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What Exactly is Histamine Intolerance?

Histamine intolerance affects at least 1% of the population, and 80% of those affected are middle-aged. The term “histamine intolerance” was introduced as a common denominator for symptoms such as abdominal pain, flatulence, diarrhea, headache, itching, swelling of the eyes, hives, runny nose, painful periods, difficulty breathing, racing heart, palpitations and low blood pressure occurring after the consumption of histamine-rich foods.

According to the American Journal of Clinical Nutrition, histamine intolerance is, “Disequilibrium of accumulated histamine and the capacity for histamine degradation.” 

Now that doesn’t mean that we are necessarily growing more and more sensitive to histamine, we just have too much of it in our bodies. There are many reasons why histamine is building up in our bodies, the most common being that the molecule does not properly break down and degrade normally.

Histamine intolerance may be caused by abnormally low levels of DAO. DAO is found, among other places, in the membranes of cells lining the small intestine and the upper portion of the colon, therefore people with damaged gastrointestinal systems seem to be at higher risk for histamine intolerance.

Women are more commonly affected than men by histamine intolerance. This may be because estrogen and histamine reinforce each other—histamine can increase estrogen levels and vice versa, which may explain why histamine intolerance is associated with pre-menstrual cramps and menstrual migraine and even uterine fibroids. Pregnant women may experience relief from food sensitivities during pregnancy because the placenta secretes very high amounts of diamine oxidase, or DAO, the enzyme that destroys histamine.


Within minutes a person exposed to histamine may experience:

  • Flushing of face
  • Nausea
  • Headache
  • Runny nose or congestion
  • Dizziness
  • Racing heart
  • Anxiety

If the reaction continues, these symptoms may occur:

  • Hives
  • Generalized swelling
  • Abdominal cramps
  • Diarrhea

And in severe cases, there may be:

  • Panic attacks
  • Blurred vision
  • Bronchoconstriction, asthma or difficulty breathing
  • Laryngeal edema or swelling of tongue

So What Causes Histamine Intolerance?

Common causes include:
  • Inflammatory bowel diseases (or anything that causes damage to the enterocytes -the cells that line the gut)
  • Celiac disease, Intestinal dysbiosis, Small Intestinal Bacterial Overgrowth (SIBO), Leaky gut or increase in intestinal permeability
  • Alcohol or other DAO inhibitors
  • Chronic viruses (EBV, etc.)
  • Medications that increase histamine
  • Food allergies (usually caused by all the above)
  • Imbalanced adrenal / ovarian hormones
  • Yeast/fungal gut infections
  • Parasitic infections, like Giardia

What Foods Are High in Histamines?

Remember how histamine builds up in aged food because bacteria eat any amino acids that are available? Well, you may not be surprised to learn that fermented foods contain the highest levels of histamines but it may be time to put down that slice of leftover pizza. Yes, the longer leftover food is left out, or in the refrigerator, the longer the bacteria have to make histamine. Of course, I remind clients that histamine levels aren’t set in stone. The levels in food may vary depending on the way it’s processed, how long it’s been stored, and its general maturity. In the case of plants, the leaves and stems may also contain different levels of histamine when compared to the fruit, vegetable, or nut. Consequently, there’s no definitive list of the quantities of histamine in different foods.

If you’re looking to avoid histamine in your diet, I recommend removing the following foods from your diet:

Foods high in histamine:

• Leftovers or spoiled food

• Over-ripe fruit or vegetables

• Alcohol

• ALL animal based milks

• Cheese, especially aged varieties

• Prepackaged meat

• Eggplant (see other nightshades on this list)

• Avocado

• Potato (some clients can still handle boiled potatoes, sweet potatoes, etc.)

• Green beans and peas

• Dried fruit

• Fermented or aged meat, including processed meats and cold cuts

• Fermented or pickled vegetables, Kimchi, Pickles, Miso, natto, Sauerkraut

• Kombucha or other fermented beverages

• Fish and seafood, particularly if leftover, smoked, or salted

• Fermented dairy , Sour cream, Buttermilk, Cottage cheese, Ricotta cheese, Yogurt, Kefir

• Tomatoes

• Grapes

• Dates

• Stone fruits o Apricots o Nectarines o Peaches o Prunes o Plums

• Ketchup and other condiments such as tabasco sauce or mustard

• Canned foods

• Spinach

• Pineapple

• Yeast products, Bread, Most baked products, Vinegar, Cereal, Stock, stock cubes, and gravy, Prepackaged fruit juices, Barley malt

• Fermented sauces, Soy sauce, Tamari , Coconut aminos, Liquid aminos, Fish sauce

• Tea, Black, Green, White

• Unpasteurized honey

Foods that may release histamine through the mast cell mechanism:

• Food containing additives, preservatives, or dyes

• Egg whites

• Cocoa and chocolate

• Citrus fruit

• Bananas

• Nuts and peanuts especially walnuts, pecans, and peanuts

• Legumes, especially soy

• Papaya

• Licorice

• Pork

• Spices, Star anise, Cloves, Curry powde, curry leaves, Cinnamon, Nutmeg, Cayenne pepper

Not all foods high in histamine are equal.

When examining histamine it’s not always a case of good foods versus bad foods. Some foods have opposing properties and can include antihistamines with the histamines. Quercetin is one such antihistamine. This flavonoid has a host of health benefits when ingested and it’s the quercetin in a dock plant leaf that gives you relief when you rub it on a painful nettle sting.

Berries such as cranberries, raspberries, and blueberries are high in histamine and quercetin.

Just because a food’s high in histamine doesn’t mean you can’t tolerate it. Natural sources of antihistamines can often exist in the same plant. This is another reason that the reintroduction stage of an elimination diet is so vital.

What one person may be able to tolerate may be unbearable for you and vice versa.

Alcohol is a DAO blocker Alcoholic drinks such as wine and spirits are double trouble for anyone with MCAS or histamine intolerance. As a fermented product, alcoholic drinks are high in histamine but they also work as a DAO blocker. Your body needs a particular enzyme to metabolize alcohol, which is the same enzyme needed to create DAO. Alcohol in the bloodstream takes precedence and halts DAO production. This results in higher levels of histamine in your blood and you may have allergy-like symptoms or brain fog after one drink or alongside a hangover, so it’s best to skip alcohol whenever possible.

How Do I Eat a Low Histamine Diet?

After reviewing the lists above, you may think that moving to a low histamine diet is difficult. In the short term, figuring out your histamine triggers through the elimination diet can be trick, but afterward you may be able to reintroduce some of these foods back into your diet.

The key to eating low histamine in the long term is to ensure that you don’t consume potential sources of histamine in large amounts. Make sure that you eat widely to maximize your nutrient intake, helping your gut and any underlying inflammation to heal.

Remember freshness is key.

You may have to visit the grocery store more often each week and skip the marked-down stickers. As tempting as they are, they’re simply not worth the risk. Batch cooking (meal prepping) for the week is also out, unless you cook meals that can immediately go into the freezer and can be thawed from frozen. You may have to cook and prepare smaller amounts to avoid wasting leftovers. Overly ripe fruit and vegetables may not be suitable. It may also be worthwhile considering moving to locally produced vegetables and fruit, as the air miles required to transport these from elsewhere can contribute to a buildup of histamine. If you can buy your meat from a local supplier that can vouch for the freshness it may also make a difference for your health. Otherwise, always check the date on which the meat was packaged to determine the freshest package and remember that whole-cuts contain less histamine producing bacteria than ground meat. You can pick up your meat at the end of your shopping trip and take it home in a cooler to ensure maximum freshness.

Organic fruits and vegetables, although preferable, have a much shorter shelf life and tend to become moldy and histaminic much more quickly than sprayed produce.

Foods you may be able to eat on a low-histamine diet:

● Coconut and coconut milk

● Baked products leavened by baking powder (no yeast), Soda bread, Scones, Muffins, Biscuits (find recipes with no yeast) (make sure all baked goods are vegan and gluten free)

● Cereals without artificial additives or ingredients from the above list

● Crackers not containing yeast

● Fruit, Apple, Pear, Kiwi, Mango, Lychees, Passion fruit, Rhubarb, Melon, Fig, Pomegranate

● Vegetables, Asparagus, Bell peppers, Arugula, Beets, Broccoli, Bok choy, Cabbage, Brussel sprouts, Carrots, Garlic, Cauliflower, Leeks, Lettuce, Onions, Shallots, Rutabaga, Summer squash, Winter squash, Turnip, Watercress, Zucchini , Taro root, Breadfruit, Lotus root, Fresh herbs

● Olive oil , Vegan “butter”

● Fresh meat, Chicken, Beef, Lamb, Goat

● Freshly caught fish, 30 minutes from hook to

● Coconut or date sugar

● Pure jams and jellies

● Maple syrup

● Pure juice

● Coffee

● Plain gelatin

Be wary of using low-histamine recipes that you might find online, as again what may be tolerated by one person may not be good for you. It’s going to take some work to find what works for YOU. I totally understand that some clients might complain that when they drink coffee or eat asparagus that they feel awful… and then get upset that it’s on the list of “OK” foods. Remember… what works for one may not work for everyone… these are the best foods to eat BUT… you still will need to introduce slowly and see what works for you out of these lists. Also, be aware that your method of cooking can increase the histamine levels in food. For example, frying and grilling should be avoided, but boiling is fine.

Can You Take Antihistamines for Histamine Intolerance?

I’ve written previously about supplements and medication that I recommend as part of the holistic protocol for MCAS. Part of the protocol emphasizes the use of antihistamines that aren’t the same as mast cell blockers. The most important aspect of treatment is help with DAO levels, gut health, and mast cell regulation.

Improving your DAO levels and breaking down histamine

I recommend the following supplements alongside your low-histamine diet to assist in regulating your histamine levels:

• DAO enzyme supplements – Taking these enzymes as an oral supplement fifteen minutes before you eat allows them to reach your gut and aid in the breakdown of histamine in food. These enzymes can aid in the reduction of GI discomfort, among other symptoms. You can find these on Amazon.com

• Vitamin C – This is a powerful antioxidant and natural antihistamine. Intravenous vitamin C reduces allergy symptoms and if taken orally it can reduce histamine-induced nausea. We carry an excellent blend that contains quercetin called: PROTECTION (take 1 each meal)

• Vitamin B6 – Your body needs vitamin B6 to create DAO, so a B6 deficiency can have ramifications regarding how well you handle histamine. Vitamin B6 should be taken with magnesium for best absorption. We carry an excellent blend called: ASSIST (take 1 each meal) on our online shop.

• Quercetin – The flavonoid is a powerful antioxidant, but it also works as a mast cell stabilizer in animal models. We have this formulated in our PROTECTION supplement which also includes vitamin C.

• L-Glutamine works beautifully to lower inflammation in the gut and repair leaky gut. We offer a well formulated one called GASTRO HEALTH (take 1 each meal) on our online store.

• Probiotics are necessary to rebalance the gut microbiome. We recommend a single (not blend) of Lactobacillus rhamnosus which is a low histamine probiotic. You can easily find this online at different labs.


No two people are the same so it’s important to have a full range of tests of your mineral or hormonal levels before you start supplementing. As I’ve emphasized, what works for one client may not work for another. It is also vital to balance your hormones naturally.

References & resources



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