Practical Guide to the Low Histamine Diet
Updated: May 2019
The low histamine diet is a guideline based on an educated guess, not precise rules.
Many people follow a low histamine diet, on-and-off, without really knowing if it is helping. A systematic trial will help you determine it is beneficial.
- The low histamine diet should be your only change. If you start a low histamine diet and new medications at the same time, and you feel better, you would not know which change was responsible for the improvement.
- Eating a healthy diet is just as important as following the restriction. Consider booking an appointment with a registered dietitian to ensure you are eating nutritiously during your restricted diet trial.
- The low histamine diet encompasses a few different theories, and it is helpful to test these theories separately. This approach will ensure you don’t follow unnecessary restrictions.
- Step 1 (one week): Cut out alcohol, because it is the most common symptom trigger.
- Step 2 (two weeks): Eat your regular diet but follow “Minimize Histamine Formation during Food Storage.” After two weeks, if these changes have not helped, leftovers are not a concern for you!
- Step 3 (two weeks): Restrict fermented foods – such as aged cheese, yogurt, kefir, kombucha, kimchi, sauerkraut, tempeh, natto, aged sausage, etc.
- Step 4 (three weeks): Follow the full low histamine diet – either my version (Wendy’s Low Histamine Diet Guidelines– below) or a different one. Change your diet gradually over a few weeks. Sudden dietary changes are hard on the body.
- Note: if a step is not helpful, continue to the next step, but include that step in your diet. For example, if step #2 – minimize histamine formation was not helpful, you can eat leftovers during step 3 and 4.
Follow these guidelines strictly during your two-week trial. If it helps and you are planning to continue, experiment to see where you can ease up.
Food spoilage bacteria produce histamine (and other diamines). Readers often ask – how long can food be in the fridge, etc. Unfortunately, there has never been any research studies looking at histamine formation over time, so there is not an exact guideline. In summary, you need to follow the typical food safety guidelines for preventing food poisoning, but more strictly.
- Don’t worry about food that is low risk for spoilage, such as food that can sit at room temperature (e.g., chips, cereal, crackers) or food that can sit in the fridge for extended periods (e.g., mustard, jam, etc.)
- Fruit and vegetables are often more problematic when they over-ripen. Histamine possibly increases (but this has never been tested, so it is only an educated guess). It is best to eat as fresh as possible:
- Buy small quantities and shop frequently
- Keep your produce in something designed to maintain quality (e.g., produce bags with a paper towel, specialized container, etc.)
- When your fruit is at its peak freshness and just about to decline, dice it and freeze to use in smoothies.
- Freeze individual meals and reheat them right before eating. You’ll spend a lot less time cooking and doing dishes.
- Be very careful not to contaminate food in your refrigerator. Use a clean utensil to take out what you need and put the food back in the fridge quickly.
- Vacuum sealing removes oxygen and reduces bacteria growth. However, for the two-week trial, it is best to prepare fresh meals or freeze meals. If you continue past the trial, experiment with vacuum sealing.
Purchasing Raw Meat
The tips below refer to “meat,” but they also apply to any animal or fish.
- High protein foods are probably more susceptible to histamine formation because they are high in histidine (the precursor of histamine). Therefore, take extra precautions with meat, especially raw meat (because it is very high in bacteria).
- Raw meat is highly contaminated, and bacteria grow very quickly if the meat is in the Danger Zone (4 – 60°C or 40 – 140°F).
- Ideally, purchase meat that has been butchered and frozen quickly.
- If you purchase fresh meat, make sure it has not been sitting for very long. Pick it up from the store soon after it has been delivered (call ahead and talk to the butcher).
- Pick up your meat at the end of grocery shopping, and keep it cool in an insulated bag. If it is fresh, add an ice pack.
- Avoid ground meat/chicken, unless it has been ground and frozen quickly. A chunk of meat has bacteria on the outside, but grinding spreads the bacteria throughout the entire batch. Bacteria multiply quickly in ground meat.
- Avoid mechanically tenderized meat. Meat is poked with small blades to break down the tough fibers, but this contaminates the inside of the meat.
- Some internet websites suggest avoiding hung meat (e.g., beef). However, federally inspected plants hang meat at about 2°C or (35°F) which is just above freezing so very little bacteria would grow. In some parts of the world, meat hangs at room temperature (avoid this meat).
- Fish that is gutted and cooled (or frozen) quickly would not be high in histamine. Most commercial companies, gut and flash freeze fish right on the ship.
- When you get home from the grocery store, freeze your raw meat or cook it. Don’t let raw meat sit on the counter (or more than three hours in the fridge).
- Thaw frozen meat quickly by:
- microwaving on low power
- put thin cuts of meat it in a waterproof, sealed baggie and submerge in cool water. Keep checking and cook as soon as it is thawed
- place frozen meat in a steamer basket in a pot. Add water, bring to a boil and then simmer. The level of water should be below the meat (even when it is simmering). After thawing, you can continue cooking in the steamer basket or cook with a different method (e.g. pan fried).
- You can freeze cooked meat, but it can be a little dry when you reheat. However, it works well to slice it and use in salads, wraps, etc.
- Slow cooking meat is not recommended on the low histamine diet, because the meat may sit in the Danger Zone for an extended period. Pressure cooking is a better option. If you decide to slow cook:
- Heat the slower cooker before adding the food. Keep it on high.
- Heat the liquid (ideally boiling) before pouring in the hot slow cooker and then add the meat/chicken immediately after.
- Smaller pieces will cook faster than larger ones.
- Use fresh or thawed, not frozen.
- Brown the outside of the meat/chicken, before putting it in the slow cooker.
- Marinating is potentially problematic because the meat sits in the fridge for several hours. Using a rub on the surface of the meat is a better choice during the two-week trial (salt and pepper even work). Once the two-week trial is over and if you decide to continue with the guidelines, experiment with marinating in a vacuum sealed container in the fridge.
My diet guidelines are less restrictive than most low histamine diets on the internet. The low histamine diet is an “educated guess, so this is not the “right diet.”
There is not enough definitive information to indicate “allowed” and “restricted.” Therefore, I’ve used “usually does not increase symptoms” and “commonly reported to increase symptoms.” Use your judgement. Everyone has individual tolerances!
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Here are the most common questions that readers have asked.
Will a low histamine diet help me?
Currently, there are no reliable tests to determine if a person has histamine intolerance. Systematically trialling a low histamine diet is the only way to know.
Many factors (e.g., seasonal allergies) cause histamine intolerance symptoms. If you experience these symptoms, it does not mean that you have histamine intolerance and must follow a low histamine diet. However, it is worth trying a low histamine diet and continuing with it, only if you experience significant improvement.
Before starting a low histamine diet trial, consider the disadvantages. Dietary changes can be time consuming and stressful.
How long should I follow a low histamine diet?
If you feel better on a low histamine diet, follow it for about four weeks before starting to liberalize your diet.
If you don’t feel better, a three-week trial is sufficient. If the diet is going to help, you will know by then.
What about food that is not on the guidelines above?
If the food is not fermented and is fresh (e.g., is not leftovers and is not an overripe fruit or vegetable), you will probably tolerate it.
What if I still have symptoms on the low histamine diet?
Puzzling food allergy symptoms are often related to several, cumulative triggers (diet and non-diet). Changing your diet may reduce, but usually does not eliminate symptoms. However, this does not mean the low histamine diet is ineffective. The question is: Are your symptoms better on the diet?
Should I try other food restrictions at the same time?
It is best to make only one dietary change at a time. For example, if you start a low histamine and a gluten-free diet at the same time, and you feel better, you won’t know which restriction was helpful.
What about minute quantities of restricted food?
Minute quantities are okay. You don’t need to worry about cross contamination.
Is there a “histamine-free” diet?
Clients often want a “histamine-free” diet for two reasons. Firstly, some clients feel better on a low histamine diet, but not completely. They would like to further improve symptoms with additional food elimination. However, many non-diet factors contribute to symptoms and symptoms will still occur, no matter what they eat. Secondly, some clients want to follow a “histamine-free diet” because they are scared about severe reactions.
A “histamine-free” diet is not possible because it is an educated guess, based on anecdotal reports. If you restrict every problematic food on the internet, there wouldn’t be anything left to eat! Over restriction leads to stress and malnutrition, further compromising health.
I’ve listed some meal plan ideas to help you follow Wendy’s Low Histamine Diet Guidelines. Individual tolerances vary, so you will likely need to make substitutions.
A balanced meal contains protein, whole grain or starchy vegetable, fruit or vegetable and some fat (i.e. the items in each row would provide a balanced meal). An additional source of calcium and vitamin D may be needed. A registered dietitian can work with you to plan a nutritious menu.
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