In my functional nutrition practice, I often hear the following: “I am having allergic reactions, but the doctor says I don’t have any allergies.” People come in with hives or red itchy bumps or breathing troubles, but with no identifiable true allergies.
In such cases, we explore food sensitivities, autoimmune conditions and other gastrointestinal (GI) issues. In addition, we know that there could be an underlying histamine problem. It’s not the first thing we investigate because many of those other issues can cause or exacerbate histamine problems. We like to start with the basics and move to considering complex conditions like histamine overload or mold toxicity only after we have optimized nutrition and GI function.
HISTAMINE AND ALLERGIES
Most people have heard of histamine because it is known to “cause” allergies. In fact, the body’s defense reaction to foreign proteins in the blood is what causes allergies. Part of that reaction includes the release of histamine from mast cells (a type of white blood cell that releases histamine and other substances). Although mast cells also release many other pro-inflammatory substances, histamine gets a particularly bad rap.
Histamine becomes problematic when people have too much histamine in their blood or tissue even though no allergic reaction is occurring. In the absence of true allergies (immunoglobulin E [IgE] reactions), there are essentially two major scenarios in which this can take place. The first and probably most common scenario, typically known as “histamine intolerance,” is when someone either absorbs too much histamine from the GI tract or does not break it down well in the liver (or both). Many foods contain histamine, and if the histamine is not successfully broken down in the gut, it can get absorbed in excessive amounts. Proper liver function is required to break down the histamine to be excreted as waste. When one or both of these functions is not working properly, histamine builds up in the blood.
In the second, much more complex and insidious scenario, called “mast cell activation syndrome” (MCAS), dysfunctional mast cells release too much histamine. In some people, of course, both things are happening, and there are other factors that can affect histamine levels as well. Any serious conversation about histamine “overload” thus needs to address the origin of the excess histamine. When the overload is due to improper breakdown of histamine in the gut or liver, the protocol will differ from when it originates from the mast cells.
There are at least two possible reasons why someone would absorb excess histamine from the gut. First, dysbiosis (or a disordered microbiome), so common these days, can certainly contribute to this problem and, in fact, is the leading cause of histamine intolerance. Microbial imbalance can inhibit the body’s ability to break down histamine in the gut.
Another confounding issue can be low levels of the enzyme that we naturally produce to break down histamine. This enzyme, called diamine oxidase (DAO), is responsible for breaking down histamine in the gut, the liver and other tissues. Some people are low in this enzyme due to genetic variations. Others may be low due to GI disorders such as small intestine bacterial overgrowth (SIBO), hormonal imbalances or any kind of persistent inflammation. Excess estrogen levels also can increase circulating histamine because estrogen suppresses DAO activity and stimulates mast cells.
In addition to the breakdown by DAO, histamine needs to be methylated in the liver before excretion by the kidneys. Methylation refers to the process of any molecule being transformed by the addition of a methyl group (CH3)—three hydrogen atoms bonded to a carbon atom. Histamine is methylated to a molecule called methylhistamine, which renders it much less toxic and ready for disposal through the urine.1
Low DAO activity in the GI tract and liver due to genetic variants, combined with gut inflammation, excess estrogen and insufficient levels of methyl groups can create a perfect storm for some people, causing major histamine overload. The approach to deal with this situation must be multifaceted.
MAST CELL ACTIVATION SYNDROME
When mast cells are activated, they release histamine, tryptase and other pro-inflammatory mediators. This is great when the mast cells are protecting us from pathogens or are involved in healing wounds. Sometimes, however, mast cells show up in excess (a rare condition known as mastocytosis), or, as in MCAS, they overproduce these pro-inflammatory molecules, flooding the system with them and mimicking an allergic response.
MCAS is not fully understood, and its treatments are even less clear. I like to think of MCAS as akin to an autoimmune condition because it involves mast cells (immune cells) that are overactive and somewhat trigger-happy in releasing their contents. Unfortunately, this can really wreak havoc in the body. Dr. Lawrence Afrin and Dr. Theoharis Theoharides are leading experts in MCAS, and their websites are excellent sources of information about this complex condition.2,3,4 However, individuals seeking to heal with a predominantly food-based approach will need additional help.
Symptoms of MCAS and the less complex histamine intolerance are not always clearly distinguishable. It can be challenging, therefore, to determine conclusively whether someone is suffering from MCAS or histamine intolerance or both.
In our functional nutrition practice, our initial approach focuses on improving the GI tract and liver function while supporting hormones, methylation and overall health. In this way, we are able to minimize histamine intolerance; if someone truly has MCAS, we will see some improvement but also will be able to recognize that more work needs to be done. We also will have set the stage for that person to do better on the pharmaceutical treatments that are so often necessary with MCAS.
SYMPTOMS AND TREATMENT
A first step is to be aware that both MCAS and histamine intolerance can coexist with other conditions, making it very difficult to parse out exactly what is going on. Next is the question of how they should be treated. A major component of the treatment for either condition is to reduce the dietary intake of histamine foods as well as histamine “liberators” (see below). We also use the DAO enzyme in a supplement form,5 in conjunction with a formula called NeuroProtek,6 which contains the bioflavonoids luteolin, quercetin and rutin. We have used both of these products with many patients over the past three years, and they have had a very high success rate in our clinical practice. There is research showing that DAO supplementation reduces histamine levels,7 and quercetin and luteolin reduce the release of histamine and tryptase from mast cells.8 More research is forthcoming in this area, including the results of a just-completed clinical trial.9
Histamine intolerance symptoms can include rashes, hives, itching, headache, migraine, anxiety, depression, fatigue, insomnia, vertigo and GI disorders. When treating histamine intolerance, we always try to address the GI disorders first, while supplementing with DAO and NeuroProtek. We also address methylation and, if needed, will supplement with vitamin C, additional B vitamins, copper, zinc and magnesium.
The dietary recommendations for individuals with histamine intolerance call for a diet rich in folate, vitamin B12, glycine and flavonoids such as quercetin and rutin. We also recommend juicing homemade pea sprouts (which are rich in the DAO enzyme) as well as eating rice bran (in “forbidden rice” or black or purple rice), which has been shown to reduce the release of histamine from mast cells. We exercise caution with probiotics, which can worsen the symptoms of histamine overload. We recommend only using the following bacterial strains: L. reuteri, L. rhamnosus, L. casei and B. bifidum.
Because people often have multiple food sensitivities due to intestinal permeability, or they have other food restrictions (such as low FODMAPs for SIBO), we do not recommend implementing a strict low-histamine diet; we do not want to be the ones telling people that they can only eat air from now on! However, we do encourage such people to limit or avoid the biggest offenders among histamine foods, which include alcohol, fermented foods, smoked or cured meats, citrus fruits, shellfish, canned fish or meat, fish and seafood in general (except salmon, cod and tuna frozen on the boat), vinegar, strawberries, nuts, tomatoes and cacao. This approach, coupled with addressing the major GI disorders, usually works very well.
For MCAS, the situation is much more complex. Symptoms can include rashes, hives, itching, flushing, fainting, headache, abdominal pain, nausea, vomiting, gastroesophageal reflux disease (GERD), fatigue, chronic pain, trouble breathing and many more. The conditions associated with MCAS are often complex in their own right. Related conditions may include allergies, autism, autoimmune disorders, cancer, diabetes, Ehler-Danlos syndrome, postural orthostatic tachycardia syndrome (POTS), fibromyalgia, Lyme disease, mastocytosis, migraines and obesity. When one adds MCAS symptoms on top of those conditions, the person may be extremely ill with twenty to thirty symptoms.
Unlike with histamine intolerance patients, it is imperative that MCAS patients implement a strict low-histamine diet (provided their diet is not already too restricted) and otherwise employ the same interventions that we use for histamine intolerance. However, due to the complexity of MCAS, it often requires much deeper investigative work (it is challenging even to get a diagnosis) and pharmaceutical interventions.
IMPLEMENTING A LOW-HISTAMINE DIET
The detailed low-histamine diet (next page) is as strict as they come. Individuals who are not sure about the extent to which histamine is affecting them might first want to try the less strict list described in the previous section, keeping in mind that many people do better with the stricter diet. We usually recommend following the stricter diet for six weeks before deciding whether it has helped or not, because sometimes it takes that long to reduce the body burden of histamine significantly. In most people, using the DAO enzyme and NeuroProtek will speed up the process.
Low-histamine food lists on the Internet may not be very reliable because they often derive from the author’s subjective experiences. This can make the whole subject very confusing. I recommend sticking to just one list and observing one’s body. Over time, it will become easier to identify foods that are particularly problematic. It helps to start off more strictly to establish some sort of baseline, experimenting with more variety as one starts to feel better.
HISTAMINE “LIBERATORS” TO AVOID
• Most citrus fruits
• Cocoa and chocolate
• Wheat germ
• Black tea energy drinks
• Green tea, mate tea
• Additives (benzoate, sulfites, nitrites, glutamate and food dyes)
FOODS TO ENCOURAGE
VEGETABLES: Add the following to dishes as much as possible: artichokes, basil, broccoli, celery, chives, cilantro, dill, garlic, onions (either cooked onions or spring onions in small amounts), oregano, parsley, rosemary, snap peas, watercress, and ancho, serrano and chili peppers. These are all high in quercetin and other phytonutrients, which help reduce the body burden of histamine. Capers are particularly rich in quercetin, but one should use only salt-dried capers (not capers in vinegar).10 Be sure to rinse the capers before using.
FRUIT: Apples and cranberries also are high in quercetin.
GRAINS: Rice bran (especially from black rice) reduces histamine. Heirloom black rice can be found in health food stores (often called “forbidden rice”) or online.11
PEA SPROUTS: Although consumption of pea sprouts is optional, it is encouraged when possible. Pea sprouts can be used liberally as they are high in the DAO enzyme, which helps break down histamine. The easiest way to use them is to juice or blend them and drink with meals. Sprouting peas to get the highest amount of DAO takes about ten days. The best time to drink pea sprout juice is with any meal containing meat or fish.
ALLOWED FOODS AND FOODS TO AVOID
The information below is adapted from the list provided in the book, Is Your Food Making You Sick? by James L. Gibb.12 Among the sources used by Gibb to compile the list are Dr. Janice Jones, Allergy UK, the Swiss Allergy Centre and the Swiss Interest Group Histamine Intolerance. Gibb’s list offers the strictest interpretation of what may constitute a problematic food for histamine; I have loosened it up a little to allow some sprouted beans. I also provide careful instructions on how to eat meat and fish.
ALLOWED: All fresh vegetables (except those on the “avoid” list). Water chestnuts can be used to make a starchy flour.
AVOID: Bell peppers, eggplant, onion (raw), pumpkin, purslane, spinach, tomatoes, winter squash, fermented vegetables (sauerkraut, pickles, etc.), overripe or rotten vegetables, all pickled vegetables (or anything that contains vinegar), prepackaged salad or other vegetables. Use caution with kale (small amounts only) due to its oxalate content.
ALLOWED: Apples, coconut, fig, goldenberries, longans, loquat, lychees, mango, melon, passionfruit, persimmon, pomegranate, quince, rhubarb and starfruit.
AVOID: All other fruit, especially strawberries, dried fruit that contains sulfur, overripe or rotten fruit, olives and avocado.
ALLOWED: Millet, oats, oat bran, rice (black, brown, purple, red or “regular”), rice bran, teff and wild rice. For baking, agar-agar, arrowroot, baking powder, baking soda, coconut flour, cornstarch (although this one is questionable in terms of general nutrition), guar gum, potato starch, rice flour, sago and water chestnut flour.
AVOID: Amaranth, buckwheat, quinoa and all wheat products. Avoid baked goods made with carrageenan, gelatin, tapioca starch, xanthan gum and yeast.
Histamine is present in small amounts in animal flesh but after death, histamine increases quickly (especially in fish that retain the guts). These foods may be problematic for extremely sensitive individuals and may need to be avoided completely. However, I encourage everyone to try consuming fish, poultry and red meat according to the guidelines below.
ALLOWED: Maximum one serving per day, or avoid altogether if symptoms do not subside within four to six weeks. AVOID: All shellfish, fish that has not been cleaned and frozen immediately, canned fish. All processed meat, aged meat, meat that has been cooked and not immediately frozen, leftovers from the fridge, meat that is not fresh, fermented meat and canned meat.
GUIDELINES: Fish should have the guts cleaned out on the boat and be frozen immediately. Salmon, snapper, Chilean sea bass, squid and octopus are commonly sold this way, but one should always check at the fish market. (When buying fish from a local market, make sure that the vendor is trustworthy and the fish is of the best quality.) Vital Choice is a good source of seafood because their king salmon, silver salmon, tuna and cod are guaranteed to be cleaned and frozen immediately on the boat, and they ship the fish frozen to the customer’s home. For meat and poultry, grassfed is best. Small farms often will freeze meat and poultry immediately after processing and can be good places to purchase meat. Buy in bulk and do not defrost until ready to cook. If buying from a butcher, only buy on the day the meat is processed. Do not buy already ground meat; instead, ask the butcher to grind the meat, place it in a cooler and rush home and cook or freeze. (Note: Freezing halts the bacteria-induced multiplication of histamine in animal flesh, but refrigeration does not. Cooking does not reduce or take away histamine, so once it’s there, it’s there.)
ALLOWED: Properly sprouted beans (except red beans and soybeans).
AVOID: All legumes that have not been sprouted, red beans, soybeans in any form and peanuts.
ALLOWED: Mascarpone, panir, quark, salted ricotta cheese (not the typical American kind that contains vinegar but the kind made in Italy, which may be hard to find, but is well worth the effort), fresh mozzarella, fresh cream, uncultured butter and buttermilk and fresh, raw milk. Some people tolerate any super fresh cheese such as non-aged chèvre and feta.
AVOID: Any cheeses not listed above, such as cheddar, Monterey Jack, processed cheeses, aged cheeses of all kinds, fermented dairy of any kind (yogurt, kefir, some types of cheese, sour cream, creme fraiche, etc.) and cottage cheese.
ALLOWED: Fresh raw and cooked egg yolks. If eating raw egg yolks, be sure to only use fresh, pasture-raised eggs from a known and reliable farmer; do not eat raw eggs from the supermarket. Many people tolerate cooked egg whites but some don’t, so use caution. If using as a protein source, make sure to use the whole egg. Pasture-raised eggs are ideal.
AVOID: All raw egg whites, raw commercial egg yolks and stale eggs. Use caution with cooked egg whites.
AVOID: All nuts (coconut is a fruit and is allowed), but especially almonds, pecans and walnuts.
ALLOWED: Soaked chia seeds, freshly ground and soaked flax seeds and their oils, and properly sprouted seeds. “Raw” is a good brand for sprouted seeds.
AVOID: Unsprouted seeds and sesame seeds.
HERBS AND SPICES
ALLOWED: Salt, pepper, fresh curry leaves, wasabi, fresh herbs and freshly ground spices (except those on the “avoid” list). Some allowed herbs and spices include: allspice, basil, bay leaf, caraway, cardamom, chives, coriander (cilantro), fenugreek, garlic, ginger root, marjoram, mint, myrtle leaf, oregano, parsley, peppermint, pimento leaf, rosemary, sage, savory, sumac, tarragon and turmeric. Black cumin seed (but not regular cumin) has antihistamine properties and is encouraged. Alcohol-free vanilla and other extracts are also allowed.
AVOID: Alcohol-based flavors, anise, artificial flavors, brewer’s yeast, cayenne pepper, chili, chocolate, cinnamon, cloves, cocoa, curry, mace, mustard seed, nutmeg, smoke flavor, soy sauce and all soy products, tamari, tamarind (fermented), thyme, vinegar of all kinds and any food containing vinegar.
ALLOWED: Coffee, fresh raw milk, mineral water, fresh water, chamomile tea, peppermint tea, dandelion tea, ginger tea, rooibos tea, coconut water and coconut milk.
AVOID: Soft drinks, all alcohol (but in particular wine and beer), anything fermented (such as kombucha and kefir), black tea, green tea, red raspberry tea, nettle tea, mate tea and energy drinks.
FATS AND OILS
ALLOWED: Cold pressed and unrefined seed and nut oils (Flora is the only brand I recommend), extra virgin olive oil, pure uncultured butter and cream, coconut butter and coconut cream, duck fat and goose fat.
AVOID: Vegetable oils, heat-treated or refined nut and seed oils, fried foods, processed foods, partially hydrogenated oils and fats, fish oil, avocado, olives, margarine and spreads such as Earth Balance and other fake fats.
ALLOWED: Pasteurized honey (or raw honey from a reliable source), maple syrup, brown rice syrup, coconut sugar, treacle, molasses, jaggery, palm sugar, pure jams, jellies and marmalade.
AVOID: Flavored syrups, prepared desserts and icings and dried fruit; high fructose corn syrup and agave. Caution with sugar alcohols such as xylitol (which can cause gas in those with compromised gut health).
1. Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr 2007;85(5):1185-1196.
2. MastCellAware. http://www.mastcellaware.com/index.html.
3. Molecular Immunopharmacology & Drug Discovery Laboratory. http://www.mastcellmaster.com/index.php.
4. Armonk Integrative Medicine for Optimum Health. http://www.armonkmed.com/about/dr-afrin/.
5. Umbrellux™ DAO. https://www.umbrelluxdao.com/.
6. NeuroProtek®. http://algonot.com/product/neuroprotek/.
7. Manzotti G, Breda D, Di Gioacchino M, Burastero SE. Int J Immunopathol Pharmacol 2016;29(1):105-111.
8. Research: Dr. Theoharides at Tufts University. http://www.mastcellmaster.com/research.php.
9. Study to investigate the effect of an oral diamine oxidase substitution (DAOsin) in histamine intolerant patients on the low endogenous diamine oxidase serum activity. https://clinicaltrials.gov/ct2/show/NCT03298568.
11. Histamine intolerance. www.low-histamine.com.
12. Gibb JL. Is Food Making You Sick? The Strictly Low Histamine Diet. Brighton, Victoria: Leaves of Gold Press; 2014.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Summer 2018.🖨️ Print post
Hello, thank you for this informative post. Much appreciated from someone with Mast Cell Activation. Question on the ancho, serrano and chili peppers. Everywhere I looked everyone recommended against all peppers. Do you feel all peppers besides bell peppers are ok?
And why sprouted beans are ok, but un-sprouted are not?
I did get some symptoms from regular almonds but I eat and do very well off of almond butter from Trader Joes. Thanks again.
Jill Cruz says
The tricky part about histamine is that many foods that are high in histamine are also high in constituents (flavonoids), such as quercitin, that actually help reduce histamine or tame mast cells. Pepper is one of those foods. The ancho peppers have more of the anti-histamine constituents. But always introduce new foods with caution. Beans do contain some of the DAO enzyme but they also contain some histamine. When sprouted the DAO content goes up.
What about shallots?
Sheryl Gray says
During a time of high stress I developed histamine intolerance but also developed salicylate sensitivity at the same time (though it took some time, firstly to identify the histamine intolerance, and then a further few weeks to identify the salicylate sensitivity.
It seems a lot of GP’s are not all that conversant with either problem.
Jill Cruz says
Yes, this is unfortunately true. And yes stress does exacerbate histamine problems very often, especially when mast cells are involved. The salicylate issue is often not even thought of but it does occur. We have to be on our toes :)).
A lot of these issues come from the gut so working on healing the gut WHILE avoiding those foods is a good idea…otherwise it takes a very long time to heal and the restrictive diet over time is hard and can cause nutrition deficiencies.
Sheryl Gray says
Yes, but a lot of things that can heal the gut are also very high in either histamines or salicylates, which makes it very difficult. I forgot to mention that I was sick as well. My father had just died a few weeks before then my mother had a major heart attack, my stress levels were through the roof and being sick on top of it was just an environment for a perfect storm.
If I had known right at the beginning then I think I could have overcome it rather quickly, but not knowing and continuing on eating things that exacerbated it, left me in a mess.
Almonds aren’t nuts. So?
yes they are
I think I have histamine intolerance rather than mast cell disease because I have no skin symptoms with the exception of the occasional itchy patch. Antihistamines help with symptoms which are mostly postnasal drip tickly cough and mild wheezing as well as insomnia. I’ve been dealing with this for couple of years I would be quite satisfied with my diet if I can tolerate any of this so-called low histamine grains and pulses. Rice is a huge no-no for me as is potato of any kind and all types of flour. I can’t eat sweet potato or oats either. Eggs are a huge problem too. On some days I seem to react to just chicken and lettuce. Would you advise I treat myself for leaky gut? Could that be the reason that I’m reacting to everything, albeit mildly?
Same, any progress?
Is it possible to have overload of histamine and have only one symptoms -constipation ? Just suddenly and over one month. My diet is very good but mostly included high histamine food and fermented food. I don’t have any other symptoms. Maybe tired and foggy.
Please help I tired everything.
Only herbs with senna helps to move my bowel but gives me cramps and terrible diarrhoea. What can I do ?
Tammie Sokoloff says
I have had great success taking aged cascara bark in the morning and Benfotiamine + Alpha-Lipoic Acid. I also make my own magnesium water and drink 8oz every other day. You make it by mixing 1 tsp magnesium hydroxide with a liter of sparkling water (I use whatever is on sale and sometimes I get the flavored ones). Make sure the sparkling water is cold to reduce the “foaming” action of the magnesium hydroxide. Refrigerate overnight and drink it every day on an empty stomach. Once your bowels regulate then back off to every other day or reduce the amount you take each day. Has been a miracle for me!
Janet H. says
I know I should avoid fried foods since I have histamine intolerance, but my kids love fried pork chops; I make them sometimes to satisfy their taste buds. So, is there a certain brand or type of high-heat cooking oil (non-GMO would be even better) that is easier for my body to tolerate? Thanks in advance!
Nadia lee says
I am not a nutritionist but use rice bran oil and coconut oil which tolerate high heat, also ceramic pan which encourages lower heat, supplement quercitin and 500 mg pantothenic acid, recommended by Adele Davies fifty years ago, terrible hay fever without it1. Good luck.
Hi Janet, about the pork chops, my Dad used to make baked pork chops, he would buy a pack of pork chops, make stuffing from the box, and put a layer of that between two chops and bake. It can’t be good for you but has to better than fried, right? I am having some serious itchy hive reactions, which scratching has made worse, it just isn’t healing. My husband doesn’t believe anything I read on the internet, so I have to sneak heal I guess.
Tammie Sokoloff says
I use grass fed tallow for all my frying. Try it! Also remember that American raised pork is generally fed GMO corn and is high in Polyunsaturated fats, which are also quite inflammatory.
Thank you so much for the comprehensive lists, and explainations.. I’ve suspected this intolerance and histamine overload for many years now and after much digging re: symptoms.. had reduced a few of the restricted foods for well over a year, and even more foods recently. I’ve begun to find results (and relief!).. will continue eliminating a few more I wasn’t aware of.
Tamala Poljak says
Thank you so much for this, it was the best read I found on the subject. I have recently found out I have a histamine intolerance and possibly the mast cell condition. I have had chronically watery eyes for nearly two decades that nothing has touched so I am hoping the elimination diet you recommend here will help. Is it true bone broth isn’t a good idea for people with histamine intolerence? What ways do you recommend healing my gut? I was doing bone broth and fermented foods up until now. Thanks so much!
Hi! I freeze bones as soon as poss and make broth in a pressure cooker and refrigerate as soon as cool enough and it seems ok for me mostly. It may depend on your sensitivity. My understanding is that bone broth is potentially high on histamines because in usual brewing methods people leave it simmering on low heat for a long time which can generate histamines. Also I completely avoid beef because I find it is too aged. Lamb tends to be less reactive for me. Hope that helps 🙂
I have just read in some other histamine intolerance articles elsewhere that green tea is a potent anti-inflammatory and inhibitor of the histamine producing enzyme. It is listed as an anti-histamine food/beverage on some websites. Could someone please clarify whether green tea is or is not good for histamine intolerance issues?
Green tea inhibits the DAO enzyme (DAO degrades histamine) in the body. If you’re sensitive to histamine I would avoid it.
Tammie Sokoloff says
Also, green tea (all tea) is very high in oxalates.
Gillian James says
I am a long term CFS sufferer and had eliminated more and more foods as time went on to keep as well as I could. I could not think of a logical reason for some until I started eating sauerkraut which after a while made me feel very sick and a bit spaced out. I now realise that the many ‘odd’ foods I had eliminated are now linked by a common histamine thread. I am going on a 4 week elimination diet removing histamine linked foods. After reading about histamine and oestrogen here, which again explains a lot of what has happened to me over the years, I was interested to know how histamine reacts with pytooestrogen, which I have also had problems with. There is no spell checker on here so please excuse any errors!
Even though this is more than a year old….many people with CFS actually have CIRS from living in a toxic mold-contaminated environment. Very often the mold is not visible and does not have an odor; the only way to accurately and inexpensively find out is to do an ERMI or HERTSMI-2 test. Mycometrics and Envirobiomics are the two labs. I would not do a profession air test for two reasons; one is that the test is not sensitive enough for those with the genetic propensity to have CIRS, and the other is that air tests do not test for some of the most toxic molds and may come back as “all clear” when the levels of these molds (e.g., wallemia) are astronomical. With CIRS it is the usual circumstance to only get a diagnosis with a Shoemaker-certified physician or an ISEAI physician. Others will have no idea, usually.
Hi there, I hope you get this message. I’m wondering if you can tell me more about all of this mold testing. I believe my house is infected!
Short of picking one’s own org. greens and veggies, is there a way to safely determine how long produce has sat in stores, trucks and warehouses before you buy it? What is safe? What do I ask? Are hydroponics safe? How best do I buy lettuces? Broccoli? I’m grateful for any advice or tips. Thank you in advance.
Living like a tribe on a tropical island seems to be the best place to live to combat histamine intolerance.
Kimberly D Mc Donald says
Nice! That sounds like the right solution to me 🙂
Judith Simon says
Where do cashews fall in foods allowed if you have histamine intolerance?
It says no to all nuts
Hi, thank you for the detailed and helpful information. I have mast cell activation likely triggered by chronic Lyme and mold exposures. I am following a low histamine diet and taking medication to stabilize mast cells. I am wondering as an above person was about bone broth and if it is considered helpful or unhelpful in mast cell activation and histamine intolerance. I want to heal my gut but am unsure how. Second, I have in the past made breads in the traditional way such as soaking grain and then fermenting, making a levain. Is traditionally fermented bread to be avoided in keeping with fermented food avoidance or is it helpful as the phytates and lectins are somewhat removed. Any help in clarifying this is appreciated. have an awesome day!
I’m perplexed about the inclusion of arrowroot yet exclusion of tapioca.. I thought they were essentially the same thing..?? Does anyone have knowledge to shed light on this and/or experience with reactivity of either of these things? Thank-you 🙂
I wouldn’t go by this list. If you go to the mastocytosis societies website it tells you not to go by a list. Each person is different, you have to find out what works for you. They give you a general outline of types of foods that aggravate most patients as a starting point and then you build up from there. I have mast cell disease (elevated tryptase so most likely mastocytosis…I’m scared to get a bone marrow biopsy to see what level) and have had it for 5 yrs. I can eat any type of food including high histamine foods (I have to eat those in moderation) but I don’t tolerate additives and food that’s been sulfited. For example I can eat tapioca flour but I can’t eat bleached tapioca flour. I went into around stage 3 anaphylaxis from bleached tapioca flour (health food store junk…it was so tasty tho) which is how I found that out. Mast cell disease (with the exception of histamine intolerance) can be deadly so add food with caution. This article is rather cavalier about that. Underlying MCAS is the leading cause of sudden death it’s nothing to fool around with. I recommend reading the websites of Dr. Theo and Dr. Akin that the author of this article linked to and the low histamine chefs website (it’s called healing histamine… she’s dead now…didn’t die of mast cell disease she died of cancer…I miss her so much she saved my life). Yasmina used to say something like “elemination doesn’t heal nutrition does”. The more food you cut out the sicker you’ll get. Digestion alone causes histamine release (Yasmina said that was pivitol in changing her outlook) so it’s ultimately not about the food it’s about inflammation and however you lower that is an individual thing.
Kate B says
This author ALSO reccommended ‘Dr. Theo,’ and any practitioner who tells you to NOT watch out for high-histamine &/or histamine releasing &/or DAO-supressing foods is doing no-one any favors.
Margaret N. Mukasa says
I think tapioca is from yuca/cassava and taro root is different.
Another side effect of high histamine is anaphylactic shock. I usually have an attack when histamine count rises.
Wow, an entire article and loads of comments and only ONE mention of methyl-B12?
Methylation is one of the two ways histamine is degraded in the body. Methyl-B12 and either folinic or methylfolate will help histamine intolerance.
Also a good histamine lowering probiotic.
What’s a good histamine lowering probiotic
This has been one of the better articles that I have read online about histamine intolerance. I am not sure the cause of my issue yet, but slowly trying to figure it out. One question I have is about pure jams. I have read in other places to avoid them (I would love to eat them again), because it is a preserved food. Why are they listed here as safe to eat?
I occasionally see posts that indicate that Green Tea is high in histamine because it is fermented (like black tea, etc.). Truth is that it is not fermented. Other posts (there is one above) state that green tea blocks DAO. I can find no literature to that effect. Perhaps someone can post a credible link to confirm this. I drink decaf green tea.
Here is one research paper. In addition I would like to point out that mast cell degranulation and the subsequent histamine release can be triggered by toxins. Most decaffinating processes employ toxic substances. Verify wether your brand does or doesn’t.
Epigallocatechin Gallate-Induced Histamine Release in Patients with Green Tea-Induced Asthma
Author links open overlay panelToshihiroShiraiMDAtsuhikoSatoMDKingoChidaMDHiroshiHayakawaMDJinichiroAkiyamaMDMasatoshiIwataMDMasamiTaniguchiMDKhaledReshadMDYukihikoHaraPhD
https://doi.org/10.1016/S1081-1206(10)63087-6Get rights and content
Background and objective
Epigallocatechin gallate is the causative agent of green tea-induced asthma. To determine whether an IgE-mediated mechanism plays a pathogenetic role in this disorder, we measured histamine release after in vitro exposure to epigallocatechin gallate.
Subjects included eight patients (four men and four women) with green tea-induced asthma, who had been diagnosed by skin test and inhalation challenge, and eight controls (four asthmatic subjects with no previous exposure to tea dust and four healthy volunteers). Heparinized whole blood samples were taken and incubated with epigallocatechin gallate at various concentrations (final concentration range, 0.003 to 300 micrograms/mL) for 30 minutes at 37 degrees Centigrade. After centrifugation, histamine was measured in the cell-free supernatants by radioimmunoassay. Histamine release was expressed as a percentage of total histamine. A result higher than 10% was considered positive.”
Rachel Lakewood CO says
THANK YOU. I have been treating my own histamine intolerance for 4 years, and of course many years of symptoms before that. Your article is one of the most comprehensive, primer-like that I have seen and spot on with the MOST helpful advice prioritized just as I would have put it. I have more questions and possible solutions:
Kidneys – freeze dried in capsules from grass fed animals. I am trialing these INSTEAD of DAO pills. The advantages could be that they could be beef based instead of pork based.
Question: I would like to know more about HOW cacao or cocoa would be a potent histamine liberator. I would like to know more of the molecular science behind why it works. I can give up sugar, but giving up cocoa has been so sad. I can tolerate some amounts of dark chocolate, and I’m sure this is my invitation to learn to live with moderation. But, I would like to know if I am doing further damage by eating cocoa at all. So, I need more science on this! THANK YOU
Sarah Brown says
Thank you for the excellent information.
Does anyone know if the protein powders that contain grass fed hydrolyzed beef protein are high in histamine? One company lists their beef protein as Hydrobeef. I’ve contacted the companies themselves, but they couldn’t give me a precise answer.
Rachel Lakewood CO says
Because methylation is related to being able to excrete histamine, I follow the CMJ protocol and it does help. I love that you mentioned glycine – that was an accidental first thing that helped me. So, it was at a time when my histamine was high but I didn’t know it, and I wasn’t using any remedies, yet. At that time, just adding glycine calmed my brain – without it I would get agitated, angry, easily annoyed.
But, Vitamin B2 is important:
And, here’s an explanation of why glycine and other related nutrients can be so helpful with the methylation process:
Rachel, I really appreciate your comment, but just wanted to note for others, that your link to Masterjohn’s page goes to your comment which has nothing to do with glycine. 🙂
Hey, just want to add that berries, including cranberry, apparently have high levels of Benzoates, up to 1300mg/kg (https://www.functionalnutritionlibrary.com/benzoic-acid-sample/). According to Dr. Janice Joneja (and you guys, in your additives bullet), Benzoates are no good. Perhaps it would be best to avoid foods containing high levels of Benzoates while investigating Histamine, and to get Quercetin elsewhere, if that is part of one’s strategy. Just thought I would share! Thanks guys.
Caleb, what Joneja doesn’t tell people is that glycine is what helps process benzoates (and also salicylates, which are also very high in berries). Quercetin is also high in salicylates…
My son gets hives everytime he catches a virus. Is this a sign of histamine intolerance?
My daughter had MCAS / multiple chemical sensitivities / histamine overload / dysautonomia and more. It was completely debilitating, she could barely leave the house and was in the ER with anaphylaxis on multiple occasions. She tried food rotation, ketotifen, quercetin, chromolin, low dose naltrexone, steroids, benzos, beef organs, etc. Everything helped a little, then most produced other symptoms. She then tried a neural rewiring program that treats the condition as a limbic brain injury. It took almost a year, but she’s now living a completely normal life, no longer limiting foods, taking meds or debilitated by fragrances. There are several of these programs, DNRS (dynamic neural reprograming system), The Gupta method, etc. Sufferers have had success with all of them. I really wish her doctor had recommended this first, he knew about it and said he’d had other patients heal themselves this way. We would have saved an enormous amount of money, time and suffering. I highly encourage anyone suffering to look into this.
I thought eggs were high histamine even the yolk? So I am confused in the article it says egg whites are histamine but you can eat the yolks ? Most people say eggs are high histamine I’d love to at least eat the yolk . Does anyone know after being in a histamine diet can you eat yolk and not egg whites??
The egg yoke does not have histamines.
My son can tolerate eggs though — despite genetic SNPs that affect the enzymes that make his DAO.
I give him a DAO vitamin 15 minutes before his meals, and that has helped — including with eggs. However even with DAO, he cannot have old meat (from a restaurant) without getting very sick.
Unfortunately, DAO is expensive. One company bought up the rights and charges monopolistic prices. Sadly, this is the American way.
Error in your article names “Dr. Janice Jones” but you likely mean: “Dr. Janice Joneja” (Jones vs Joneja)
In reply about yolks – to Ellen’s post: I eat the yolks only but not whites. Whites trigger me severely as a mast cell liberator, even if they are fully cooked or baked. Egg yolks have no effect on me, I can eat yolks lightly poached/soft. (but not the white!) I have mast cell activation disorder. Liberators, from what I understand, are more important for those of us with mast cell activation, because it is more than just histamine that we’re having trouble with. There are a range of chemicals released when mast cells degranulate – and histamine is only one chemical. So a liberator that causes the mast cells to degranulate can do a lot of damage (for me). Not all of us are affected by all liberators, but egg whites have been a biggy for me for decades, even before I knew I had this. To prepare the yolks, I separate raw eggs in my hands – like you might have been taught to do for baking. Break the shell, then let the egg drop out of the shell into your hand. (I sort of take one half the shell off – then pour it into my hand) Hold it gently so the yolk stays in your fingers, but the white slides through. Most often you need to jiggle it or help it with fingers. I try to get as much of the white connector pieces (called chalazae) off too without breaking the yolks – because I have no idea if the “connectors” fall under the category of white or not. If I’m baking it, I don’t worry about the membrane that’s over the yolk. However, if I’m eating the yolk poached, I will take the membrane off after poaching. That step might be overkill – probably unnecessary – but I’m cautious and it isn’t that hard to get it off after poaching – it slips off if you brush it with a napkin a little when it’s fresh out of the hot water. Hope that helps someone. 😉 (PS: Although I’ve read some people might boil the whole egg, then remove the white after it is boiled, I won’t do that. I am not taking chances with the cooking process putting the offending liberating substance into the yolks.)
I keep seeing quercetin as a mast cell stabilizer but I don’t metabolize sulfa well (I get a head to toe rash) so I’ve also read to avoid quercetin. I am so confused.
This is such a good article about histamine intolerance! I had to figure out most of this by trail and error. It is most important for hit people to know this produces severe “allergic reactions” even if antigen testing tells you have “no allergies”. I am second generation hit person, my mother had it severely without ever knowing what it really was. Quercetin, DAO, vit C and my own personal list of foods to avoid have lessened my symptoms at least 90%. I avoid Nightshade foods/herbs too.
Keep up the good work Jill!
Is coffee definitely allowed? I’ve read elsewhere that it’s bad for histamine problems.
Please look at Akari Theraputics Akaritx.com. I would live to hear your comments on this exciting research on the drug Votucalis.
I am histamine intolerant and we now have to have the corona vaccination, I will not take the Pfizer because of allergies.
The Astra Zeneca contains L-histidine and L-histidine hydrochloride monohydrate,
would like to know whether this is dangerous for the histamine intolerance, cannot find any
information on this,
i am waiting on this reply too, it is also in the gardisil vaccine, i guess common sense says it will create hyper allergenic responses, which i see in the young people these days, and something to do with estrogen?? estrogen suppresses its ability to be broken down and excreted?
Theresa Sichak says
I have high levels of candida (had the organic acids test done through Great Plains Laboratory) and moderate levels of yeast in my gut. I also have HI. What are you recommendations as far as foods and probiotics? Would L. Rhamnosus be a good probiotic?
I’m curious about meats which I can’t find on any list:
Wild Boar (wondering if genetically its different from pig/pork)
I’m also a forager and one who gravitates towards medicinal foods so I’m wondering about wild greens and histamine as well as oxalates. I react to both and wonder if others do too.
I’ve read that all mushrooms are to be avoided, but (unless I missed it) I don’t see mention of mushrooms in this article.
I hope Jill can chime in here.
Anything aged more than 24 hours will be high histamine.
Aging is a normal process in butchering where the meat rests a certain amount of time to make it softer/taste better.
Goat, Sheep, and rabbit are some that are not aged very long. Most red meats are aged longer than 24 hours.
What can I substitute for Cottage Cheese that would be low histamine? I have cottage
cheese with flaxseed oil and ground flaxseed every day which is very good for inflammation.
It’s called the budwig protocol. Is there a type of quark that would be low histamine?
Munki Munkro says
Can you recommend a good DAO supplement? Can’t find a reliable one online anywhere. Thanks
You said: “We like to start with the basics and move to considering complex conditions like histamine overload or mold toxicity only after we have optimized nutrition and GI function.” This is how practitioners waste people’s time and money. Get to the root(s) of the problem FIRST.
It’s an interesting article but not complete. I have MCAS and I have been following a organic whole food eat what I enjoy that I’m not allergic to diet. I eat fruits I like, veggies, grass fed meat, fish, free range eggs, raw dairy, sourdough and even wine. Green tea helps me, and I prefer Japanese which is steamed vs Chinese which is fried.
Don’t get hung up on lists and benzoates, sulfates, oxalates, histamine etc in foods. Pay attention to how you react to foods, ingredients in it and how it’s made.
And don’t buy fish from VitalChoice. I have had more issues with their fish than anything else. Including and order they assured me was ok but wound up making me sick. Don’t get fish from them. Go to a real fish market.
Emmeline Capel says
Hi! I have been suffering from what I believe to be MCAS related GI dysmotility, muscle/cutaneous and sub-/joint swelling/ pain/edema/arthralgia, tinnitus, skin hyperactivity, being murdered by warm/hot water, low blood pressure for some time now and have been self treating with supplements and low histamine diet/lifestyle. I just wanted to note that as far as my research has gone, L. casei strains should be avoided as they have the potential to increase histamine production in foods (and therefore food fermented in the large intestine), and of course this can be strain dependent. Unfortunately L. casei strains are rarely if ever coded on products in my experience. Making it nearly impossible to know which one you’re ingesting. I have had problems with yogurts specifically cultured with L. casei. I stick with lactobacillus paracasei as the exact stain is almost always given and I came across an article testing 40 different strains of paracasei showing analogous, MC stabilizing results. I’m also a pharmacist with a BS in biochemistry so besides loving bacteria, I am able to do decent, if not sometimes nightmarish anxiety- inducing, research into this lovely topic of immune-destabilizing tidbits.
Thanks so much for your site and resources. Without which and others like it, I would still be suffering behind a curtain of unknown!
Emmeline Capel says
Btw this is the link to the study I semi-citef 🙂
I see that green and black teas are on the no fly list. How about white tea? Does it block DAO too, or is it okay?
Khalid Mehmood says
This has great information……I have been suffering from food sensitivies for last 3 years and could not figure out what was happening……Visited several Allergist, skin speacialist and general physicians…….All my numbers were in normal range…..Then searching net I came across this Histamine Intolerance thing and found out what was wrong with me.. I get itchy skin, hives and constipation…..Since I could not locate a doctor who have heard this problem, I am now trying to eliminate foods which are listed on various website like Healing Histamine, SIGHI and Dr Berg…. Also wish to try Qurectin and DAO supplement…
Khalid Mehmood says
Additionally, I will be grateful if anybody can give some comments on which multivitamins to take since I have problem with artificial color and preservatives………
I don’t understand why nettles are listed as avoid. Those are used to ease histamine reactions. Please explain
I believe I read that the raw nettle plant is high histamine…it stings and causes reaction but that the tea deactivates it somehow …and is actually an anti histamine. Lots of people have very good results drinking nettle tea. Hope this helps
Me, Myself and I says
Thanks for the overview.
In the article I noticed that there are several items that are not protein dense (alcohol, strawberries, tomatoes, cacao, citrus), at least as far as I understand the 4 macronutrient classification (proteins, fats, carbs, alcohol).
Would you be kind enough to reconcile the root cause of excessive histamine release you explain at the beginning of the article…
“ Most people have heard of histamine because it is known to “cause” allergies. In fact, the body’s defense reaction to FOREIGN PROTEINS in the blood is what causes allergies. Part of that reaction includes the release of histamine from mast cells ”
… With the list of foods that you highlight later in the article as those known to trigger excessive histamine release…
“ the biggest offenders among histamine foods, which include alcohol, fermented foods, smoked or cured meats, citrus fruits, shellfish, canned fish or meat, fish and seafood in general (except salmon, cod and tuna frozen on the boat), vinegar, strawberries, nuts, tomatoes and cacao.”
Another question I have after reading is: are the FOREIGN PROTEINS in general triggering histamine release or are there specific AMINO ACIDS forming those proteins that are known, in abundance, to be the specific triggers?
Thanks very much.
Brian Dennis says
Most histamine websites list raw milk as a high histamine food. Any thoughts as to why that is the case?
Hi there! Came across this article and it was refreshing to read something that was science based. I was wondering if you’ve ever heard of CIRS (chronic inflammitory response syndrome) I was diagnosed last year and histamine sensitivity and issues is a huge flag for it. It’s estimated that 40 million Americans and 22% of people world wide suffer from this, yet no one seems to know about it. Heck, I didn’t until I recieved my diagnosis last year after taking every turn for the worst you can imagine after moving into a water damaged home and a concussion. Now all I feel I can do is spread awareness and try to save folks thousands of dollars of endless tests and shrugged shoulders.