Low Histamine Diet: Food List and How to Follow It

Quick answer

A short trial avoiding high-histamine foods, then reintroduction to find your limit

Histamine intolerance is thought to occur when the body cannot break down histamine from food fast enough, often due to reduced activity of the enzyme diamine oxidase (DAO) in the gut. Symptoms can include flushing, headaches, a blocked or runny nose, itching, hives, abdominal pain, bloating and diarrhoea after certain foods. High-histamine foods include aged cheeses, cured and processed meats, fermented foods, leftover fish and meat, alcohol (especially wine and beer), and some vegetables such as tomatoes, spinach and aubergine. A low histamine diet focuses on fresh foods for two to four weeks, followed by reintroduction to find individual tolerance. There is no reliable blood test, so diagnosis relies on excluding other causes and observing response to the diet.

Important. Swelling of the lips, tongue or throat, difficulty breathing, wheezing or fainting after food is an allergic emergency, not histamine intolerance; call emergency services. See a doctor before restricting your diet if you have weight loss, blood in your stools, persistent diarrhoea or vomiting.

What is histamine intolerance?

Histamine is a natural compound involved in immune responses, digestion and brain signalling. It is also present in many foods, particularly those that are aged, fermented or stored. Normally the enzyme DAO in the gut breaks down histamine from food before it is absorbed. When there is too much histamine or too little DAO activity, histamine may build up and cause symptoms in many parts of the body. Factors linked to lower DAO activity include gut inflammation, some medicines and alcohol. Histamine intolerance is a real but still debated diagnosis, and many symptoms overlap with other conditions.

Symptoms

Flushing, itching or hives.
Headaches or migraine.
Blocked or runny nose and sneezing.
Abdominal pain, bloating, wind, diarrhoea or nausea.
Palpitations or a racing heart.
Symptoms usually appear within minutes to a few hours after eating, and vary with the amount eaten.

Foods high in histamine (limit during the trial)

Aged and ripened cheeses: parmesan, cheddar, gouda, blue cheeses.
Cured, smoked and processed meats: salami, chorizo, ham, sausages.
Fish that is not very fresh, canned fish and smoked fish.
Fermented foods: sauerkraut, kimchi, soy sauce, miso, kefir; see fermented foods.
Alcohol, especially red wine, champagne and beer.
Vinegar and pickled foods.
Some vegetables: tomatoes, spinach, aubergine (eggplant), avocado.
Leftovers of meat and fish kept for more than a day.
Possible “histamine liberators” reported by some people: citrus fruits, strawberries, chocolate, nuts; evidence is weaker.

Foods usually well tolerated

Freshly cooked meat and poultry, eaten soon or frozen promptly.
Very fresh fish, cooked the same day or frozen immediately after catching.
Eggs (cooked).
Fresh milk, butter, cream cheese, ricotta and other young cheeses.
Rice, oats, quinoa, potatoes, fresh bread without long fermentation.
Most fresh vegetables other than those listed above.
Fresh fruits such as apples, pears, melon, mango and blueberries.
Olive oil and fresh herbs.

How to do a low histamine trial

Keep a diary for one or two weeks first: note foods, timing and symptoms.
Exclude high-histamine foods for two to four weeks, focusing on fresh, simply cooked food and avoiding leftovers.
Review: if symptoms have not clearly improved, histamine is unlikely to be the main cause and the diet should be stopped.
Reintroduce foods one at a time, every two or three days, starting with small amounts, to find which foods and portion sizes you tolerate.
Aim for the least restrictive diet that controls symptoms.
A dietitian can help keep the diet balanced, especially for calcium, iron and fibre.

Testing and DAO supplements

Blood tests for DAO activity and histamine levels are commercially available, but they correlate poorly with symptoms and are not recommended for diagnosis by current guidelines. A skin-prick histamine test is also unreliable. Diagnosis instead relies on ruling out food allergy, coeliac disease, inflammatory bowel disease, irritable bowel syndrome and mast cell disorders, then seeing whether a structured diet helps. DAO enzyme supplements taken before meals show promising but limited results in small studies. Some people with symptoms after many foods benefit from a broader approach; see our guide to the low FODMAP diet if digestive symptoms dominate.

Risks of an overly strict diet

Long-term restrictive diets can lead to nutritional deficiencies, weight loss, anxiety about eating and an unnecessarily limited social life. Lists of “forbidden” foods online often contradict each other, and histamine content varies with freshness and storage. If you find yourself cutting out more and more foods, seek help from a registered dietitian and your doctor. Medicines that may affect histamine breakdown should only be reviewed with your prescriber, never stopped on your own.

A sample low histamine day

Breakfast: porridge made with fresh milk or an oat drink, topped with pear or blueberries.
Lunch: freshly cooked chicken breast with rice, courgette and carrots dressed with olive oil and fresh herbs.
Snack: an apple with a few rice cakes and cream cheese.
Dinner: very fresh white fish, cooked the day it was bought, with boiled potatoes and green beans.
Drinks: water and herbal teas; avoid alcohol during the trial.
Cook in small batches and freeze portions straight away rather than keeping leftovers in the fridge for several days.

Key points to remember

Histamine intolerance may cause flushing, headaches, nasal and gut symptoms after certain foods.
Avoid aged, fermented, cured and leftover foods and alcohol for a short trial.
Reintroduce foods to find your personal limit.
There is no reliable test; rule out other conditions with your doctor.

Questions about the low histamine diet

These answers are general information and do not replace an examination or individual medical advice.

How long should I follow a low histamine diet?

Usually two to four weeks, followed by gradual reintroduction. It is not meant to be followed strictly for life.

Is there a test for histamine intolerance?

Blood tests for DAO and histamine exist but are not reliable for diagnosis. A structured elimination and reintroduction, after ruling out other conditions, is the recommended approach.

Are eggs high in histamine?

Eggs contain little histamine, but some people report reactions to raw egg white. Cooked eggs are usually tolerated.

Can coffee be drunk on a low histamine diet?

Coffee is not particularly high in histamine, but some people find it worsens symptoms. Test it during reintroduction.

Is histamine intolerance the same as a food allergy?

No. Food allergy involves the immune system and can cause severe reactions. Histamine intolerance is a non-allergic reaction related to the amount of histamine eaten.

Sources

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.