Histamine Intoleranz: Dietary approach
Content
1. What is Histamine?
1.1 Functions of Histamine
2. What is Histamine Intolerance?
3. Diet in Histamine Intolerance
3.1 Beneficial Foods in Histamine Intolerance
3.2 Harmful Foods in Histamine Intolerance
4. Specific Foods in Histamine Intolerance
4.1 Pretzels in Histamine Intolerance
4.2 Pumpkin in Histamine Intolerance
4.3 Lentils in Histamine Intolerance
4.4 Whole Grain Bread in Histamine Intolerance
4.5 Black Cumin Oil in Histamine Intolerance
4.6 Curry in Histamine Intolerance
4.7 Feta in Histamine Intolerance
4.8 Quark in Histamine Intolerance
4.9 Banane bei Histaminintoleranz
4.10 Potato in Histamine Intolerance
4.11 UHT Milk in Histamine Intolerance
4.12 Sesame in Histamine Intolerance
4.13 Tomatoes in Histamine Intolerance
5. Summary
1. What is Histamine?
Histamine is one of the so-called biogenic amines (compounds produced by biological organisms from ammonia). Histamine is naturally found in animal and plant cells.
1.1 Functions of Histamine
Histamine is considered a tissue hormone and has many different functions. These include its involvement in inflammatory and allergic reactions (3): In response to known allergens, histamine can be released, which in turn allows the surrounding blood vessels to dilate, making it easier for other immune system components to reach the perceived threat and fight it off. A properly functioning histamine metabolism is therefore very important for humans.
2. What is Histamine Intolerance?
In the case of histamine intolerance (often also referred to as histamine sensitivity), there is an increased presence of histamine in the body. This can be due to the body releasing too much histamine in response to stress, ingesting too much histamine through food, producing it otherwise, or because the breakdown of histamine is too slow (for example, when the histamine-degrading enzymes DAO (diamine oxidase) or HNMT (histamine-N-methyltransferase) are inhibited). In short, HIT describes the accumulation of histamine in the body in amounts that make it difficult for the body to eliminate it (6).
The symptoms of HIT are diverse and can affect, among others, the gastrointestinal tract, the skin, and the circulatory system (4).
3. Diet in Histamine Intolerance
Since diet plays a crucial role in HIT, it is important to eat appropriately. Histamine naturally occurs in many foods or forms through maturation, fermentation, or storage (2). By consciously choosing foods low in histamine and avoiding histamine-rich foods as well as histamine-releasing substances, the body’s burden can be reduced. An adjusted diet helps to avoid symptoms and improve quality of life, while also ensuring adequate nutrient intake.
3.1 Beneficial Foods in Histamine Intolerance
In histamine intolerance, fresh, unprocessed, and little-ripened foods are particularly beneficial because they generally have a low histamine levels. Fresh fruits such as apples, pears, and blueberries, as well as vegetables like zucchini, cucumbers, and carrots, are often well tolerated. Fresh meat, poultry, and fresh fish processed immediately after catching can be suitable protein sources. Among herbs, fresh parsley and basil are good flavor enhancers.
3.2 Harmful Foods in Histamine Intolerance
In histamine intolerance, foods that are high in histamine or histamine-releasing should primarily be avoided, as they can trigger or worsen symptoms. This includes matured cheeses such as Parmesan or Camembert, cured and smoked meats such as salami or ham, and heavily processed or fermented foods such as sauerkraut, soy sauce, or vinegar. Fish products such as canned tuna or smoked salmon often contain high amounts of histamine, as do alcoholic beverages, particularly red wine and beer. Tomatoes, eggplants, and spinach are among the histamine-containing vegetables that are often poorly tolerated.
The degradation of histamine-degrading enzymes can be inhibited by certain food components such as alcohol or caffeine. Heavy metal contamination and impaired liver metabolism can also affect the capacity of these enzymes.
Protein-rich foods should also be avoided in HIT because bacteria in the gut can convert the histidine found in proteins into histamine. Protein-containing foods should be reduced depending on the amount of histamine-producing bacteria in the gut. By avoiding these listed foods, histamine load can be effectively reduced, and symptoms controlled (7).
4. Specific Foods in Histamine Intolerance
The following sections describe foods that are often searched for in connection with histamine intolerance. To assess whether a food is suitable for HIT, the SIGHI list (Swiss Interest Group Histamine Intolerance) can be consulted (1).
4.1 Pretzels in Histamine Intolerance
Pretzels, such as pretzel rolls or pretzel sticks, are often well tolerated in histamine intolerance, as they typically do not have a high histamine content. However, individual differences in tolerance can occur. Some people may be sensitive to certain ingredients or production processes. For example, yeast or long dough resting times can influence tolerability. It is recommended to pay attention to individual body reactions and, in case of doubt, choose fresh, artisan-made products.
4.2 Pumpkin in Histamine Intolerance
Pumpkin is generally considered a low-histamine food (1) and is well tolerated by many people with histamine intolerance. Particularly varieties like Hokkaido pumpkin are popular due to their low histamine content and nutrient density. However, it is important to consume pumpkins as fresh as possible, as longer storage or improper storage can increase the risk of bacterial contamination, which could increase histamine content.
4.3 Lentils in Histamine Intolerance
Lentils are naturally low in histamine. However, they contain other biogenic amines that can affect the enzyme diamine oxidase (DAO), which is responsible for histamine breakdown. Canned lentils may have a higher histamine content due to longer storage. In the SIGHI list, lentils are classified as “Incompatible, clear symptoms at usual serving size.”
4.4 Whole Grain Bread in Histamine Intolerance
Bread and cereal products are generally well tolerated in HIT. Whole grain bread contains many valuable nutrients such as fiber, vitamins, and minerals that are important for a balanced diet. However, the manufacturing process of whole grain bread, especially long dough fermentation and the use of yeast, can lead to histamine release.
4.5 Black Cumin Oil in Histamine Intolerance
Black cumin oil is generally considered well tolerated in histamine intolerance. It is frequently valued for its diverse health benefits, as it has anti-inflammatory, antimicrobial, and antioxidant properties.
4.6 Curry in Histamine Intolerance
Curry dishes and curry spice blends may be problematic in histamine intolerance (1). Spicy curries, especially those containing chili, may irritate the gut due to the capsaicin. Another component often found in spice mixes that may cause issues in HIT is glutamate. The exact relationship between glutamate and HIT symptoms is not fully clarified.
4.7 Feta in Histamine Intolerance
Feta is a cheese that may often be problematic in histamine intolerance because it is a matured cheese. During maturation, histamine forms, and the content increases with the duration of storage. Particularly industrially produced feta or feta with longer maturation often contains higher histamine amounts. Some individuals tolerate fresh, mild feta better, as it tends to contain less histamine. However, it is important to pay attention to individual tolerance and, if in doubt, opt for alternatives like fresh cottage cheese or ricotta, which are usually lower in histamine.
4.8 Quark in Histamine Intolerance
Quark is generally well tolerated in histamine intolerance (1) since it is a fresh cheese and does not undergo maturation. This means it contains very little histamine compared to matured dairy products like cheese or yogurt. However, tolerability may vary individually, especially in sensitive individuals or when the quark has been stored for a long time. It is best to use fresh quark.
4.9 Banane bei Histaminintoleranz
Bananas contain some biogenic amines that are broken down by the same enzymes as histamine. This can lead to an increase in histamine concentration in the body. Particularly, the biogenic amine putrescine should be mentioned, as it can inhibit histamine breakdown by the enzyme DAO by competing with it (5).
Whether and to what extent bananas are tolerated in histamine intolerance cannot be answered generally. It depends more on the individual’s reaction. Affected individuals should therefore try out how they personally react to bananas and avoid the fruit in case of doubt. In the SIGHI list, bananas are classified as “Intolerant, clear symptoms at usual consumption level” (1).
4.10 Potato in Histamine Intolerance
Potatoes are generally considered well tolerated in histamine intolerance (1), as they naturally contain little histamine and do not trigger histamine release. They belong to non-fermented foods and are therefore a safe choice for most affected individuals. It is important that the potatoes are freshly prepared, as long-stored or already cooked potatoes could theoretically develop higher levels of biogenic amines.
4.11 UHT Milk in Histamine Intolerance
UHT milk (long-life milk) contains only small amounts of histamine and should therefore be suitable for people with histamine intolerance. While fresh milk generally contains even less histamine, the long storage times and thermal treatment of UHT milk can lead to the formation of more biogenic amines. Personal testing is therefore recommended; however, UHT milk should generally not cause discomfort.
4.12 Sesame in Histamine Intolerance
Sesame is classified in the SIGHI list as “moderately tolerated, minor symptoms, occasional consumption of small amounts is generally tolerated” (1). The classification “moderately tolerated” means that sesame is tolerated in small amounts by most affected individuals, but can still trigger symptoms in larger quantities or in particularly sensitive persons.
4.13 Tomatoes in Histamine Intolerance
Tomatoes are considered problematic foods for many people with histamine intolerance. They naturally contain histamine and other biogenic amines that can trigger symptoms in sensitive individuals. Additionally, tomatoes can act as histamine liberators, meaning they can stimulate the release of endogenous histamine even if they do not contain much histamine. Particularly ripe tomatoes (such as in ketchup or tomato paste) have a higher histamine content, as histamine forms during ripening. Dried tomatoes are also often problematic because the drying process can increase histamine content. Fresh, not overripe tomatoes contain less histamine than their ripe or processed variants, but they can still trigger symptoms in some affected individuals. Therefore, it is often recommended to consume tomatoes in moderation and according to individual tolerance.
5. Summary
In HIT (histamine intolerance), there are certain foods that should be avoided. However, there are just as many foods whose tolerance must be tested individually. Keeping a food diary can help figuring out individual tolerance. The SIGHI list (Swiss Interest Group Histamine Intolerance) can be used to help assess the suitability of foods.
References
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- Lebensmittel-Verträglichkeitsliste, Schweizerische Interessengemeinschaft Histamin-Intoleranz (SIGHI), https://www.mastzellaktivierung.info/downloads/foodlist/11_FoodList_DE_alphabetisch_mitKat.pdf, last checked 18.01.2025
- https://www.daab.de/ernaehrung/nahrungsmittelunvertraeglichkeit/histamin-unvertraeglichkeit; last checked 23.02.2025
- Leitlinie zum Vorgehen bei Verdacht auf Unverträglichkeit gegenüber oral aufgenommenem Histamin; AWMF; Register-Nr. 061-030; 2021; 061-030l_S1_Vorgehen-bei-Verdacht-auf-Unvertraeglichkeit-gegenueber-oral-aufgenommenem-Histamin_2022-03.pdf; last checked 23.02.2025
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