Practical Guide to the Low Histamine Diet

If you think a low histamine diet may help, it is important to try it systematically.

Many people follow a low histamine diet, on-and-off, without really knowing if it is helping. A systematic trial will help you decide if the diet is helping. Here are a few things to keep in mind.

  • The low histamine diet is a guideline based on an educated guess, not a precise diet based on fact. Please read Histamine Intolerance for a further discussion.
  • The low histamine diet should be the only change. For example, if you start a low histamine diet at the same time as new medications, and 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 good to test these parts separately. Ideally, you should not restrict your diet anymore that necessary. If your symptoms improve at any stage, continue with the restriction and add the next restrictions to see if you experience further benefit. If a restriction is not helpful, discontinue it, but try the next restriction.
    • 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, you do not need to continue with them. 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) or a different one. Change your diet gradually over a few weeks. For most people, sudden dietary changes are hard on the body. Note: if any of the above restrictions were not helpful, follow the low histamine diet guidelines, but ignore that restriction. For example, if minimizing histamine formation was not helpful, follow the low histamine diet, but don’t worry about leftovers.

As food spoilage bacteria grow in food, they produce histamine (and other diamines). Therefore, an important part of the low histamine diet is to eat fresh food. Clients often ask – how long can food be in the fridge, etc. Unfortunately, there are not exact guidelines. In summary, you need to follow the typical food safety guidelines for preventing food poisoning, but much more strictly.

Typical food safety guidelines suggest discarding food if it has been in the Danger Zone (4 - 60°C or 40 - 140°F) for more than two hours or in the refrigerator for more than 4 days. Bacteria grow rapidly in the danger zone and more slowly in the fridge.

General Tips

  • Don’t worry about food that is low risk for food poisoning, 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 of time (e.g., mustard, jam, etc.)
  • Clients report that fruit and vegetables are more problematic as 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 by:
    • 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, chop it up and freeze to use in smoothies.
  • Freeze individual meals. Rather than cooking for each meal, you just need to reheat.
  • Shed cheese and freeze in small containers.
  • Be very careful not to contaminate yogurt, sour cream, cream cheese, etc. Use a clean utensil to take out what you need and put it immediately back in the fridge. Don’t keep these products more than three days.
  • Vacuum sealing should help – because it removes oxygen. However, for the two week trial, it is best to freeze foods instead. If you are going to continue to avoid leftovers, you can experiment with vacuum sealing.

Meat-Specific Tips

  • The tips below refer to “meat,” but they also apply to any animal or fish.
  • High protein foods are thought to be more susceptible to histamine formation because the precursor of histamine is histidine (an amino acid which is the building blocks of protein). Therefore, take extra precautions with meat.
  • Some clients experience inconsistent reactions to meat. For example, one client tolerated ground chicken on most occasions but experienced a reaction with about 1 in 10 batches. These batches probably had more bacteria when purchased and were, therefore, more susceptible to histamine/diamine formation.
  • Raw meat:
    • Raw meat has a lot of bacteria which can grow very quickly, so it is very susceptible to histamine/diamine formation. In summary, keep the raw meat out of the Danger Zone (4-60°C or 40 - 140°F). Cook it or freeze it as soon as possible.
    • Ideally, purchase meat that has been butchered and frozen very quickly. Ask if each piece can be frozen individually.
    • If you purchase fresh meat, make sure it has not been sitting very long. Pick it up from the store soon after it has been delivered (most butchers can tell you this will be, but call ahead to make sure it has been delivered).
    • 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 or something else that is frozen.
    • Avoid ground meat/chicken, unless it has been ground and frozen quickly. A piece of meat has bacteria on the outside, but grinding spreads the bacteria throughout the entire batch. That’s why the public health department recommends cooking hamburger until the middle is well done, but is less concerned about rare steak. Bacteria and histamine can develop much more quickly in ground meat.
    • Avoid mechanically tenderized meat. Tough meat is broken down by poking it with small blades, which introduces bacteria into the inside.
    • Some internet websites suggest avoiding hung (e.g., beef). However, federally inspected plants hang meat at about 2°C (35°F) which is just above freezing, so very little bacteria should grow. In some parts of the world, meat is hung at room temperature (and you want to avoid this meat).
    • Fish is low in histamine, but only if was gutted and cooled quickly. Most commercial companies, gut and flash freeze fish right on the ship.
  • Try cooking your meat as soon as you get home and then freezing it in individual portions. Steaming is a great way to reheat the meat, without drying it out.
  • You can also steam the frozen meat. After it has thawed and cooked, you can brown it. For example, put some water and a steamer basket in a large fry pan. Steam the meat until cooked through the middle, cool and dry the frying pan, heat some oil and brown the meat.
  • Ideally, thaw meat in the fridge, but another option for thin cuts of meat is to put it in a waterproof, sealed baggie and submerge in cool water. Keep checking it. Remove it promptly.
  • 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 for the entire time (above 60°C or 140°F).
    • 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.

The most common questions that clients ask about the low histamine diet are listed below.

Will a low histamine diet help me?

Currently, there are no reliable tests to determine if a person has histamine intolerance. The only way to know is to follow a low histamine diet and observe symptoms.

Histamine intolerance symptoms could apply to many other inflammatory conditions as well (e.g., seasonal allergies). 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 the diet, you must 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 increasing dietary histamine.

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 is the difference between histamine intolerance and mast cell activation syndrome?

If the “histamine- releasing foods” theory is correct, this would mean that that food can directly cause mast cells to release histamine (i.e., food dependent, non-allergic mast cell activation). These are both theories, so it is hard to make a definitive statement. The good news is that the dietary approach to improving the symptoms is the same, regardless of what you call it.

What about food that is not on the guidelines above?

If the food is not fermented and is very fresh (e.g., is not leftovers and is not an overripe fruit or vegetable), it will likely be low in histamine.

What if I still have symptoms on the low histamine diet?

Puzzling food allergy symptoms are often related to several, cumulative triggers (diet and no-diet triggers). Changing your diet may reduce, but usually does not eliminate symptoms. 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 very small quantities?

Very small quantities of a “food commonly reported to increase symptoms” is usually okay for most clients.

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 eliminate additional food to improve symptoms even more. However, many non-diet factors contribute to symptoms and symptoms will still occur, no matter what they eat. Secondly, some clients request a “histamine-free diet” because they are scared about a very severe reaction.

A “histamine-free” diet is not possible because the diet is primarily based on an educated guess and anecdotal reports of problematic foods. If you restricted every food that is suggested to cause a problem on the internet, there would not be anything left to eat! Over restriction leads to stress and malnutrition, further compromising health.

14 comments on “Practical Guide to the Low Histamine Diet
  1. Steve says:

    Hello and Thank you for this pointed article, clear and concise! I have a question about antihistamines. I’ve been on Astelin and Zyrtec for about 5 years, and noticed I’ve slowly become flushed(face) almost 24X7. Reading the endless versions of histamine intolerance articles, it came to my attention that these antihistamines could be a contributor of my redness due to the DAO blocking. Also my diet is not horrible but certainly includes a fair share of high histamine foods. What is your take on these antihistamines, should I stop them first, then proceed with diet. Would love to hear your opinion.

    • Wendy says:

      Hi Steve – I hope this information helps.

      There are many reports on the internet that antihistamine medications cause the body to produce more histamine. To my knowledge, there is no research to prove or disprove this. However, if this were true, the side effect of H1 antihistamines would be increased stomach ulcers, and reflux (i.e., increased acid) and the side effect of H2 antihistamines would be increased allergic symptoms. These are not common side effects listed with these medications.

      Also, there is no evidence that antihistamines block the DAO enzyme. These statements are speculation.

      It’s hard to say how exactly you should proceed (e.g. stop medication, then diet). My best advice would be to make changes systematically and objectively observe the impact of these changes. Action plans can help.

  2. steven mostow says:

    After reading your article I am not doing to well not following your recommended guide lines. Following your guide lines should help me quite a bit. A drug store pharmacist also mentioned try taking IBgard. Any opinion on that OTC supplement? Your article on IBS was a great help to me on my IBS and watching the foods that can help or increase my IBS problem. A great presentation.

    • Wendy says:

      Hi Steven – I don’t have experience with this supplement. However, there have been studies to show that peppermint oil can improve IBS symptoms, so it is worth trying. If you do try it, ask your pharmacist how long you should try it for. When you start , don’t make any other changes and take the peppermint oil exactly as prescribed for the necessary time. Try not to judge it as you are going through the trial, at then end of the trial decide if it has been helpful. You can read more about a systematic approach at: Food Sensitivity! Make Progress with an Action Plan

  3. Jay says:

    Hi wendy my 20 month daughter gets hives recently its often around her mouth after fish walnuts cashew peanut and avocado they last about 15 to 30 mins. Shes previously had times when these foods caused no reaction. Is this histamine intolerance she has bad ezcema and had reflux but is slowly improving she is also cow protein allergic. What should I do I’ve been to doctors and they have offered no solutions. Will she be able to outgrow this? Should I keep giving her these foods in small amounts? Many thanks Jay

    • Wendy says:

      Hi Jay – This question needs to be answered by an allergist, because they can determine if her body is making IgE antibodies to those foods (this is an important piece of the puzzle). The doctors won’t be able to give you an exact answer, but if you can find an allergist or pediatrician who is willing to discuss it, they can work with you to come up with a plan. In answer to your question, it probably is not histamine intolerance.

  4. Andrea Nepa says:

    I have vestibular migraines (intermittent episodes of dizziness with nausea) as well as almost constant ringing in my ears and a feeling of fluid in my ears. This gets particularly bad the day after I have just one alcoholic drink. Do you think this could be related to histamine intolerance?

    • Wendy says:

      Hi Andrea – that sounds very difficult. Having increased symptoms with alcohol is a possible sign of histamine intolerance. However, alcohol affects the body in different ways and is a trigger for a variety of symptoms (even those that are not histamine related). Most people with histamine intolerance find certain alcohol, like red wine, to be more problematic. Is this the case for you? Do other foods or leftovers bother you?

  5. joan bowersock says:

    I am Kim’s mother and have been on this extremely restricted diet with her for moral and cooking support. We are lucky to live in California where we have weekly Farmers’ Markets where we can get very fresh fruit and vegetables. I don’t see how people in heavy winter areas could do what we are doing or how a person could do it alone. We spend an entire day with the two of us working to prepare and freeze a week’s worth of meals.
    Your discussion and meal plans seem much more reasonable and doable than what we are doing. Kim’s blood test will tell us if it was successful or not.

  6. Kim Couder says:

    Hi, thank you so much for this. I’m dealing with chronic Lyme disease and coinfections plus genetically impaired DAO and MAO and mastocytosis… ugh. Everything else I have seen (aside from being contradictory) is soooo restricted and leaving me basically housebound because of diet. Right now I’ve been given a diet that includes only 17 ingredients for 4 weeks and then a blood test on my inflammation markers to see if they’ve changed. It’s a nightmare even though I am an experienced cook and have always used fresh ingredients… All that to say that I am drooling over your list above and extremely appreciative of the information you’ve shared!

    • Wendy says:

      Good luck and I hope your restricted diet is helpful. You may want to look into dehydrating or freeze-drying, so that you can make food to eat on-the-go. Being housebound makes life difficult!

  7. Lisa says:

    Thank you for making sense of all of this. I have read so many lists that contradict each other my head was spinning. I have been on an anti-inflammatory whole food diet for 2 years so this list isn’t a huge adjustment. I have found that there are so many wonderful fruits and vegetables out there that it is difficult to get bored with your diet. I will miss my fermented foods and drinks the most. Was making my own and enjoying them several times a day. Vinegar is one of my favorite things.

    • Wendy says:

      Thanks for the kind words. You are right – restricted diets can open your eyes to many new foods!

      It would be helpful to reintroduce the restricted foods – like fermented products and vinegar – periodically to see if you tolerate them. Try not to avoid any foods, unless the restriction is making a definite difference.

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