Histamine intolerance can be treated with various methods; including low histamine diet, certain supplements, and antihistamine drugs.

Low histamine diet

Low histamine diet is by far the most effective treatment for histamine intolerance. Since the vast majority of histamine comes from foods, going on a low histamine diet is the most reliable way to drastically reduce histamine exposure.

Problematic foods fall into three categories:

• High-histamine foods – Foods rich in histamine. Histamine in foods is formed through microbial action as bacteria and yeast turn amino acids into histamine and other biogenic amines. This explains why fermented and aged foods often have the most histamine. Similarly, food that has been allowed to sit for a long time or spoil has a lot of histamine.
• Histamine liberators – Foods that liberate histamine from mast cells (white blood cells).
• DAO inhibitors – Foods and drinks that inhibit DAO.

However, they all do more or less the same thing (increase your histamine exposure), so I haven’t separated the problem foods into these categories.

Caveats

Before we talk about low histamine diet, I want to mention a few caveats and warnings.

There are no universally agreed upon and comprehensive lists of problem foods. A 2016 paper reviewed all the studies that measured histamine levels in foods. Their results showed that specific foods could be classified either as high or low histamine in different studies. Histamine content in foods may vary depending on growing conditions, ripeness, and storage time. Different laboratory measurement methods may also yield somewhat different results.

So don’t be surprised if you see conflicting recommendations from different sources.

That’s the bad news. The good news is that you don’t have to do this perfectly. Think back to our river analogy. Any reduction in rains, or improvements in water clearance, will ease flooding.

The point is that it’s vastly better to do something, even if it’s just cutting out the biggest offenders, than worrying about eliminating all of the problem foods from your diet while never actually getting started.

Remember, it’s the cumulative exposure that matters. It’s highly likely that you’ll be okay with some histamine-rich foods in your diet if your cumulative exposure is sufficiently small.

There’s no one right way to do this. Different studies have used different diets; some have eliminated just a handful of the most problematic foods, some have used stricter diets, but the participants have improved in all cases.

So do something, don’t get stuck on the details.

Finally, food lists can serve as a starting point, but what matters is how you react to a given food. Do your best to listen to your body and use that as the ultimate guide on whether to include or exclude a particular food from your diet.

Problem foods

This list contains what I believe to be the main problem foods for people with histamine issues:

• Alcoholic beverages: Champagne, red wine, beer.
• Fish: Mackerel, herring, sardine, anchovies, tuna, and just about any fish that is not very fresh.
• Cheese: Hard and matured cheeses. Fresh cheese that spoils quickly is usually low in histamine.
• Dairy: Yogurt, sour milk, kefir, and other fermented dairy products.
• Meat: Fermented sausage, salami, ham, cured and aged meats, liver and organ meats.
• Bakery products: Bread and other bakery products raised with yeast. Yeast-free bakery goods should be ok.
• Vegetables: Sauerkraut and all fermented vegetables, tomato, spinach, eggplant.
• Fruits: All dried fruits, citrus fruits (orange, grapefruit, lemon, and lime), banana, kiwi, most berries, papaya, pineapple.
• Most nuts.
• Condiments: Vinegar, soy sauce, fish sauce.
• Fermented soy products: Natto, miso.

I would also encourage you to check out this Google Slides doc I created: https://docs.google.com/presentation/d/1dkZ3QBIwzRKjYWfF0YsxxIb-M2AmNNNZFcARTjI4VA0/edit?usp=sharing

Along with a more detailed breakdown, it also contains known safe foods for most food categories.

Don’t eat two days old leftovers

It’s also important to avoid or minimize leftover foods. Please don’t eat leftovers that have been sitting in the fridge for 2 to 3 days. While the food isn’t spoiled yet, bacteria will convert amino acids into histamine as the food sits in the refrigerator. If you want to cook in larger batches, please freeze the food in portion-size packages and defrost right before eating.

How long to stay on the diet?

Studies that have put people on low histamine diet vary in length from 2 to 4 weeks. All of the studies have shown impressive results in conditions ranging from chronic headaches to eczema and dermatitis.

Here’s what I recommend:

• Stay on the diet until symptoms of histamine intolerance subside.
• After symptoms have subsided, stay on the diet for another week to allow things to stabilize and histamine levels drop further.
• Start introducing problematic foods back into your diet one by one.
• I recommend still keeping every other day free from problem foods to better pinpoint your problem foods and histamine tolerance.

You may or may not have to stay on some form of histamine limited diet for the rest of your life. In one study, DAO activity recovered in 60% of the participants following two weeks on low histamine diet. However, this was a small study and it’s hard to say anything definitive based on it. But it showed that DAO activity did recover in some people.

Easier version of the diet

A 1993 study on chronic headache sufferers put the participants on an easier version of the diet. The following foods were restricted for four weeks:

• Fish: Tuna, sardines, anchovy, mackerel
• Cheese: Emmenthal, Harzer, Gouda, Roquefort, Tilsiter, Camembert, Cheddar.
• Meat: Salami, dried ham.
• Vegetables: Pickled cabbage, spinach, tomatoes and tomato sauces.
• Alcoholic beverages: Red wine, white wine, sparkling wine, beer.

33/45 (73%) patients reported that their symptoms improved by 50% or more with the diet. 12/45 (27%) reported no improvements.

So if you find the full histamine free diet too strict, try to restrict the foods in the above list to see what happens. It might be enough for you.