What Causes Parkinson’s Disease?
What Causes Parkinson’s Disease? Understanding the Complex Origins of a Growing Pandemic Parkinson’s disease (PD) affects over 10 million ...
The Low Histamine Diet
The Low Histamine Diet: A Science-Backed Guide to Managing Histamine Intolerance
Introduction: Understanding Histamine Intolerance
Histamine intolerance is a misunderstood and often misdiagnosed condition that can profoundly affect quality of life. It occurs when the body accumulates more histamine than it can effectively degrade, leading to symptoms like headaches, bloating, skin rashes, heart palpitations, and more. These symptoms often mimic allergies, but unlike classic allergic reactions, histamine intolerance isn’t immune-mediated. The low histamine diet is the first point of call when to both investigate, and treat, histamine intolerance.
At the heart of this issue is an enzyme called Diamine Oxidase (DAO)—the body’s primary defence against dietary histamine. When DAO activity is compromised—whether genetically, pharmacologically, or due to gut dysbiosis—histamine accumulates, leading to systemic effects.
Recommended Product: DAO by Seeking Health.
What Is a Low Histamine Diet?
A low histamine diet aims to reduce the intake of foods that either contain histamine, promote its release, or interfere with its breakdown. This diet is the most commonly recommended and effective non-pharmacological intervention for managing histamine intolerance.
However, there’s often confusion about what to include or avoid. Contrary to popular belief, not all low-histamine diets are created equal. A recent review highlighted significant inconsistencies across recommendations, particularly around foods that contain low histamine but are still commonly excluded.
Histamine in Foods: The Basics
Histamine is not present in all foods, but it forms primarily during microbial fermentation or spoilage. The main culprits include:
-
Fermented foods: Aged cheese, dry-fermented sausages, sauerkraut, soy sauce, wine, and beer.
-
Fish and seafood: Especially when freshness is not guaranteed.
-
Certain vegetables and fruits: Tomatoes, spinach, eggplant, strawberries and some citrus fruits.
Interestingly, some foods don’t contain histamine but can release it from mast cells or contain other amines like putrescine and cadaverine, which compete with histamine for DAO degradation, reducing its breakdown (source).
DAO Enzyme: The Body’s Histamine Filter
DAO, primarily active in the intestinal lining, breaks down ingested histamine before it enters systemic circulation. When DAO levels are insufficient, even foods with moderate histamine levels can cause symptoms (source).
New evidence confirms that other biogenic amines—like putrescine and cadaverine—can significantly inhibit DAO’s ability to degrade histamine, especially when present in high concentrations (up to 80% reduction in enzymatic activity).
This helps explain why:
-
Some individuals react to low-histamine foods.
-
Histamine-free foods like bananas or citrus may still cause symptoms due to DAO competition.
DAO Supplementation: A Clinically Valid Strategy
For individuals with diagnosed or suspected DAO deficiency, DAO supplementation has emerged as a scientifically validated tool. Derived from animal or plant sources, these supplements provide exogenous DAO, helping to break down histamine in the gut.
Why Recommend DAO Supplements?
-
Clinical Efficacy: DAO supplements reduce symptoms in patients when taken 15–30 minutes before meals high in histamine.
-
Scientific Support: In vitro studies have shown exogenous DAO effectively degrades histamine, though its efficacy may vary based on the presence of competing amines.
-
Complementary Strategy: Supplements are best used alongside a low-histamine diet—not as a standalone cure.
✅ Recommended Product: DAO by Seeking Health.
Building a Low Histamine Diet: What to Eat & Avoid
Foods to Avoid (High Histamine or DAO-Inhibiting)
-
Aged cheeses, processed meats, canned and smoked fish
-
Fermented foods and drinks (sauerkraut, kombucha, wine, beer)
-
Overripe fruits, avocados, bananas, citrus fruits, tomatoes
-
Leftovers (histamine increases with time)
-
Foods with high putrescine/cadaverine (e.g., spinach, eggplant, soy)
-
Chickpeas, cumin,
- Cocao (yes your dark chocolate can be a trigger!)
Foods Generally Safe
-
Fresh meat and poultry (consume immediately after cooking)
-
Most gluten-free grains (rice, quinoa, millet, amaranth)
-
Fresh vegetables (excluding spinach, tomato, eggplant)
-
Apricot, blueberries, apples, pears, cherries,
-
Non-dairy milk alternatives (rice, coconut)
- Brazil nuts,
Why One-Size-Fits-All Doesn’t Work
Not all individuals react the same way to histamine. Histamine tolerance is dose-dependent and varies significantly between people. What causes symptoms in one person may be completely tolerable in another. That’s why individualised approaches, often starting with an elimination and reintroduction phase, are key.
Moreover, some foods might trigger symptoms not because of histamine but due to liberation of endogenous histamine or coexisting food intolerances (e.g., FODMAPs or salicylates).
Other Influential Factors
Gut Health And Histamine
A growing body of research links gut microbiota imbalances (dysbiosis) to DAO activity. Some bacteria produce histamine, while others may degrade it. Supporting a balanced microbiome through prebiotics, probiotics (non-fermented), and dietary fiber may enhance tolerance.
One I have seen great success with in clinic is lactobacillus Rhamnosus GG.
Stress And Histamine
Stress and histamine are closely interconnected in ways that can significantly impact your symptoms. When you’re under stress, your body releases cortisol and adrenaline, which can trigger mast cells—the immune cells that store and release histamine. This means that even if you’re carefully following a low histamine diet, high stress levels can cause your body to release additional histamine from within, potentially leading to symptoms like headaches, flushing, or digestive issues. Chronic stress also impairs your body’s ability to break down histamine by affecting the enzyme diamine oxidase (DAO), creating a double burden. This is why many people notice their histamine intolerance symptoms worsen during stressful periods, even when their diet hasn’t changed. Managing stress through techniques like deep breathing, gentle exercise, adequate sleep, and mindfulness can be just as important as dietary changes when addressing histamine intolerance.
Medications
Common drugs like NSAIDs, antidepressants, and antihistamines may inhibit DAO or trigger histamine release. Always review medications with your healthcare provider if symptoms persist.
Conclusion: An Evidence-Based Approach to Histamine Intolerance
The low histamine diet is not a fad—it’s a clinically supported intervention grounded in biochemistry and backed by evolving scientific research. When paired with high-quality DAO supplementation and an understanding of individual triggers, it becomes a powerful strategy for symptom relief and long-term wellness.
As a world-leading authority in histamine science, my mission is to help patients and clinicians move beyond the guesswork. With the right tools, knowledge, and personalised approach, histamine intolerance can be effectively managed—and quality of life dramatically improved.
FAQs
1. How long should I follow a low histamine diet?
Start with 2–4 weeks of strict elimination, then reintroduce foods slowly to identify personal triggers.
2. Can DAO supplements cure histamine intolerance?
No, they manage symptoms. They’re most effective when combined with dietary modifications.
3. Is histamine intolerance the same as an allergy?
No. It does not involve the immune system. It’s due to enzyme deficiency or overload of histamine.