Low Histamine Diet 101 + Recipes & Guidebook -EA Stewart, RDN

Updated & reviewed by EA Stewart, RDN, Registered Dietitian Nutritionist, March 8, 2023

Learn how a low histamine diet may help with bloating, headaches, & other histamine intolerance symptoms. Get low-recipes, food lists, and more!

Overhead photo of a variety of vegetables, including carrots and potatoes, to eat on a low histamine diet.

This post is for informational purposes only and is not meant to diagnose or provide medical advice. If you suspect histamine intolerance, please consult your physician or primary healthcare provider.

What is Histamine?

Histamine is a chemical compound produced by the body’s immune system. It plays a vital role in the body’s response to injury and infection by causing inflammation and increasing blood flow to the affected area. However, excessive histamine production can lead to multiple symptoms, including headaches, itching, and digestive issues.

In addition to endogenous histamine, this chemical is also found in certain foods or can increase over time in meat, fish, and high-protein leftover foods.

What is Histamine Intolerance?

Histamine intolerance is a condition in which your body can’t break down high amounts of histamine quickly enough due to inadequate levels of enzymes called diamine oxidase (DAO). Dietary histamine is produced by bacteria in foods and is also a biogenic amine found in mast cells in our body (1). The release of histamine, without adequate breakdown, leads to multiple symptoms listed below.

Symptoms of Histamine Intolerance

Histamine intolerance typically causes various symptoms, primarily similar to food allergies. However, histamine intolerance is not a food allergy. While high histamine concentrations are in the lungs, basophils, and mast cells, it’s present within all body tissues, resulting in a variety of histamine issues and symptoms.

Gastrointestinal symptoms include (1,2)

Abdominal Pain
Bloating (most common)
Constipation
Diarrhea
Emesis (vomiting)
Nausea
Postprandial fullness (fullness after eating)

Additional symptoms, including those similar to seasonal allergies (1, 3)

Asthma
Dysmenorrhea (painful menstruation)
Hives
Hypotension (low blood pressure)
Itchy Skin
Migraine or other headaches
Nasal Congestion
Runny Nose
Sneezing
Tachycardia (fast heart rate)
Watery Eyes

Who Can Benefit from a Low Histamine Diet?

A low-histamine diet is beneficial to people with histamine intolerance. A diagnosis occurs when an individual experiences two or more typical symptoms that improve with a low-histamine diet. (4) While traditional skin-prick testing shouldn’t be used to diagnose histamine intolerance, it may be used to rule out other conditions with similar symptoms.

Because other medical conditions can cause symptoms of histamine intolerance, it is essential to rule out these conditions, such as food allergies/malabsorption, celiac disease, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and other food intolerances. But, it is not surprising if an individual has more than one condition.

Although limited research has been conducted on the relationship between histamine intolerance and IBS, one small study showed a significant reduction (eightfold) in histamine on a low FODMAP diet (5). Therefore, combining a modified low FODMAP and a low-histamine diet may help with digestive symptoms for those who haven’t done well on a low FODMAP diet.

To further help you decide whether you should try a low-histamine diet, below are some pros and cons of following this diet:

Pros of a Low Histamine Diet

A low-histamine diet is considered the gold-standard treatment to manage symptoms of histamine intolerance. (4)
It can help you identify which histamine-rich foods to avoid or minimize. And, conversely, you may be able to resume eating other foods, such as high FODMAP foods, you had previously been avoiding.

Cons of a Low Histamine Diet

Following a highly restrictive diet, such as a low histamine diet alone or combined with a low FODMAP diet, can deprive your body of essential nutrients. So, seeing a physician and ruling out other conditions before trying the diet is important. And then, work closely with your dietitian experienced in low histamine diets to help you plan a nutritious low histamine diet. Please reach out to schedule a consultation. I would love to work with you!
As with any restrictive diet, it’s easy to get caught up in the trap of thinking all of your symptoms are related to food. This can lead to a fear of food and disordered eating. If your diet becomes too limited and you’re constantly worried about what you eat, you must work with a GI dietitian and consider an assessment with a Gastropsych practitioner.

Low Histamine Diet General Tips

Keep it short. If you and your healthcare provider determine a low histamine diet trial is warranted, keep it short for ~ four weeks. Although you may find some recommendations on the internet to try a low histamine diet for two to eight weeks, most of my clients know if the diet is helping or not within four weeks.
Keep a journal. Keeping a food diary during the elimination and reintroduction phase of the diet is essential for determining what foods you can eat and in what amounts. I also recommend noting any allergies, illness, and stress levels, all of which may contribute to high histamine levels.
Keep it simple to start. You may want to begin with a simple low-histamine diet. This includes eating fresh, unprocessed, or minimally processed foods and avoiding alcohol, aged cheese, cured meats, fermented foods, and leftover foods.
Advance when needed. For example, if you’re still experiencing uncomfortable symptoms on the simple diet, now is the time to try a more advanced low-histamine diet.

High & Low Histamine Diet Food Lists

Note: This is not a complete list. Please refer to The Ultimate Guide to a Low Histamine Diet for a complete list of high, moderate, and low FODMAP foods.

What high-histamine foods should I avoid?

Certain Fish: e.g., tuna, sardines, mackerel, herring
Shellfish
Processed meats: e.g., sausages, ham
Ready-to-eat meals
Canned, smoked, or pickled foods: e.g., canned soups
Fermented foods: e.g. sauerkraut, kimchi, kombucha, yogurt, kefir
Aged cheese: e.g., cheddar, Swiss, Parmesan
Vegetables: e.g., avocado, eggplant, tomatoes, eggplant, spinach
Fruits: e.g., citrus fruits, papaya, pineapples, kiwi, bananas
Nuts: walnuts, peanuts, cashews, all rancid or stale nuts
Beans and legumes: chickpeas, soybeans, etc.
Chocolate and cocoa
Vinegar: e.g., balsamic vinegar, wine vinegar
Alcohol and energy drinks: e.g., red wine, white wine
Miscellaneous: yeast extract, MSG, bouillon, soy sauce, hot spices, cocoa, carob

What low-histamine foods can I eat?

Some fresh fish (or frozen): hake, trout, plaice
Fresh meat and chicken (or frozen/cooled)
Eggs
Pasteurized milk, fresh mozzarella cheese, butter
Fresh fruit: e.g., apples, apricot, blueberries, mango, persimmon, cherries, cranberries, peaches, blueberries
Nuts: macadamia nuts, chestnuts
Fresh vegetables: e.g., artichoke, arugula, beets, bell pepper, broccoli, carrots, cauliflower, kale, potatoes, romaine lettuce, zucchini
Grains and grain products: quinoa, millet, oats, rice, etc.
Most cooking oils, leafy herbs, and herbal teas: e.g., coconut oil, basil, oregano, parsley, chamomile tea
Miscellaneous: herbs, mild spices, distilled white vinegar, sugar, honey

1-Day Sample Low Histamine Diet

Bowl of oatmeal with mango slices and coconut.

Breakfast: Tropical Oatmeal. Top oats with pasteurized milk, mango, unsweetened shredded coconut, and toasted macadamia nuts.

Lunch: Salmon Quinoa Bowl with Broccoli. Place cooked quinoa in a serving bowl. Top with freshly prepared cooked salmon (or other fish) and steamed broccoli. Drizzle coconut oil on top and add minced garlic, salt, and pepper to taste.

Snack: Apple Slices with Pumpkin Seed Butter

Dinner: Chicken & Veggie Pasta. Top cooked brown rice pasta with freshly cooked chicken breast, chopped bell peppers, arugula, canola oil, garlic, basil, salt, and pepper. Add mozzarella cheese to taste.

Dessert: Chia Pudding with Blueberries + Coconut Milk. Combine nine tablespoons of chia seeds with 1 1/2 cups of coconut milk. Sweeten to taste with maple syrup and top with fresh blueberries. Makes four servings.

Supplements & Additional Foods for Histamine Intolerance

DAO

DAO (diamine oxidase) is an enzyme our bodies naturally produce that helps break down histamine. Although research is limited, the available studies suggest DAO supplements may help reduce symptoms associated with histamine intolerance. In addition, supplementation may allow for a less restrictive diet. (4)

Quercetin

Quercetin has been shown to help improve allergy symptoms. Therefore it may also help with histamine intolerance symptoms (6). A few foods high in quercetin that are also appropriate for a low-histamine diet include kale, broccoli, blueberries, and apples.

Probiotics: Proceed with Caution

While probiotic-rich foods and some probiotic supplements benefit gut health, certain gut bacteria produce histamine; thus, not all strains, including Lactobacillus casei and Lactobacillus bulgaricus, are suitable for someone with histamine intolerance.

This may also explain why fermented foods like yogurt are typically not well-tolerated on a low-histamine diet.

Strains that may decrease histamine levels are Lactobacillus rhamnosus, Lactobacillus plantarum, Bifidobacterium infantis, and Bifidobacterium longum (6). However, more research is needed to study the benefits of different strains of probiotics on histamine intolerance.

However, more research is needed to study the benefits of different strains of probiotics on histamine intolerance.

Work with your physician or registered dietitian if you want to try DAO enzymes, probiotics, or other supplements to help with histamine intolerance and gut health. Also, if you need supplement recommendations, please get in touch!

Putting it into practice: Low Histamine Recipe Book PDF & Guidebook

Low histamine diet guidebook cover image.

If you’ve decided you want to try a low-histamine diet but need help putting it into practice, be sure to check out The Low Histamine Recipe Book and Guidebook!

What’s Included

42 low-histamine recipes cookbook including breakfast, entrees, side dishes, snacks, and dessert.
A gorgeous guidebook featuring detailed low, moderate, and high histamine food lists for each food category and a one-page low/high histamine “cheat sheet.”
Bonus meal planner & a food worksheet to help keep track of your symptoms.

GET THE LOW HISTAMINE DIET RECIPE BOOK & GUIDEBOOK!