If you find that your body reacts to various foods – such as spinach, tomatoes, red wine, and sauerkraut – with symptoms, it is not necessarily an allergy. Instead, you may have something called histamine intolerance, as all of these foods are high in histamine. For people who are histamine intolerant, a low-histamine diet can help relieve these symptoms. As a little help, this article provides a list of permitted foods and useful nutrition tips.
What is histamine intolerance?
Histamine is a natural messenger substance that is formed in the body and is also found in certain foods. In “real” allergy situations, your body releases histamine, and that histamine in turn provokes what we call an allergic reaction.
Histamine intolerance is not a real allergy. Rather, it relates to a response some people have to foods high in naturally occurring histamine. People with histamine intolerance often have low levels of one of two very specific enzymes – diamine oxidase (DAO) and histamine N-methyltransferase (HNMT) – that process histamine in our bodies. If there aren’t enough of these enzymes to process the histamine, the messenger substance can build up over time and cause symptoms throughout the body.
Histamine intolerance symptoms and diagnosis
Histamine intolerance, also known as enteral (i.e., intestinal) histaminosis, is a very rare condition that is estimated to affect around 1% of the population. It is also very difficult to diagnose. The most common symptoms of histamine intolerance are migraines, indigestion such as diarrhea, hot flashes, hives, eczema, and allergic rhinitis (the medical term for hay fever). Eating large amounts of foods rich in histamines can trigger this reaction, but figuring out what exactly are the triggers can be tricky.
Histamine intolerance test
Once food allergies and other gastrointestinal conditions like celiac disease have been ruled out, your doctor may test you for histamine intolerance. Since conventional allergy tests such as the prick test (skin prick test) and the IgE antibody test can often be unreliable, a DOA blood test is recommended. A blood sample is used to determine the concentration of the enzyme diamine oxidase (DOA), which breaks down histamine in the intestine. A DAO deficiency in combination with an increased histamine level can reinforce a suspicion of histamine intolerance.
Histamine intolerance treatment and rotation diet
If the doctor diagnoses histamine intolerance, you should change your diet and stick to a low-histamine diet. This type of diet is very restrictive and should not be followed over the long term. It is recommended that one seek individual advice from a registered nutritionist to ensure that one is receiving adequate nutrients and calories. Since everyone reacts differently to histamine, an individual meal plan should be created. Depending on the symptoms, foods are removed from the menu and then gradually reintroduced.
Keeping a food diary for a few weeks and tracking your symptoms is also important to discover the triggers. If you find that your symptoms have improved, you can temporarily omit this food and try to add it back to your diet after about a month. Working with a nutritionist will help you balance your nutrient intake and reduce stress.
Medicines and food supplements
While a histamine-free diet is the only long-term treatment for histamine intolerance, there are certain supplements or medications, such as antihistamines, that can be taken to improve symptoms. Antiallergic drugs with diphenhydramine (or diphenhydramine hydrochloride) can be useful, for example, if you accidentally eat a histamine-containing food or if you have to take a drug that can block the activity of the histamine-processing enzyme.
There are also dietary supplements that some doctors recommend for people who are histamine intolerant. These include vitamin C and vitamin B6 (which can stimulate the activity of these histamine-processing enzymes in your body), as well as capsules containing the DAO enzyme to supplement the body’s natural supplies. Sometimes calcium, copper, zinc, and other micronutrients can also be prescribed.
Histamine intolerance food list
Here’s what you can eat if you are histamine intolerant:
Fresh fruit: apples, pomegranates, blueberries, melons, cranberries, apricots, cherries, pears, plums, peaches, rhubarb (almost all except citrus fruits, strawberries, avocado)
Fresh vegetables: rocket, lettuce, cabbage, zucchini, corn, asparagus, garlic, artichokes, broccoli, carrots, onions, radishes, peppers, cucumbers, spaghetti squash, etc. (all vegetables except those on the no-go list )
Fresh herbs: basil, parsley, oregano, rosemary, coriander, thyme, turmeric
Gluten-free cereals: quinoa, brown rice, oatmeal, rice cakes
Dried legumes: chickpeas, black beans, kidney beans
Starchy vegetables: sweet potato, yam, butternut squash, winter squash
Fresh meat and fish: chicken, turkey, salmon, sea fish, lean ground beef, lamb
Carob powder (an alternative to chocolate)
Milk substitutes: almond milk, hemp milk, coconut milk
Hemp seeds, flax seeds, chia seeds
Olive oil, coconut oil
Drinks: all non-citrus fruit juices, vegetable juices, herbal tea, yogi tea
These foods should be avoided if you are histamine intolerant:
Hard cheese: Parmesan, Cheddar, Gouda, Camembert, Swiss cheese
Fermented foods and drinks: sauerkraut, pickles, pickled vegetables, kefir, kombucha
Dairy products such as yogurt, sour cream, and buttermilk (the more mature, the more histamine-rich)
Processed meat: cold cuts, bacon, sausage, salami, ham, chorizo, hot peppers
Alcohol and alcoholic beverages
Beers such as wheat beer
Tea (black tea, yerba mate tea, green tea)
Peanuts, walnuts, cashews
Smoked fish and canned fish (such as salmon and tuna)
Certain vegetables: spinach, tomatoes, eggplant, mushrooms, garlic
Certain types of fruit: strawberries, raspberries, kiwi, grapes, bananas, cherries, citrus fruits (papaya, orange, lemon, pineapple)
Spices and sauces: ketchup, chilli powder, cinnamon, cloves, vinegar
Packaged and processed foods: snacks, cookies, sweets
Food additives, preservatives and colors
Licorice, cocoa, chocolate, marzipan, nougat
Meat and fish: The longer a food is stored or processed, the more histamine is formed in it. At best, buy meat and fish on the day they are prepared.
Starchy vegetables: Starchy vegetables like sweet potatoes, yams, and butternut squash are high in vitamins A, C, and other antioxidants. They are healthy, high-fiber foods that fill you up and can replace processed grains.
Carob: Carob powder is rich in antioxidants and a great alternative to cocoa and chocolate. It’s also gluten-free and contains bioactive compounds like fiber, polyphenols, flavonoids, cyclitols (like d-pinitol), and tannins. These compounds have anti-cancer effects and have been linked to a variety of health benefits, including controlling blood sugar levels (glycemia), lowering cholesterol, and more. Here you can check out a few interesting recipes with carob powder.
Fresh herbs: Fresh herbs can add flavor and nutritional value to any meal without adding calories and fat. They can spice up any stir-fry or salad and are a wonderful and colorful addition to any meal plan. You can also create your own herb garden on the windowsill or on the balcony.
Nut milk: Enriched with calcium and vitamin D, nut milk has fewer calories and fewer saturated fatty acids than cow’s milk and is ideal as a milk substitute for people on a vegan or vegetarian diet.
Coffee for histamine intolerance
Caffeine blocks the enzyme diamine oxidase. Many people with histamine intolerance therefore resort to healthy coffee substitutes, such as grain coffee or carob coffee (carob coffee). That way you can still enjoy coffee, but without the caffeine. You can also try drinking espresso instead of filter coffee to test your tolerance. Coffee is usually better tolerated by the stomach with a dash of nut milk or a glass of water. Here are some examples of pick-me-up drinks to drink in the morning instead of coffee.
Cook fresh food as often as you can. Focus on simple preparation and cooking methods. Baking, roasting, grilling, sautéing, and steaming food are simple cooking techniques that you can use to prepare your meals.
Identifying the triggers of specific reactions can help improve symptoms. It is important to keep a detailed food diary describing post-food symptoms as most people react differently to histamine. For example, while some people have to avoid strawberries entirely, others can tolerate small amounts well.
A low-histamine diet can improve the symptoms of histamine intolerance and relieve allergy-related symptoms such as sneezing, headaches, itchy skin, etc. However, it is important to consult a registered dietitian to ensure a balanced diet that contains sufficient vitamins and nutrients. Since the focus is on avoiding food, it is important to avoid nutritional deficiencies. Sometimes people with histamine intolerance also need additional supplements and / or medication to help relieve symptoms.