How To Follow a Low Histamine Diet (And Is It Right For You?)

I’m seeing more histamine intolerance in my functional medicine telehealth center than ever before. 

If you’re here, you may suspect or know that you are dealing with histamine intolerance too. 

You may have noticed that you’re reacting to certain healthy foods like avocado or spinach, or you may be experiencing symptoms including headaches, heart palpitations, itchiness, and fatigue that you haven’t been able to figure out or resolve. 

You may also be dealing with dysautonomia, POTS, or long COVID, all of which are connected to histamine and mast cell activation. (1) 

If you’ve been wondering about how to follow a low histamine diet and if it’s even the right choice for you, keep reading, as I’m going to take you through exactly what you need to know. 

What Is Histamine?

Let’s start with a simple overview of what histamine is, because I think there’s a lot of confusion around this compound—understandably, as it wears a lot of different hats. 

Histamine is a chemical messenger that the body naturally produces and releases from certain kinds of white blood cells (primarily mast cells) as part of a healthy immune system response. The release of histamine creates inflammation, which we need in order to fight off pathogens. 

In addition to the important role it plays in immune system reactions, histamine is involved in stomach acid production, certain brain functions, and, of course, allergic reactions. 

Beyond the histamine we make ourselves, there is histamine present in varying quantities in many different kinds of foods and beverages. 

We produce two different kinds of enzymes that break down histamine in the digestive system (diamine oxidase or DAO) and in the brain (HNMT). 

Histamine becomes problematic when: 

• We are producing or releasing too much of it from mast cells 
• We are producing insufficient enzymes for its breakdown 
• A combination of the two 

This imbalance often occurs because of underlying gut dysfunction and/or immune system dysregulation. (2)   

What Is the Low Histamine Diet (and Why Follow It)? 

The low histamine diet is a therapeutic diet used to help manage histamine intolerance and sometimes related conditions including mast cell activation syndrome (MCAS). (3, 4) 

It involves restricting or eliminating foods that naturally contain high levels of histamine, as well as foods and beverages that can trigger the release of histamine from mast cells or block the enzymes that break histamine down. 

Unlike with true food allergies, when you have a histamine intolerance, it’s not really the foods themselves that are the problem. As described above, there’s something going on behind the scenes that is causing your system to struggle with the normal breakdown of histamine, to release too much histamine from mast cells, or both. 

This leads to what’s often likened to a full bucket of histamine. When that bucket reaches a point of overflow, symptoms occur. High histamine foods, then, are contributing to an overload and exacerbating the problem, rather than being the actual cause of illness. 

So why follow a low histamine diet? You’re doing this to a) help identify the issue (a low histamine diet can be thought of as a test for histamine intolerance), and b) to help clear your bucket and lighten the load on your system while you work on healing underlying causes. 

Is the Low Histamine Diet Right For You? 

The low histamine diet may be right for you if you suspect or know you have histamine intolerance or MCAS. 

Symptoms of histamine intolerance may include (but are not limited to): (5)

• Bloating, nausea, vomiting, diarrhea, constipation, reflux, or other gastrointestinal symptoms
• Fatigue
• Brain fog 
• Hives (urticaria) or general itchiness 
• Headaches or migraines
• Flushing
• Heart palpitations or rapid heart rate, especially after eating 
• Anxiety 
• Shortness of breath 
• Insomnia or trouble sleeping 
• PMS and/or heavy periods 

The low histamine diet is also a worthwhile option if you have tried other healthy eating frameworks, such as an anti-inflammatory or Mediterranean diet, without success. It can help with other conditions including IBS or SIBO, as well as dysautonomic conditions like POTS, which often have an underlying histamine or mast cell component. (6, 7, 8) 

It’s not a starting point or an overall healthy eating plan for most people, as a number of generally healthy, nutrient-rich foods are restricted. Instead, it’s usually best as a short-term diet while working to heal from histamine intolerance or a related condition. 

How To Follow a Low Histamine Diet

The best way to follow a low histamine diet is to treat it like an elimination diet. This is broken down into three simple phases: elimination, reintroduction, and personalization. 

Elimination Phase

To put it simply, you will start by following the diet strictly, avoiding all high histamine foods, for at least one month (I usually recommend longer especially for those who have been symptomatic for quite a while). 

Pay attention to how you feel, and ideally keep a food diary. You can think of the diet like an experiment: as there are no definitive tests to diagnose histamine intolerance (though there are a handful that can help), you’re allowing your experience to be the test. 

During this period of time, it’s also crucial to work on identifying and healing underlying causes of your histamine intolerance. This is really key. A functional medicine practitioner can help you work through possible causes and contributing factors, and put together a plan for healing. 

Reintroduction Phase

The next phase of your diet is the reintroduction phase. You’ll want to start reintroducing healthy higher histamine foods one at a time, monitoring any reactions, once you have felt some improvement with both your diet and the root cause work you’ve been doing. 

(If you haven’t observed any improvements after several months, there may still be more work to do on treating underlying causes, and/or the low histamine diet may not be right for you.) 

I recommend leaving a few days between each new food introduction, as symptoms and reactions can be delayed. 

If you reintroduce a food and find that it triggers symptoms, continue to avoid it at least for now (come back to it later). If it doesn’t trigger symptoms, you can work it back into your diet in the third phase, which is the personalization phase. 

Personalization Phase

This is where you’ll develop your own longer-term healthy eating plan, based on your observations about which foods you now can and can’t tolerate. This is an ongoing process that you can continue to tweak. The goal is to ultimately be able to eat a wide variety of healthy, whole foods. 

There are certain high histamine foods that I don’t recommend reintroducing or including in your longer-term personalized diet, including processed meats, additives and alcohol. This isn’t specifically because of their histamine content but rather because they are foods that can trigger inflammation for many reasons. 

Low Histamine Diet Food List

Here’s a simple low histamine diet food list to follow, including some of the key high histamine (as well as DAO blocking) foods to avoid, and low histamine foods you can eat liberally (unless you have any other issues with them). 

There is some disagreement and uncertainty around certain foods, as the amount of histamine can be difficult to measure and varies within the same type of food based on freshness and other factors. But these are some of the most agreed upon foods to avoid and enjoy. 

Foods to Avoid

• Alcohol (especially red wine and champagne, but I highly recommend avoiding all alcohol) 
• Aged cheeses
• Smoked, processed, aged, or cured meat products (sausages, salami, ham, bacon, etc.) 
• Pickled or fermented foods (sauerkraut, pickles, olives, kimchi, yogurt, kefir, kombucha, etc.) 
• Chocolate 
• Spinach
• Eggplant
• Tomatoes
• Squash
• Avocado 
• Black tea
• Energy drinks 
• Citrus fruits
• Papaya, plums, bananas, kiwi
• Wheat and gluten-containing grains 
• Peanuts, walnuts, cashews
• Chili powder, cayenne, paprika, cinnamon, nutmeg, curry powder 
• Shellfish 
• Soy sauce and other soy products
• Most milk products 
• Most legumes
• Preservatives and additives 

Foods to Enjoy

• Fresh chicken or fresh meat (ideally organic)
• Fresh fish
• Olive oil, coconut oil 
• Most vegetables (if unsure, look up the specific vegetable) 
• Most non-citrus fruits (if unsure, look it up) 
• Most herbs and spices (if unsure, look it up) 
• Almonds, pine nuts, pistachios 
• Flaxseeds, chia seeds 
• Potatoes (if tolerated) 
• Dairy free milks including almond or coconut 
• Eggs (if tolerated—and there is some debate about this; raw egg whites may trigger histamine release from mast cells, but cooked eggs are generally considered low histamine) 

Additional Considerations

Here are a few other important things to consider when following a low histamine diet. 

• Consider freshness. One of the biggest determinants of the histamine content in a food is its freshness. As a rule of thumb, any aged, fermented, or canned foods should be avoided for this reason. But this principle also applies to things like leftovers. A fresh chicken breast you cooked yesterday and refrigerated will have significantly higher histamine content today. Within reason, try to eat food that is as fresh as possible.
  
• Consider other triggers. Keeping the bucket concept in mind, remember that other things besides foods can trigger histamine release from mast cells and contribute to an overload. Some of the most common triggers include excess heat, excess cold, stress, and certain medications including NSAIDs and some antibiotics.
  
• Consider root causes. I know I’ve said this several times now, but it’s so crucial. A low histamine diet can help to manage histamine intolerance, but it’s not going to solve the problem. For true healing, you want to make sure you’re addressing gut health imbalances, immune system dysregulation, chronic stress, chronic viral infections, and any other underlying concerns. (9)
  
• Consider adding supplements. There are certain supplements that can be very helpful for stabilizing mast cells and that can act as natural antihistamines. These can be great additions to a low histamine diet, while you work on addressing root causes. Some of my favorites include vitamin C, quercetin, luteolin, DAO, and curcumin. 

Start Clearing Your Histamine Bucket

If you’re dealing with histamine intolerance, MCAS, or a related condition including long COVID, POTS, or another type of dysautonomia, clearing your histamine bucket with the low histamine diet as one tool is a crucial first step. If you’re looking for personalized guidance on this and the rest of your healing journey, we can help at our telehealth functional medicine center. 

Beyond calming the histamine overload problem, we run specialized labs to help uncover root causes and triggers, and work to address these upstream issues holistically. 

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

Image source: Unsplash

Sources

• Sumantri, S., & Rengganis, I. (2023). Immunological dysfunction and mast cell activation syndrome in long COVID. Asia Pacific Allergy, 13(1), 50-53.
• Schnedl, W. J., & Enko, D. (2021). Histamine intolerance originates in the gut. Nutrients, 13(4), 1262.
• Maintz, L., & Novak, N. (2007). Histamine and histamine intolerance. The American journal of clinical nutrition, 85(5), 1185-1196.
• Comas-Basté, O., Sánchez-Pérez, S., Veciana-Nogués, M. T., Latorre-Moratalla, M., & Vidal-Carou, M. D. C. (2020). Histamine intolerance: The current state of the art. Biomolecules, 10(8), 1181.
• Jochum, C. (2024). Histamine intolerance: Symptoms, diagnosis, and beyond. Nutrients, 16(8), 1219.
• Siraj, H. M., Usaid, M., Shaikh, S., Dalain, M., Ansari, Y., Naqvi, S. Z., … & Balasubramanian, A. (2025). Bacterial Histamine as a Therapeutic Target for Abdominal Pain in Irritable Bowel Syndrome: A Literature Review. Cureus, 17(4).
• Fabisiak, A., Włodarczyk, J., Fabisiak, N., Storr, M., & Fichna, J. (2017). Targeting histamine receptors in irritable bowel syndrome: a critical appraisal. Journal of neurogastroenterology and motility, 23(3), 341.
• Kohno, R., Cannom, D. S., Olshansky, B., Xi, S. C., Krishnappa, D., Adkisson, W. O., … & Benditt, D. G. (2021). Mast cell activation disorder and postural orthostatic tachycardia syndrome: a clinical association. Journal of the American Heart Association, 10(17), e021002.
• Sánchez-Pérez, S., Comas-Basté, O., Duelo, A., Veciana-Nogués, M. T., Berlanga, M., Latorre-Moratalla, M. L., & Vidal-Carou, M. C. (2022). Intestinal dysbiosis in patients with histamine intolerance. Nutrients, 14(9), 1774.