Low Histamine Diet…
Only a stepping stone to a Personalized Low-Trigger Diet
Ultimately this “low histamine diet” thing becomes so tailored to the patient based on their own sensitivities and experiences, that it becomes something else entirely. The name is misleading. Maybe the best way to think about it is a trial elimination diet that serves as a general helpful starting place for determining what I’ll just call a personalized low-trigger diet. Think of it as a place to start, but not a place to stay!
What is it?
The low histamine diet is an elimination diet. The idea is to minimize the amount of histamine getting into your system by means of your food to see if doing so can get you feeling any better. Many people with mast cell activation syndrome (MCAS) already have a hefty amount of histamine in their system thanks to their mast cells spilling mediators improperly. Histamine acts as vasodilator (among many other things), and is something someone with POTS or MCAS definitely doesn’t need more of… standing is hard enough already. It’s not that the histamine you’re ingesting is causing these ailments, but instead it could be exacerbating them. This diet isn’t going to cure mast cell issues, but the hope is to help reduce them to a degree.
Does it help? Will I see a difference?
Results vary by person. Some people don’t see a difference at all, while others see a modest or even a significant improvement on the diet. Some fellow patients find they can add in a couple higher histamine foods most days without setting themselves back. I personally can do modest amounts of tomatoes, beans and other higher histamine foods without a problem, but the key for me seems to be making them a smaller part of my overall diet. And of course, know each person with a mast cell disease is unique with their specific food sensitivities (regardless of a food’s histamine content), so it’s expected that each person has their own personal list of safe foods!
Tip- Keep a Daily Health Journal
Sometime the effects can be more subtle or symptoms can be hard to pinpoint on a specific cause, so track and document your progress. Maybe you feel a little queasy but you can’t tell if it’s the rosemary or if you just simply ate too much. Being able to reference previous experience can help you identify what’s really going on.
In a daily health journal, throughout the day jot down all the specific foods & drinks you have along with symptoms as they appear, also include medications and your daily activities. It’s best to document in chronological order to help deduce cause and effects. At the end of each day, give yourself a “health” score on a scale from 1 to 10. You may also want to include a separate mental health score as well. This can help determine if your diet is helping, and what foods/spices/additives may be making you feel worse.
Which food list to use?
All of these pages are based on the Swiss histamine food list.
It’s confusing. All the low histamine food lists out there seem to be conflicting and different. Is the list only excluding foods with the highest histamine content? Are they also excluding foods that tend to trigger histamine release by your own body? Are they excluding foods with compounds that block the body’s ability to break down histamine efficiently? I found a list that accounts for all these aspects of histamine in a diet… I prefer to reference the most researched and organized list I could find, one done by the Swiss Interest Group for Histamine Intolerance’s detailed histamine food list.
The fact is many of these lists online aren’t well referenced, and seem based on the author’s subjective experience. The important thing is to choose a list, and have it serve as a baseline. As long as you’re drastically reducing histamine in your diet, you should have the opportunity to see an improvement if there’s any to be had. Any foods that were making you feel worse before, but were flying “below the radar” before should become more obvious.
No list is guaranteeing that all its foods will sit great with you, because as it’s belabored everywhere, each person has their own personal list of sensitivities (due to the complexity of biology). I might love blueberries, but you might get completely sick from them regardless of histamine. It’s an empirical study for each person, meaning you’ll have to learn from your own experience. If you know if makes you sick, remove it from the list before you even begin! A low histamine food list serves as a foundation for you to red-line and make your own. What you are developing in this process is your own personalized low-trigger diet. What’s great about the Swiss histamine food list is that you might also find some patterns in your sensitivities too, hopefully making diet choices a little easier. For example, you might find you’re most sensitive to the foods with other biogenic amines, or foods that tend to cause histamine liberation by the body.
How much and how long?
A popular strategy is to try this at first as a strict elimination diet, so that it becomes much more obvious which foods (if any) are making symptoms worse. This way you’ll also know what foods to trust as you add more foods slowly back into your diet, making culprits more obvious. If you feel especially sensitive to food, try avoiding spices and seasonings the first week or so, and introducing even the “low histamine” ones in one-by-one. A couple doctors I’ve seen recommended trying at least 6 weeks for any elimination diet, because the benefits (if any) might take a little while to show. After which point, the goal should be to systematically add-in more variety over a longer period of time. Talk to your doctor or dietician to map out a great plan for your needs.
An important part after trying this strict diet is adding in more variety of the “higher histamine” foods you can tolerate. It’s important to keep your long term diet as varied as you can, to keep your diet as balanced and nutritious as possible. Many patients with less food sensitivity add in most foods (besides their own trigger foods of course), but generally try to minimize those foods listed as the highest “3” on the Swiss reference list. You’d only want to minimize those foods long-term if and only if you find it helps you feel better, if not move on and enjoy all your bountiful food options!
Will my diet need to change?
As if it weren’t complicated enough, sensitivities to certain foods may come and go, maybe because of a flare-up of your chronic illness or simply because body chemistry changes over time. Expect your diet to change. Just because you can’t eat a food (or many) now, doesn’t mean you won’t be able to have it back in your diet later as you get your condition better under control. There’s hope. Sometimes losing a food is only temporary.
What if you feel worse?
Another thing to keep in mind is that some with MCAS are specifically sensitive to salicylates, a chemical naturally occurring in many plants. If you find a lot of these low histamine foods, especially fruits and veggies, make you feel worse you might be salicylate sensitive. Others are even finding they seem sensitive to oxalates, a naturally occurring organic compound also found in many fruits and vegetables in varying degrees. There’s currently little research that could directly explain this. It is known, however, that oxalates readily bind to calcium and other minerals including potassium (often an issue for those on florinef/fludrocortisone). So if you’re struggling to maintain adequate levels of those minerals, keep that in mind and talk to your doctor.
What about my salty foods?
If you also have POTS, you may find this diet removes a lot of your salty food options. Try The Salt Tool to see how much to add by salt shaker versus other supplements. Know it may only really be an issue long-term if you try the low histamine diet and find that eliminating your salty foods has you feeling better… if not, they should definitely be added back in.
What about gluten free?
The Swiss list says potato, rice, corn, coconut and tapioca starches are all low histamine alternatives, and they’re clearly listed in the German version of their list, which is much more comprehensive than the English version. (They are Swiss, so naturally German is probably easier for them to update, also you may notice some food names in the English version are a little muddled from translation.) Almonds are lower histamine- probably a viable alternative. Arrowroot is derived from a tuber (as tapioca is) and might also be low histamine, but isn’t listed. Some gluten free options use bean derived ingredients, which would be higher histamine. Note: Some people avoid nightshades altogether, which would rule out potato, a popular gluten-free alternative.
Simplified Food List
This Low Histamine Grocery List is to help someone kick-off their low histamine diet. No fancy recipes. Let’s keep it real… being sick is exhausting and the last thing you’re going to want to do is make fancy dishes. (Based on the Swiss list.)
This is a growing collection of FREE Low Histamine Diet Recipes. The goal here is to not feel totally deprived, though making some of these might be for more spoon-plentiful days. (Based on the Swiss list.)
Last updated June 8th, 2018