Low-histamine diet: how to eat, what I can/cannot eat (food list)

The low-histamine diet, or low-histamine diet, has been gaining more and more attention recently.

This diet is a form of treatment for confirmed histamine intolerance, for skin eczematous problems, and is even recommended for some patients with problems after overcoming covid-19.

What is histamine?

Histamine is found naturally in the cells of the body. It is part of the nervous and immune systems.

Histamine is also found in food and the body makes some of it. Normally, histamine is regulated by enzymes that break it down.

If large amounts of histamine build up in the body and are not broken down sufficiently, it can cause a range of symptoms. These include rashes, swelling, headaches, digestive problems and more.

Histamine is not only formed in our bodies, but is also a component of some foods.

Histamine intolerance means a mismatch of increased histamine intake and its removal from the body. When there is a large release of histamine, symptoms such as headache, nervousness, digestive problems or general discomfort occur.

The release and processing of histamine depends individually on each person and their state of health and well-being.

Everyone has their own tolerance to histamine.

You can read more about histamine, histamine intolerance and its symptoms in our article What is histamine intolerance? What are its causes and symptoms?

How does a low histamine diet help?

The basis of the diet is eating a low-histamine diet. A low-histamine diet reduces the total amount of histamine in the body and also eliminates DAO-blocking foods.

DAO (diamine oxidase) is an enzyme that helps break down histamine so that it can be eliminated from the body. If this enzyme is blocked by foods, histamine remains in the body and causes problems.

The level of the enzyme DAO is tested from the blood by measuring its activity. In histamine intolerance, this level is out of balance with histamine levels.

The DAO enzyme is blocked in its secretion by caffeine, canned foods, chocolate, vinegar.

The goal of the diet is to reduce, but not completely eliminate histamine levels.

The risk of histamine intolerance is increased by diseases

• Gastrointestinal disorders
• Crohn's disease
• Diseases of the liver
• Stress
• Trauma
• Disorder of intestinal microflora
• Frequent consumption of a diet high in histamine
• Gluten or lactose intolerance
• Long-term treatment with antibiotics, antidepressants, antirheumatic drugs

You can read more about the symptoms of indigestion in our article What is dyspepsia: What are the symptoms and course of indigestion?

Most people begin to experience problems even before they are diagnosed with reduced DAO levels and confirmed histamine intolerance. Some experience feelings of instability, drowsiness, headaches, weight loss, skin rashes that persist for long periods of time.

They are referred from doctor to doctor for investigation of these symptoms.

For example, with frequent headaches, they are sent to a neurologist.
with digestive problems to a gastroenterologist,
with skin reactions to a dermatologist.
No clear cause of the problems is found anywhere. The prescribed drugs only suppress the symptoms or do not work at all.

If histamine intolerance is found, you will be advised to follow a strict diet for 4-6 weeks.

An elimination diet is a diet with a restriction of foods containing histamine and foods that, although they do not contain histamine, lead to its accumulation in the body.

Only after following the diet is it recommended to gradually add new foods each day and monitor how your body reacts to the foods and what is giving you trouble.

It is best to add a new food every other day and wait to see if you have a reaction to it. Sometimes reactions can occur more than 24 hours apart, and up to 48 hours after eating.

For those foods that do not cause a problem, you can start adding them to your diet. However, it can also happen that a food has not caused you any problems for several consecutive days and then suddenly a problem occurs when you eat it again. It may be related to the food itself or to a combination with another food.

Along with diet, probiotics are recommended to improve gut flora. In many cases, taking the enzyme diaminooxidase, which is needed to break down histamine, is also recommended.

A replacement for the enzyme DAO, which is lacking in histamine intolerance, is available in pharmacies in tablet form.

The most reliable and best method is strict adherence to diet and reduction of stress to a minimum.

There are no drugs to treat histamine intolerance directly.

Your doctor may prescribe antihistamines, which block the receptor for histamine, if you develop allergic manifestations such as swelling, itching, skin reactions.

However, antihistamines do not cure, and histamine can continue to build up in the body from food. These drugs prevent subsequent symptoms. But this makes it difficult to know which food is causing you a problem and which is not.

For histamine intolerance, it is recommended to supplement vitamin C and B6, which are needed for the DAO enzyme to function, and vitamin D, which is often lacking in the body.

Another important method to aid treatment is avoiding stress, which releases the body's own histamine.

If you suffer from histamine intolerance, you know yourself that some foods give you a problem and others don't. Every person reacts to foods in a different way, every body is different.

Symptoms are especially exacerbated if you eat more foods high in histamine during the day.

Histamine intolerance does not behave according to the charts.

If one person does not mind a certain food, it can cause a big problem for another person in different forms. For example, if someone eats a ripe banana, he is fine and does not experience any problems. Another person gets sick after eating a ripe banana, feels nauseous, has a headache, has abdominal cramps.

That is why every person with confirmed histamine intolerance should be monitored after every meal.

The best and easiest way is to make a notebook and write down all foods and reactions to them.

What are the principles of diet and food preparation?

• Food must be as fresh as possible.
• Fruits should not be eaten overripe, only ripe to almost ripe.
• The diet should be varied so that histamine from other non-problematic foods does not accumulate in the body.
• Foods should always be eaten fresh and reheating them afterwards is not recommended.
• Once the food is cooked, store it in the refrigerator as quickly as possible. The longer the food sits, the more the proteins in the food break down and cause increased levels of histamine in the body.
• Food should not be reheated repeatedly. Each time it is reheated, more histamine is secreted.
• Avoid semi-processed foods, chemically processed foods, alcohol, benzoates, sulphites (hidden ethers in foods) and coloured foods.
• Only buy meat that is fresh, from verified sources, has not been refrigerated or deep-frozen for a long time.
• It is best to prepare your own food at home and avoid restaurants.

What can I eat?

There are many tables and lists of low-histamine diets on the internet, but it is individual for everyone.

Many of the tables and information regarding allowed foods contradict each other.

It really is individual. Your food list can only be determined by trying foods and getting to know your body and its reactions to foods.

In most cases there is a consensus of opinion

• Eat skinless and fresh chicken.
• Egg whites are also one of the foods that are high in histamine, but in a meal already overcooked they usually don't make a problem.
• Some food combinations can give you a problem. Some people can tolerate ketchup and puree and are fine. Others get heartburn, vomiting, swelling. You need to try everything really slowly and in small doses, especially at the first meal.
• It is better to eat sourdough bread, which is more digestible than yeast bread, which is a problem.

Many people with histamine tolerance disorder have other associated diseases such as celiac disease, intolerance or milk protein allergy.

Milk is hard to digest for most of them. Therefore, they substitute coconut or rice milk, which do not taste much different.

They should also be careful with histamine-releasing foods: citrus, cocoa, chocolate, nuts, papaya, legumes, tomatoes, food dyes, additives.

Table of foods explaining each group and their likely tolerance

A table of foods is attached, starting with those that are well tolerated in normal use, where no symptoms are expected, marked with the number 0.

Moderately tolerated foods often tolerated, with mild symptoms, marked with 1.

Poorly tolerated foods are marked with a number 2 and very poorly tolerated foods with a number 3.

We remind you that this is really individual. The table has been compiled on the basis of the information gathered.

Table explaining the numbering of histamine tolerance in the diet

Foods are divided into animal and plant foods according to their origin.

Animal foods

Animal foods come from animals. They include meat, dairy products, eggs and fats of animal origin.

Table with subgroup eggs

Egg whites are not recommended to be eaten raw due to their high histamine content.

Table of subgroups of dairy products

Table showing the breakdown of foods of animal origin into meat, fish, seafood and fats of animal origin

Vegetable foods

Vegetable foods include cereals, pulses, potatoes, vegetables, fruits, mushrooms, nuts, spices and fats of vegetable origin.

Table of plant foods and products of plant origin

When choosing foods, read carefully the information about their ingredients, added substances, colours and flavours that may cause a reaction in the body.

When choosing bread, sourdough bread is preferable to yeast bread, which is more digestible.

Table with breakdown of types of nuts and seeds of plant origin

Nuts and seeds are allowed, especially unroasted. In larger quantities they can be taxing on the stomach, especially for people with digestive problems. Nuts are also considered highly allergenic.

Tolerance distribution of fats and oils of vegetable origin (table)

Most of the oils and fats that are allowed do not cause problems, but their use should be moderate and not overused.

Vegetables by tolerance groups (table)

Fruit distribution by tolerance (table)

All fruits are not recommended to be eaten overripe or dried. Overripe fruit can contain fermentation, which is high risk for people with histamine intolerance and can cause a reaction in the body.

Always reach for fresh, firm and preferably less ripe fruit that is not at risk of fermentation and high histamine levels.

Table with herbs divided into groups according to tolerance

Herbs have always been considered medicinal, but some species increase histamine levels in the body and cause problems.

Table of mushrooms and mycelium by presumed tolerance

Consumption of mushrooms on a low-histamine diet is very individual. It is generally recommended to avoid eating them. If you are a mushroom lover, you can try mushrooms, which are quite well tolerated by some people.

When eating mushrooms, focus on fresh, just-picked and quickly processed mushrooms rather than those that have been on the shelves for some time.

Table of sweeteners by likely tolerance

Distribution of spices, flavourings and flavouring substances used in food preparation (table)

Handle spices, flavourings and aromas with care, don't overdo it.

Drinks by tolerance (table)

Alcoholic drinks by tolerance (table)

Alcoholic beverages are not well tolerated by most people.