When to avoid sauerkraut? An essential guide for your nutrition diet

November 4, 2025 •

4 min read

While sauerkraut is widely celebrated for its probiotic benefits, it contains high levels of tyramine and histamine that make it unsuitable for some individuals. Understanding when to avoid sauerkraut? is essential for navigating your nutrition diet safely and preventing adverse health effects.

Quick Summary

Sauerkraut should be avoided under specific circumstances related to health and medication. This includes interactions with MAOI drugs, high histamine content causing intolerance, and high sodium posing risks for blood pressure. People with certain digestive conditions, migraines, or who are pregnant should also exercise caution or avoid it entirely.

Key Points

MAOI Medication Warning: Never eat sauerkraut when taking MAOIs, as the tyramine can cause a life-threatening increase in blood pressure.
Histamine Intolerance: Avoid sauerkraut if you have histamine intolerance, as its high levels of histamine can trigger digestive and allergy-like symptoms.
High Sodium Alert: People with high blood pressure or kidney issues should consume sauerkraut in strict moderation due to its high salt content.
Digestive Sensitivity: Start with small servings to avoid gas, bloating, and other digestive discomfort, especially if you have IBS.
Pregnancy Precaution: Unpasteurized or homemade sauerkraut carries a risk of bacterial contamination; opt for pasteurized versions or avoid it entirely during pregnancy.
Migraine Trigger: The tyramine and histamine in sauerkraut can be a trigger for those susceptible to migraines.

Medication Interactions: The Danger of MAOIs

Perhaps the most critical reason to avoid sauerkraut is its potential interaction with monoamine oxidase inhibitors (MAOIs), a class of medications used to treat depression, anxiety, and other conditions. Sauerkraut is a fermented food that contains high levels of tyramine, an amino acid that helps regulate blood pressure. In a healthy individual, the enzyme monoamine oxidase breaks down excess tyramine. However, MAOI medications block this enzyme, causing tyramine levels to build up dangerously.

This interaction can lead to a hypertensive crisis, a severe and sudden increase in blood pressure that can result in a stroke or other life-threatening complications. People taking MAOIs are typically advised to follow a strict low-tyramine diet, which includes avoiding fermented foods like sauerkraut, aged cheeses, and cured meats. If you are taking MAOIs, it is essential to consult your healthcare provider and follow their dietary restrictions carefully before consuming any fermented foods.

Histamine Intolerance and Sauerkraut

For some individuals, a key reason to avoid sauerkraut is histamine intolerance. Histamine is a compound involved in allergic reactions and is found naturally in many foods, with fermented items being particularly high in it. People with histamine intolerance have a reduced ability to break down histamine, which can lead to a range of symptoms, including:

Digestive issues like bloating, gas, and diarrhea
Headaches or migraines
Skin rashes or hives
Sneezing, runny nose, and other allergy-like symptoms

If you experience any of these symptoms after eating fermented foods, including sauerkraut, you may have histamine intolerance. In such cases, removing high-histamine foods from your diet is necessary to manage your symptoms. Listen to your body and observe how it reacts to fermented foods to determine if this is a concern for you.

High Sodium Concerns for Blood Pressure and Kidney Health

The traditional fermentation process for sauerkraut involves using salt to inhibit the growth of unwanted bacteria. As a result, sauerkraut is naturally high in sodium. A single serving can contribute significantly to your daily sodium intake, which is a concern for people with or at risk of high blood pressure, as well as those with kidney disease.

Excessive sodium consumption is linked to an increased risk of cardiovascular and renal issues. If you are on a low-sodium diet, or if your healthcare provider has concerns about your blood pressure, you should exercise caution with sauerkraut. Choosing a homemade, low-salt version or rinsing commercially produced sauerkraut can help reduce sodium content, but moderation remains crucial.

Navigating Digestive Issues: IBS and Bloating

While some studies suggest lacto-fermented sauerkraut can improve symptoms for some people with Irritable Bowel Syndrome (IBS), it can also cause significant discomfort in others. For those with sensitive stomachs or new to fermented foods, the sudden introduction of a large number of probiotics and fiber can cause side effects like gas and bloating as the gut microbiome adjusts.

Moreover, the FODMAP content of sauerkraut can be problematic for some people with IBS. Although raw cabbage is low-FODMAP in specific amounts, the fermentation process can increase its FODMAP content, particularly in larger servings. If you have IBS, it is best to start with a very small portion (e.g., 1-2 tablespoons) and monitor your symptoms. If adverse reactions occur, reducing or eliminating it may be necessary.

Special Health Considerations

Pregnancy and Immunocompromised: Raw or unpasteurized sauerkraut, which contains live and active probiotic cultures, poses a higher risk of bacterial contamination from pathogens like Listeria. Since pregnant women and individuals with compromised immune systems are more susceptible to foodborne illnesses, it is generally recommended that they avoid unpasteurized fermented foods. Pasteurized or canned sauerkraut is a safer alternative, though it lacks the live probiotics.
Migraine Triggers: The tyramine and histamine found in fermented foods like sauerkraut are common migraine triggers for sensitive individuals. If you frequently experience migraines, especially after eating aged or fermented foods, tracking your intake and potentially avoiding sauerkraut could help manage your condition.

Comparison Table: Sauerkraut Suitability


Health Condition/Concern	Suitability for Sauerkraut Consumption	Key Reason	Alternative Considerations
MAOI Medication	Avoid completely	Tyramine can cause dangerous blood pressure spikes.	Consult doctor for diet plan.
Histamine Intolerance	Avoid completely	High histamine can trigger allergic or digestive symptoms.	Focus on fresh, low-histamine foods.
High Blood Pressure	Consume in moderation	High sodium content can elevate blood pressure.	Look for low-salt versions or make your own.
IBS	Proceed with caution	Can cause bloating and gas; FODMAP content can vary.	Start with small portions; other probiotics may be better.
Pregnancy (Unpasteurized)	Avoid completely	Risk of bacterial contamination (Listeria).	Opt for pasteurized or cooked sauerkraut instead.
Migraine Sufferers	Proceed with caution	Tyramine and histamine can act as triggers.	Monitor symptoms with a food journal.
Healthy Individual	Generally safe	Provides probiotics and nutrients.	Consume in moderation to avoid digestive upset.

Conclusion: Listen to Your Body

While sauerkraut is a nutritional powerhouse for many, packed with probiotics, vitamins, and minerals, it is not a universally suitable food. For some, underlying health conditions, prescribed medications, and food sensitivities make it a poor dietary choice. It is essential to be aware of the specific health risks associated with its tyramine and histamine content, as well as its high sodium levels. The most responsible approach is to consult with a healthcare professional or registered dietitian to determine if sauerkraut is appropriate for your individual needs. When in doubt, prioritize fresh vegetables and other lower-risk probiotic sources to support your gut health safely.

For more detailed information on food safety during pregnancy, refer to authoritative sources like the CDC or a healthcare provider.

Frequently Asked Questions

No, you must avoid eating sauerkraut and other fermented foods while taking MAOI antidepressants. Sauerkraut is high in tyramine, which can interact dangerously with MAOIs and cause a severe spike in blood pressure.

Sauerkraut contains tyramine and histamine, which are known migraine triggers for some individuals. If you experience headaches or other allergy-like symptoms after consuming it, you might have a sensitivity or intolerance.

Sauerkraut is typically high in sodium due to the fermentation process, which can be a concern for individuals with high blood pressure or kidney disease. It should be consumed in moderation, or a low-salt homemade version should be considered.

During pregnancy, it is safest to avoid unpasteurized sauerkraut due to the higher risk of bacterial contamination, such as Listeria. Pasteurized or canned versions are a safer alternative, though they do not contain live probiotic cultures.

Bloating and gas can occur when introducing fermented foods like sauerkraut to your diet, especially in large amounts. This is a normal adjustment period as your gut microbiome changes, but it can also be a sign of a sensitive digestive system, such as with IBS.

Yes, there are many alternative sources of probiotics. These include other fermented foods like yogurt, kefir, or kimchi (if tolerated), as well as probiotic supplements.

Histamine intolerance occurs when your body has a reduced ability to break down histamine, a compound found in many fermented foods. Sauerkraut's high histamine content can trigger various allergy-like or digestive symptoms in those with the intolerance.