For a small but significant subset of people, normally healthy foods can cause mental, digestive, heart, skin, and sexual dysfunction. My patients with histamine intolerance are always surprised to hear that good foods like bone broth, beans, and spinach can make them feel worse.

I am Dr. Will Cole, your go-to functional medical doctor, and I have to tell you about this condition that many people don’t even know about: histamine intolerance. (1) I have found for many of my patients, it is an underlying cause of inflammation and chronic symptoms.

Looking to reset your immune system? Check out my Autoimmune Health Reset training.

What Is Histamine Intolerance?

A histamine intolerance (sometimes called “histamine allergy”) means your body either produces too much histamine or does not produce enough enzymes to break down histamine. Excess histamine in your body results in systemic health problems.

Your body produces white blood cells (specifically, mast cells) that release histamine chemicals in response to allergens. This is part of a healthy, balanced immune system.

Many foods naturally contain histamine or trigger the release of histamine in the body.

When there is a dysfunction or deficiency of the enzymes that break down histamine, such as histamine N-methyltransferase (HNMT) and diamine oxidase (DAO), you can’t get rid of excess histamine. You could experience a histamine overflow, which can cause widespread issues.

Causes

As a functional healthcare practitioner, my goal is to identify and treat the root cause of inflammatory problems like histamine intolerance. But of course, we need to figure out that underlying problem first.

Below, I’ve listed a few common causes:

• Leaky gut syndrome
• Small intestinal bacterial overgrowth (SIBO)
• Irritable bowel syndrome (IBS)
• Inflammatory bowel disease (IBD), which may lead to DAO deficiency
• Gluten intolerance
• Lactose intolerance
• Nutrient deficiency or malabsorption
• Medications, such as NSAIDs and painkillers
• Dysregulated nervous system
• Mold toxins (mycotoxins) (2)
• Methylation impairments
• Abnormal mast cell production, sometimes due to mastocytosis

Not sure if your symptoms are due to inflammation or histamine intolerance? Take our inflammation quiz to learn more.

Symptoms

Histamine intolerance is basically an allergic reaction without the allergen, sometimes called a “pseudoallergy.” The typical symptoms of histamine intolerance are similar to those of allergic reactions but also go beyond that.

Common histamine allergy symptoms include:

• Anxiety
• Arrhythmia
• Brain fog
• Constipation
• Diarrhea
• Dizziness
• Eczema
• Fatigue
• Headache
• Hormone imbalances
• Irritability
• Low blood pressure (hypotension)
• Low sex drive
• Migraines
• Nausea
• Racing heart
• Rash
• Runny nose
• Sneezing
• Trouble breathing

Avoid High-Histamine Foods

There are many aspects of a low-histamine diet. You’ll want to avoid histamine-containing foods, histamine-promoting foods, and foods that block enzyme activity and break down histamine. I’ve separated these into different categories.

Adhering to a low-histamine diet is one of the most fundamental parts of healing. Avoid these most common high-histamine content foods that could cause a histamine reaction: (1)

• Alcohol (including wine)
• Bone broth
• Canned food
• Aged cheese
• Chocolate
• Eggplant
• Fermented food (kefir, kimchi, yogurt, sauerkraut)
• Legumes (soybeans, chickpeas, peanuts)
• Mushrooms
• Nuts
• Processed foods
• Smoked meat products (bacon, salami, salmon, ham)
• Certain fish (tuna, mackerel, herring)
• Shellfish
• Spinach
• Vinegar

Avoid Foods That Release Histamine

Certain types of foods are low in histamines but can trigger the release of histamine in your body. People with histamine intolerance should consider avoiding these pro-histamine foods:

• Avocados
• Bananas
• Citrus fruits (kiwi, lemon, lime, papayas, pineapple, plums)
• Strawberries
• Tomatoes

Avoid DAO Enzyme Blockers

Some foods block DAO activity that regulates histamine. Avoid these pro-histamine beverages:

• Alcohol
• Energy drinks
• Teas (black, green, oolong)

Avoid Medications That Affect Histamine Levels

Certain medications can deactivate the DAO enzymes which break down histamine. Talk to your doctor about the following medications if you’re concerned about histamine intolerance:

• Antidepressants
• Antibiotics
• Antihypertensives
• Gastrointestinal medications
• Narcotics
• Over-the-counter medications that affect metabolization

LISTEN: Brooke Siem & Will Cole Reveal the Shocking Truth About Antidepressant Side Effects and More

Natural Treatments for Histamine Intolerance

So can you fix a histamine intolerance? If you struggle with histamine intolerance or find that these foods give you problems, here’s what I recommend: Get a proper diagnosis, change your diet, and support a healthy gut (and, therefore, your immune system).

Get a Proper Diagnosis

In my functional medicine clinic, I run labs to measure a high amount of histamine to DAO levels. A high ratio suggests that you’re eating too many histamine-rich foods and that you have low levels of enzymes that would break histamines down.

Some practitioners use a histamine skin prick test.

Detecting high levels of histamine is relatively easy, but figuring out why you have a histamine intolerance is a whole other story.

I may run an allergy test, or it could be medication overuse. There are tests for nutrient deficiencies and food intolerances that I recommend running. Also, I’d check for leaky gut or SIBO.

Follow an Elimination Diet

When figuring out what is triggering your histamine intolerance, I recommend a short-term elimination diet.

An elimination diet is the gold standard for uncovering foods that trigger inflammation and histamine intolerance for you. The elimination diet I cover in my mindbodygreen video course is low histamine-friendly. I’ll walk you through reintroducing foods after an elimination period to determine the cause of your problems.

It shouldn’t take more than 4-6 months to reintroduce most foods to your diet. After this elimination diet, you should know what not to eat and what you don’t have to be afraid of eating.

Eat Fresh Foods

Bacterial growth in foods left unrefrigerated can increase histamine and sometimes lead to a histamine reaction. Eat fresh foods and freeze leftovers immediately in single-serve portions to avoid triggering histamine intolerance.

For a low-histamine diet, focus on these foods: (3)

• Coconut milk
• Egg yolk
• Fresh wild-caught fish
• Fresh organic meat
• Fresh vegetables (except eggplants, tomatoes, and spinach)
• Gluten-free grains (like rice, corn)
• Herbal teas (not true teas like green tea or black tea)
• Non-citrus fresh fruits
• Rice milk

Eat Foods That Support Histamine Breakdown

If you have a histamine intolerance, increase your intake of antihistamine nutrients that support the breakdown of histamine. You can increase the following nutrients through your diet or through supplements:

• Copper: asparagus and liver
• Vitamin B6: chicken, turkey, and potatoes
• Vitamin C: fruits and vegetables (except for those high in histamine)

Consider DAO supplements that support the breakdown of histamine, including black cumin, zinc, and quercetin. (4, 5)

Read More: Black Cumin Benefits for Immune Health

Maintain a Healthy Gut

Gut microbiome imbalance can also release histamine and trigger symptoms. Problems like leaky gut syndrome, SIBO, and candida overgrowth could be fueling your histamine intolerance.

For more details on gut health’s relationship to whole body health, pick up Gut Feelings by yours truly.

Probiotics can help. In one study, two strains of Bifidobacterium suppressed histamine release. (6) In another, Lactobacillus rhamnosus suppressed histamine receptors. (7)

Note: Certain probiotic supplements, especially those containing prebiotics, won’t agree with you if you have certain types of bacterial overgrowth. Talk to your healthcare provider about the best probiotics for you or if they’re a good fit for your current situation.

Seeking Support From a Functional Medicine Expert

It’s vital to get support from a functional medicine expert who can help pinpoint your body’s specific functions, imbalances, and any other underlying conditions. With this guidance, you can confidently follow the most effective treatment path for your unique case of histamine intolerance. Take back your health!

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

FAQs

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