Low-histamine diet: food list and what to avoid
In shortOn a low-histamine diet you avoid, for a while, foods that are often high in histamine: aged cheeses, dry-cured sausages, fermented foods, wine, beer, and fish or meat that has been stored too long. Freshness matters most. According to a German-speaking guideline, the strict phase lasts 10–14 days. After that you reintroduce foods one by one for up to six weeks, so the diet does not stay narrower than it needs to be.
Contents
On a low-histamine diet you avoid, for a while, foods that are often high in histamine. The most important ones to avoid are fermented and aged foods: aged cheeses, dry-cured sausages, sauerkraut, soy sauce, wine and beer. Fish and meat that have been stored for a long time can also contain a lot of histamine [1, 2].
The single most important rule is freshness. Histamine forms in food when bacteria produce it during storage. Fresh fish is usually low in histamine, but the same fish after a few days in the fridge may not be [1].
The diet is an experiment, not a lifelong list of bans. According to a guideline from German, Swiss and Austrian allergy societies, the strict phase lasts 10–14 days, after which you bring foods back one at a time [2].
What is a low-histamine diet?
Histamine is one of your body’s own signalling substances. It works like an alarm bell: it widens blood vessels, makes your nose run and your skin itch. Read more about what histamine does in the body.
Histamine also comes from food. In the gut, an enzyme called DAO (diamine oxidase) breaks it down. If food brings in more histamine than your body can break down, you may get symptoms. This is called histamine intolerance [1].
Typical symptoms are flushing, itching, a runny nose, stomach pain and diarrhoea, nausea, headache, and a racing heart or dizziness. Symptoms usually come within minutes to about four hours after eating. If your symptoms have no link in time to meals, a food intolerance is less likely [2].
Which foods are high in histamine?
Histamine is highest in foods where bacteria have had a long time to work: fermented and aged foods, and fish and meat that have been stored badly [1].
All published low-histamine diets agree on only one group: fermented foods and drinks, such as dry-cured sausages, aged cheeses, wine and beer. Otherwise the lists differ a lot [3].
| Food group | Often high in histamine | Usually low in histamine |
|---|---|---|
| Cheese and dairy | Aged cheeses such as Emmental, Parmesan and blue cheeses | Fresh milk, cottage cheese, cream cheese |
| Meat | Dry-cured and aged sausages (salami), air-dried ham | Fresh meat that is cooked and eaten straight away or frozen |
| Fish | Badly stored fish, especially tuna and mackerel; fermented fish products such as fish sauce | Fresh or quickly frozen fish |
| Vegetables | Sauerkraut and other fermented vegetables, spinach, tomato, aubergine | Most fresh vegetables, such as cucumber, carrot, courgette and lettuce |
| Drinks | Wine, beer, sparkling wine | Water, milk |
| Other | Soy sauce, miso, other fermented sauces | Rice, potatoes, oats, fresh herbs |
Sources: [1, 3]. You do not need to avoid fish altogether: in Spanish data, most fresh fish and canned fish sold in shops contained only a little histamine [3]. Spinach, tomato and aubergine naturally contain a little histamine, but the amount can rise during storage. In spinach, histamine was found to increase clearly over two weeks in the fridge [3].
The same food can contain very different amounts of histamine. The German-speaking guideline gives Emmental cheese as an example: its histamine content ranged from almost zero to 2,000 milligrams per kilogram [2]. So do not take exact milligram tables too literally.
What are “histamine-releasing” foods?
Many lists also ban foods that contain hardly any histamine, because they are said to release the body’s own histamine. Examples given include citrus fruits, strawberries, pineapple, papaya, nuts, chocolate and tomato [3].
Preliminary research There is no reliable evidence for “histamine-releasing” foods [2, 3]. Citrus fruits and bananas do contain putrescine, however. It is another amine that may compete with histamine for the same breakdown enzyme, which could explain some symptoms [3].
In practice: do not cut these foods out just in case. If you suspect one of them, test it on its own during the reintroduction phase.
What about alcohol?
Alcohol can make symptoms worse in two ways. Wine and beer contain histamine themselves. In addition, acetaldehyde, which your body makes from alcohol, competes with histamine for the same enzyme, so histamine is broken down more slowly [1].
Why does freshness matter most?
Histamine forms when bacteria turn the amino acid histidine in food into histamine. The longer food sits warm or in the fridge, the more time the bacteria have to work [1]. That is how fresh fish and meat can become high in histamine if they are stored badly.
The best-known example is scombroid poisoning. Badly transported tuna or mackerel can contain so much histamine that anyone who eats it gets symptoms [1].
How do you try a low-histamine diet?
The German, Swiss and Austrian guideline suggests a three-step trial. The aim is to find your own tolerance, not to stay on a strict diet for good [2].
- Restriction phase, 10–14 days Avoid foods high in histamine and other biogenic amines. Eat a varied, mainly plant-based mixed diet and light meals. The aim is to reduce symptoms as much as possible.
- Test phase, up to 6 weeks Bring suspected foods back one at a time. Take into account things that change your tolerance, such as stress, your menstrual cycle and medicines. The aim is to find out what you tolerate and how much.
- Long-term diet Eat as varied a diet as possible and avoid only the foods that really give you symptoms.
Keep a food and symptom diary throughout the trial. Write down every meal and every symptom with the time. Only then can you see which food goes with which symptom [1].
If your symptoms do not ease at all during the restriction phase, histamine is probably not the cause. In that case there is no point in continuing the diet; look for other causes with your doctor.
Does a low-histamine diet work?
Preliminary research The diet is the most common treatment for histamine intolerance [1, 3], but there are no proper placebo-controlled studies. The studies are small:
- A Korean study included 22 adults with chronic hives (urticaria). A four-week histamine-free diet reduced their symptoms, and their blood histamine levels fell [4].
- A German study included 56 people with chronic hives and stomach symptoms. After at least three weeks on the diet, 34 of them (6 in 10) improved as much as the study aimed for [5].
The German-speaking guideline points out that symptoms of histamine intolerance do not reliably come back when people are given histamine in a test. It does not recommend measuring DAO in the blood for diagnosis, because the result is not reliable. It does not consider DAO enzyme supplements proven to work [2].
This does not mean your symptoms are not real. It means that your own careful trial tells you more than any lab test.
Who should not try the diet alone?
A strict diet can lead to nutrient shortfalls if it goes on for a long time. Talk to a doctor or dietitian before you start if:
- it is for a child, or you are pregnant or breastfeeding
- your diet is already narrow or you are losing weight
- you have had an eating disorder
- you have bleeding, weight loss, fever or stomach symptoms at night.
Other conditions cause similar symptoms, such as coeliac disease, inflammatory bowel disease, lactose intolerance and the rare condition mastocytosis. It is worth ruling them out [2].
If you have trouble breathing, swelling of your tongue or throat, or feel faint after eating, call emergency services straight away.
What if CIRS is behind it?
Expert view Many people living with chronic inflammatory response syndrome (CIRS) have histamine symptoms, and their diet can shrink step by step. In the CIRS model, histamine symptoms come from an immune system stuck in overdrive. A low-histamine diet may then ease symptoms, but it does not fix the cause. This has not been studied.
Read more about why histamine symptoms do not settle in CIRS and why the diet shrinks in CIRS.
Remember these
Test yourself: Can you explain why the same fish can be low in histamine today but not three days from now? And why there is no point in continuing the diet if the restriction phase does not help?
What next?
- Read about histamine intolerance and the DAO enzyme.
- Read why the diet shrinks in CIRS.
- Read what CIRS is.
References
- Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT, Latorre-Moratalla M, Vidal-Carou MDC. Histamine intolerance: the current state of the art. Biomolecules. 2020;10(8):1181. PubMed
- Reese I, Ballmer-Weber B, Beyer K, et al. Guideline on management of suspected adverse reactions to ingested histamine: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergology and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA) as well as the Swiss Society for Allergology and Immunology (SGAI) and the Austrian Society for Allergology and Immunology (ÖGAI). Allergol Select. 2021;5:305–314. PubMed
- Sánchez-Pérez S, Comas-Basté O, Veciana-Nogués MT, Latorre-Moratalla ML, Vidal-Carou MC. Low-histamine diets: is the exclusion of foods justified by their histamine content? Nutrients. 2021;13(5):1395. PubMed
- Son JH, Chung BY, Kim HO, Park CW. A histamine-free diet is helpful for treatment of adult patients with chronic spontaneous urticaria. Ann Dermatol. 2018;30(2):164–172. PubMed
- Wagner N, Dirk D, Peveling-Oberhag A, et al. A popular myth – low-histamine diet improves chronic spontaneous urticaria – fact or fiction? J Eur Acad Dermatol Venereol. 2017;31(4):650–655. PubMed
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