cubes, and gravy
o Prepackaged fruit juices
o Barley malt
• Fermented sauces
o Soy sauce
o Tamari
o Coconut aminos
o Liquid aminos
o Fish sauce
• Tea
o Black
o Green
o White
• Unpasteurized honey

Foods that may release histamine through the mast cell mechanism:

• Food containing additives, preservatives, or dyes

• Egg whites
• Cocoa and chocolate
• Citrus fruit
• Bananas
• Nuts and peanuts especially walnuts, pecans, and peanuts
• Legumes, especially soy
• Papaya
• Licorice
• Pork
• Spices
 o Star anise
o Cloves
o Curry powder or curry leaves
o Cinnamon
o Nutmeg
o Cayenne pepper

A detailed and up to date list is kept at the Swiss Interest Group Histamine Intolerance (SIGHI)
website, but be wary of sticking to a list like this religiously. It’s far better to use these lists while
undergoing an elimination diet that’s supervised by a doctor, as you may find it difficult to
maintain these restrictions for a significant length of time without having a meal plan in action.
Please see our ‘cheat sheet’ in which all the histaminic foods are highlighted in brown.

Not all foods high in histamine are equal

When examining histamine it’s not always a case of good foods versus bad foods. Some foods
have opposing properties and can include antihistamines with the histamines. Quercetin is one
such antihistamine. This flavonoid has a host of health benefits when ingested and it’s the
quercetin in a dock plant leaf that gives you relief when you rub it on a painful nettle sting.

Berries such as cranberries, raspberries, and blueberries are high in histamine and quercetin.
Just because a food’s high in histamine doesn’t mean you can’t tolerate it. Natural sources of
antihistamines can often exist in the same plant. This is another reason that the reintroduction
stage of an elimination diet is so vital. What one patient may be able to tolerate may be
unbearable for you and vice versa.

Alcohol is a DAO blocker

Alcoholic drinks such as wine and spirits are double trouble for anyone with MCAS or histamine
intolerance. As a fermented product, alcoholic drinks are high in histamine but they also work as
a DAO blocker. Your body needs a particular enzyme to metabolize alcohol, which is the same
enzyme needed to create DAO. Alcohol in the bloodstream takes precedence and halts DAO
production. This results in higher levels of histamine in your blood and you may have allergy-like
symptoms or brain fog after one drink or alongside a hangover, so it’s best to skip alcohol
whenever possible.

How Do I Eat a Low Histamine Diet?

After reviewing the lists above, you may think that moving to a low histamine diet is difficult. In
the short term, figuring out your histamine triggers through the elimination diet can be tricky
without an experienced doctor’s help, but afterward you may be able to reintroduce some of
these foods back into your diet. The key to eating low histamine in the long term is to ensure
that you don’t consume potential sources of histamine in large amounts. Make sure that you eat
widely to maximize your nutrient intake, helping your gut and any underlying inflammation to
heal.

Remember freshness is key. You may have to visit the grocery store more often each week and
skip the marked-down stickers. As tempting as they are, they’re simply not worth the risk. Batch-
cooking for the week is also out, unless you cook meals that can immediately go into the freezer
and can be thawed from frozen. You may have to cook and prepare smaller amounts to avoid
wasting leftovers.

Overly ripe fruit and vegetables may not be suitable. It may also be worthwhile considering
moving to locally produced vegetables and fruit, as the air miles required to transport these from
elsewhere can contribute to a buildup of histamine. If you can buy your meat from a local
supplier that can vouch for the freshness it may also make a difference for your health.
Otherwise, always check the date on which the meat was packaged to determine the freshest
package and remember that whole-cuts contain less histamine producing bacteria than ground
meat. You can pick up your meat at the end of your shopping trip and take it home in a cooler to
ensure maximum freshness. Organic fruits and vegetables, although preferable, have a much
shorter shelf life and tend to become moldy and histaminic much more quickly than sprayed
produce.

Foods you may be able to eat on a low-histamine diet:

● Non-fermented cheese
○ Ricotta
○ Mascarpone
○ Paneer
○ Mozzarella
● Milk
○ Cow
○ Goat
● Cream
● Ice cream without artificial additives or ingredients from the high histamine list
● Coconut and coconut milk
● Baked products leavened by baking powder
○ Soda bread
○ Scones
○ Muffins
○ Biscuits
● Cereals without artificial additives or ingredients from the above list
● Crackers not containing yeast
● Fruit
○ Apple
○ Pear
○ Kiwi
○ Mango
○ Lychees
○ Passion fruit
○ Rhubarb
○ Melon
○ Fig
○ Kiwi
○ Pomegranate
● Vegetables
○ Asparagus
○ Bell peppers
○ Arugula
○ Beets
 ○ Broccoli
○ Bok choy
○ Cabbage
○ Brussel sprouts
○ Carrots
○ Garlic
○ Cauliflower
○ Leeks
○ Lettuce
○ Onions
○ Shallots
○ Rutabaga
○ Summer squash
○ Winter squash
○ Turnip
○ Watercress
○ Zucchini
○ Taro root
○ Breadfruit
○ Lotus root
○ Fresh herbs
● Olive oil
● Fresh meat
○ Chicken
○ Beef
○ Lamb
○ Goat
● Freshly caught fish
○ 30 minutes from hook to table
○ Frozen at Sea label
● Sugar
● Pure jams and jellies
● Pasteurized honey
● Maple syrup
● Pure juice
● Coffee
● Plain gelatin

Please note that some of these foods, such as ice cream, are never recommended when eating
a healthy diet and are included here simply for list completion.

Be wary of using low-histamine recipes that you might find online, as again what may be
tolerated by one person may not be good for you. It’s better to work with a professional with
experience in dealing with histamine intolerance and MCAS to find the right meal plan for you.
Also, be aware that your method of cooking can increase the histamine levels in food. For
example, frying and grilling should be avoided, but boiling is fine.
Can You Take Antihistamines for Histamine Intolerance?
I’ve written previously about supplements and medication that I recommend as part of treatment
for MCAS. Part of the treatment emphasizes the use of antihistamines that aren’t the same as
mast cell blockers. The most important aspect of treatment is help with DAO levels, gut health,
and mast cell regulation.

Improving your DAO levels and breaking down histamine

I recommend the following supplements alongside your low-histamine diet to assist in regulating
your histamine levels:

• DAO enzyme supplements - Taking these enzymes as an oral supplement fifteen

minutes before you eat allows them to reach your gut and aid in the breakdown of
histamine in food. These enzymes can aid in the reduction of GI discomfort, among
other symptoms.
• Vitamin C - This is a powerful antioxidant and natural antihistamine. Intravenous vitamin
C reduces allergy symptoms and if taken orally it can reduce histamine-induced nausea.
• Vitamin B6 - Your body needs vitamin B6 to create DAO, so a B6 deficiency can have
ramifications regarding how well you handle histamine.
• Quercetin - The flavonoid is a powerful antioxidant, but it also works as a mast cell
stabilizer in animal models. We recommend and use Natural-D Hist from Ortho
Molecular Products, which contains both vitamin C and quercetin.

No two people are the same so it’s important to have a full range of tests of your vitamin levels
before you start supplementing. As I’ve emphasized, what works for one patient may not work
for another and what I may recommend for a patient with MCAS may not fit your needs as a
histamine intolerant patient. Always test before you treat.

Taking probiotics for gut health

A healthy gut is crucial to minimize your daily symptoms of histamine intolerance. While I’d
normally recommend that you take your probiotics through eating foods such as yogurt and
kimchi, unfortunately any foods that are high in bacteria are also high in histamine. In this case,
it’s better to use probiotic supplements containing strains that don’t create histamine.

Stick to the following probiotic species:

• Bifidobacterium lactis
• Bifidobacterium infantis
• Bifidobacterium longum
• Lactobacillus plantarum
• Lactobacillus rhamnosus

Many of the other bacteria strains provided in supplements release histamine in your gut, so it’s
important that you investigate exactly what supplements contain before you buy them. As this
area of research is still in its infancy, there’s still a lot to learn about probiotics and histamine. I
always recommend introducing probiotics slowly and not during the elimination diet or at other
times when you’re trying out different supplements.
Stabilizing your mast cells

Mast cell stabilizers are a great option if you continue to struggle with GI symptoms. They work
to stop your mast cells from bursting open and releasing mediators, reducing inflammation.
Reducing inflammation in the gut can help your gut recover and become healthier.

Mast cell stabilizers such as disodium cromoglycate (DSCG) are available as a prescription-only
oral solution, but there are a number of histamine blockers available. While more commonly
used topically on the skin or eyes to treat allergic reactions, mast cell stabilizers are a good
option for treatment of histamine intolerance.

Treating Histamine Intolerance at the Hoffman Centre for

Integrative and Functional Medicine
Treatment for histamine intolerance isn’t as simple as trying new medication. A lot of thought
needs to be put into deciding what foods you’ll eat and into determining the right supplements
for you. If you suspect that you have histamine intolerance or MCAS, please remember that
you’re not alone.

You don’t need to go it alone on this health journey. You’re better off with an experienced doctor
guiding you through the changes, to help your body from within. This should be a doctor that
understands that it’s impossible to cut histamine from your diet completely and that the process
is a delicate balancing act.

At the Hoffman Centre, we pride ourselves on our professionalism combined with customized
care. No two patients are the same. We want to take the steps with you in order to help you get
better and lead the life you want. Although histamine intolerance can seem tricky to treat, by
looking at your body as a whole and figuring out the root cause, we can make a big difference to
your health.

We encourage you to get in touch through our contact form or by calling (403) 206-2333 if you
suspect you have histamine intolerance. We’re located in Calgary, Alberta and are ready to help
you make some changes on the road to a healthy life.

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