What Are High Histamine Foods and Who Should Avoid Them?

Many people never think about the fact that most food contains histamines. And, for the most part, the body is able to break down and digest high histamine foods. But a very small subset of people have histamine intolerance that takes a toll on their digestive health.

Just like those with food allergies rely on allergy-free food swaps, people with histamine intolerance should try to avoid eating high histamine foods. That's why we've rounded up this list of high histamine foods, as well as foods low in histamines. Keep these foods and diet and nutrition tips in mind if you're histamine intolerant.

Causes of Histamine Intolerance

First, know that histamine intolerance is not likely; intolerance is not terribly common. That said, three factors influence whether you can digest high histamine foods, explains Amy Burkhart, MD, RD, a registered dietitian and physician who often works with individuals dealing with histamine intolerance.

Genetics

"The first is genetics," Burkhart says. "Different people will metabolize histamines differently." A genetic predisposition is the most common cause of histamine intolerance. If histamine intolerance runs in the family, the chances are higher (though certainly not guaranteed) that you have it, too.

Medications

Taking medications can affect how histamines are broken down. There are two key enzymes that break down histamine: DAO and HNMT. Some medications can affect how these two enzymes work, which ultimately affects how histamines break down (or don't break down). This includes non-steroidal and anti-inflammatory drugs.

Underlying Health Conditions

"Underlying health conditions can affect a person's ability to tolerate histamine," Burkhart says. Histamine intolerance is most commonly reported alongside digestive issues, specifically a deficiency of the diamine oxidase enzyme or health conditions like Celiac disease.4 If you have GI symptoms that aren't improved even with treatment for a known condition like Celiac or IBS, then investigating whether you have histamine intolerance is worthwhile.

Symptoms of Histamine Intolerance

"Histamine intolerance affects everyone differently," says Burkhart, who notes that, while there are many different symptoms, some of the most common include:

• Bloating

• Nausea

• Diarrhea

• Stomachaches

• Headaches

• Itching

• Eczema

Histamines also have a "bucket effect." Over the course of a day, you may experience more symptoms as the overall amount of histamines in your body increases.

Because there are so many ways histamine intolerance can affect someone, Burkhart recommends visiting a doctor and making sure you can rule out other GI conditions before you embark on a low-histamine diet.

Foods High in Histamines

Determining which foods are high in histamines is fairly difficult to study, explains Burkhart. Most foods have some, but the amount in the food increases over time.

It's also worth noting that there isn't a test for histamine intolerance. "In fact, [histamine intolerance] is still emerging as a cause for digestive issues—but it's important to discuss with your doctor before embarking on any major dietary changes," Burkhart adds.

If you are considering dietary changes, here are some foods that are high in histamines of which you should be aware.

Old Food

"Food contains bacteria, and certain bacteria react with substances in foods and produce histamine," Burkhart says. "As bacteria count goes up—from getting older, or sitting out on the counter—the histamine content goes up. When people are working with histamine intolerance, they need to eat everything fresh, and if they have leftovers, freeze them immediately. Then, don't defrost it until right before you eat it," Burkhart explains.

So one part of avoiding histamines in food is making sure everything you eat is super-fresh. Otherwise, foods to avoid typically include anything that's been around for a while, explains Burkhart. This includes:

• Aged cheeses

• Canned fish

• Fermented food (like kombucha or kimchi)

• Yeast or yeast extract

Processed Foods

Processed foods, such as processed meat, are also foods to avoid if you have a histamine intolerance. While processed meat is already high in histamines, the way you cook it may exacerbate histamine levels.

In one study, grilled pork showed the highest histamine level; it ticked up about 1.5-fold by grilling. The histamine level after grilling beef changed less than that of other cooked meats, but it still increased 1.8-fold. Ham's histamine level went up about 1.4-fold after grilling.

While frying and grilling seem to up histamine levels the most, boiling seems to have little influence and may even decrease histamine levels in some foods.

Alcohol

Alcohol is also high in histamines. Plus, alcohol serves as an inhibitor of DAO enzymes, which break down histamine.1 This can, of course, worsen any symptoms you may have if you have histamine intolerance.

Strawberries and Citrus

Anecdotally, Burkhart also says strawberries and citrus are high in histamines. This is why Burkhart recommends avoiding these types of fruits or strawberry- or citrus-flavored beverages, like juices, flavored water, and herbal teas.

Foods Low in Histamines

So you've ruled out other health conditions or are on a maintenance diet and still don't feel better? You might have histamine intolerance. But don't worry, there are still a lot of foods you can still enjoy. Here are some foods that you should consider keeping as mainstays in your diet.

Fresh Whole Foods

"Primarily stick with fresh, non-processed foods—that's number one," says Burkhart. Fresh meats, most vegetables, and the majority of fruits (minus citrus and strawberries) are usually well-tolerated. "That whole time factor is important, as well," Burkhart says. For example, some people have better luck with green unripe tomatoes and bananas than with riper versions.

Gluten-Free Foods

People with histamine intolerances can generally tolerate most gluten-free grains (like rice and gluten-free oatmeal), as well as teas that aren't heavily fermented (like white tea).

Tips to Maintain a Low Histamine Diet

If you're able to avoid high histamine foods and stick to low histamine options, you will likely feel better within a few weeks. Sticking to healthy eating and recipes with low histamine foods usually helps a lot, and it only has to be temporary. Here are some tips to help you get through those weeks:

• Keep your food as fresh as possible. (Refrigerate your ripe fruits to keep them fresh for longer, and stay away from leftovers or food that's been hanging out on the counter for too long.)

• Carefully read the labels. This step will help you to identify ingredients or additives that could contain histamines (like citrus flavoring).

• Plan your meals accordingly. You want to make sure that you have suitable options available to you. If you go out to eat, get an idea of what's on the menu ahead of time so you can make informed decisions. Meal-planning apps can also help you think ahead.

• Track your meals and any symptoms in a food journal. Keeping a record of the foods you eat and any symptoms after you eat them can help you rule out certain foods and focus on those that feel good.

• Educate yourself on histamine intolerance. While there's no test to determine if you have histamine intolerance, knowing low and high histamine foods can help you be more mindful of your diet.

"You often feel better in three to four weeks," says Burkhart. Burkhart counsels people to keep a detailed food log and reintroduce foods with histamines slowly after they start feeling better. "It's hard for the first few months, but it gets easier."