The low histamine diet can appear to be very restrictive and complicated, but it’s often necessary for people with mast cell activation disorders (MCAD) to take on the diet to achieve better health overall. Usually, it is used in conjunction with antihistamines, mast cell stabilizers and other medications and methods to achieve the best outcomes possible. I’ve recently delved into this diet myself to help get control of a flare that began with spring and has caused me to begin reacting to a wide range of foods that up to now I thought I could enjoy without consequence. It didn’t take long for me to identify a number of triggers utilizing information from the low histamine diet.
While on the low histamine diet, you should keep a food diary. Writing down what you consume and how much, any resulting reactions, symptoms and revelations will help you and your doctor determine what’s working for you while on the low histamine diet and as you begin to reintroduce certain foods. For more information on food diaries, take a look at this.
The most important thing to understand is that the low histamine diet as a whole is something you adhere to only for a short period of time before attempting to add foods back in. It is not a cut and dried list of dos and don’ts for all time. The diet is designed to help you get things under control and then identify triggers. When you’re in a flare that could be just about everything on the list, like what is happening to me. However, when your MCAD is well under control, you may find that you can add some foods back to your diet. You want to attempt this after being on the diet for at least 4-6 weeks. When you test foods, test only one at a time, so you’re clear what’s causing you to react (SIGHI) and pay careful attention to how many high histamine and histamine triggering foods you eat overall.
How you cook your food matters. When it comes to meat, boiling can reduce the amount of histamine, while grilling actually increases it. In seafood, higher histamine levels were seen in grilling and frying than boiling. Fried vegetables have higher histamine content than raw, while no difference in histamine was detected in cooking fermented foods or eggs (NIH).
It’s also important to understand that fresh is always better. The older the food, the higher the histamine content. For this reason, fermented food and beverages such as hard cheeses, sauerkraut, kimchi, wine and beer are some of the worst offenders. This also holds true of fish, which begins to build histamines the moment it dies, so it’s not recommended you eat it unless you can cook it within two hours of being caught.
Meat is different from fish and should only be purchased fresh or frozen and never canned or cured. Histamine build up doesn’t begin until you cook it. Once cooked, you either want to eat it right away or freeze it, as refrigeration does nothing to halt histamine growth. This is why cured meats contain high histamine counts and vary significantly in histamine content. For this reason, it’s best for people with MCAS to avoid these products all together.
Finally, be sure to check ingredient lists carefully. For example, most condiments contain vinegar and most breads (even gluten-free) contain yeast. We must examine labels with care to ensure we’re not getting any unintended triggers in our diet.
Of course histamine containing foods aren’t the only problem. There are also foods which cause the body to release histamine, called mast cell liberators, and those which inhibit certain histamine blocking enzymes in the body, such as diamine oxidase (DAO). Many of foods both contain histamine and are either liberators or block DAO, such as alcohol, many nuts, beans and pulses. I’ve only included items on the foods to avoid that scored a 2 or higher on SIGHI’s list, but you may find you’re sensitive to those scoring a 1. We’re all different. See the full list for more information.
Foods to Avoid:
- Pickled or canned foods – sauerkraut, olives, kombucha, kimchi, soy sauce, etc.
- Matured cheeses
- cured meat products – salami, ham, sausages, deli meats
- Egg whites
- Beans and pulses – chickpeas, soy beans, peanuts
- Chocolate and other cocoa based products
- Ready meals
- Most citrus fruits, such as lemon, lime, plums, pineapple, oranges
- Cocoa and chocolate
- Some nuts (see list)
- Beans and pulses
- Wheat germ
- Additives – benzoate, sulphites, nitrites, glutamate, food dyes
- Black tea
- Energy drinks
- Green tea
- Artificial dyes and preservatives
Low histamine level foods:
- Fresh meat and poultry
- Freshly caught fish
- Egg yolk
- Fresh fruits – with the exception of strawberries and citrus, most fresh fruits are considered to have a low histamine level
- Vegetables – with the exception of tomato, spinach, avocado, eggplant, beans, pulses and pickled or fermented vegetables.
- Grains – rice noodles, yeast free rye bread, rice crisp bread, oats, puffed rice crackers, millet flour, pasta (spelt and corn based),
- Fresh pasteurized milk and milk products
- Milk substitutes – coconut milk, rice milk
- Soft cheeses (Farmer, Gouda, curd), mozzarella, Cream cheese, sweet cream butter
- Most cooking oils – check suitability before use
- Most leafy herbs – check suitability before use
- Most Herbal teas
Here’s a handy graphic you can download for easy reference:
And don’t forget about molds. If you are sensitive to mycotoxins, they can have the same affects as any other allergen:
For a comprehensive low histamine diet list, see the Food Compatibility List by SIGHI.