Understanding Why You Would Go on a Low Histamine Diet

January 8, 2026 •

4 min read

According to a 2021 review in Nutrients, histamine intolerance may affect up to 1% of the population, a condition that often goes underdiagnosed. For these individuals, starting a low histamine diet is a medical strategy to manage and reduce recurring symptoms caused by an excess of histamine in the body.

Quick Summary

This guide explains the medical reasons for adopting a low histamine diet, detailing conditions like histamine intolerance and MCAS, common symptoms, trigger foods, and how the diet helps manage the body's histamine load.

Key Points

Histamine Intolerance: Many people follow a low histamine diet to manage histamine intolerance, a condition caused by a deficiency of the DAO enzyme, leading to excess histamine.
MCAS Management: The diet is also used to manage symptoms of Mast Cell Activation Syndrome (MCAS), where overly active mast cells release excessive chemical mediators, including histamine.
Symptom Relief: The primary motivation is to find relief from a wide range of symptoms, including migraines, digestive issues, hives, and heart palpitations, which can be linked to high histamine levels.
Diagnostic Tool: A low histamine elimination diet helps individuals and their doctors identify if and which specific foods contribute to their symptoms.
Personalized Approach: The diet is not one-size-fits-all; fresh foods are prioritized while high-histamine items like aged, fermented, and processed products are limited, with individual tolerance determining the extent.
Requires Guidance: Due to its restrictive nature, a low histamine diet should be undertaken with the guidance of a qualified healthcare provider or dietitian to prevent nutritional deficiencies.

What is Histamine?

Histamine is a crucial chemical that is a part of our immune and nervous systems. Our bodies produce it naturally, and it is stored in cells, primarily mast cells. When the body detects a potential allergen or harm, mast cells release histamine to trigger an immune response, causing inflammation, flushing, and other typical 'allergic' symptoms. Beyond its role in immunity, histamine is also involved in regulating stomach acid, neurotransmission, and sleep-wake cycles.

While this process is a normal and vital part of bodily function, problems arise when the body has an overabundance of histamine. This can happen for two primary reasons, which often lead someone to explore a low histamine diet: Histamine Intolerance (HIT) and Mast Cell Activation Syndrome (MCAS).

Histamine Intolerance (HIT)

Histamine intolerance is not a food allergy but rather a mismatch between the amount of histamine in the body and its ability to break it down. The primary enzyme responsible for breaking down histamine in the digestive tract is diamine oxidase (DAO). If a person has a low level or low activity of the DAO enzyme, ingested histamine from food is not effectively metabolized and builds up in the bloodstream. This accumulation can lead to a wide variety of symptoms, mimicking an allergic reaction. Causes for a DAO deficiency can be genetic, pathological (e.g., from gut diseases like Crohn's), or even temporary due to certain medications or alcohol.

Mast Cell Activation Syndrome (MCAS)

MCAS is a condition where mast cells, for often unclear reasons, are abnormally sensitive and release too many chemicals, including histamine, at inappropriate times. While MCAS involves a broader range of mediators, not just histamine, the resulting symptoms are often significant and multi-systemic. A low histamine diet is a valuable tool for managing symptoms in MCAS, helping to reduce the overall histamine load and preventing the 'bucket' from overflowing, so to speak.

A Wide Array of Nonspecific Symptoms

Due to the presence of histamine receptors throughout the body, symptoms of HIT and MCAS are highly diverse and can affect multiple organ systems. This nonspecificity often makes diagnosis difficult, and patients may suffer for a long time with seemingly unrelated or unexplained health issues. Common symptoms include:

Gastrointestinal: Bloating, abdominal pain, diarrhea, constipation, nausea, or reflux.
Dermatological: Hives, itching, flushing, or eczema.
Neurological: Headaches, migraines, dizziness, and "brain fog".
Cardiovascular: Heart palpitations, rapid heart rate (tachycardia), or low blood pressure.
Respiratory: Nasal congestion, runny nose, or wheezing.

The Low Histamine Diet: A Diagnostic and Management Tool

The main purpose of a low histamine diet is not a long-term solution but a diagnostic and short-term management strategy. By reducing the intake of histamine from external sources (food), the body's systems are given a chance to recover and stabilize. This temporary dietary modification helps a person and their healthcare provider identify whether histamine is indeed the cause of their discomfort. The process typically involves two phases under medical supervision:

Elimination Phase: For a few weeks, high-histamine foods are strictly avoided. If symptoms improve significantly, histamine sensitivity is likely the culprit.
Reintroduction Phase: After the initial period, foods are systematically reintroduced to test individual tolerance levels. This personalized approach helps determine what foods can be added back and which should be limited moving forward.

High vs. Low Histamine Foods

Histamine levels in food are affected by factors like aging, fermentation, and storage. As a general rule, the fresher and less processed a food is, the lower its histamine content.


Food Type	High Histamine (Typically Avoided)	Low Histamine (Often Well-Tolerated)
Meat & Fish	Processed, cured, or aged meats (salami, sausage, bacon); Canned, smoked, or old fish (tuna, mackerel, herring).	Freshly cooked or flash-frozen meat, poultry, and fish (e.g., trout, cod, chicken, beef).
Dairy	Aged cheeses (parmesan, cheddar), fermented dairy (yogurt, kefir, buttermilk).	Fresh, pasteurized milk; cream cheese, mozzarella, butter.
Vegetables	Tomatoes, spinach, eggplant, avocado.	Most other fresh vegetables, including broccoli, carrots, onions, lettuce, and sweet potatoes.
Fruits	Citrus fruits, bananas, strawberries, pineapple, papaya, dried fruit.	Apples, berries, melons, mangoes, peaches.
Drinks	Alcohol (especially wine and beer), black tea, green tea.	Water, herbal teas (non-black/green), fresh fruit juice (non-citrus).
Fermented Foods	Sauerkraut, kimchi, pickles, kombucha, vinegar.	N/A

Avoiding Triggers and Supporting Your Health

Beyond just food, several other factors can influence histamine levels and tolerance. Alcohol and certain medications are known to block the DAO enzyme, making symptoms worse. Stress, physical activity, and changes in temperature can also be triggers for mast cell activation in susceptible individuals. Following a low histamine diet, therefore, is part of a broader management strategy that requires a holistic approach, often including stress management and trigger avoidance.

Working with a qualified healthcare provider or a dietitian is crucial for a low histamine diet. Since the diet is restrictive, professional guidance ensures you don't develop nutrient deficiencies. A personalized eating plan is developed based on individual tolerance, ensuring the diet is effective without being overly restrictive in the long term. The ultimate goal is to identify and manage the root cause of the histamine buildup, whether it's related to DAO function, mast cell instability, or gut health.

Conclusion

People go on a low histamine diet primarily to identify and manage the symptoms of histamine intolerance and Mast Cell Activation Syndrome. These conditions, which stem from the body's inability to properly handle its histamine load, can cause a wide and confusing array of symptoms affecting multiple body systems. The diet serves as both a short-term diagnostic tool and a long-term management strategy under medical supervision, allowing individuals to identify personal food triggers and reduce their daily histamine intake. By focusing on fresh, unprocessed foods and avoiding high-histamine items, many people find significant relief and an improved quality of life. This dietary approach, combined with addressing any underlying causes, is key to regaining control over one's health and dietary freedom.

For more detailed information and guidance on this topic, consult authoritative resources such as the Cleveland Clinic on Histamine Intolerance.

Frequently Asked Questions

A food allergy is an immune system response to a protein in food, whereas histamine intolerance is a chemical reaction caused by an accumulation of too much histamine in the body, often from a deficiency of the DAO enzyme.

High-histamine foods commonly include aged and fermented items like cured meats, aged cheeses, wine, beer, sauerkraut, and fermented dairy. Other foods include leftovers, canned fish, and some fruits and vegetables like spinach, tomatoes, and citrus.

No, the diet does not cure the underlying cause, but it can effectively manage symptoms by reducing your histamine load. The goal is often to address the root cause, such as gut health issues, under medical supervision.

A strict low histamine diet can be highly restrictive and is generally not recommended for long-term use without professional medical guidance. It is most often used as a short-term tool to identify triggers, followed by a personalized, less restrictive approach.

Symptom improvement can sometimes occur within a few weeks of following a strict elimination phase. However, individual results vary, and it is important to work with a healthcare provider to properly monitor progress.

Some individuals may benefit from DAO enzyme supplements, which help break down dietary histamine. Other supplements like vitamin C, B6, zinc, and copper may also support the body's histamine-degrading pathways, but these should be discussed with a doctor.

No. The goal is a 'low histamine' diet, not a 'no histamine' one, which is impossible. The objective is to reduce the histamine burden to a level your body can tolerate, which is highly individual.