Low-histamine diet: Nutritionist explains who needs it

What is histamine

Histamine is a biologically active substance released by mast cells as part of a complex allergic reaction. When someone has a food allergy, mast cells release histamine to protect the body from perceiving the food as a threat. Histamine sends various signals to the body: it dilates blood vessels, constricts airways, and stimulates the contraction of smooth muscles in the gastrointestinal tract.

Everyone produces histamine, and many of the foods we consume also contain histamine in varying amounts. Enzymes, particularly diamine oxidase (DAO), break down histamine to prevent its excessive accumulation. However, in individuals with histamine intolerance, these enzymes do not function properly for various reasons.

Histamine intolerance is not an allergy but a dose-dependent non-immune reaction to high levels of this substance. When histamine levels exceed a certain threshold, individuals may experience various unpleasant symptoms, such as diarrhea, bloating, nausea, vomiting, headaches, runny nose, nasal congestion, shortness of breath, itching, rashes, hives, redness, menstrual cycle disturbances, menstrual pain, low blood pressure (hypotension), rapid or irregular heartbeat (arrhythmia), and swelling of the lips, tongue, or throat. These symptoms can also be caused by other factors or conditions.

The diagnosis of histamine intolerance is made after ruling out other possible diseases, such as inflammatory bowel disease, celiac disease, mastocytosis, or mast cell activation syndrome. Certain medications can also induce histamine intolerance. This condition is often part of chronic diseases, such as Crohn's disease.

Histamine intolerance is not a life-threatening condition. Some people may not even be aware of its presence or may attribute their symptoms to other illnesses. While a low-histamine diet does not cure histamine intolerance, it can improve quality of life by reducing unpleasant symptoms.

Characteristics of a low-histamine diet

Histamine intolerance is a rare condition affecting about 1% of the population. In individuals with this intolerance, histamine levels can vary significantly, complicating the diagnosis.

If you have characteristic symptoms, you should not attempt a low-histamine diet on your own, as it is quite specific. This dietary plan involves limiting foods that naturally contain higher levels of histamine and those that inhibit the enzyme diamine oxidase. While it is impossible to eliminate all histamine, it is crucial to reduce its amount so that enzymes can partially break it down.

People with histamine intolerance can consume various foods daily, but they may tolerate some high-histamine foods better than others. Symptoms can also vary with seasonal changes, as different seasonal products become available.

A low-histamine diet is not static and should be tailored to an individual's needs. Therefore, a dietitian or doctor needs to monitor the patient while on this diet to ensure the reduction of unpleasant symptoms without the risk of nutritional deficiencies.

Basic principles of a low-histamine diet

There is a lot of information available online about which foods to restrict or exclude on a low-histamine diet. While this information can be accurate, it is not universal and may not take into account individual differences and needs. People with histamine intolerance can have different thresholds for what they can or cannot tolerate. Additionally, there is no definitive way to measure histamine levels in food.

Here are some general principles for those who need to follow a low-histamine diet:

• Choose fresh, whole, and unprocessed foods. During fermentation, processing, or storage, bacteria can break down histamine, increasing its levels in food. Those with histamine intolerance should consume the freshest foods possible, such as whole and unprocessed items.
• It is often advisable to limit certain foods as much as possible. These can include alcoholic beverages (wine, beer, champagne), aged or processed meats (sausages, cold cuts, bacon), aged, smoked, unpasteurized, or blue cheeses, fermented products (kimchi, kefir, sauerkraut), canned, pickled, salted, dried, or smoked foods, certain vegetables (tomatoes, eggplants, spinach), tropical fruits (pineapples, bananas, papayas, citrus fruits), fish or seafood that is not freshly caught or frozen (e.g., canned mackerel, tuna, sardines, herring), strawberries, nuts, peanuts, legumes (lentils, beans), soy products, chocolate, and foods with additives (colorants, preservatives), among others.

This list is not exhaustive. All foods contain some amount of histamine, so the level of restriction in a low-histamine diet varies depending on the nature of symptoms and individual histamine threshold.

Who should avoid a low-histamine diet

A low-histamine diet is not suitable for everyone with histamine intolerance due to its significant dietary restrictions. This is especially true for individuals who have previously experienced eating disorders or who have recently been diagnosed with such disorders.

For managing symptoms, antihistamine medications prescribed by a doctor may be more effective. Focusing on excessive dietary restrictions rather than exploring other forms of intervention to achieve therapeutic goals (such as symptom control) could lead to a resurgence of eating disorders or contribute to their progression.

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