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Histamine Intolerance Diet – Low Histamine Nutrition Guide

The histamine intolerance diet is a nutritional approach that avoids histamine-rich foods to relieve symptoms such as headaches, skin reactions, and digestive complaints.

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The histamine intolerance diet is a nutritional approach that avoids histamine-rich foods to relieve symptoms such as headaches, skin reactions, and digestive complaints.

What Is the Histamine Intolerance Diet?

The histamine intolerance diet is a specialized nutritional therapy for individuals who suffer from histamine intolerance. In this condition, the body is unable to break down excess histamine efficiently, leading to a wide range of symptoms. The diet aims to reduce daily histamine intake in order to control or completely prevent these symptoms.

Histamine is a biogenic amine that naturally occurs in many foods, particularly in fermented, aged, or stored products. In the body, histamine is broken down primarily by the enzyme diamine oxidase (DAO). In people with histamine intolerance, the activity of this enzyme is reduced, allowing histamine to accumulate and trigger complaints.

Causes of Histamine Intolerance

Histamine intolerance can have several underlying causes:

Genetic DAO deficiency: An inherited reduction in the activity of the diamine oxidase enzyme.
Acquired enzyme deficiency: Intestinal diseases such as Crohn's disease or celiac disease can reduce DAO activity.
Drug interactions: Certain medications such as antihistamines, ACE inhibitors, or non-steroidal anti-inflammatory drugs (NSAIDs) can inhibit histamine breakdown.
Excessive histamine intake: Consuming too many histamine-rich foods can exceed the breakdown capacity even in otherwise healthy individuals.

Symptoms of Histamine Intolerance

Symptoms of histamine intolerance are diverse and can affect multiple organ systems:

Headaches and migraines
Skin reactions such as flushing, itching, or hives (urticaria)
Gastrointestinal complaints: abdominal pain, bloating, diarrhea
Nasal symptoms: runny or congested nose
Heart palpitations or a drop in blood pressure
Dizziness and fatigue

Foods in the Histamine Intolerance Diet

Foods to Avoid (High in Histamine or Histamine-Releasing)

The following foods should be avoided or significantly reduced on a histamine intolerance diet:

Fermented foods: sauerkraut, kimchi, fermented soy products, vinegar
Aged cheeses: Parmesan, Gouda, Camembert, Roquefort
Alcohol: particularly red wine, beer, sparkling wine, and champagne
Fish and seafood: especially smoked, pickled, or canned varieties
Processed meats: salami, pepperoni, smoked ham
Histamine liberators: tomatoes, strawberries, citrus fruits, chocolate, cocoa, nuts
Non-alcoholic beverages: energy drinks, certain fruit juices

Well-Tolerated Foods

The following foods are generally low in histamine and well tolerated:

Fresh meat and fresh fish (not smoked or pickled)
Fresh vegetables (except tomatoes, spinach, and eggplant)
Most grains and rice
Fresh dairy products (e.g., cream cheese, butter)
Fresh herbs (except oregano and dried spices)
Most fruits except citrus fruits and strawberries

How to Follow the Histamine Intolerance Diet

The histamine intolerance diet is typically carried out in two phases:

Phase 1: Elimination Phase

During the elimination phase (approximately 4 to 8 weeks), all histamine-rich and histamine-releasing foods are strictly removed from the diet. The goal is to bring symptoms under control and establish a baseline. This phase should ideally be supervised by a qualified nutrition or medical professional.

Phase 2: Reintroduction Phase

In the reintroduction phase, foods are systematically and individually reintroduced into the diet. Reactions are carefully monitored to determine which foods and in what quantities can be tolerated. This creates an individualized tolerance profile that allows for as varied and balanced a diet as possible.

Complementary Measures

In addition to dietary changes, other measures can help improve tolerability:

DAO enzyme supplements: Dietary supplements containing diamine oxidase can be taken before histamine-rich meals to support histamine breakdown.
Vitamin B6, Vitamin C, and copper: These nutrients act as cofactors for the DAO enzyme and can support its activity.
Antihistamines: In acute cases, antihistamines prescribed by a doctor can help relieve symptoms.
Stress reduction: Stress can worsen histamine tolerance, so relaxation techniques are beneficial.

Diagnosing Histamine Intolerance

Diagnosing histamine intolerance is complex, as no single definitive test exists. Diagnosis is typically made through:

A thorough medical history and symptom diary
Keeping a detailed food and symptom journal
Performing a controlled elimination diet
Measuring DAO activity in the blood (as an indicator, though not conclusive on its own)
Excluding other conditions such as allergies or mastocytosis

References

Maintz L, Novak N. Histamine and histamine intolerance. American Journal of Clinical Nutrition. 2007;85(5):1185–1196. doi:10.1093/ajcn/85.5.1185
Reese I et al. German guideline on food intolerance: histamine intolerance. Allergologie. 2017;40(3):121–139.
Schnedl WJ, Enko D. Histamine Intolerance Originates in the Gut. Nutrients. 2021;13(4):1262. doi:10.3390/nu13041262

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