For those suffering from a histamine intolerance it is important to trial a histamine elimination diet. Not quite sure what histamine intolerance is? Be sure to check out part 1 of this blog series where you’ll learn all about it!
Part 2 of this blog series walks you through the steps involved with implementing a histamine elimination diet and also explains exactly what to eat while you’re on the plan.
What foods are high in histamine?
The following is a list of foods that naturally contain high histamine levels and should be avoided during a 4 week elimination phase (note: this list is not comprehensive, but it gives a broad overview of most foods that should be avoided).
High Histamine Foods:
|Type of Food||Examples|
|Gouda, Cheddar, Parmesan, Swiss, Mozzarella, Cottage cheese, etc.|
|Herring, Sardines, Tuna, Mackerel, Salmon, Shrimp, Crab, etc.|
|Bacon, Salami, Pepperoni, Ham, Sausage, Frankfurters, Bologna|
|Kimchi, Sauerkraut, Pickles, Kefir, Buttermilk, Yogurt, Soy sauce, Vinegar, Alcohol|
|Eggplant, Spinach, Tomatoes, Pumpkin|
|Citrus fruits, Apricot, Cherry, Plum, Strawberry, Raspberry, Cranberry|
*It’s important to know that as foods age, their histamine levels increase. This means the longer you wait to eat leftover foods, the higher histamine levels rise. You can freeze uneaten protein foods to help decrease histamine production.
Foods That Promote Histamine Release:
Remember that while some foods naturally contain high histamine levels, like in the chart above, other foods promote the body’s immune cells to release more histamine. Remove both types of foods to get the most relief from symptoms.
Examples of foods that promote the release of histamine include-
- Chocolate and Cocoa
- Egg (yolk and whites)*
- Additives & Preservatives – azo food dyes (tartrazine), benzoates, sulfites, and possibly salicylates **important to check medications and vitamins for these chemicals
- Coffee & Tea
- Dried fruits
- Spices- chili powder, cinnamon, cloves, curry powder, nutmeg, thyme
*Eggs can be eaten in small quantities in baked products
What CAN I eat during the histamine elimination diet?
You might be thinking, “What’s left for me to eat?” A low histamine diet focuses on fresh foods that don’t provoke a histamine response in your body. Keep in mind that everyone responds differently and has a different histamine threshold. It is important to find what works best for you!
Often we focus on what NOT to eat, but it is easier to focus on what TO eat to avoid feeling confused and frustrated. The following is a list of low histamine foods to enjoy during the elimination phase: (these are suggested foods within each food group, not a comprehensive list)
Low Histamine Foods:
|Type of Food||Examples|
|Dairy/Dairy Substitutes||Rice milk, Almond milk, Coconut milk, Uncultured cow’s milk, Goat’s milk|
|Meat/Protein||Turkey, Beef, Chicken, Lamb, Pork, Eggs (keep to a minimum)|
|Grains & Legumes||Quinoa, Rice, Wheat, Rye, Oats, All Legumes (except red beans)|
|Vegetables||Any except those listed above to avoid|
|Fruits||Any except those listed above to avoid|
|Oils/Fats||Butter, Ghee, Olive oil, Coconut oil, etc.|
**All vegetables and fruits are allowed except what is indicated on the high-histamine foods list. The chart above provides some options, but is not comprehensive.*Animal proteins increase in histamine content the longer they are stored. It’s best to buy meats and fish that have been stored on ice in a case and immediately use or freeze them when you get home.
Sample Menu Options During Histamine Elimination Diet:
Below are some ideas for your meals and snacks during the elimination phase. As you can see there are plenty of delicious and healthy options!
- Oatmeal with blueberries, flaxseed, cinnamon, and maple syrup
- Grain Free Coconut Pancakes
- Vegan chickpea burger with mixed greens side salad
- Black bean and sweet potato salad (eliminate the citrus from the dressing to make low histamine friendly)
- Arugula salad with grilled chicken, carrots, cucumbers, onion topped with balsamic vinaigrette
- 1 cup roasted Brussels sprouts, 4 oz. steak and ½ cup quinoa or brown rice
- Thai Chicken Salad (eliminate the citrus from the dressing to make low histamine friendly)
*These recipes may contain spices that can increase the body’s internal production of histamine. Once you know what you are sensitive to and what you can tolerate, you can swap out spices in recipes as your individual needs dictate.
Reintroducing High Histamine Foods
After the elimination phase, you’ll want to reintroduce each food one by one. Start by reintroducing one new high-histamine food every 4 days. During day #1 of the trial, it is best to eat that food a few times throughout the day. For instance, if you are trialing eggplant, then eat some eggplant with each of your meals, approximately every 4 hours. Then, for the next three days you will not eat the eggplant at all. Instead, you’ll track any and all symptoms you experience in response to trialing the eggplant. If you don’t experience any symptoms, you may include that food back into your normal diet. However, if you do experience symptoms you’ll want to continue avoiding that food.
Symptoms to look for after reintroducing the trial food include:
- Allergy-like symptoms
- GI upset (pain, bloating, gas, diarrhea or constipation)
- Mood disturbances
- Joint pain
- Trouble sleeping
Additionally, it’s wise to retrial any food that may have “failed” the trial after about 3 months have passed (read more about this in the section below). It is vital to take detailed notes of your experience. Try using a food/symptom diary or the app My Symptoms.
Will I Have To Eliminate the High Histamine Foods I Reacted To Forever?
Don’t worry; you may not need to avoid those foods forever! The body has an amazing capacity to regain tolerance to foods after you allow it heal. Let’s do a quick review of why one may have histamine intolerance in the first place to better address this question.
There is often a genetic defect in histamine intolerance that causes low DAO levels on a permanent basis. Remember, DAO is the enzyme that helps breakdown histamine in the body. However, there are also other causes of DAO deficiency that can be alleviated through diet and supplement protocols. These include:
- Imbalance of bacteria in the gut (SIBO and/or dysbiosis)
- Gut bacteria are capable of producing histamine, so an imbalance of good to bad gut microbes can cause high amounts of histamine in the blood
- GI diseases like Celiac Disease, Crohn’s Disease, Ulcerative Colitis or Leaky Gut Syndrome
- These conditions are characterized by inflammation of the intestinal lining, which can lead to damage and increased absorption of histamine into the blood
- Taking certain medications like NSAIDs, Antidepressants, H2 Histamine Blockers or Immunosuppressants
- Some medications actually release histamine, while others inhibit the action of DAO causing increased histamine buildup
Let’s Wrap It Up This Histamine Elimination Diet…
So, to recap: After doing the 4 week histamine elimination diet and reintroduction, you’ll want to avoid the foods that caused a reaction for at least 3 months. Avoiding the high histamine foods you reacted to and addressing any of the underlying causes of DAO deficiency can help reduce or eliminate your histamine intolerance symptoms.
After avoiding those foods for at least 3 months, you should consider a retrial of some of the foods that provoked symptoms after their initial reintroduction. Start with the foods that you miss the most and work your way through the list. Use the same 4-day reintroduction protocol described above. Remember, it is the buildup of histamine that causes symptoms. So, you might find you can tolerate some foods in small amounts every few days, but eating them everyday might provoke a return of your symptoms.
If you still experience any of these symptoms, it’s probably best to continue to avoid the food that provoked a negative reaction.
Everyone responds to the diet differently, so it’s important to keep re-trialing your reactive foods every few months to avoid having an overly restrictive diet long-term. Restrictive diets cause reduced quality of life, reduced intake of important nutrients and consequently nutrient deficiencies over time. This causes a vicious cycle and may make your symptoms worse if you become malnourished.
If you need help navigating your issues with histamine, let’s set up a personalized nutrition program.
Stay tuned for part 3 of this blog, we will discuss helpful supplements that help support histamine intolerance!
Guest article contributed by: Elizabeth Herbert, MS candidate at the Maryland University of Integrative Health
Lipski, E. (2011). Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion. McGraw Hill Professional.
Vickerstaff-Joneja, J. (2013). The Health Professional’s Guide to Food Allergies and Intolerances. Diana Faulhaber.