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- see 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.
Danger Zone 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 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.

Cooking Meat

  • 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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16 comments on “Practical Guide to the Low Histamine Diet
  1. Golly says:

    How does one sign up for a consultation or appointment

  2. 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.

  3. 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

  4. 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.

  5. 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?

  6. 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.

  7. 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!

  8. 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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