- Mast Cell Disease – Nasar Nutrition
- Histamine Intolerance And Mast Cell Activation Disorder
- Treatment for MCAD
- Did You Know?
- Nutrition – TMS – The Mastocytosis Society
- It is possible to have both IgE food allergy and mast cell triggers?
- Is there a specific diet to be followed for mast cell disease? How can I figure out which foods I cannot tolerate?
- What is a low histamine diet?
- Will dietary changes completely control my symptoms?
- Should I take nutrition supplements?
- How do I introduce solid foods safely for my child with Mast Cell disease?
- What do I do when I am sending my child to a playdate or birthday party?
- How do I eat in a restaurant?
- The Low Histamine Diet
- Low Histamine Diet…
- Simplified Food List
- Grocery List
- Free Recipes
- Foods High & Low in Histamine + Other Mast Cell Triggers
- What are Biogenic Amines?
- High Histamine Food List
- 1) Fermented Foods
- 2) Canned & Processed Foods
- 3) Certain Fresh Foods
- 4) Chocolate
- Why do Mast Cells Release Histamine?
- DAO inhibitors
- Acute Stress
- Prescription Medication
- H. pyloriInfection
- Low Histamine Food List
- Fresh Meat & Dairy
- Personalizing Your Diet
- More About Histamine
Mast Cell Disease – Nasar Nutrition
A low histamine diet consists of eliminating foods that are either high in histamines or provoke a histamine response the body. Histamine is, in medical terminology, a biogenic amine. This means it can cause mast cells to release chemicals that will result in the following symptoms:
- Gastrointestinal issues
- Irregular heartbeat
- Low blood pressure
- Trouble breathing
DAO (diamine oxidase) is the main enzyme for metabolizing histamine. Some foods can also inhibit this enzyme, which can lead to more circulating histamine in the body. Higher blood histamine levels will elicit the symptoms mentioned above.
So who needs a low histamine diet? Those who are diagnosed with Mast Cell Activation Syndrome (MCAS), Mastocytosis, and those who suspect they might be suffering from histamine intolerance.
It is important to note that un an IgE-mediated allergy, where even a small amount ingested can cause a reaction, with mast cell disease and histamine intolerance, the amount of histamine ingested and/or generated is important in determining if a reaction will occur and how severe it will be.
And, guys, this is where implementing the diet can get tricky; not every person will react to the same foods! The Swiss Interest Group Histamine Intolerance (SIGHI) has put together a comprehensive list of foods to avoid which are high in histamine and foods that are histamine liberators, meaning they provoke the body to release histamine. The list can be found HERE and it is considered a good place to start. However, a skilled registered dietitian is necessary to help you eliminate foods and then reintroduce them, looking for patterns to identify your individualized triggers.
Why the need to be monitored by a health professional? Because it is important not to limit yourself to only a few safe foods. A registered dietitian specializing in a low-histamine diet can make sure you are not compromising your nutrient intake.
There is always going to be a study supporting one diet or product over another. So how are we to decide what is sound medical/nutrition advice? Let’s break it down into the right questions to ask:
1. Can you find the source of the study? You will find many Instagram posts, diet guru articles, and news outlets stating “Studies show….”. If a specific study is cited, find it and read it. Find out who sponsored the study, how large the study was, etc.
For example, if a study is done on the positive effects of soy on health, but was sponsored by the American Soybean Association and had only 10 patients in it, we don’t put much stock in that. However, if the study was an unaffiliated center, and had hundreds of participants, we can consider it more valid.
(There are still many other factors involved, but this info will quickly tell you if you should close your browser window on an article or keep reading).
2. Who is giving you the information? There are many influencers on social media today who are paid to give their two cents. Are they experts? No! They are the modern day equivalent of a paid T.V. commercial ad. Ask yourself, is this a medical professional? What is their degree? Is it accredited and nationally recognized?
3. Are they trying to sell you something? Many times you will find what is called “click-bait” online. Pseudo-practitioners will cite studies showing that they have a miracle product. If something seems too good to be true, it is.
Real medical practitioners know that science is an ever-changing field of study, and will not promote miracle cures.
Any product or supplement that claims to “cure everything” will at best swindle you your money, or at worst, harm you with unsafe ingredients.
Those with chronic illnesses such as Ehlers Danlos Syndrome, Postural Orthostatic Tachycardia Syndrome, and Mast Cell Disease are at particular risk of being taken advantage of since there aren’t many treatments available. Be careful what you read out there- ask questions! Knowledge is power, but only if the knowledge comes from reputable sources.
Many people to start off the new year with a resolution or two. I prefer to start it off with a blessing for all of my followers. When we put things out into the universe, the universe hears us!
So for all of you reading, may you be blessed with the ability to try new remedies and to figure out your triggers (and avoid them). May your troubles improve, and your happiness & health leap to new bounds.
I wish for you a year filled with better things! You don’t know how strong and capable you are until you try!
To your health,
Bonnie Nasar RDN
It can be difficult to figure out which foods are causing an issue for mast cell patients. The best way to address it is by keeping a food & symptom diary. You can use a notebook or an app to jot down what you ate, what time you ate it, and any symptoms you experience.
A food diary allows me, as the dietitian detective, to look for patterns. Sometimes I find a specific food is a culprit, other times I have to scrutinize the data. More often than not there is a common additive in foods that are being eaten unbeknownst to the patient. So, while there is no pattern in the foods consumed, the ingredient list shows otherwise.
Talk to your doctor or dietitian about keeping a food and symptom diary.
Histamine Intolerance And Mast Cell Activation Disorder
Histamine intolerance has become a popular term in the natural health community. Characterized by symptoms that appear to worsen with the intake of foods that are high in histamine or that stimulate the release of histamine, histamine intolerance is not really a diagnosis as much as it is a description of symptoms.
Most clinicians, including myself, now believe that Mast Cell Activation Disorder is a more accurate description of what patients with so-called “histamine intolerance” are suffering from.
There are a number of factors that can contribute to, or cause, histamine intolerance, including excess histamine production, diamine oxidase (DAO) enzyme deficiency, HMNT mutation, and poor methylation in the liver; however, my experience has been that MCAD is responsible for a large number of cases of histamine intolerance. have been shown to destabilize mast cells. This makes sense, as the very purpose of using these as vaccine adjuvants is to elicit a heightened inflammatory immune response. Lead, cadmium, and bismuth have also been found to activate mast cells and cause mast cell mediator release (12).
Infections or gut dysbiosis: The gut is home to 70% of the immune system (13), including a large number of mast cells.
Parasitic infections, bacterial/viral infections, or bacterial/fungal overgrowth activate mast cells (14). Helminth parasites and Candida have been shown to be potent stimulators of mast cell activation (15, 16).
Mast cells regularly interact with microbes, and gut dysbiosis itself may lead to MCAD (17).
Modern life is making you sick to your stomach. Download this free eBook to find out what you can do to correct gut dysbiosis.
CIRS: Chronic Inflammatory Response Syndrome could also play a role. Those who are particularly susceptible to mold and have a reduced ability to clear mycotoxins from the body, which leads to a constant activation of mast cells.
Treatment for MCAD
Conventional treatments for MCAD are pharmacological agents that block the action of mast cell mediators. While these may provide much-needed relief to patients, they are not a long-term solution and can have unwanted side effects. Safer short-term action steps that you can take to provide some relief include:
- Adopting a low-histamine diet: For some people with MCAD, a low-histamine diet provides significant relief. Supplemental diamine oxidase can also help by increasing histamine breakdown. But, it’s important to keep in mind that this is only reducing exogenous (outside) histamine, and not altering the amount produced by your mast cells endogenously (within the body). Histamine is also only one of many mediators produced during mast cell degranulation.
- Focus on nutrients and foods known to stabilize mast cells: Many nutrients, including selenium (18) and vitamin C (19), have been shown to stabilize mast cells. A number of herbs and spices, holy basil (20), peppermint (21), ginger (22), thyme (23), and turmeric (24) also have this effect. I have also seen good results with supplemental forms of quercetin (25), bromelain, nigella sativa (26), nettle (27), and butterbur (28).
- Reducing stress: Corticotropin hormone, released in response to physical or psychological stress, destabilizes mast cells and causes them to release their mediators (26).
- Entraining circadian rhythms: Mast cell activity closely mirrors circadian rhythms (27), so getting enough sleep and avoiding blue light at night is crucial.
Ultimately though, we need to address the root cause:
- Remove heavy metals from your system: Chelating agents can help to remove heavy metals from your system. This is best done under the guidance of a healthcare practitioner. Removal of old mercury fillings by a trained professional can also reduce the burden of heavy metals in the body.
- Treat infections: A comprehensive stool test can help identify parasites and other infections that could be contributing to mast cell activation.
- Heal your gut: Remove inflammatory foods and focus on nutrient density. Include plenty of probiotic, prebiotic, and healing foods in your diet.
Did You Know?
Symptoms of histamine intolerance vary, but can include:
- Itchy skin, eyes, ears, and nose
- Swelling of the soft tissues on the face, mouth, or throat (often described as “throat tightening”)
- Nasal congestion
- Red, watery eyes
- Low blood pressure
- Chest pain
- Rapid heart rate
- Feelings of panic or extreme anxiety
- Fatigue, irritability, or confusion
- Joint and muscle pain
- Tinnitus (ringing in the ears)
- Gastrointestinal distress
While the underlying cause of histamine intolerance should be addressed, adopting a low-histamine diet can help alleviate some of these symptoms. That can mean making significant lifestyle shifts, avoiding food additives, prepared foods, certain spices, and alcohol.
As a health coach, you could offer the support needed to help someone adopt a new dietary approach a low-histamine diet. Health coaches facilitate life changes and empower their clients to uncover their motivations and establish their own goals for their health.
Mastering those skills is part of what we teach in the ADAPT Health Coach Training Program. We also offer an in-depth education into Functional and ancestral health, covering topics histamine intolerance, eating for gut health, environmental toxins, and more.
Find out more about the ADAPT Health Coach Training Program.
Nutrition – TMS – The Mastocytosis Society
Some people have a genetic tendency to produce IgE (a type of antibody) to normally harmless substances, such as food, pollen, insect stings and medication. The body produces IgE directed against specific substances.
For example, one person may produce IgE antibodies directed against peanut and birch pollen, while another person might produce IgE directed against egg white and dust mites. Once produced, IgE will attach to mast cells. If the IgE are exposed to the triggering substance, the mast cells can activate (degranulate).
For example, a patient develops peanut IgE which attach to mast cells around the digestive system. When peanut is eaten, the IgE are exposed to the peanut, which causes the mast cells to activate, leading to anaphylactic symptoms. In most cases, IgE mediated food allergies are consistent.
The allergic individual reacts every time the food is eaten. The symptoms also occur quickly after the food is eaten. As a result, IgE mediated food allergy is often called immediate food allergy.
It is possible to have both IgE food allergy and mast cell triggers?
Your physician may use skin tests and/or food specific IgE blood tests to determine if your body has produced IgE to a suspected item. Each food is tested individually. If the test to a specific food is negative, IgE mediated allergy to that food is very unly (although the food could still be a mast cell trigger).
If the test is positive, an IgE mediated allergy to that food is possible. However, false positives are very common. In other words, IgE to a specific food, does not necessarily mean you are allergic to that food.
If you have been consuming a positive food regularly without symptoms, it is unly that you have a true IgE mediated allergy to that food, even if you have a positive skin or blood. A good article on this topic can be found at www.foodallergy.org/diagnosis-and-testing . Read about false positives under the skin prick test and blood test sections.
Please note, it is extremely important to speak with a knowledgeable allergist to sort this out. You should not introduce IgE positive foods without medical supervision and/or guidance.
Mast cell activation can also be triggered by other substances or events, including a variety of food, food additives, inhaled chemicals, medications/supplements, temperature changes, etc. These are commonly called mast cell triggers.
The symptoms can be very similar to IgE mediated allergy. However, the reactions tend to be less consistent. A mast cell trigger may be problematic one day, but well tolerated on a different day.
Unfortunately, there are no tests to determine mast cell triggers.
Is there a specific diet to be followed for mast cell disease? How can I figure out which foods I cannot tolerate?
There is no specific diet, however there are basic guidelines. Using an elimination diet can be helpful to determine food triggers. Mast cell disease patients often report symptom improvement with dietary changes; however, these changes vary from person to person. Identifying helpful changes takes some experimentation.
There are foods that patients with mast cell disease seems to be more reactive to overall. These include but are not limited to: Monosodium Glutamate (MSG), alcohol, shellfish, artificial food dyes and flavorings, food preservatives, pineapples, tomatoes & tomato based products, and chocolate.
While these foods commonly trigger a lot of patients, they may not be an issue for everyone. That is why an elimination diet is recommended. With the help of a registered dietitian, you can start off with a limited diet and then slowly introduce each food while keeping a written record of what foods you eat and any symptoms that occur.
This can help you identify and eliminate food-based triggers from your diet. If you seem to be reacting to all foods, you might be reacting to the act of eating rather than specific foods. It would be best in this case to find a physician to help you with a plan of action to reduce overall mast cell reactions.
Once you get your mast cells under control, you can re-evaluate your diet for potential triggers.
What is a low histamine diet?
A low histamine diet restricts foods that are potentially high in histamine and/or may lead to histamine release. Histamine is one of several inflammatory chemicals released from mast cells (and other immune cells) and is responsible for many of the troubling mast cell disease symptoms. Histamine can be absorbed into the body from food.
Food with very high levels of histamine can lead histamine poisoning (a type of food poisoning that is common with improperly handled fish). Some people may have lower levels of the enzymes which break down food histamine, and may be more ly to absorb histamine from food (histamine intolerance). Histamine forms during fermentation and spoilage.
It may also be present in certain fruits and vegetables. However, there has been very little research to accurately measure the amount of histamine in food. A second part to the theory is that certain foods may trigger mast cells to release histamine.
There are long lists of histamine releasing foods on the internet, but these lists are anecdotal reports. Since there is so much individual variation, and very little concrete information, the low histamine diet is a general guideline that requires experimentation, rather than a diet that should be followed exactly.
With the help of a registered dietitian, an elimination diet your personal experience with symptoms is a good course of action.
Will dietary changes completely control my symptoms?
While improving your diet by eliminating triggers and eating wholesome, balanced meals can help to decrease your symptoms, there is no cure-all for mast cell disease.
Should I take nutrition supplements?
A multivitamin and mineral supplement is a good idea. Some people report benefit of specific supplements, but there have not been any studies to confirm this. Vitamin C is the most common one to report.
Quercetin, an antioxidant, has been shown in some studies to inhibit mast cell activity. Before taking any supplement, talk to your physician or dietitian. Be sure to check all ingredients for potential triggers.
If you decide to try specific nutrient supplements, do so systematically, and only continue if it makes a significant difference.
How do I introduce solid foods safely for my child with Mast Cell disease?
The American Academy of Pediatrics recommends solid food introduction when a baby has met ALL of the following basic milestones: 1) Able to hold his/her head up unassisted, 2)Opens his/her mouth and seems eager to eat when watching others eating, 3) Has doubled his/her birth weight. These milestones usually occur between 4-6 months of age.
Introduce foods one at a time. This will help you to know what foods might be triggering your child. For instance, if you would to start with rice cereal, do not mix the rice cereal with anything other than water or formula/breastmilk that the baby has previously consumed and is known to tolerate well.
With mast cell diseases, it is important to wait at least 3 days between new foods. Monitor your baby for any signs of intolerance. Mast cell reactions to foods usually include a rash around mouth, diarrhea, vomiting, flushing , coughing or drooling, wheezing or stridor, diaper rash, or hives. Rarely, anaphylaxis can occur.
Know the symptoms of anaphylaxis and have an anaphylaxis action plan signed by your physician. AAAAI Anaphylaxis Action Plan. Keep a food and symptom log, noting the time and amount of food given. Usually 1-2 tablespoons of a new food per meal is appropriate. Discuss any possible reactions with your physician.
If you think a reaction occurred, discontinue that food and observe the child closely to be sure that the symptoms do not progress to anaphylaxis. Wait at least 3 days or as long as it takes for the reaction to resolve before introducing another new food. Questionable foods can be reintroduced at a later date after talking with your physician.
It is important to note that infants/children with mastocytosis should have an Epi-pen Jr available at all times in case of anaphylaxis, and all caregivers should be trained in using it.
What do I do when I am sending my child to a playdate or birthday party?
Call the child’s parents in advance to find out what they will be serving. You can then send a packed meal similar to what is being offered from your home. Keep safe cupcakes in your freezer and defrost them the day of any party your child will be going to.
You can try to match the colors of the birthday party cake by using all natural food dyes which are becoming more available these days. Explain to the parent who will be in charge that your child has what is comparable to allergic reactions.
It is helpful to have a printed paper with the information on it. Always give the parent in charge all rescue medications your child may need, including antihistamines and epinephrine auto injector. For more help in dealing with children and food issues, go to www.
foodallergy.org or www.allergyhome.org.
How do I eat in a restaurant?
Choose restaurants that are allergy-friendly. Call the restaurant in the middle of the afternoon, when the chefs are not busy and can speak on the phone. Explain that you have severe allergic reactions to certain foods.
Even though you may not be truly IgE allergic, using the words “severe allergy” gets people to pay attention and realize the risk involved. Ask about cross-contamination prevention. Go over the menu with the chef and figure out which foods are safe for you.
This eliminates the need for the server to ask detailed questions while the chefs are busy at mealtimes.
The Low Histamine Diet
This is a FREE resource. In lieu of paying for a cookbook, please instead donate to Dysautonomia International or The Mastocytosis Society.
Low Histamine Diet…
Ultimately this “low histamine diet” thing becomes so tailored to the patient their own sensitivities and experiences, that it becomes something else entirely. The name is misleading.
Maybe the best way to think about it is a trial elimination diet that serves as a general helpful starting place for determining what I’ll just call a personalized low-trigger diet.
Think of it as a place to start, but not a place to stay!
What is it?
The low histamine diet is an elimination diet. The idea is to minimize the amount of histamine getting into your system by means of your food to see if doing so can get you feeling any better. Many people with mast cell activation syndrome (MCAS) already have a hefty amount of histamine in their system thanks to their mast cells spilling mediators improperly.
Histamine acts as vasodilator (among many other things), and is something someone with POTS or MCAS definitely doesn’t need more of… standing is hard enough already. It’s not that the histamine you’re ingesting is causing these ailments, but instead it could be exacerbating them.
This diet isn’t going to cure mast cell issues, but the hope is to help reduce them to a degree.
Does it help? Will I see a difference?
Results vary by person. Some people don’t see a difference at all, while others see a modest or even a significant improvement on the diet. Some fellow patients find they can add in a couple higher histamine foods most days without setting themselves back.
I personally can do modest amounts of tomatoes, beans and other higher histamine foods without a problem, but the key for me seems to be making them a smaller part of my overall diet.
And of course, know each person with a mast cell disease is unique with their specific food sensitivities (regardless of a food’s histamine content), so it’s expected that each person has their own personal list of safe foods!
Tip- Keep a Daily Health Journal
Sometime the effects can be more subtle or symptoms can be hard to pinpoint on a specific cause, so track and document your progress. Maybe you feel a little queasy but you can’t tell if it’s the rosemary or if you just simply ate too much. Being able to reference previous experience can help you identify what’s really going on.
In a daily health journal, throughout the day jot down all the specific foods & drinks you have along with symptoms as they appear, also include medications and your daily activities. It’s best to document in chronological order to help deduce cause and effects.
At the end of each day, give yourself a “health” score on a scale from 1 to 10. You may also want to include a separate mental health score as well. This can help determine if your diet is helping, and what foods/spices/additives may be making you feel worse.
Which food list to use?
All of these pages are the Swiss histamine food list.
It’s confusing. All the low histamine food lists out there seem to be conflicting and different.
Is the list only excluding foods with the highest histamine content? Are they also excluding foods that tend to trigger histamine release by your own body? Are they excluding foods with compounds that block the body’s ability to break down histamine efficiently? I found a list that accounts for all these aspects of histamine in a diet… I prefer to reference the most researched and organized list I could find, one done by the Swiss Interest Group for Histamine Intolerance’s detailed histamine food list.
The fact is many of these lists online aren’t well referenced, and seem the author’s subjective experience. The important thing is to choose a list, and have it serve as a baseline.
As long as you’re drastically reducing histamine in your diet, you should have the opportunity to see an improvement if there’s any to be had.
Any foods that were making you feel worse before, but were flying “below the radar” before should become more obvious.
No list is guaranteeing that all its foods will sit great with you, because as it’s belabored everywhere, each person has their own personal list of sensitivities (due to the complexity of biology). I might love blueberries, but you might get completely sick from them regardless of histamine.
It’s an empirical study for each person, meaning you’ll have to learn from your own experience. If you know if makes you sick, remove it from the list before you even begin! A low histamine food list serves as a foundation for you to red-line and make your own.
What you are developing in this process is your own personalized low-trigger diet. What’s great about the Swiss histamine food list is that you might also find some patterns in your sensitivities too, hopefully making diet choices a little easier.
For example, you might find you’re most sensitive to the foods with other biogenic amines, or foods that tend to cause histamine liberation by the body.
How much and how long?
A popular strategy is to try this at first as a strict elimination diet, so that it becomes much more obvious which foods (if any) are making symptoms worse. This way you’ll also know what foods to trust as you add more foods slowly back into your diet, making culprits more obvious.
If you feel especially sensitive to food, try avoiding spices and seasonings the first week or so, and introducing even the “low histamine” ones in one-by-one. A couple doctors I’ve seen recommended trying at least 6 weeks for any elimination diet, because the benefits (if any) might take a little while to show.
After which point, the goal should be to systematically add-in more variety over a longer period of time. Talk to your doctor or dietician to map out a great plan for your needs.
An important part after trying this strict diet is adding in more variety of the “higher histamine” foods you can tolerate. It’s important to keep your long term diet as varied as you can, to keep your diet as balanced and nutritious as possible.
Many patients with less food sensitivity add in most foods (besides their own trigger foods of course), but generally try to minimize those foods listed as the highest “3” on the Swiss reference list.
You’d only want to minimize those foods long-term if and only if you find it helps you feel better, if not move on and enjoy all your bountiful food options!
Will my diet need to change?
As if it weren’t complicated enough, sensitivities to certain foods may come and go, maybe because of a flare-up of your chronic illness or simply because body chemistry changes over time. Expect your diet to change.
Just because you can’t eat a food (or many) now, doesn’t mean you won’t be able to have it back in your diet later as you get your condition better under control. There’s hope. Sometimes losing a food is only temporary.
What if you feel worse?
Another thing to keep in mind is that some with MCAS are specifically sensitive to salicylates, a chemical naturally occurring in many plants. If you find a lot of these low histamine foods, especially fruits and veggies, make you feel worse you might be salicylate sensitive.
Others are even finding they seem sensitive to oxalates, a naturally occurring organic compound also found in many fruits and vegetables in varying degrees. There’s currently little research that could directly explain this. It is known, however, that oxalates readily bind to calcium and other minerals including potassium (often an issue for those on florinef/fludrocortisone).
So if you’re struggling to maintain adequate levels of those minerals, keep that in mind and talk to your doctor.
What about my salty foods?
If you also have POTS, you may find this diet removes a lot of your salty food options. Try The Salt Tool to see how much to add by salt shaker versus other supplements. Know it may only really be an issue long-term if you try the low histamine diet and find that eliminating your salty foods has you feeling better… if not, they should definitely be added back in.
What about gluten free?
The Swiss list says potato, rice, corn, coconut and tapioca starches are all low histamine alternatives, and they’re clearly listed in the German version of their list, which is much more comprehensive than the English version.
(They are Swiss, so naturally German is probably easier for them to update, also you may notice some food names in the English version are a little muddled from translation.) Almonds are lower histamine- probably a viable alternative. Arrowroot is derived from a tuber (as tapioca is) and might also be low histamine, but isn’t listed.
Some gluten free options use bean derived ingredients, which would be higher histamine. Note: Some people avoid nightshades altogether, which would rule out potato, a popular gluten-free alternative.
Lowest histamine: potato flour, rice flour, corn flour, coconut flour, tapioca flour
High histamine: bean flours
Simplified Food List
Here’s a food summary I used for my attempt at an ultra-low histamine diet… the Low Histamine Food List. It’s the detailed Swiss histamine food list, which I highly encourage you to review.
This Low Histamine Grocery List is to help someone kick-off their low histamine diet. No fancy recipes. Let’s keep it real… being sick is exhausting and the last thing you’re going to want to do is make fancy dishes. ( the Swiss list.)
This is a growing collection of FREE Low Histamine Diet Recipes. The goal here is to not feel totally deprived, though making some of these might be for more spoon-plentiful days. ( the Swiss list.)
Last updated January 4th, 2019
Foods High & Low in Histamine + Other Mast Cell Triggers
Many foods contain histamine, while others can trigger your mast cells to release it directly into your tissues. Read on to learn which foods are high & low in biogenic amines and which might activate mast cells.
What are Biogenic Amines?
Biogenic amines are natural nitrogen-containing compounds often produced in large quantities by bacteria. As such, foods are more ly to contain biogenic amines after fermentation, storage, or decay .
These compounds include beta-phenylethylamine, tyramine, tryptamine, putrescine, cadaverine, spermine, and spermidine, but histamine is the most common and the one most frequently linked to food-related symptoms .
Many biogenic amines are harmful, while others are beneficial to human health. Spermidine, for example, prolongs the lifespan of several model organisms yeast, nematodes, and flies. It reduces oxidative stress and helps cells clear waste and recycle useful components .
Biogenic amines are commonly found in fish, fish products, meat, dairy products, wine, cider, and beer, as well as spinach, tomatoes, and yeast products [3, 4].
High Histamine Food List
In general, foods ly to contain high levels of biogenic amines are fermented foods or foodstuff exposed to microbial contamination during storage. However, histamine content varies widely, even in foods that usually contain a lot [3, 5].
1) Fermented Foods
Fermentation is a process by which microbes partially digest, chemically alter, and change one food into another: milk into aged cheese, for example, or cabbage into sauerkraut. The microbes responsible for these changes often produce large quantities of histamine, which can spell trouble for someone with histamine intolerance [6, 7].
The main bacteria responsible for biogenic amine production in fermented food are lactic acid bacteria (LAB). These bacteria can break down amino acids into amine-containing compounds. Bacteria produce these compounds as defense mechanisms to withstand acidic environments .
Some types of yeast also produce histamine during fermentation. Careful management of yeast during fermentation can drastically change the histamine content of wine [7, 8]. Fermented foods include :
- Sauerkraut and kimchi
- Kombucha, beer & wine
- Tofu, Nattō & other fermented soy products
- Yogurt, buttermilk & kefir
- Cheese (aged cheese tends to contain more histamine than fresh, soft cheese)
- Sausage, pepperoni & salami (and other cured or fermented meats)
During the winemaking process, yeast and lactic acid bacteria (LAB) produce histamine when they ferment grape must. Management is crucial during this time; the chemical composition of the grape affects the histamine content of the finished wine .
According to one study, the average levels of histamine in wine were 3.63 mg/L for French wines, 2.19 mg/L for Italian wines, and 5.02 mg/L for Spanish wines. Generally speaking, red wine has more histamine than white [9, 7].
Some countries place limits for histamine in wine such as Germany (2 mg/L), Holland (3 mg/L), Finland (5 mg/L), Belgium (5 to 6 mg/L), France (8 mg/L), Switzerland, and Austria (10 mg/L). If you are intolerant, but you love red wine, choose wines from countries that place the strictest limits on histamine .
2) Canned & Processed Foods
Canned and otherwise processed foods tend to have more histamine than fresh foods. Tomato paste may have as much as 16.6 mg of histamine per 100 g of paste, while canned fish products can have more than 20 mg per 100 g [5, 10].
Even if you are not histamine intolerant, canned fish should be eaten immediately after opening. The longer a can of fish remains open, the more bacteria will grow and produce histamine, increasing the risk of scombroid poisoning [11, 12].
3) Certain Fresh Foods
Most fresh foods, especially fruits and vegetables, are low in histamine. There are exceptions to this rule, however: spinach, eggplant, and tomatoes tend to contain higher amounts. These vegetables may contain enough histamine to trigger an inflammatory response in an intolerant person [7, 13].
Some meats also contain more histamine than others. Pork may be the worst offender. Grilling further increases the histamine levels in meat, while boiling seems to reduce them .
Cocoa can be relatively high in histamine as well; however, the caffeine and theobromine in cocoa stabilize mast cells, preventing them from releasing histamine into your tissues. It may be appropriate to eliminate chocolate from your diet and reintroduce it later to see how well you tolerate it [14, 15, 16, 17, 18].
Why do Mast Cells Release Histamine?
Mast cells are the immune cells that produce the most histamine in your body. They release stored histamine in response to a number of triggers, including allergens and infection. For a more complete explanation of mast cells and their mechanisms, see this post on the low histamine diet and how to avoid triggering histamine release.
Some researchers believe that there are foods that encourage mast cells to release histamine; they call these “histamine liberators.” Citrus fruits seem to be the worst offenders here, though there is some evidence that sulfites in red wine may be troublesome as well [4, 19].
Other possible so-called histamine liberators include :
- Papaya, strawberries & pineapple
- Peanuts & tree nuts
- Tomatoes & spinach, which also contain histamine
- Chocolate; however, chocolate also contains methylxanthines theobromine, which can stabilize mast cells .
- Preserved or canned fish & seafood
- Egg whites
- Some spices
- Artificial food additives
Some supplements, including probiotics, have been found to trigger the release of histamine from mast cells and basophils. The extent to which these results apply to the human body is unknown, and this may not be an exhaustive list of potentially problematic substances. Talk to your doctor to avoid any adverse events or unexpected reactions.
These bacteria can be beneficial for some people, but they produce enough histamine that may cause trouble for those with histamine intolerance.
These compounds prevent diamine oxidase (DAO) from effectively breaking down histamine in animal and cell studies.
- Alcohol. Though not a supplement, many people consume significant enough quantities of alcohol at one time that it may affect histamine metabolism .
- Carnosine. This compound, often used as an anti-aging supplement, is made of histidine and beta-alanine. Its close structural relationship with histamine means that it may compete to bind with DAO [25, 26, 27].
- Curcumin. In one study, curcumin inhibited the release of DAO in the intestines of rats; however, it also appeared to prevent mast cells from releasing histamine. According to the authors, the decrease in histamine release may have caused the decrease in DAO release (due to a lower demand for DAO); curcumin’s net effect may still be beneficial .
Additionally, some conditions and events can increase the release of internal histamine in the body. These include :
- Hypoxia (a lack of oxygen)
- Extreme temperatures
Additionally, stress increases histamine reserves in mast cells. Any of the factors listed above can liberate this histamine supply, making for a dangerous combination .
Unfortunately, some prescription medication can inhibit HMNT and DAO, the enzymes that break down histamine. These drugs can thereby increase histamine levels in the blood and make intolerance symptoms worse [31, 32, 33].
Some people simply cannot avoid these medications; if that’s the case for you, ask your doctor if the substances on our list of natural antihistamines might help you manage these side effects.
The following drugs may increase histamine release or interfere with HNMT and DAO:
- Heparin, an anticoagulant 
- Cimetidine, an antacid and H2R blocker; despite being an antihistamine, this drug significantly inhibits DAO [7, 32]
- Chloroquine; this malaria drug’s effect on histamine is considered relatively minor 
- Dihydralazine, a drug prescribed for high blood pressure in some countries 
- Isoniazid, a tuberculosis drug 
- Cefuroxim, an antibiotic 
- Cefotiam, an antibiotic 
- Chloroquine, an antibiotic 
- Aminophylline, an asthma medication 
- Verapamil, a calcium channel blocker often prescribed for high blood pressure 
- Alprenolol, a beta-blocker often prescribed for high blood pressure 
- Dihydralazine, prescribed for high blood pressure 
- Opioid analgesics, including morphine and codeine [36, 37]
- Monoamine oxidase inhibitors (MAOIs, the first class of antidepressants) 
- Contrast media, given before medical imaging procedures 
- Imidazoles, including many fungicides [25, 39]
H. pylori Infection
Helicobacter pylori is a spiral-shaped bacterium that infects about half of all people around the world. Left unchecked, it can cause inflammation, ulcers, and even cancers of the stomach .
H. pylori produces lipopolysaccharides (LPS) that stimulate the enterochromaffin- cells of the stomach to multiply and release histamine. As such, H. pylori infection may increase the quantity of histamine in the gut [41, 42].
Check out our post on H. pylori here.
Low Histamine Food List
Reading through lists of foods, supplements, and lifestyle choices to avoid can be daunting, so let’s take a look at the good stuff next! The foods in this section are low in histamine and shouldn’t encourage your body or gut flora to produce more.
In a study of 22 people with chronic hives, researchers developed an experimental, very low histamine diet that we can use as inspiration. The staple foods for this diet included many of the items in the following list .
- Bean sprouts
- Onions 
- Carrots 
- Cabbage 
Researchers investigating low-histamine foods recommend eating raw or lightly-cooked vegetables. Fried vegetables are higher in histamine .
Fresh Meat & Dairy
- Boiled fresh meat (avoid pork and sausage) 
- Boiled fresh fish
Note that the foods above may contain small amounts of biogenic amines, including histamine; on the whole, however, eating these foods drastically reduced the quantity of histamine in participants’ diets. Their chronic hives were drastically reduced when eating these foods .
The longer a food is stored, the more biogenic amines it contains. This rule applies even to leafy green vegetables, so make sure you buy and eat the freshest possible produce. Don’t let it sit in your fridge or on your countertop !
Personalizing Your Diet
Remember: it’s more important to avoid foods that trigger your symptoms than to follow any one list exactly. Histamine content can vary broadly, even between two different dishes that contain the same food prepared in different ways. Grilled pork, for example, may contain twice as much histamine as boiled pork .
If you suspect that a particular food triggers your symptoms, try cutting it out to see if they improve. Then, reintroduce it later to see if those same symptoms return. This is called anelimination diet, and it’s probably the best way to identify your sensitivity triggers .
To help combat histamine intolerance, Joe developed the lectin avoidance diet to minimize food sensitivities, along with a cookbook.
More About Histamine
This is the fifth post in a six-part series on histamine, histamine intolerance, and how to manage it. To learn more, click through the links below.